lunes, 4 de julio de 2016
Brexit 'will make NHS staff shortages worse'
Brexit 'will make NHS staff shortages worse'
By Nick Triggle Health correspondent
30 June 2016
The vote to leave the EU risks making staffing shortages in the NHS worse, health leaders are warning.
The NHS Confederation said doctors and nurses from Europe may be put off accepting jobs after the referendum.
If that happened the NHS could face some major problems, it said.
The organisation, which represents health managers, said there were currently 130,000 EU health and care workers in the UK, including 10% of doctors and 5% of nurses.
Elisabetta Zanon, the director of the NHS Confederation's European office, said: "There is a real risk the uncertainty and the falling value of the pound will make people think again.
"If that happens, we could see shortages in some key areas get worse."
A report earlier this year from the House of Commons Public Accounts Committee warned the front line in England may be as many as 50,000 staff short - out of a workforce of slightly more than 800,000 clinical staff.
Ms Zanon also said Brexit could have an impact on medical research and the free healthcare Britons received when abroad.
But she said the workforce issue was the most pressing, as the impact could be felt straightaway.
And there were signs this had already started happening, with reports that an EU recruitment drive in West Yorkshire had already run into difficulties.
To counter the problems, the NHS Confederation has even launched a Twitter campaign called #LoveOurEUStaff.
Image copyright Science Photo Library
Speaking at a conference in London, the former Health Secretary and Tory peer Lord Lansley agreed there were many areas of concern.
"The EU may not tell us how to manage our NHS, but it impacts in many ways," he said.
Lord Lansley said the medical research community was clearly "distraught" and leaving the EU would require steps such as writing the UK's own competition law for the public sector.
And he called on the sector to help put the case in the coming months for why it was important to protect the rights of people from the EU working the NHS.
"If we don't have enough people coming from the EU, our care sector cannot deliver."
Sarah Pickup, of the Local Government Association, which represents councils, which are in charge of services such as care homes and home help, said that sector would be affected too - an estimated 5% of care workers come from the EU.
She said while it was still early days, the impact on social care "needed thinking about".
Jeremy Hunt, England's health secretary, has tried to reassure EU health workers. "You do a brilliant job for your patients, you are a crucial part of our NHS and as a country we value you.
"We must all now do everything we can to ensure our whole workforce feels secure - because that is the only way we'll ensure we can deliver high-quality care for all.
What Does Brexit Mean For The UK's NHS And Healthcare In Europe?
What Does Brexit Mean For The UK's NHS And Healthcare In Europe?
Reenita Das
The United Kingdom’s decision to leave the European Union has sent shock waves across the world. The economic fallout is widely expected to result in a recession in the UK along with reduced GDP growth across several European countries. The United Kingdom Independent Party (UKIP), which has championed the cause for “Brexit,” has indicated that funds sent to the EU can be recovered and used to invest in the NHS, thereby improving quality of care provision; the facts, however, say otherwise.
By 2020, UK’s National Health Service (NHS) is expected to face a shortage of around 16,000 primary care physicians. By 2022, nurse shortages are expected to be in the vicinity of 100,000. The UK has traditionally tried to fill the gap by recruiting both doctors and nurses from foreign countries, especially other EU countries. The guarantee of stable, long-term contracts is a huge draw for a broad range of care providers across different EU countries. With the UK voting to leave the European Union, citing immigration as one of the key reasons, the NHS will struggle in recruiting manpower from these countries.
The biggest impact on manpower is expected to be in social care provision. The NHS has sought to recruit 100,000 social care workers to help manage chronically ill and elderly patients outside hospital settings. This is considered a critical aspect of healthcare transition as the UK seeks to reduce the spending on secondary care, which accounts for 78% of the total health budget, and place greater emphasis on primary and long term care, which currently account for around 22% of the total health budget. Most of these social workers are recruited from the EU, and the Brexit is set to guarantee continued vacancies for social care jobs. Some experts predict an exodus on existing social care workers back to their native countries, thereby making a bad situation worse.
The NHS also seeks to bring about efficiency savings of £22 billion over the next few years. These savings are contingent upon transition of care away from hospital-based episodic care models to primary and long-term care based managed care models. Creation of integrated care solutions, linking the entire spectrum of care providers, is also necessary to improve efficiency of care provision. The lack of trained manpower will pose severe challenges to this transition. A key campaign promise made by the UKIP was the reallocation of £350 million sent to the EU by the UK every week towards NHS funding. With senior party leadership now backtracking away from this commitment, the NHS continues to remain as vulnerable as ever. The Economic Intelligence Unit predicts that by 2020, the UK NHS will spend £135 less per head if the UK leaves the EU. With rising healthcare costs, this will most certainly result in lower quality of care provision.
Broader Impact of Brexit on European Healthcare
The UK is also set to lose indirectly in terms of improving healthcare quality and innovation in a post-Brexit environment. For example companies seeking to conduct clinical trials for new drugs across the EU can run multi-country studies by registering on a single EU clinical trial database. In a post-Brexit environment, companies in the UK seeking to conduct multi-country clinical trials will be forced to apply individually to each country, resulting in a huge administrative and cost burden. From a regulatory standpoint, the UK would lose influence over the European Medicines Agency, the organization that approves drugs for use within the EU. This would mean that the UK and the EU would be required to maintain separate databases on pharmaceutical products in the market. As a result, this would entail more spending by the UK, contributing to the NHS’s budgetary woes. The UK, which also currently gains disproportionately from current funding streams for medical research, will incur significant losses.
A major challenge would be future coordination between the UK and the EU in dealing with pandemics, as well as other health threats. Close coordination with the EU is critical in reducing spread of potential new outbreaks. Going forward, the UK will need to coordinate with individual countries within in the EU, which will be a huge administrative burden. While frameworks could eventually be put in place for the creation of a new EU-UK joint coordination mechanism, this process could take a few years.
Reenita Das
The United Kingdom’s decision to leave the European Union has sent shock waves across the world. The economic fallout is widely expected to result in a recession in the UK along with reduced GDP growth across several European countries. The United Kingdom Independent Party (UKIP), which has championed the cause for “Brexit,” has indicated that funds sent to the EU can be recovered and used to invest in the NHS, thereby improving quality of care provision; the facts, however, say otherwise.
By 2020, UK’s National Health Service (NHS) is expected to face a shortage of around 16,000 primary care physicians. By 2022, nurse shortages are expected to be in the vicinity of 100,000. The UK has traditionally tried to fill the gap by recruiting both doctors and nurses from foreign countries, especially other EU countries. The guarantee of stable, long-term contracts is a huge draw for a broad range of care providers across different EU countries. With the UK voting to leave the European Union, citing immigration as one of the key reasons, the NHS will struggle in recruiting manpower from these countries.
The biggest impact on manpower is expected to be in social care provision. The NHS has sought to recruit 100,000 social care workers to help manage chronically ill and elderly patients outside hospital settings. This is considered a critical aspect of healthcare transition as the UK seeks to reduce the spending on secondary care, which accounts for 78% of the total health budget, and place greater emphasis on primary and long term care, which currently account for around 22% of the total health budget. Most of these social workers are recruited from the EU, and the Brexit is set to guarantee continued vacancies for social care jobs. Some experts predict an exodus on existing social care workers back to their native countries, thereby making a bad situation worse.
The NHS also seeks to bring about efficiency savings of £22 billion over the next few years. These savings are contingent upon transition of care away from hospital-based episodic care models to primary and long-term care based managed care models. Creation of integrated care solutions, linking the entire spectrum of care providers, is also necessary to improve efficiency of care provision. The lack of trained manpower will pose severe challenges to this transition. A key campaign promise made by the UKIP was the reallocation of £350 million sent to the EU by the UK every week towards NHS funding. With senior party leadership now backtracking away from this commitment, the NHS continues to remain as vulnerable as ever. The Economic Intelligence Unit predicts that by 2020, the UK NHS will spend £135 less per head if the UK leaves the EU. With rising healthcare costs, this will most certainly result in lower quality of care provision.
Broader Impact of Brexit on European Healthcare
The UK is also set to lose indirectly in terms of improving healthcare quality and innovation in a post-Brexit environment. For example companies seeking to conduct clinical trials for new drugs across the EU can run multi-country studies by registering on a single EU clinical trial database. In a post-Brexit environment, companies in the UK seeking to conduct multi-country clinical trials will be forced to apply individually to each country, resulting in a huge administrative and cost burden. From a regulatory standpoint, the UK would lose influence over the European Medicines Agency, the organization that approves drugs for use within the EU. This would mean that the UK and the EU would be required to maintain separate databases on pharmaceutical products in the market. As a result, this would entail more spending by the UK, contributing to the NHS’s budgetary woes. The UK, which also currently gains disproportionately from current funding streams for medical research, will incur significant losses.
A major challenge would be future coordination between the UK and the EU in dealing with pandemics, as well as other health threats. Close coordination with the EU is critical in reducing spread of potential new outbreaks. Going forward, the UK will need to coordinate with individual countries within in the EU, which will be a huge administrative burden. While frameworks could eventually be put in place for the creation of a new EU-UK joint coordination mechanism, this process could take a few years.
Opinion: The Brexit vote wasn’t democratic at all
Opinion: The Brexit vote wasn’t democratic at all
Published: June 27, 2016 11:18 a.m. ET
By
Kenneth
Rogoff
CAMBRIDGE, Mass. (Project Syndicate) — The real lunacy of the United Kingdom’s vote to leave the European Union was not that British leaders dared to ask their populace to weigh the benefits of membership against the immigration pressures it presents. Rather, it was the absurdly low bar for exit, requiring only a simple majority. Given voter turnout of 70%, this meant that the “Leave” campaign won with only 36% of eligible voters backing it.
This isn’t democracy; it is Russian roulette for republics. A decision of enormous consequence — far greater even than amending a country’s constitution (of course, the United Kingdom lacks a written one) — has been made without any appropriate checks and balances.
Does the vote have to be repeated after a year to be sure? No. Does a majority in Parliament have to support Brexit? Apparently not. Did the U.K.’s population really know what they were voting on? Absolutely not. Indeed, no one has any idea of the consequences, both for the U.K. in the global trading system, or the effect on domestic political stability. I am afraid it is not going to be a pretty picture.
The current standard for breaking up a country is arguably less demanding than a vote for lowering the drinking age.
Mind you, citizens of the West are blessed to live in a time of peace: changing circumstances and priorities can be addressed through democratic processes instead of foreign and civil wars. But what, exactly, is a fair, democratic process for making irreversible, nation-defining decisions? Is it really enough to get 52% to vote for breakup on a rainy day?
In terms of durability and conviction of preferences, most societies place greater hurdles in the way of a couple seeking a divorce than Prime Minister David Cameron’s government did on the decision to leave the EU. Brexiteers did not invent this game; there is ample precedent, including Scotland in 2014 and Quebec in 1995. But, until now, the gun’s cylinder never stopped on the bullet. Now that it has, it is time to rethink the rules of the game.
The idea that somehow any decision reached anytime by majority rule is necessarily “democratic” is a perversion of the term. Modern democracies have evolved systems of checks and balances to protect the interests of minorities and to avoid making uninformed decisions with catastrophic consequences. The greater and more lasting the decision, the higher the hurdles.
That’s why enacting, say, a constitutional amendment generally requires clearing far higher hurdles than passing a spending bill. Yet the current international standard for breaking up a country is arguably less demanding than a vote for lowering the drinking age.
With Europe now facing the risk of a slew of further breakup votes, an urgent question is whether there is a better way to make these decisions. I polled several leading political scientists to see whether there is any academic consensus; unfortunately, the short answer is no.
For one thing, the Brexit decision may have looked simple on the ballot, but in truth no one knows what comes next after a leave vote. What we do know is that, in practice, most countries require a “supermajority” for nation-defining decisions, not a mere 51%. There is no universal figure like 60%, but the general principle is that, at a bare minimum, the majority ought to be demonstrably stable. A country should not be making fundamental, irreversible changes based on a razor-thin minority that might prevail only during a brief window of emotion. Even if the U.K. economy does not fall into outright recession after this vote (the pound’s decline might cushion the initial blow), there is every chance that the resulting economic and political disorder will give some who voted to leave “buyers’ remorse.”
Since ancient times, philosophers have tried to devise systems to try to balance the strengths of majority rule against the need to ensure that informed parties get a larger say in critical decisions, not to mention that minority voices are heard. In the Spartan assemblies of ancient Greece, votes were cast by acclamation. People could modulate their voice to reflect the intensity of their preferences, with a presiding officer carefully listening and then declaring the outcome. It was imperfect, but maybe better than what just happened in the U.K.
By some accounts, Sparta’s sister state, Athens, had implemented the purest historical example of democracy. All classes were given equal votes (albeit only males). Ultimately, though, after some catastrophic war decisions, Athenians saw a need to give more power to independent bodies.
What should the U.K. have done if the question of EU membership had to be asked (which by the way, it didn’t)? Surely, the hurdle should have been a lot higher; for example, Brexit should have required, say, two popular votes spaced out over at least two years, followed by a 60% vote in the House of Commons. If Brexit still prevailed, at least we could know it was not just a one-time snapshot of a fragment of the population.
The U.K. vote has thrown Europe into turmoil. A lot will depend on how the world reacts and how the U.K. government manages to reconstitute itself. It is important to take stock not just of the outcome, though, but of the process. Any action to redefine a long-standing arrangement on a country’s borders ought to require a lot more than a simple majority in a one-time vote. The current international norm of simple majority rule is, as we have just seen, a formula for chaos.
Kenneth Rogoff, a former chief economist of the IMF, is professor of economics and public policy at Harvard University.
This article was published with the permission of Project Syndicate.
Latin America’s Tough Lesson: Beware of Charming Leaders
Latin America’s Tough Lesson: Beware of Charming Leaders
Dangerous Populists Tend to Instill Fanaticism In Their Followers
Hana Fischer June 20, 2016 at 10:13 am
latin america charming leaders
A charming leader exerts his power through charisma and emotional rhetoric. (Wikimedia)
Many are astounded by the fact that Venezuela is so deeply entrenched in poverty considering its wealth of natural resources.
Even the most elemental necessities are scarce now, from toilet paper to groceries to medicine. Nearly everyone has suffered, and many have died, most notably children.
More developed countries realized centuries ago that prosperity comes from the ideas, habits and laws that promote progress. In other words, prosperity comes from the nation’s spirit.
A scientific mentality is one of the distinctive traits of developed countries. Experience passed through the filter of reason is what drives both individuals and world leaders. They don’t let rhetoric seduce them; they rigorously investigate and fact-check claims.
Montesquieu claimed laws play the biggest part in the people’s welfare. Good legislation drives progress, both individually and for all the country; bad legislation brings widespread misery. Legal institutions drive their roots into the habits and doctrines dominant in a certain country.
Max Weber analyzed the traits of different people that have reached — for the good or bad of their fellow citizens — an elected political office. It was he who described the idea of a charismatic leader, certain people who stand out for being unusual in a way that is hard for others to imitate.
Charisma is an intense magnetism projected on others at an emotional level. The charismatic leader is a good communicator, persuasive and egocentric. He adapts his language to the traits of the people to which it is directed. He exerts his power through verbal persuasion and emotional excitation.
These kind of leaders to be dangerous because they frequently stir up fanaticism among followers.
Read More: Uruguay’s Biggest, Dirtiest Lie: Pepe Mujica
Read More: Uruguayan Journalists Denounce Government Persecution
Hugo Chávez was a charismatic leader and he sunk Venezuela into poverty and despair. José “Pepé” Mujica was too, having set Uruguay off on a similar path. In both cases, this was possible because the culture and habits of Latin Americans was susceptible to the appearance of these so-called caudillos.
What happened with Chávez is well known. Not so much with Mujica, because Uruguay is still in an earlier stage of the same process.
Mujica ruled the country between 2010 and 2015. Most of that time, the price of exports reached levels similar to that of the 1950s. Consequently, public income grew exponentially.
However, the fiscal deficit in January 2015 was 3.6 percent of GDP, the same as it was in December 2002 — the year in which a bank crisis swept the country.
So how was this new money administered? There was colossal waste. The priority of the Mujica administration was to benefit friends, sympathizers, to perpetuate power and to create the Chavista-Cuban model.
This money didn’t belong to the president, but rather to taxpayers, and yet he administered it as if it were his own.
Mujica acknowledged he had told the heads of public companies to invest as much as they could without listening to the Economy Minister, who had the job of “trimming” things down.
Among the many dreadful decisions taken by Mujica, these are the ones that stand out:
Naming somebody to the state oil company Ancap who was notoriously unprepared to direct it. As a result, he bankrupted it, and nearly had it shut down for good. The bail-out costed taxpayers somewhere between US$800 million and $1,2 billion.
Ancap’s dire state of affairs was known through the only legislative commission on the matter that the ruling party allowed. Mujica declared that it had been a grievous mistake to authorize it. This is why the real situation of the rest of state-owned companies is unknown, although it’s suspected to be similarly in the red.
He created a fund to finance workers cooperatives and other projects that he claimed shouldn’t be measured with an “narrow economic criteria.” Fondes was “his candle to socialism” as he put it.
The final result of such “philosophy” has been that Fondes granted credits to the tune of US$70 million to 28 companies, in many cases breaking laws related to this. At the end of Mujica’s term, there was a huge unpaid debt and the next leadership had to cut its loses for 60 to 70 percent of the organization’s capital.
Under Mujica’s rule, 33,361 more public employees were hired. Keep in mind that Uruguay’s population is just 3.3 million people. In the electoral year, 9.384 were hired, meaning the state now employs one fifth of all workers.
He hastily closed Pluna, the Uruguay state airline, but then created a new one, Alas-U, with former Pluna workers. These workers were given privileged conditions because they enjoyed an unemployment subsidy for three years (normally six months). Fondes gave them a US$15 million loan with nearly no guarantees. In total, the state spent US$24 million on the change.
A mere two months after starting its operations, the airline faced serious financial difficulties that made it cancel flights, raising doubts about whether it can function.
Right now, Uruguay’s fiscal deficit is four percent of GDP, inflation is over 10 percent, unemployment in the private sector is rising, companies face mounting difficulties to remain open and people’s real income is nosediving.
Charming Latin American leaders, like snake charmers, will keep captivating foreigners with their speeches against capitalism and consumerism. And simultaneously, the countries ruled by them will continue to suffer the consequences of so much “cheap philosophy.”
Dangerous Populists Tend to Instill Fanaticism In Their Followers
Hana Fischer June 20, 2016 at 10:13 am
latin america charming leaders
A charming leader exerts his power through charisma and emotional rhetoric. (Wikimedia)
Many are astounded by the fact that Venezuela is so deeply entrenched in poverty considering its wealth of natural resources.
Even the most elemental necessities are scarce now, from toilet paper to groceries to medicine. Nearly everyone has suffered, and many have died, most notably children.
More developed countries realized centuries ago that prosperity comes from the ideas, habits and laws that promote progress. In other words, prosperity comes from the nation’s spirit.
A scientific mentality is one of the distinctive traits of developed countries. Experience passed through the filter of reason is what drives both individuals and world leaders. They don’t let rhetoric seduce them; they rigorously investigate and fact-check claims.
Montesquieu claimed laws play the biggest part in the people’s welfare. Good legislation drives progress, both individually and for all the country; bad legislation brings widespread misery. Legal institutions drive their roots into the habits and doctrines dominant in a certain country.
Max Weber analyzed the traits of different people that have reached — for the good or bad of their fellow citizens — an elected political office. It was he who described the idea of a charismatic leader, certain people who stand out for being unusual in a way that is hard for others to imitate.
Charisma is an intense magnetism projected on others at an emotional level. The charismatic leader is a good communicator, persuasive and egocentric. He adapts his language to the traits of the people to which it is directed. He exerts his power through verbal persuasion and emotional excitation.
These kind of leaders to be dangerous because they frequently stir up fanaticism among followers.
Read More: Uruguay’s Biggest, Dirtiest Lie: Pepe Mujica
Read More: Uruguayan Journalists Denounce Government Persecution
Hugo Chávez was a charismatic leader and he sunk Venezuela into poverty and despair. José “Pepé” Mujica was too, having set Uruguay off on a similar path. In both cases, this was possible because the culture and habits of Latin Americans was susceptible to the appearance of these so-called caudillos.
What happened with Chávez is well known. Not so much with Mujica, because Uruguay is still in an earlier stage of the same process.
Mujica ruled the country between 2010 and 2015. Most of that time, the price of exports reached levels similar to that of the 1950s. Consequently, public income grew exponentially.
However, the fiscal deficit in January 2015 was 3.6 percent of GDP, the same as it was in December 2002 — the year in which a bank crisis swept the country.
So how was this new money administered? There was colossal waste. The priority of the Mujica administration was to benefit friends, sympathizers, to perpetuate power and to create the Chavista-Cuban model.
This money didn’t belong to the president, but rather to taxpayers, and yet he administered it as if it were his own.
Mujica acknowledged he had told the heads of public companies to invest as much as they could without listening to the Economy Minister, who had the job of “trimming” things down.
Among the many dreadful decisions taken by Mujica, these are the ones that stand out:
Naming somebody to the state oil company Ancap who was notoriously unprepared to direct it. As a result, he bankrupted it, and nearly had it shut down for good. The bail-out costed taxpayers somewhere between US$800 million and $1,2 billion.
Ancap’s dire state of affairs was known through the only legislative commission on the matter that the ruling party allowed. Mujica declared that it had been a grievous mistake to authorize it. This is why the real situation of the rest of state-owned companies is unknown, although it’s suspected to be similarly in the red.
He created a fund to finance workers cooperatives and other projects that he claimed shouldn’t be measured with an “narrow economic criteria.” Fondes was “his candle to socialism” as he put it.
The final result of such “philosophy” has been that Fondes granted credits to the tune of US$70 million to 28 companies, in many cases breaking laws related to this. At the end of Mujica’s term, there was a huge unpaid debt and the next leadership had to cut its loses for 60 to 70 percent of the organization’s capital.
Under Mujica’s rule, 33,361 more public employees were hired. Keep in mind that Uruguay’s population is just 3.3 million people. In the electoral year, 9.384 were hired, meaning the state now employs one fifth of all workers.
He hastily closed Pluna, the Uruguay state airline, but then created a new one, Alas-U, with former Pluna workers. These workers were given privileged conditions because they enjoyed an unemployment subsidy for three years (normally six months). Fondes gave them a US$15 million loan with nearly no guarantees. In total, the state spent US$24 million on the change.
A mere two months after starting its operations, the airline faced serious financial difficulties that made it cancel flights, raising doubts about whether it can function.
Right now, Uruguay’s fiscal deficit is four percent of GDP, inflation is over 10 percent, unemployment in the private sector is rising, companies face mounting difficulties to remain open and people’s real income is nosediving.
Charming Latin American leaders, like snake charmers, will keep captivating foreigners with their speeches against capitalism and consumerism. And simultaneously, the countries ruled by them will continue to suffer the consequences of so much “cheap philosophy.”
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