The Monday Morning Quote #395

“Men do not shape destiny,
Destiny produces the man for the hour”
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The Monday Morning Quote #394

You can fool all the people some of the time,

and some of the people all the time,

but you cannot fool all the people all the time.

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Oasis. BUPA. Round and round until the music stops….

(Apologies for mixed metaphors)

I remember a staple of children’s parties was a game called pass the parcel. In this a present was wrapped in many layers of paper and passed from child to child who were seated in a circle. When the music stopped whoever had the parcel removed a layer of wrapping paper. As the game wore on it became more exciting as to who would be holding the parcel when the last sheet of wrapping was removed.

The present wasn’t always what you wanted. Some parents would wrap cabbages or other vegetables.

The news that Bridgepoint is selling Oasis to BUPA has been rumoured for a couple of months. The price is apparently £835 million. They paid £185 million when they bought it in 2013. They have made serious acquisitions and expansions (including using the fact that they also owned Smiles to further expand into Ireland).

They (BUPA) already have a number of practices which I believe are all private, taking on the conglomerate that is Oasis with lots of NHS practices will be a challenge. I have heard stories of associate dentists having to buy their own materials  and other less than thrilling tales of the pursuit of the UDA target that made me feel it was a “buy, build, expand and sell exercise”. That’s what venture capitalists do.

BUPA is a name that one readily associates with private health care and i wonder if this is the first step into their creating an alternative very large private dental chain. In which case they will have to set about developing a culture of customer service, communication and patient care that many of Oasis practices are sadly lacking at the moment.

That’s a very big ticket for them to repay. As with all these takeovers about which I seem to write 3 or 4 times a year I wish them success because the workforce of dentists and DCPs deserve good management and appreciation and the patients should be able to expect and receive the very best treatment.

It is a myth that any business is too big to fail. I am concerned that this parcel may well reveal itself to have a balloon at its centre. In which case be careful how you tear the paper and sellotape, because, to use a line which I seem to write every couple of weeks at the moment, there’s nothing sadder than a burst balloon. My memory of a lot of children’s parties is them ending with the someone in tears.

This time the balloon could be very big indeed….

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The Monday Morning Quote #393

“The only thing necessary for the triumph of evil is for good men to do nothing.”

Edmund Burke

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The Monday Morning Quote #392

“The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy.”
— Martin Luther King, Jr.

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A Trump Tower Goes Bust in Canada

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I try to keep my political views to myself, but some weeks you have to acknowledge what’s happening elsewhere. This story is from my friend Jason Cupp’s newsfeed here. It’s worth a read.

A Trump Tower Goes Bust in Canada

The failure this week of Trump Toronto showcased a familiar scenario: big promises, glitzy image, a Russian-born financier, aggrieved smaller investors – but few losses for the mogul himself.

The 65-story Trump International Hotel & Tower Toronto has all the glitz and ambition of the luxury-brand businessman with his name in giant letters near its spire. It’s the tallest residential skyscraper in Canada, and probably the fanciest. The hotel’s sleek cream-and-black interiors were inspired by Champagne and caviar. Every room features Italian Bellino linens and Nespresso coffeemakers. Guests can book a Trump Experience outing through the Trump Attache concierge service. Their furry friends are eligible for the Trump Pets program, which “will fill your best Fido’s tummy with gourmet treats, and see them off to sleep on a plush dog bed.

This Trump-branded and Trump-managed jewel is also, as a business venture, a bust.

On Tuesday, a Canadian bankruptcy judge placed the glass-and-granite building into receivership, just four years after Trump and his children cut the ribbon at its grand opening. Once it’s auctioned off, whether or not Trump is the leader of the free world by then, his name may well vanish from its marquee.

Trump is not the project’s developer or even an investor; one of his partners, a Russian-born billionaire who got rich in Ukraine’s steel industry, controls the firm that’s in default. The Trump Toronto is still a posh hotel, and even though nearly two thirds of the tower’s condo units remain unsold, they’re still upscale residences. Still, the saga of the property’s glittering rise and rapid fall is classic Trump, featuring a tsunami of litigation and bitterness, money with a Russian accent, and a financial wreck that probably won’t hit its namesake particularly hard.

Trump has vowed to run the country the way he runs his businesses, and Trump Toronto is yet another reminder that his businesses do not always run smoothly. Even before the bankruptcy, the Trump Organization was already mired in litigation over management issues with the project’s owner, Talon International—led by Alex Shnaider, the steel magnate who is perhaps better known for buying a Formula One racing team and hiring Justin Bieber to sing at his daughter’s Sweet Sixteen. The project also faced lawsuits filed by middle-class investors who claim they were suckered into buying time-share-style units in the hotel with wildly overstated projections of Trump Toronto’s performance. Now it’s in receivership, which will produce new ownership and, quite possibly, a new brand.
Continues here.

RCS warns of risks of increasing litigation pay-outs

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The Royal College of Surgeons (RCS) has warned that NHS trusts risk facing a dramatic increase in the number of litigation pay-outs made if they do not make changes to the processes they use to gain consent from patients before surgery. The warning comes after a landmark judgment given in a Supreme Court case in 2015, Montgomery vs Lanarkshire Health Board, clarified our understanding of patient consent.

The Royal College of Surgeons has today published new guidance for surgeons that aims to help doctors and surgeons understand the shift in the law and its implications, as well as give them the tools to assist in improving their practice.

According to the NHS Litigation Authority (NHSLA), which handles medical negligence claims on behalf of hospitals NHS trusts in England paid out more than £1.4 billion in claims during 2015/2016 . The RCS is concerned that this bill could go up significantly if hospitals do not take the Montgomery ruling seriously.

Traditionally clinical practice in the NHS has considered that it is up to doctors to decide what risks to communicate to patients. The court in the Montgomery case changed this and held that doctors must ensure patients are aware of any and all risks that an individual patient, not a doctor, might consider significant. In other words doctors can no longer be the sole arbiter of determining what risks are material to the patient.

Full article here

Consent: Supported Decision-Making – A Guide to Good Practice explains the change in case law and the impact this has on gaining consent from patients. It offers a set of principles to help surgeons support patients to make decisions about their care and gives a step-by-step overview of how the consent process should happen.

Further comments..

Clinical negligence practitioners and patient safety groups have welcomed the new approach to consent. However, the organisational challenge now facing the NHS is considerable. Clinicians already adopting the new guidelines report that typical consultation times have increased, often due to the need for a senior doctor with experience of a range of treatments to talk through the options in detail.

Kirsten Wall, partner in the clinical negligence department at Leigh Day, said of the RCS’s new guidelines: ‘This new approach to obtaining a patient’s consent is an important step away from the previous approach of ‘doctor knows best’ to allowing patients the opportunity to weigh up all the risks and alternative treatment options so they can make a decision that is right for them and their family’.

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