The Monday Morning Quote #92

“Some folks go through life pleased that the glass if half full.

Others spend a lifetime lamenting that it’s half-empty.

The truth is: There is a glass with a certain volume of liquid in it.

From there, it’s up to you!”

Dr James S. Vuocolo

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The Monday Morning Quote

“There is a wonderful reason that explains why human beings have developed two different minds.

It is because in the whole world there are really only two problems.

I’ve always found that to be a comforting thought, only two problems in the whole world.

One problem is, “you know what you want but you don’t know how to get it”,

and the only other problem is, “you don’t know what you want.”

Steven Snyder

via David Allen

BDA says enough is enough

The British Dental Association has been criticised for its lack of resistance to the recent impositions of HTM01-05 and the Care Quality Commission. In the past couple of days they have issed the following statement and have done a U-turn on making the advice package available free of charge to members, (it was originally going to priced at £75).

Although frequently accused of not listening to its members I have some sympathy for their position as there appears to be as many different views as there are members – all of whom consider themselves to be correct.

The CQC must explain calculations behind proposed fee scale to register dental practices warns BDA
The British Dental Association is calling on the Care Quality Commission to explain the calculations behind its proposed fee scale to register dental practices, following concerns that single practice owners could end up subsidising owners of larger practices.

With registration fees for one practice proposed to start at £1,500, the sliding scale means that the more practices a provider owns, the cheaper the unit cost, despite the CQC’s assertion that the cost of registration would be linked directly to providers’ responsibility for meeting the essential standards.  The CQC’s consultation on registration fees for dental practices gives no indication of the actual cost to CQC of regulating dental practices.

In a letter addressed to the CQC’s Chief Executive, Cynthia Bower, the BDA asks her to explain the details underpinning the proposed fees.
Susie Sanderson, Chair of the BDA’s Executive Board, said:
“The profession has already expressed grave concerns over the Commission’s regulation of dental services and the poor handling of the registration process.  The lack of clarity over how the proposed fee scale was calculated will do nothing to allay these concerns.
“In the first instance, how did the CQC calculate that the minimum fee to register a practice annually should be £1,500, when the fee to register a practice in the equivalent body in Wales is under £100?
“And how can it be equitable that a large number of small providers will effectively subsidise the smaller number of large providers, whether NHS Trusts or chains of practices?”

John Milne, Chair of the BDA’s General Dental Practice Committee, said:
“If the CQC is genuinely interested in feedback from dentists on its proposed fee scale, then it must explain how it calculated it, otherwise this is a pointless exercise and will only further erode the profession’s confidence in a regulation process which seems unnecessary.”

BDA supports members with CQC compliance

The BDA has today announced that it is making available free of charge online to members its dedicated toolkit helping members comply with the CQC requirements.

The toolkit is a value-added product.  It contains not only guidance on how to complete the application form and how to comply with the requirements – which is already free on the website and has been accessed by many members over the past few months – but also over 40 BDA-approved models, protocols and templates to smooth the process.  Part of our ongoing support and advice for members, the kit enables us to get this critical and practical information to the large number of members who have asked us for it.  The toolkit CD-Rom was originally priced at just £75 for members, with a non-member price of £520 more accurately reflecting its commercial value.  The many members who have already paid for a copy will receive a full refund.

The kit is the latest in the BDA’s well-known series of practice aids that are ordinarily available for members to buy. But in this case it will be available on the website by the end of next week at no cost until the end of the registration period at the end of March 2011.

Commenting on the decision to offer such a comprehensive level of support free, BDA Chief Executive Peter Ward said “The BDA has lobbied government consistently that the way CQC regulation is being implemented is plain wrong, being disproportionate, draconian and chaotic.  We will continue to fight for change and are enlisting the support of our members to help by sending a postcard to their MPs asking the Secretary of State to act.  The postcard will be distributed in the December issue of BDA News.

“The fact is though that members do have to comply with these unreasonable demands until change is won and accordingly we have developed a reliable toolkit that will be available to all to help them do so.  The demands of CQC are almost unprecedented in recent times and the BDA has responded rapidly by devoting significant time and expertise in delivering a product that will protect members from some of the unnecessary pressure CQC compliance entails.”

The Weekend Read – Man’s Search for Meaning

One of the smallest books that I own and one of the most influential. There is little that I can add to the reviews that have already been written. Written in  9 days in 1945 and intended to be published anonymously  it was first published in Englisj 1959.

Victor Frankl was born in Vienna in 1905 and trained as a psychiatrist, as a Jew he was persecuted by the Nazis and spent years in the death camps including Auschwitz. Miraculously he survived; this book is not so much about his experiences, although those he mentions are chilling enough, but how how he found the strength to survive. As he says it is not the fact that so many died but that any one survived is so remarkable.

From the foreward by Harold S. Kushner: Terrible as it was, his experience in Auschwitz reinforced what was one of his key ideas: Life is not primarily a quest for pleasure, as Freud believed, or a quest for power, as Alfred Adler taught but a quest for meaning.

The greatest task for any person is to find meaning in his or her life. Frankl saw three possible sources for meaning: in work (doing something significant), in love (caring for another person), and in courage during difficult times. Suffering in and of itself is meaningless; we give our suffering meaning by the way in which we respond to it. At one point, Frankl writes that the person is “may remain brave, dignified and unselfish, or when the bitter fight for self preservation he may forget his human dignity and become no more than an animal”. He concedes that only a few prisoners of the Nazis were able to do the former, “but even one such example is sufficient proof that man’s inner strength may raise him above his outward fate.”

Finally, Frankl’s most enduring insight, one that I have called on often in my own life and in countless counselling situations: forces beyond your control can take away everything you possess except one thing, your freedom to choose how you will respond to the situation. You cannot control what happens to you in life, but you can always control what you will feel and do about what happens to you.

Man’s Search For Meaning is available here.



Why do people get angry?

I read this week that “The UK government is poised to start measuring people’s psychological and environmental wellbeing” (all papers & the BBC website).

At the risk of doing two Meldrews out of three can I suggest that people would feel less irritated in their day-to-day lives and therefore more likely to feel happy with their lot if the didn’t have to put up with the sort of email I received earlier today.

I use the http://www.trainline.com to book train tickets when I make journeys on the railways, I consider using the train for most of my journeys and, where I possibly can, I let the train take the strain.

That’s what I do, I know where I’m going and I book it, I don’t need The Trainline when I’m not going anywhere, I don’t need to be told that they have offers, I get plenty of emails of dubious enough need already thank you. That’s why I opted to not be told about the services.

Here’s the email:

Dear Doctor Rees,
We are currently updating our database and noticed that you are not opted in to receive messages, promotional fares and the latest news from thetrainline.com.

So far so good…ish, in fact I had opted out of receiving messages rather than what they intimate.

Next:

If you wish to receive these types of messages, follow the instructions below. Otherwise we will not contact you any further in this regard.

That’s what they say today, how long before I get the next Mrs Doyle missive “are you sure that you don’t want to be in now? Go on, go on, go on, go on.”

Which bit of please don’t email me don’t you understand?

Sign up now

UK Dental Corporates – More movement?

For such a small business sector the UK Dental “Corporates” do seem to attract a lot of attention along the “who’s selling what now?’ lines. It makes me wonder how stable the whole edifice really is. For as long as I have been writing I seem to have been bringing news of re-financing, buyouts & consolidation. The short history is one of almost constant change.

On the other hand,  anybody who has worked in Dental Practice knows that patients want stability and hate change. If they are going to have someone furtle about in a very sensitive area of their anatomy they would like to know more about them than a grunt from behind a facemask.

How can staff feel secure when there are regular murmurings  and gossip about the “mother ship”? Caring for people is usually the main reason that dentists enter the profession, sadly it doesn’t seem to be at the top of the list for the owners of and manipulators within the corporates. I am still not sure whether it is the right model for (UK) dentistry. Dentist owned franchises seem to make far more sense.

From Business Sale Report” (which sounds to me like the sort of journal usually featured on “Have I Got News For You”) a report on IDH. I was once interviewed by David Hudaly and found him to be a nice guy and a very good operator – sadly I hadn’t realised that I was there to be interviewed, nobody had let me have a job description, T&Cs etc but that’s another story.

Integrated Dental Holdings in a £300m sale
Mon, 15 Nov 2010
By Eilis Jordan
Merrill Lynch has put the UK’s biggest chain of dental practices, Integrated Dental Holdings, on the market with a price tag of between £300 million and £400 million.
Set up by dentist David Hudaly in 1996, the Bolton-based business now operates 250 practices offering private and NHS services to around 1.5 million patients each year, and boasts more than 700 dentists.
Merrill Lynch’s previous attempt to sell IDH in September last year, with a sale price of £200 million, was unsuccessful.
Merrill Lynch, which owns a controlling stake in the group, is managing the sale process itself this time round with Hawkpoint acting as advisor.
The private equity outfit of Merrill Lynch took on the majority stake in early 2008, in a deal which is believed to have valued IDH at £300 million, including its debts. The seller, LGV Capital, the private equity arm of Legal & General, also sold two other healthcare businesses within one week.
At the time, a hefty windfall was expected for David Hudaly and his team out of the deal, with the intention to put most of the cash back into the business.
Under ownership of LGV Capital from early 2006 to early 2008, IDH’s number of surgeries increased from 130 to about 190 and its turnover jumped from £75 million to £90 million.

Please tell me it’s April 1st

Politicians and HEALTHCARE seem to be mutually exclusive, the temptation to adopt a Meldrew pose and yell as loud as my lungs & larynx will allow “I DON’T BELIEVE IT!” is almost overwhelming.

From the Guardian www.guardian.co.uk/politics/2010/nov/12/mcdonalds-pepsico-help-health-policy

McDonald’s and PepsiCo to help write UK health policy
Exclusive: Department of Health putting fast food companies at heart of policy on obesity, alcohol and diet-related disease.

The Department of Health is putting the fast food companies McDonald’s and KFC and processed food and drink manufacturers such as PepsiCo, Kellogg’s, Unilever, Mars and Diageo at the heart of writing government policy on obesity, alcohol and diet-related disease, the Guardian has learned.

In an overhaul of public health, said by campaign groups to be the equivalent of handing smoking policy over to the tobacco industry, health secretary Andrew Lansley has set up five “responsibility deal” networks with business, co-chaired by ministers, to come up with policies. Some of these are expected to be used in the public health white paper due in the next month.

The groups are dominated by food and alcohol industry members, who have been invited to suggest measures to tackle public health crises. Working alongside them are public interest health and consumer groups including Which?, Cancer Research UK and the Faculty of Public Health. The alcohol responsibility deal network is chaired by the head of the lobby group the Wine and Spirit Trade Association. The food network to tackle diet and health problems includes processed food manufacturers, fast food companies, and Compass, the catering company famously pilloried by Jamie Oliver for its school menus of turkey twizzlers. The food deal’s sub-group on calories is chaired by PepsiCo, owner of Walkers crisps.

The leading supermarkets are an equally strong presence, while the responsibility deal’s physical activity group is chaired by the Fitness Industry Association, which is the lobby group for private gyms and personal trainers.

In early meetings, these commercial partners have been invited to draft priorities and identify barriers, such as EU legislation, that they would like removed. They have been assured by Lansley that he wants to explore voluntary not regulatory approaches, and to support them in removing obstacles. Using the pricing of food or alcohol to change consumption has been ruled out. One group was told that the health department did not want to lead, but rather hear from its members what should be done.

Professor Sir Ian Gilmore, the leading liver specialist and until recently president of the Royal College of Physicians, said he was very concerned by the emphasis on voluntary partnerships with industry. A member of the alcohol responsibility deal network, Gilmore said he had decided to co-operate, but he doubted whether there could be “a meaningful convergence between the interests of industry and public health since the priority of the drinks industry was to make money for shareholders while public health demanded a cut in consumption”.

He said: “On alcohol there is undoubtedly a need for regulation on price, availability and marketing and there is a risk that discussions will be deflected away from regulation that is likely to be effective but would affect sales. On food labelling we have listened too much to the supermarkets rather than going for traffic lights [warnings] which health experts recommend.” Employers are being asked to take on more responsibility for employees in a fourth health at work deal. The fifth network is charged with changing behaviour, and is chaired by the National Heart Forum. This group is likely to be working with the new Cabinet Office behavioural insight unit, which is exploring ways of making people change their behaviour without new laws.

Lansley’s public health reforms are seen as a test case for wider Conservative policies on replacing state intervention with private and corporate action.

While public interest groups are taking part in drawing up the deals, many have argued that robust regulation is needed to deal with junk food and alcohol misuse.

The Faculty of Public Health, represented on several of the deal networks, has called for a ban on trans fats and minimum alcohol pricing. Professor Lindsey Davies, FPH president, said: “We are hopeful that engaging with the food industry will lead to changes in the quality and healthiness of the products we and our children eat.  It is possible to make progress on issues such as salt reduction through voluntary agreements, and we’re keeping an open mind until we see what comes out of the meetings, but we do think that there is still a role for regulation.”

Responding to criticism that industry was too prominent in the plans, the Department of Health said: “We are constantly in touch with expert bodies, including those in the public health field, to help inform all our work. For the forthcoming public health white paper we’ve engaged a wide range of people, as we are also doing to help us develop the responsibility deal drawn from business, the voluntary sector, other non-governmental organisations, local government, as well as public health bodies. A diverse range of experts are also involved.”

He added that the government wanted to improve public health through voluntary agreements with business and other partners, rather than through regulation or top-down lectures because it believed this approach would be far more effective and ambitious than previous efforts.

An over-arching board, chaired by Lansley, has been set up to oversee the work of the five responsibility deal networks, with representatives of local government and a regional health director – but it too is dominated by the food, alcohol, advertising and retail industries. Gilmore called for a better balance of commercial interests and independent experts on it.

Other experts have also expressed concern at Lansley’s approach. Professor Tim Lang, a member of the government’s advisory committee on obesity, doubted the food and drink industry’s ability to regulate itself. “In public health, the track record of industry has not been good. Obesity is a systemic problem, and industry is locked into thinking of its own narrow interests,” said Lang.

“I am deeply troubled to be sent signals from the secretary of state about working ‘with business’ and that any action has got to be soft ‘nudge’ action.”

Jeanette Longfield, head of the food campaign group Sustain, said: “This is the equivalent of putting the tobacco industry in charge of smoke-free spaces. We know this ‘let’s all get round the table approach’ doesn’t work, because we’ve all tried it before, including the last Conservative government. This isn’t ‘big society’, it’s big business.”

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