Tag: NHS

Lords Debate on NHS Sustainability

Last week I wrote a blog post on “The NHS is killing us” – see https://roliscon.blog/2024/04/12/the-nhs-is-killing-us/ . Last night I had a dialysis session and after watching a couple of old movies I turned over to the BBC Parliament Channel and was surprised to see my sister (Baroness Murphy) speaking on a debate on NHS sustainability – recording here: https://www.bbc.co.uk/iplayer/episode/m001yg9p/house-of-lords-sustainability-of-the-nhs?seriesId=unsliced&page=1 .

She made a good contribution and there were several others. Often from people very knowledgeable about the NHS (for example by sister worked in it for many years and latterly chaired an NHS trust).

Many people think the House of Lords should be replaced by an elected body or similar but it actually does good work as it’s now full of people who are expert in their fields. Perhaps the hereditary peers should go but otherwise I would leave it unchanged.

Roger Lawson (Twitter: https://twitter.com/RogerWLawson  )

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Babylon Healthcare and WeWork Collapsing

A report in the Daily Telegraph has suggested that Babylon Health is close to collapse. Babylon have developed an innovative software product for diagnosis in a GP environment and has been used by the NHS. The company listed in the USA in 2021 and was one of the UK tech hopefuls for which a bright future was foreseen. It was even backed by the Government as it might relieve pressure on GP services. But the party is over it seems. I am not clear why it is failing – lack of cost control may be the problem.

I have been using the NHS a lot of late due to declining kidney function (25-year-old transplant is failing) and had a fistula added in readiness for dialysis last week. Am apparently not fit enough for another transplant at present. I am receiving lots of advice about improving mobility and health from an “elderly person’s review” at Guys Hospital and from local social services (albeit 3 months too late). My short-term memory is clearly declining not helped by the drugs I am taking but I can cope with that. If we meet don’t be surprised if I can’t remember your name!

Another past shooting star that has fallen back to earth is WeWork which I commented on in previous blog posts – see https://roliscon.blog/?s=wework. The FT has reported that “substantial doubt exists about the Company’s ability to continue as a going concern”. This is a property company in essence, renting out short-term office space with a dubious business model particularly when New York and other major cities are now awash with empty office space.

Bearing in mind I am averaging two hospital appointments per week at present, you may find my blog posts become less frequent. Just had another call to arrange a heart scan.

The NHS, particularly Guys Hospital, are generally efficient and do not deserve all the criticism they get although they could certainly use more technology.

Can’t say the same about other hospitals or GP services.

Roger Lawson (Twitter: https://twitter.com/RogerWLawson  )

See https://www.telegraph.co.uk/business/2023/08/08/babylon-tech-nhs-digital-gp-app-faces-collapse/

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Reflections on the NHS, and Managing its Resources

Many people are celebrating the 75th anniversary of the founding of the National Health Service (NHS). As someone who has relied on it to keep me alive for the last 75 years, I am not however applauding it.

The NHS was certainly an improvement on health care provision in the UK before 1948 which I recall my parents talking about, but it does not compare well against the systems in most countries now. This was made very clear in a recently published report by the Kings Fund – see  https://www.kingsfund.org.uk/blog/2023/06/comparing-nhs-health-care-systems-other-countries-five-charts

To quote from it: “The UK has less medical equipment and fewer beds. Spending on health care increased substantially in the UK during the Covid-19 pandemic. But despite this, spending per person remains lower than the average [of comparable countries]. This impacts on the patient experience. For example, although there is no objectively ‘ideal’ number of scanners, the UK has fewer CT and MRI scanners than any of the comparator countries, which could be a reason – alongside shortages of imaging staff – for why diagnostic waits in the UK are so high.

The UK also has fewer hospital beds; 2.5 beds per 1,000 people, compared to an average of 3.2 beds per 1,000 in our basket. Again, fewer beds are not necessarily bad – this could reflect shorter hospital stays – but the high occupancy rates of beds in the UK (88 per cent in 2022/23, above recommended levels, and third highest in our basket) implies there is a shortage”.

There are clearly shortages of staff and long waits for non-urgent treatment which is driving people to pay privately for treatment. The Government has recently announced a new “long-term” plan for NHS staffing – see https://www.england.nhs.uk/2023/06/record-recruitment-and-reform-to-boost-patient-care-under-first-nhs-long-term-workforce-plan/ which includes this statement: “For the first time the Plan sets out long term workforce projections. Staffing shortfalls have been an issue since the foundation of the NHS and vacancies now stand at 112,000. The growing and ageing population, coupled with new treatments and therapies, means that without action, the gap could grow up to 360,000 by 2037”. Is it not astonishing that there has been no long-term plan before to match recruitment and training of staff to match likely demand?

As someone who has been a big user of the NHS over the last 75 years I have seen the problems in person. I have had a long history of kidney disease and other problems and a visit this week seems to suggest that the NHS is managing demand in a new way.

I have been on kidney dialysis before and had a transplant 25 years ago. But I either need another transplant or need to go on dialysis again. A meeting with a consultant last week was somewhat disconcerting. He explained how tedious dialysis can be, which I already knew. Without spelling it out, he seemed to be suggesting that at the age of 77, did I really want to stay alive much longer?

Is this another way to manage demand on the NHS? Persuade patients to give up hope? Dialysis is an expensive process for the NHS – more expensive than a kidney transplant but I am allegedly not fit enough for that. I am not keen to give up living just yet but the NHS appears to be managing its resources in a new way.

There is one thing for certain. The NHS is very bad at planning and managing its capacity. Last year I spent two weeks in Farnborough hospital which was an absolute waste of my time and hospital resources when I could have been treated as an out-patient while the ward conditions in a heatwave were very uncomfortable. This is simply not good enough in the modern world.

The NHS needs much more substantial reform to make it fit for the future. More money alone is not the solution. It needs major management reforms.

Roger Lawson (Twitter: https://twitter.com/RogerWLawson  )

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EMIS Bid and Comments on Capital Gains Tax

Last week was certainly a depressing one for stock market investors. My portfolio was down substantially even taking into account the last-minute announcement on Friday of an agreed takeover bid for EMIS Group (EMIS).

This is a cash offer of 1,925p which is a premium of almost 50% to the recent trading price so is surely likely to be accepted. EMIS is one of my longer-term holdings – first purchased at 485p in 2011, but it has been somewhat disappointing. Overall total return has been 12.7% per annum including the latest bid premium but with a strong position in the supply of medical solutions they should surely have been making big profits in the recent pandemic and in the support of the NHS where large amounts of money are being spent. I think the big problem has been having the Government as a major customer who tend to dictate the pricing.

I did buy a few more shares recently at 1,272p but failed to have the courage of my convictions and should have bought more. Like many investors no doubt, I have gone on a buying strike and am selling as the market trends down rather than buying.

My capital gains tax charge for last year is only moderate but with holdings in Ideagen and EMIS soon to be realised I will be paying a big bill this year. Capital gains tax should be indexed now that inflation is reaching 10%. I will be paying tax on fictitious, not real, gains.

Perhaps ShareSoc should be taking up that issue.

Will the market improve over the summer? I doubt it until there is better news on the economic front. We appear to be heading into a worldwide recession prompted by higher commodity prices. There may be some share bargains appear in the next few weeks but I personally won’t be rushing back into the market.

Meanwhile I am at least out of hospital but have written to the Chairman of the local NHS Trust to complain about the dysfunctional management and waste of resources. There is lots of money being spent on the NHS but the patient experience is still crap.

Roger Lawson (Twitter: https://twitter.com/RogerWLawson  )

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Barton Biggs and Hedge Hogging, plus NHS Dysfunction

I managed to finish reading the book Hedge Hogging last week during my 7 days in hospital. Here is a longer review.

The author Barton Biggs spent 30 years at Morgan Stanley building up their investment management business. In 2003 he formed his own hedge fund named Traxis Partners which was wound up after his death in 2012. But this is no out of date history of past financial events as much of what it covers is topical and relevant to today’s stock markets.

It’s partly a journal of events in his life but with extensive diversions into the big issues most investors face particularly the psychological difficulties that you can face. Topics such as short-selling, private equity, emerging markets, market bubbles and investment cycles are covered – we certainly seem to be in a down cycle at present rather than a temporary correction. As an investment strategist over 30 years he obviously experienced a variety of market conditions. He covers the two main investment approaches – based on growth and value but in essence was agnostic.

He has some interesting comments on Ronald Reagan and Margaret Thatcher – the latter he met more than once. He explains the success of the Yale Endowment Fund under David Swensen and explains to an audience of tech stock fanatics that “the human emotions of fear and greed that drive the stock market to excess have not changed over the course of human history and remain as valid today as in the past. Busts are busts, booms are still booms, and bubbles always burst, but this was boring stuff, and the crowd stirred restlessly. The glitterati understandably had no interest in hearing about busts or bursting bubbles. On to the next IPO and salacious stock idea”.

A good paragraph that gives you an impression of his writing style is the following: “If you hang around the investment business long enough eventually you experience some mysterious, almost supernatural events because the stock market is a capricious beast, almost a force of nature like the sea or the arctic. It can be bountiful and loving in its embrace but also hard and cruel and sadistic. Making your living from the stock market is a strange, hazardous, yet beguiling occupation. It’s a little like being a ship’s captain back in the time of wind and sail. As the master of a whaler out of Nantucket in those days of yore, in good fair, you blissfully rode the ocean’s friendly currents. Then suddenly without warning, the sea would turn and you would find yourself driven helplessly toward some distant rocky shore by one of its fierce, irrational storms. Men and women who live at the mercy of the whims of the sea and weather are a superstitious lot”.

He ends with a review of the biography of John Maynard Keynes by Robert Skidelsky which I have lined up as my next book to read. In all Hedge Hogging is a fascinating look at the world of hedge funds but there are many lessons to be learned from it for ordinary investors.

Lastly let me say about a few words about my stay in an NHS hospital, which was not for the first time. The popularity of the NHS is falling and quite rightly. It is a dysfunctional organisation that does not compare well with the systems in other countries (bar the USA).

I cannot complain about the treatment I had but the big problem is the culture. Treating patients as children to be organised and disciplined, not as people. It was also very wasteful, keeping me in bed when I was only “walking wounded” as the army might say when I could have been treated at home for most of the time at less cost. How do you reform the culture of an organisation? With great difficulty is the answer. Easier to start from scratch.

Roger Lawson (Twitter: https://twitter.com/RogerWLawson  )

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FT Article on the NHS

There is a very good article in the Financial Times today concerned with the panic over privatising the NHS. I added this comment on-line: ” I write this from my NHS hospital bed. There can be wonderful service from the NHS but it can also be very bad – waiting lists for surgery or cancer treatments are examples. I would hate to have to rely on the NHS solely for medical treatment as most people do. Over 30 years I have learned that the NHS is slow to reform and adopt new technology. It’s a bureaucracy and not run like a business with customers. The NHS still treats you in what they consider is best and most efficient for them. There is little response to customer demands or views. That is what needs changing with more financial incentives”.

It looks like I may be here some time but I expect they will keep me alive as they have done for the last 30 years (I am a kidney transplant patient). It does enable me to finish reading Barton Biggs book Hedge Hogging which I mentioned in a previous blog post. This is a really good book that everyone involved in the financial world should read. I’ll try to do a more expansive review at a later date as it’s not easy to use a laptop in bed. It’s not just relevant to hedge fund managers!

Glad to see the market is in soporific mode with no big movements in my holdings. Trading from your sick bed is never a good idea as treatments can affect your brain or your emotions.

Roger Lawson

Collecting Your Personal Health Data – Should You Object?

There seems to be quite a furore developing over the plans by the NHS to make your personal medical data available for research to a wide range of organisations, including commercial companies. It is no doubt true that the NHS has an enormous amount of medical data on the UK population which is unrivalled anywhere else in the world except possibly in China.

That data which might be as simple as weight and blood pressure, through to blood tests and even DNA samples, could be exceedingly useful by using “big data” analysis techniques to identify possible causes of disease. It would of course include past diagnoses and treatments including medication.

But there have been a number of protests raised about the risk of loss of confidentiality and the fact that it might not be completely depersonalised (i.e. the data released might enable people to be identified). Even some of my neighbours on the App Nextdoor have been advising people to opt-out.

This is a complex area and I remember discussing it with my GP some years ago when it was first contemplated. He had concerns but I do not while I think such data could be enormously useful in diagnosis and the development of new treatments. The Investors Chronicle ran an informative article on the subject last week and covered some of the companies active in this area.

For example it mentioned Alphabet (parent of Google) partnering with hospital chain HCA Healthcare to develop algorithms using patient records. As I have recently been treated in an HCA facility (they own London Bridge Hospital) that might include me. The article pointed out that even your Apple Smartwatch will be recording some medical data such as heart rate exercise data.

A number of companies are developing partnerships with hospital groups to collect and analyse the data they have on patients. For example, AIM listed Sensyne Health (SENS) is doing so. They recently announced an agreement with the Colorado Center for Personalized Medicine which will extend their database by 7.3 million patients to over 18 million. They obviously plan to “monetise” that data by supplying it to other companies for research purposes. I do hold a few shares in Sensyne.

What are the concerns? Insurance companies would certainly like to know who might be bad risks by looking at patient data. They are unlikely to be able to do that, particularly as any data released will be depersonalised. But will it be impossible to identify people as some might enable linkages to be made? Perhaps not totally impossible but the risks seem low to me and personally I could not care less who knows my medical history. Others might disagree on that point but the benefits of having a good database of medical data to help with research, much of which is done by commercial companies, is surely invaluable.

There are opt-out provisions for those who have any concerns.

See https://digital.nhs.uk/data-and-information/data-collections-and-data-sets/data-collections/general-practice-data-for-planning-and-research for more information.

Roger Lawson (Twitter: https://twitter.com/RogerWLawson  )

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RNS Announcement Emails, Mello Presentation and NHS Politics

Many private investors like me have been using a service from Investegate to deliver new RNS announcements via email. But recently, and not for the first time, delivery of such announcements has been delayed, or they have not been delivered at all. This can be positively dangerous – for example I only realised that I had missed seeing one after the share price of a company I held rose sharply. Missing bad news can be even more traumatic.

After complaining to Investegate and getting no response I decided to change to another service. The London Stock Exchange offer a similar free service (see https://www.londonstockexchange.com under Email Alerts). It appears to work reliably so I recommend it.

Many readers will be aware of the Mello events that attract many private investors to company presentations and for networking. Mello London is a 2-day event in Chiswick on the 12th and 13th of November (see: https://melloevents.com/event/ ). I will be giving a talk on Business Perspective Investing based on my recently published book on the Tuesday at 12.55pm. So please come along and learn more about why financial analysis is not the most important aspect of selecting companies in which to invest.

I note that the NHS is likely to be a political football in the coming General Election. As a heavy user of the NHS for the last 30 years during which it has kept me alive, I consider this is a grave mistake. The NHS is not a perfect service and could do with some more money as the UK spends relatively less on healthcare in comparison with other countries. But the service has improved enormously over the last 30 years regardless of the political party or parties that were in power. One of the most damaging aspects has been constant change and reorganisation driven by political dictates and concerns to improve efficiency. It’s also been slow to adopt new technology such as IT software because it is so monolithic and bureaucratic a body. When it did commit to a major IT project for patient records and associated systems it wasted £10 billion or more on an ultimately abandoned project. More diversity and local decision making are needed in the NHS. But I see no chance of it being threatened by any trade deal with the USA or by our exit from the EU.

Roger Lawson (Twitter: https://twitter.com/RogerWLawson )

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