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Memo to Boris: Bulk Medicine Purchases Could Save the NHS Millions Annually

by John Brian Shannon

The UK’s excellent National Health Service could save millions of pounds annually if the UK government were to bulk purchase all medicine for the entire country and thereby obtain huge discounts from pharmaceutical manufacturers.

The NHS can save itself millions of pounds sterling per year by simply purchasing a year’s worth of medicines in advance, similar to what is done in Canada where the government of Canada, using their mass-purchasing power, negotiates massive discounts on medicines from multinational pharmaceutical corporations.

In Canada, each province operates its own provincial health service and pays the entire cost of it via provincial income tax, sales tax and other fees — but they couldn’t succeed without the huge price discounts that the federal government of Canada obtains from its medicine suppliers. Not only do Canada’s healthcare systems benefit from lower drug costs, but the Canadian military and Coast Guard also benefit from those lower prices.

It’s not the whole answer to solve all NHS spending problems all the time but it could be a good part of the answer.

As the NHS constantly struggles to meet the demands placed on it by attempting to treat everyone, all the time, no matter the disease, ailment or injury; Saving millions annually on medicine costs could allow NHS funding to be better spent on treatment for patients, instead of it being consumed by drug costs.

It’s not about purchasing low quality medicines, nor is it about payoffs or patronage.

It’s about deciding how much medicine to purchase (a year in advance) and thereby obtain competitive pricing from the legitimate pharmaceutical corporations in America and Europe which appreciate knowing (in advance) how much of each medicine to manufacture and (in the case of some medicines) they are willing to offer deep discounts (usually about 50% off the listed prices, but in certain cases those discounts can reach 80% off the list price) which can help healthcare providers to lower their costs.


Using the Mass Purchasing Power of the UK Government to Lower Medicine Costs

Of course, the NHS has almost certainly looked at this model in the past.

But ‘timing is everything’ they say, and in the midst of recession, austerity, or during times of political upheaval, it isn’t practical to divert millions of pounds to prepay an entire year’s worth of medicines, nor is it likely to be done without prior approval of the UK government.

However, once we move out of the Coronavirus crisis (but while there’s still plenty of well-deserved focus on the heroic NHS workers) it might be time to have a national conversation about bulk purchasing the UK’s entire annual medicinal requirements — including purchasing on behalf of all devolved territory NHS units and the UK military. The UK government would thereby become the sole wholesale purchaser and wholesale seller of medicines in the UK, even acting as the sole supplier to every wholesale medicinal distributor in the country.

It might take a bit of UK legislation for this to happen and some money, because for all it’s merits, you must still pay for an entire year’s worth of medicine in advance in order to qualify for those quite wonderful discounts.

Also, every NHS unit including NHS Scotland, NHS Wales, NHS Northern Ireland and NHS England, and the UK military and every pharmacy supplier would need to provide a list of medicines to the UK government a year in advance so they could form an accurate picture of the pending mass purchase and consequent deep discount.

Yes, it would take some work to calculate that list and perfect it over time. But if Canada (and certain other countries and militaries) can do it; Why not the UK?

The truth is that certain global healthcare systems benefit massively from volume discount medicine purchases and the UK government needs to act now to create the requisite legislation so each NHS unit can save millions, allow the UK military to save hundreds of thousands of pounds sterling, and allow pharmacies to lower their retail prices via significant cost saving on the wholesale price they pay their suppliers.

But other than the price — as everything else would remain the same — the UK must get organized so it can obtain those astonishing discounts and benefit as other healthcare systems benefit from bulk purchasing.


The NHS Will Save Multi-Millions on Medicine Costs

You’ve got to like that.

Ditto for the UK military and for retail pharmacies.

Therefore, I respectfully submit that the UK government pass legislation to create a National Medicines Purchasing Agency (or ministry) that should thenceforth operate as the sole purchaser for all (non-homeopathic) medicines for the entire UK, including on behalf of all NHS units, the UK military, and for suppliers to pharmacies UK-wide, and provide it with generous funding to accomplish the task.

The legislation should require the agency or ministry to create a continuously updated website that is robust enough that the public and medical professionals could find relevant information on every medicine sold in the country — including general information, dosages, contraindications, along with high quality images of each pill or tablet to help counter possible fraudulent imitation pills or tablets.

Further, I believe that such an agency should be set-up — not to earn a profit from reselling medicines, but to simply recover the cost of each medicine — and that should remain true whether the agency is selling to any NHS unit, to the UK military, or to pharmacy suppliers across the UK.

However, if other national healthcare systems wish to purchase surplus UK medicines, then perhaps that UK agency could offer them to other healthcare systems at cost-plus-ten-per-cent for example, or whatever seems reasonable. No favouritism, please. Just enough to maintain a zero deficit/zero profit annual budget within the national medicines purchasing agency.


Selling Medicine that is ‘Near To Expiry Date’ & Selling Other Surplus Medicine to the UK Foreign Aid Office in Lieu of Monetary Donations to Developing Nations

The UK is highly regarded globally for its foreign aid commitment of .7% of GDP. It’s one of the most generous foreign aid budgets in the world by percentage and compares well with larger countries even when measured in total currency amounts.

However, more can always be done.

And instead of dumping ‘near to expiry date’ medicines or other surplus medicine in a landfill or incinerator; By staying current with the expiry dates, the UK could boost its foreign aid spending by sending such surpluses to developing nations once those medications are down to 6-months remaining on their batch number expiry date.

Therefore, whatever those drugs have cost the UK government, by simply reallocating them to the Foreign Aid Office for transshipment to a developing nation along with a note to the Foreign Aid Office explaining how much the National Medicines Purchasing Agency (or ministry) paid for that pallet of medications, it’s a just way to increase the UK’s foreign aid budget by that exact amount. Or to top it up  to .7% during lean years.

In either case, it won’t hurt to send a truckload or two of nearly outdated medicine (annually) to the developing nations that need them and include those donations as part of the UK’s foreign aid spending.

It’s a ‘Win-Win’ when you bulk purchase an entire country’s worth of pills annually and thereby receive astonishing discounts from multinational pharmaceuticals, it’s ‘Win-Win’ when each NHS unit never again runs short of medicine and only ever pays the deeply discounted wholesale price, it’s ‘Win-Win’ for pharmacy suppliers that benefit from a much lower wholesale price than they could ever hope to negotiate themselves, the UK military wins by having lower cost medicine for its personnel, and it’s a ‘Win-Win’ for the UK foreign aid budget/developing nations.

And all that, just by getting the UK organized on its total annual medicine purchase.
Who knew?

It’s Time for a Dedicated NHS Tax

by John Brian Shannon

As we begin to deal with the middle stage of the COVID-19 crisis, it’s time to relook how the UK funds its excellent National Health Service.

On that note, you may recall that I’ve said many times on this website that things ‘evolve’ but they don’t always ‘evolve’ to the best result. While each individual decision over the decades on behalf of the NHS was well-meant and likely the only logical choice at the time, were we to now create the NHS ‘from scratch’ in 2020, it would look much different than the National Health Service we see today.

For example, we might see more, but smaller Hospitals — instead of the fewer, but larger Hospitals built in the 19th and 20th-centuries. Also, NHS Hospitals might be located closer to areas where the highest annual concentrations of injuries occur, complete with NHS-only access to on-ramps and off-ramps to get Ambulances on and off the motorways more quickly. Also, helicopters sitting and ready to fly from the roof of each Hospital, every minute of the year. And more.

Obviously, there are plenty of ideas that should receive fair consideration because continuing to do things the way we’ve always done them isn’t good enough when it comes to the health of every UK citizen, resident and tourist.

To wit; Early on in the Coronavirus timeline it became known that enough Personal Protective Equipment (PPE) for NHS workers hadn’t been stockpiled and lives were thereby endangered. Who knows how many were endangered, but enough that the government must ensure it never happens again.

In Germany, the same thing occurred (not enough PPE’s on hand to deal with their COVID-19 crisis) until someone remembered that many years earlier a brilliant person in the German military had decided to stockpile millions of PPE’s — consequently, the German healthcare system had surplus PPE’s, even delivering some to the UK’s NHS. Impressive. Los Deutschland!

Thinking ahead like Germany did costs money. (But it costs more if you don’t think ahead) It also takes political will and perseverance. It speaks to the quality of government delivered or not delivered to the people by the politicians in each decade, and that’s the whole point, isn’t it? Either the politicians are up to the task, or they’re not. If they’re not, let’s hope they become unemployed at the next election.

Now, let’s not lay all that on Boris and his team, after all, he’s only been Prime Minister for 9-months and he’s had some rather large items to deal with… Brexit, a future trading relationship with the EU, his own serous bout with COVID-19, and more recently, a newborn son with his partner Carrie Symonds. Congratulations to Boris and Carrie!

So let’s cut Boris some slack, shall we?

Still, we should add momentum to the idea that we need to fund the NHS properly instead of expecting them to provide the best healthcare in the world without the funding to accomplish the task.


One Tax to Fund Them

It’s time for the UK to add 1% to the existing VAT — and every pound sterling of that 1% should go directly to the NHS without being touched by any level of government. In fact, new legislation should be created to make it illegal for anyone in government (even the Prime Minister or the country’s Head of State) to delay or divert any of that 1% VAT NHS funding with mandatory prison sentences for any person involved in interfering with the 1% VAT NHS revenue stream.

Without healthy citizens and a well-funded NHS the United Kingdom is a much-diminished country, therefore, NHS needs to be well-funded and that funding must remain untouchable by any UK politician.

In practical terms, it means each of the devolved territories and England need to enact their own 1% VAT and direct all the revenue collected within their own jurisdiction to their own NHS organization to form the baseline of their respective NHS funding. (Let’s call the proposed 1% VAT “primary funding” for their respective NHS organization)

“Secondary funding” would be allocated via the respective Northern Ireland, Scotland, Isle of Man, Wales, and England annual budgets and “tertiary funding” can be allocated by the UK government.


Why would the UK government want to provide tertiary NHS funding to each of the five jurisdictions?

In order for the central UK government to have any say in Scotland’s NHS (for example) the UK government would need to provide some funding towards Scotland’s NHS.

To illustrate this further; In Canada, healthcare is the exclusive domain of each province which raise their own revenues from a combination of provincial income tax and provincial sales tax. Consequently, nowhere in Canada must people pay healthcare premiums. Therefore, almost the entire cost of each provincial healthcare system is raised via provincial revenue. But the federal government of Canada also kicks-in additional healthcare funding for the provinces each year (representing about 6.5% of each provincial healthcare budget) to, (a) ensure uniformly high healthcare standards across the country, (b) to ensure that citizens and residents of all provinces are treated without delay if injured while visiting another province, (c) and to maintain an universal healthcare database so that out of province visitors can be treated without delay if they suddenly become ill or sustain injury.

Why would the five jurisdictions want to accept tertiary NHS funding from the UK government?

Remember, primary healthcare funding would come from each territory’s 1% NHS VAT (including England) but it might not be enough to cover the full cost of providing all the healthcare necessary for their own residents. Therefore, secondary funding for each territory’s NHS service would come from a combination of (‘provincial’) income and sales tax, while tertiary funding would be provided to each NHS unit (annually) by the UK central government in a sort of ‘top-up’ modality to meet 100% of the annual costs of each of the five NHS units.

In this way, no monthly or annual healthcare premiums would be paid by individuals or companies and each NHS unit would receive funding from their devolved government with supplementary funding courtesy of the UK government.

Three funding streams, and one stream arrives completely free of government interference. If you’re a healthcare professional or healthcare administrator you’ve got to like that!


Let’s Recap

  • No healthcare premiums for individuals or companies — ever!
  • PRIMARY NHS FUNDING: All the 1% VAT revenue collected in each territory would go directly to their own NHS unit (only) bypassing government control or restrictions, thereby raising significant revenue to fund their own NHS unit.
  • SECONDARY NHS FUNDING: Each territory (Northern Ireland, Scotland, Wales, Isle of Man, England) would levy its own (‘provincial level’) income and sales taxes on their respective residents and use some of that revenue to help fund their own NHS unit.
  • TERTIARY NHS FUNDING: By definition, the UK government collects (‘federal level’) taxes and some of this revenue can be used to ‘top-up’ the budget of each NHS unit. This top-up should never exceed 10% of the funding of any NHS unit and the exact percentage would be negotiated annually between the (‘provincial level’) territories bloc and the UK government.

Finally, a shout-out to today’s NHS heroes, who risk their lives every day to protect us from a killer virus. Thank You! for your professionalism, sacrifice and courage.


A MUST-READ for anyone wanting to understand why the UK should adopt Canada’s excellent healthcare funding model

  • Canada’s Health Care System (Government of Canada website) click here.

What Lessons from the Coronavirus?

by John Brian Shannon

It has been reported by Johns Hopkins Medical Center that more than 100,000 people have died worldwide as a result of the COVID-19 Coronavirus.

Thus it follows that in the post-Coronavirus economy some things might need to change, as it’s doubtful that things will return to what we once considered ‘normal’ — but if we do return to that normal we might set ourselves up for another Coronavirus event that will play havoc with the economy and needlessly harm millions of people.


ONE: Let’s Be Prepared Next Time

It seems obvious that there will be another SARS or MERS health crisis. In fact, the Novel Coronavirus is itself a SARS-type virus named SARS-CoV-2 which journalists have (thankfully) named COVID-19, and it is simply the latest version of a long line of SARS or MERS type viruses that mutate at irregular intervals.

Let’s hope we never face the prospect of two highly infectious viruses at the same time, say, one mutated SARS virus (COVID-20, or COVID-21) and another mutated virus of the MERS family, because healthcare systems would reach full capacity within 7-days and millions of people worldwide would die before ever seeing the inside of a Hospital.

With that prospect in mind, let’s ensure that our politicians work on preparations for the next killer pandemic to the point that we could be in a strong enough position to take on, not one, but two killer pathogens at the same time, because given enough time, that will occur. Eventually.

But for now, let’s just be ready for the next SARS or MERS virus and we can do that by consolidating our best knowledge and practices into official government policy by passing an Emergency Infectious Disease Protocol bill in the House of Commons, soon.

How to Do That?

  1. The UK government should mail a package of 5-individually-wrapped surgical masks to every UK household to hang in the pantry/utility room/in the RV, or wherever appropriate.
    I fully realize that surgical masks provide little protection, but in the case of unwitting carriers of an infectious respiratory virus, etc., they help to protect others from being contaminated by that person’s breath. But even more importantly is that ‘perception’ is everything. When people see other people out and about and wearing surgical masks, it will automatically cause people to remember to maintain proper social distancing!
  2. The UK government mailout that I propose, should include an 8″x10″ plastic laminated card with a pre-punched hole so that every household can use a thumbtack to hang the infectious disease info card (and the package of masks) from a thumbtack or nail in their pantry or utility room. This card should show each type of respiratory protection (surgical, N95, and medical respirator) and the reasons for wearing each type of mask, and when to switch from one type of mask to another:
    A pictogram, followed by an explanation such as; “Surgical Mask; Wear this kind of mask if you’re walking in the park or uncrowded shopping mall.” and “N95 Surgical Mask: Wear this kind of mask if you work in a crowded environment where you can’t maintain proper social distancing OR if you’re a healthcare worker OR if you work in a Senior Citizens long-term care facility.” and “Medical Respirator: Wear this kind of protection if you’re a surgeon, or other operating theatre staff, OR if you work as a pathogen researcher.”
  3. The “8×10” card should show pictograms of each type of mask and the legitimate reasons for wearing each type of mask — and should CLEARLY summarize typical respiratory symptoms and what to do about them, such as: “If you experience any combination of fever, malaise, dry cough or uncontrollable coughing, or weakness/tiredness (or whatever symptoms you feel are appropriate for such an info card) call this toll-free number for instructions and ensure your front door is unlocked in case you can’t make it to the door.” Or words to that effect.
  4. A list of websites where people can re-order any of those respiratory protections online (along with the part number or model number) and have them delivered to their home, to ensure they can maintain (a minimum of 5 masks, for example) in their home, which would be helpful for most people. If the government provides such a headstart for people now and in the future, I believe that for the duration of this COVID-19 crisis and any mutated (say, COVID-20 or COVID-21, or MERS mutation) virus which may be more infectious, or more deadly (or both) UK citizens and residents will be better prepared, better educated, and better able to survive this event and the (almost certainly more dangerous) next mutation.

TWO: ‘Social Distancing’ is Now a Thing

Many people were/are completely asymptomatic — meaning, they had no symptoms at all, or may have felt a bit ‘off’ for a few days — in regards to the COVID-19 virus, however, those people may unwittingly carry on with their normal schedule and interact with dozens of people daily, thereby passing the virus on to everyone they come into close contact with.

If you have “B” type blood, you already know that you don’t catch as many colds or flu as your friends and co-workers. Which is handy for you, but you could pass infectious respiratory disease to everyone you interact with. Please use caution. Your ‘off day’ could become someone else’s major healthcare crisis simply because they don’t have the same built-in defences you have. Thank your parents and be considerate to others. Please.

While in public, we’ll be urged to maintain social distancing, which is difficult to get used to until you do get used to it, and then you’ll never go back to the old informal distancing rules.

Every year, I expect that a call will go out via the media telling people there’s a novel coronavirus or MERS-type virus making the rounds and to take appropriate precautions. And we all know that the best way to avoid such a virus is to lock yourself in your house until the crisis is over — which isn’t a lot of fun. But the second-best way to avoid contracting such an infection is to maintain proper social distancing, which isn’t that difficult. In addition to social distancing, wearing a surgical mask or an N95 mask will help, and even better, if you have the virus, you won’t be passing it along to everyone you come into close contact with. Unless you take it off, of course.

The UK government should create legislation that requires transportation operators to reconfigure their seating arrangements to allow for proper social distancing. In trains and buses, this could take the form of perimeter seating around the entire train car or bus, while in airlines, seating that faces each other might be the way to go. “Look ma, I’m flying backwards!” Seriously though, perimeter seating in airlines, with opposing seats in the centre of the aircraft would maximize passenger safety and still allow a large number of passengers and permit two aisles. On ferries, similar seating arrangements could be made and onboard restaurants and cafeterias should be able to reconfigure their seating area to opposing (and easy clean fabric) seating to maintain social distancing rules. Remember, when you’re eating your prime rib or vegan tortellini you can’t wear a mask, so the seating plan in those areas must consider passenger safety more seriously.

Some sidewalks in the UK are barely wide enough for one person let alone the busyness of the tourist season, therefore, cities and towns across the UK need a complete rethink of their pedestrian areas. In many cities around the world we’re seeing typical four-lane city streets turned into two-lane cobblestone streets that are only open to buses or trams. Allowing taxicabs and limos seems appropriate too, but not passenger cars or motorcycles. By converting a four-lane road into a two-lane road, it allows wider sidewalks for people to maintain the recommended social distancing rules. This can look very attractive and many cities have succeeded in this in recent years.

Working from home four days per week could become the new normal for many office workers and others who can work from home. Imagine a worker assembling 250 car mirrors per day (or 250 car tail lights per day) at a factory; Now, imagine that worker doing the same in their (formerly) two-car garage. It’s the same thing except for the location. The worker gets paid a standard price for each piece they assemble instead of payment by the hour, yet all other employee benefits for that worker would remain the same. FedEx or the automobile manufacturer’s own delivery vans could pick up and deliver the parts from the home worker. Final assembly, of course, would be done at a large factory designed exclusively for ‘just-in-time-delivery’ of the necessary parts.

Shopping online is one way to limit exposure to potentially infected persons, it also frees-up the roadways for transport trucks and delivery vans and ends the daily gridlock that spews billions of tons of pollutants into the air which, as we now find out, breathing those toxins for a few hours every day further weakens our immune system response to infectious disease. Seems obvious in retrospect, doesn’t it?


THREE: Government Policy Must Allow the NHS to ‘Hit the Ground Running’

Boris Johnson’s government has handled this healthcare crisis about as well as any government on the planet.

However, when the next SARS or MERS-type virus hits, the NHS should be fully stocked with every PPE they need, they should have standing arrangements with every available airport hangar or unoccupied office tower or movie theatre, etc., they should have millions of test kits which should be used on each person who enters a Hospital (with or without symptoms) and test kits should be used to test every passenger arriving in the country — before they debark the aircraft, ferry, cruise ship or pleasure craft — and they could be notified via SMS if their test proved positive, allowing them to self-isolate or see a Doctor, as appropriate. This would give the infected person a jump start on their treatment and provide the NHS with almost realtime tracking of infected persons arriving in the UK.

Finally, the NHS needs an entire fleet of state-of-the-art Hospitals that are built to suit the modern NHS. Yesterday’s hospitals, built in the 18th, 19th and 20th-centuries, just aren’t up to scratch. Some of them cost more than £1 million per month to heat let alone pay the lighting bill. Many aren’t fit for purpose, or are located in the worst possible place now that entire cities have sprung up around them over the past 10 or 20 decades. Some NHS facilities are simply too small to serve regular needs let alone having enough capacity to handle a major epidemic. Ten new Hospitals need to be built every year until the NHS reaches 130% capacity so that it can then offer so-called medical tourism and thereby earn valuable foreign cash from its foreign patients. Each new Hospital should be much smaller than the 1950’s era monster-sized facilities. Modern Hospitals need a smaller footprint, they need to be easily accessible, and the UK needs many more locations — more + smaller + energy efficient Hospitals, instead of few + large + energy inefficient + barely fit for purpose Hospitals.

MORE, SMALLER, ENERGY EFFICIENT HOSPITALS are the future.


Captain Tom Moore Raises Millions for the NHS

And to end on a positive note, let’s give a warm shoutout to the UK’s 99-year-old Captain Tom Moore who has raised over £18 million since April 10th for NHS Charities Together, by walking laps in his back yard. Thank you again, Captain Moore. He is 2020’s best example of the spirit of the United Kingdom. Hats off!

You can still donate HERE or SEE HOW MUCH HE’S RAISED SO FAR, if you like!

There’s a petition that already has more than 500,000 names on it to award this great military warrior and NHS hero the George Cross, please consider signing it HERE.