Health And Emergency Permission Record: Fill & Download for Free

Your physician does not require your permission to access your medical records. It is part of the doctor-patient relationship. Your EMR (electronic medical record), has links to other sites and these often are available on the EMR of your PCP.If a record is NOT attached to your doctor’s EMR, there is a release of information form that is required. That will involve proving you are a real doctor and having a secure fax sent.I am wondering why you would not want your PCP to have your health information. If you have a substance use problem (substance abuse is the #1 main reason people do not want their PCP to see their ER charts, due to them being in the ER for an overdose or DTs or something that they are trying to hide from their PCP) it is truly important for your PCP to know what is going on. This will help you to get the best care for whatever problem you have that you feel should be kept secret. You will not be judged. Hiding a health problem can only harm you in the long run.

Unless, you are Matt Hancock, the Secretary of State for Health and Social Care, or maybe Theresa May - or a Cabinet Member - there is only one answer possible, and it is: ‘I don’t know’.The answer to ‘will there be medicine shortages?’ in the Brexit debate amongst political figures takes into account all sorts of things BUT NOT ACTUALLY WHAT IS BEING DONE BEFORE BREXIT.This is what Matt Hancock, the Secretary of State for Health and Social Care, said in an interview on BBC Radio 4, on the 24th January, 2019.‘Well, we are confident that in the event of a No Deal Brexit, then, if everybody does what they need to do, we will have an unhindered supply of drugs’.It was confirmed in Parliament by a Minister at the Department for Health and Social Care, that external parties contributed to No Deal planning were required to sign an NDA. They have consulted with 16 private companies and 10 trade associations, who were given verbal information or hard copy during meetings that had to be returned, so, as far as the quality of planning goes, the only people able to tell us are Goverment Ministers.Evidence given to various select committees makes clear that those plans have not been shared with NHS organisations, or distributors, as up to January 2019, they were still on record seeking clarity, having no instructions from the Department for Health and Social Care, other than not to stockpile, and tell patients not to stockpile and that there would be no interruption to medical supplies in the event of a No Deal Brexit.MPs, political commentators and the public cannot say whether or not there will be medical shortages in the event of a No Deal Brexit.MPs, however, have Parliamentary privileges that enable them to represent any concerns the public - patients, NHS employees, UK businesses - might have. They are the only ones who can hold the Department for Health and Social Care’s No Deal planning to account before 29th March, 2019.If the Department for Health and Social Care have planned well, they have told everybody that, in their plan, needs to do what they are supposed to - what they need to do having being defined in the plan - ensured they understand it, have done due diligence on them, and have a binding commitment that requires them to do it.If the Department for Health and Social Care have planned badly, the only people who can identify potential errors and ensure that something is done about them before the 29th March, 2019 are the MPs sitting in the Commons.MPs have an enormous responsibility here.Any problem the public have accessing medicines in the event of a No Deal Brexit, by default, has the potential to cause them clinical harm.Scrutinising the Department for Health and Social Care planning is an entirely separate issue from whether MPs support a No Deal Brexit, or want to trade on WTO terms, as we leave the EU. This is not No Deal debating fodder: it is perfectly possible to say that the No Deal planning for medicines is a mess, puts the public at risk, and be in favour of No Deal.Debating fodder, however, is what we seem to have. It’s limited to:We could have problems with accessing medicine.We shouldn’t have problems accessing medicines.‘We could have problems’ - confers a duty to scrutinise.‘We shouldn’t have problems’ - is irrelevant to an MP’s public duty.Arguing that ‘there will be a problem/there won’t be a problem’ is futile as the information is not there. It can only take place on terms of having an opinion on what the outcome will be on 29th March, 2019, should we leave without a deal.An opinion that there won’t be a problem is not an evidence-based one.Rather like taking bets on whether some bloke you don’t know will make it to the North Pole, or not, as he sets off without telling you what transport he’s using, what supplies he’s taking, and what his level of fitness is. He can tell you that he’s totally going to get there, but that’s no basis on which you can make an informed bet, and is just as useless as all the other information you already don’t have about his expedition.We are not talking about one bloke taking his own life in his hands when we talk about medicine and No Deal Brexit. We are talking about the governance of a country and everybody who lives in it, who depend upon their elected representatives, to perform their public duty and hold the Government to account.It is hugely irresponsible for any MP to say in definitive terms that ‘there will be no problem for the public, with regard to access to medication, in the event of No Deal.They don’t know.False reassurance is a very dangerous thing. When an MP says there is no problem, they want their constituents to believe them, and when constituents do believe them about the security of medical supplies, they do not think they need to exert democratic pressure - through their MP - to ensure that what is promised by Government, can, and will, be delivered.There are MPs in the governing party, who do not accept their Government’s assurances about the Irish backstop in the Withdrawal Agreement, as is their prerogative. They are communicating that loudly and clearly, citing their duty as Parliamentarians towards their constituents and their country. They have every right to do so.Some of those same MPs are making definite statements that ‘there will be no interruption to the supply of medicines in the event of a No Deal Brexit.’To say that is to say that they fully accept the assurances of their own Government in that regard. That’s not an empty thing - we know they are willing to criticise what they do not believe to be true - to accept one thing, and not another, implies scrutiny of both.Yet they do not have the information they need to make that call.Nor, if their position is that ‘medicines will be fine’ are they challenging the Government on behalf on their constituents and the country, in the way they are over the backstop.Their responsibilities go beyond their constituents: the State, itself, has statutory duties towards vulnerable people. There are people who are entirely in the care of the State: children in care, and the elderly and physically and mentally disabled in State Institutions. Prisoners. All children in this country have State protection regarding their healthcare, where they are protected against parents, who, for all kinds of reasons and in all kinds of circumstances, might not be making the best medical decisions for their child.MPs in Parliament have a duty towards ensuring their access to medicines too, in the event of a No Deal Brexit, even if every single one of their constituents voted for Brexit, support a No Deal Brexit and are persuaded that ‘it’s going to be fine’, and are prepared to take the hit if it isn’t.MPs cannot know that it will be fine.Nor are MPs the only ones who have no more to go on that statements made by the Government.Heads of NHS membership organisations representing all NHS trusts still have no clarity. All NHS organisations know is that they must not stockpile. It’s the same for CEOs of NHS Hospital Trusts.All NHS Clinicians know is that they must tell patients that their medicines will be uninterrupted, and that patients must not stockpile.Distributors of medical supplies in the UK don’t know anything either. Only private pharmaceutical companies have been consulted and they have signed NDAs.Pharmacists must not stockpile. Emergency legislation has been passed where a patient’s prescribed medicine can be changed without permission from the clinician who prescribed it, should there be shortages following a No Deal Brexit.How on earth any MP can say ‘medicines will not be affected’ I do not know, but some are. They may think it unlikely, they may think the risks are exaggerated, but there are MPs who are not limiting themselves to that.Any MP playing debating games and making definitive statements about access to medicines is telling the public a story about what they are and the care they take over the accuracy of what they say. They are, by definition, not trustworthy.All of these statements are an irrelevance:‘There shouldn’t be any problems with the supply of medication after a No Deal Brexit’,‘Market forces will ensure a continuity of supply of medicine after Brexit’,‘It will be bad for the EU not to allow medicines to flow freely across borders after a No Deal Brexit’‘We are not dependent upon the EU for medicines after Brexit’‘We won’t stop and inspect medicines coming into the UK that we don’t stop now, after a No Deal Brexit’‘WTO rules mean that we can import whatever medicines we need after a No Deal Brexit’‘Matt Hancock said that ‘Whatever comes out of the Brexit negotiations, British people will be able to access their drugs’.‘There will be no problem with access to medication in the event of a No Deal Brexit’ - to be true and accurate - requires the MP saying it to know it be true and to know it true requires information they don’t have.Political Rhetoric and ResponsibilityConsider the Ad put out by ‘StandUp4Brexit’There has been no action taken about the kind of digital political campaigning we had thrown in our faces during the Referendum and beyond.Many of these campaigns are anonymous, but some are not.StandUp4Brexit describes itself as a grassroots organisation and enjoys the support of 59 MPs. It seems reasonable to think those MPs should take care with the messages they actively endorse: had this campaign put out a pro-Irish backstop message, you’d think they’d object and withdraw support.That support matters because it makes this campaign highly visible. It has elected politicians on board which gives it gravitas that the multitude of other Brexit campaigns don’t have. Each MP supporter has a large digital reach, providing amplification of these messages to millions of British voters.This is what they put out after the Matt Hancock interview of 24th January, 2019. There’s Matt Hancock’s face. Presumably they believe and endorse what he’s saying, unlike Theresa May and the backstop.“Whatever comes out of the Brexit negotiations people will be able to access their drugs” @MattHancockQ: So, there will be no need for any individual to have an extra supply of any drug that he or she may be using?A: That’s right.#StandUp4Brexit #Get2KnowWTO pic.twitter.com/n5GyV8xaXv— #StandUp4Brexit (@StandUp4Brexit) January 24, 2019Whilst the Q and A are accurate, the statement above them is not.StandUp4Brexit have attributed a statement with quote marks which isn’t exactly what he said - it is a mangling of words in the same ball park - but the most important thing is that they omitted the condition that Matt Hancock put on his statements of that type.‘ … if everybody does what they need to do, we will have an unhindered supply of drugs’That caveat is important because it leads to the question ‘who is everyone and what do they need to do?’ - and that might be a question the public would ask of supporters like Boris Johnson David Davis Iain Duncan Smith Owen Paterson Priti Patel John Whittingdale David Jones Mark Francois Jacob Rees-Mogg Steven Baker …Asking ‘who is everyone and what do they need to do?’ naturally leads on to questions about these supporter MPs and how they satisfied themselves about the reliability of what Matt Hancock was saying to the public.Has anyone seen Boris Johnson assure himself that the Government planning for medicines for his constituents after 29th March 2019 is as good as it could be good?Has anyone seen Steve Baker asking difficult practical questions about the reliability of those companies responsible for importing medical supplies?How about Priti Patel, has she ever looked over the No Deal planning by the Department of Health and demanded clarity over the any Government stock-piling of insulin and reassured herself, on behalf of her constituents, that diabetics have a security of supply?Pro-No Deal MPs still have a duty to their constituents. ‘It’s the responsibility of The Government’ does not mean it isn’t theirs as well.The Government, the Health Minister, could be making all kinds of mistakes and assumptions - and to be fair, they could be entirely unintended, rarely are plans flawless - and they wouldn’t even know if all MPs decided they were not interested in scrutinising their plans.The ‘direct quote’ evidence from various relevant sources - Government, MPs, Lords, NHS bodies, NHS Trusts, Clinicians and so on - follow at the end of the answer. As do the ‘direct quotes’ from MPs on the record as saying there will be no impact after 29th March, 2019.Look at the dates: most are from December 2018/January 2019.There is also interdependency with Departments such as Transport and the management of customs and the borders. The amount of what is unknown is considerable.To answer anything, but ‘I don’t know’ is to be in the business of making predictions - of arguing over what we see in crystal ball for the 30th March 2019, as we gaze into today and decide what we want to see - based on a opinion of whether the Government will sort this thing out before 29th March 2019, with absolutely no information on what the Government are doing now.The answer to ‘will there be medicine shortages?’ in the Brexit debate takes into account all sorts of things BUT NOT ACTUALLY WHAT IS BEING DONE BEFORE BREXIT.I don’t know if there will be medicine shortages, and I don’t how anyone else can either.Thanks for the A2A.Further information follows.What is the Secretary for Health and Social care saying to the public about the UK Government's planning for Access to Medicines in the event of a No Deal Brexit?'Well, we are confident that in the event of a No Deal Brexit, then, if everybody does what they need to do, we will have an unhindered supply of drugs.Matt Hancock, Secretary of State for Health and Social Care, on 24th January, 2019 – BBC 4, Today programme Today - 24/01/2019 - BBC Sounds (about 1;14;40 in)Full transcript of the interview on Radio 4 'Today' on 24th January, 2019John Humphreys interviews Matt Hancock, Secretary of State for Health and Social CareJH: To a shorter term drug issue, you gave us an update some time ago now about stock-piling of drugs in case there is a No-Deal Brexit. There are people with diabetes, people who are on cancer treatments, asthmatics as well, who are worried still - and some of them being told by doctors and pharmacists that there may be a problem. What today are you saying to them?MH: Well, we are confident that in the event of a No Deal Brexit, then, if everybody does what they need to do, we will have an unhindered supply of drugs. Look, I understand how worrying it must be if you need a drug and you worry about the supply. We’ve out in a huge amount of effort, and some taxpayers’ money, in order to make sure that, in whatever comes out of these Brexit negotiations, people will be able to access their drugs. Now there’s twelve thousand different drugs that are used in the UK on us to keep us safe and we have plans in place for the vast majority of those and, for the very small number we don’t yet, we are actively working and we will have those plans in place, so people can get the drugs they need, unhindered, whatever the Brexit outcome.JH. Right, so no individual should be stock-piling. You’re saying that, if we were to leave without a deal at the end of March, there would be no need for any individual to have an extra supply of any drug that he, or she, may be using.MH: That’s right, and, indeed it might be counter-productive for people to stock-pile because we’re trying to build those stock-piles within, and we are building those stock-piles within the pharmaceutical industry.Matt Hancock, Secretary of State for Health and Social Care, on 24th January, 2019 – BBC 4, Today programme Today - 24/01/2019 - BBC Sounds (about 1;14;40 in)What is the Secretary for Health and Social care saying to patients about the UK Government's planning for Access to Medicines in the event of a No Deal Brexit?'We will have those plans in place, so people can get the drugs they need, unhindered, whatever the Brexit outcome … it might be counter-productive for people to stock-pile because we’re trying to build those stock-piles within, and we are building those stock-piles within the pharmaceutical industry'Matt Hancock, Secretary of State for Health and Social Care, on 24th January, 2019 – BBC 4, Today programme Today - 24/01/2019 - BBC Sounds (about 1;14;40 in)What is NHS England – the non-departmental, department sponsored body that is responsible for the NHS - saying to UK clinicians about the UK Government's planning for Access to Medicines in the event of a No Deal Brexit?'It is not helpful or appropriate for anyone to stockpile medicines locally.Registered pharmacy professionals must always consider the consequences for patients of their actions. As we know from managing normal medicines shortages, instances of individual organisations stockpiling can risk additional pressure on the availability of medicines for patients in other areas of the country.To ensure we manage supply effectively across the NHS, any incidences involving the over ordering of medicines will be investigated and followed up with the relevant Chief or Responsible Pharmacist directly. I am expecting senior pharmacy leaders to ensure local collaboration to meet patient needs wherever necessary. NHS pharmacy leaders are also well placed to provide information and advice to patients and other health professionals about the plans for continuity of supply, and this should be a priority over the coming weeks'Dr Keith Ridge, Chief Pharmaceutical Officer, NHS England, 17th January, 2019 - https://www.england.nhs.uk/wp-content/uploads/2019/01/medicines-supply-update-letter.pdfWhat is the UK Government saying about the UK Government's planning process for Access to Medicines in the event of a No Deal Brexit?‘The government is working with pharmaceutical companies, suppliers, and the NHS to make sure patients continue to receive the medication they need if the UK leaves the EU without a deal.The government has analysed the supply chain, made plans to reduce the risk of disruption, and given instructions to pharmaceutical companies to ensure that they have adequate stocks to cope with any potential delays at the border.We are confident that if everyone does what they should do, the supply of medicines and other medical supplies will be uninterrupted in the event of exiting the EU without a deal’Advice Published by the UK Government for the Public, regarding access to Medicines in the event of a No Deal Brexit on 18th January, 2018 - http://2019https://www.gov.uk/government/publications/getting-medication/getting-medicationWhat are the external parties consulted during the UK Government's planning process saying about the plans for Access to Medicines in the event of a No Deal Brexit?Nothing. They’ve been ‘gagged’.'Since July 2016, the department has signed 16 non-disclosure agreements with private companies and 10 with trade associations related to our medical supply no-deal Brexit contingency planning'The draft NDA document published by Department of Health and Social Care reveals that information is only being provided to firms orally, or via hard copies of documents that must be returned at the end of meetings. Firms consulted on no-deal arrangements are threatened with injunction if they breach the terms of the agreements.Stephen Hammond, Health Minster, response to Parliamentary question from Rushanana Ali, MP, 21st December,2018 - http://2018https://www.parliament.uk/business/publications/written-questions-answers-statements/written-question/Commons/2018-10-16/180178/What are the external medical distributors able to speak about the UK Government's planning process saying about the plans for Access to Medicines in the event of a No Deal Brexit?Mr Bradshaw: Do you think that is enough? If we see some of the problems that have been predicted at Dover, is six weeks going to be enough?Martin Sawer: I think the problem is at Calais. We need the infrastructure to come backwards and forwards because most medicines come in through Dover and Folkestone, and we do not know how France, or the EU, is going to treat the UK. If we are treated as a third country, the boats and lorries will be tied up in Calais; they will not come back because it is a closed loop system, using -Mr Bradshaw: Do you think we should be aiming for a stockpiling of longer than six weeks?Martin Sawer: We have not seen the basis on which that six weeks has been developed, so we cannot answer the question'Evidence to Health and Social Care Select Committee upon the Impact of a No Deal Brexit, Martin Sawer, Executive Director, Healthcare Distribution Association on 23rd October, 2018What is the Secretary for Health and Social care saying to UK clinicians about the UK Government's planning for Access to Medicines in the event of a No Deal Brexit?'Hospitals, GPs and community pharmacies throughout the UK do not need to take any steps to stockpile additional medicines, beyond their business as usual stock levels. There is also no need for clinicians to write longer NHS prescriptions. Local stockpiling is not necessary and any incidences involving the over ordering of medicines will be investigated and followed up with the relevant Chief or Responsible Pharmacist directly.Clinicians should advise patients that the Government has plans in place to ensure a continued supply of medicines to patients from the moment we leave the EU.Patients will not need to and should not seek to store additional medicines at home'Letter from Matt Hancock, Secretary for Health and Social Care to NHS staff, 23rd August, 2019 - http://2018https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/735742/Govt_preparations_for_potential_no_deal_-_letter_to_health_and_care_sector.pdfWhat is the Chief Pharmaceutical Officer, NHS England, saying to UK clinicians about the UK Government's planning for Access to Medicines in the event of shortages, following a No Deal Brexit?'Serious Shortage Protocol: The government has also put in place legislation to enable Ministers to issue protocols that, where appropriate, enable community pharmacies to dispense against a protocol instead of a prescription without going back to the prescriber first. Any protocol will be developed with input from clinicians and could cover dispensing a different quantity, pharmaceutical form, strength or a generic or therapeutic equivalent' -Dr Keith Ridge, Chief Pharmaceutical Officer, NHS England, 17th January, 2019 - https://www.england.nhs.uk/wp-content/uploads/2019/01/medicines-supply-update-letter.pdfWhat are distributors of medical supplies saying about the UK Government's planning for Access to Medicines in the event of a No Deal Brexit?'As a third industry supplier, what keeps us awake at night is the uncertainty of no deal. On average, 50% of the medicines in most of our depots have been through the EU before they get to UK warehouses, and this whole integrated supply chain that we rely on was clearly set up after we joined the EU. It is only in the last 20 years that it has been put in place. It is very sophisticated - twice a day delivery, almost “just in time.” We normally have only two or three weeks’ stock in a wholesale warehouse,and it is very dependent on supplies coming in when they say they are going to come in. Any challenge to that without an arrangement that it makes a frictionless border will mean shocks to the supply chain. We are worried about shortages, patients not getting medicines and huge price rises for the NHS …… You have read about the shortage of EpiPens and methadone in the past. Any shortage can always rise to the surface very quickly because of the just in time nature. I have a weekly list here of where medicines have not been delivered to our warehouses. It is 13 pages long, which is quite normal. We work with the Department of Health and Social Care to manage supply through the NHS where we can because we can find product around the UK. I suggest that the system would become very unbalanced very quickly if there was a shortage in any particular area'Evidence to Health and Social Care Select Committee upon the Impact of a No Deal Brexit, Martin Sawer, Executive Director, Healthcare Distribution Association on 23rd October, 2018What is the Commons Health and Social Care Select Committee saying about the UK Government's planning for Access to Medicines in the event of a No Deal Brexit?Mr Bradshaw: The Royal Pharmaceutical Society warned in, I think, The Sunday Times that there are already shortages and that they will get worse in the event of a no-deal or hard Brexit. Mr Sawer, you were on the radio this morning talking about the need for Government to take emergency powers in that scenario. Will you explain why you think that is necessary?Martin Sawer: Yes. If there is no deal, as Saffron referred to earlier, we need to make use of, if you like, the NHS’s command and control mechanisms to allow for certainty of supply of the medicines that we do have in the country at that time.Remember that in a no deal scenario the ports will be a challenge for some time, so we think that what medicines are in the UK should be managed more appropriately — for example, allowing pharmacists to substitute prescriptions, perhaps alternate prescriptions to medicines that they have available, and allowing pharmacists to share and use other pharmacies’ medicines, which they used to be able to do but cannot do at the moment by law.You could relax that law to allow a local community to share medicines around. The other point I suggested this morning is to remove and stop all wholesale licences for a limited time. There are 2,500 of them out there. It allows for a lot of trading and for a lot of export of UK packs that we would want to keep in the country. Our members have 20 of those licences and we distribute 90% of the NHS medicines, so there are a lot of small businesses out there whose main business is not wholesaling and distribution.The Government and MHRA could control it to just those businesses whose main or only purpose is distribution. France has 35 wholesale licences, and that is what they do. We have 2,500 because it allows for a free market, which has produced very low prices for generics —I cannot deny that and the Government have saved £11 billion over 10 years— but no deal would be a catastrophic time for medicines supply. I am not pulling any punches. I think we have to think of emergency powers.Mr Bradshaw: This could involve patients being put on different drugs from the ones they are used to without consultation with their GP.Martin Sawer: CorrectEvidence to Health and Social Care Select Committee upon the Impact of a No Deal Brexit, Ben Bradshaw, MP, questioning Martin Sawer, Executive Director, Healthcare Distribution Association on 23rd October, 2018Oral evidence - Impact of a no deal Brexit on health and social care - 23 Oct 2018What is the Lords Committee saying about the UK Government's planning for Access to Medicines in the event of a No Deal Brexit?'When will the Government contact suppliers of medicines and medical products to give them notice and guidance on rerouting their supplies?In the letter to UK-based manufacturers of medicines on 7 December, you warned that a ‘no deal’ scenario “may now affect you even if you do not supply prescription only or pharmacy medicines from or via the EU/EEA into the UK”.Can you please clarify what affect on the UK pharmaceutical manufacturers you were referring to?In the letter to health and care providers on 7 December you noted there is a separate programme to ensure the continuity of supply for centrally-procured vaccines and other products …used for urgent public health use.”Can you please provide more information on this programme, including whether Public Health England is planning to stockpile these medicines and if there is a list of other products for urgent public health use?'Letter to Matt Hancock, Minister for Health and Social Care, 11th January, 2019, asking for issues not responded to in the committee's letter of 22nd November, 2019 to be clarified - https://www.parliament.uk/documents/lords-committees/eu-home-affairs-subcommittee/access-to-medicines-no-deal/letter-from-lord-jay-to-matt-hancock-24.01.19.pdfWhat is being said in Parliament about the UK Government's planning for Access to Medicines in the event of a No Deal Brexit?'Worst of all, our public services, including the national health service and social care, would suffer as we would be unable to recruit from countries within the EU. In the Select Committee on Health and Social Care, we heard that there is a real threat to medical supplies.The permanent secretary at the Department for Health and Social Care told us that he was having sleepless nights over the continuation of imports of vital medical supplies, and that the issue was very complex'Luciana Berger, MP, 11th January, 2019, EU Withdrawal Act debate - European Union (Withdrawal) ActWhat is being said in the Lords about the UK Government's planning for Access to Medicines in the event of a No Deal Brexit?'Is the Minister aware that 99% of the insulin used in the UK is manufactured in Denmark and Germany, and that 421,000 type 1 diabetic users of insulin are feeling quite anxious about what will happen? Can she give us a guarantee—a copper-bottomed, simple pledge—that there will be enough insulin available if we Brexit? Can the Government also assure us that every single insulin user will have a legally binding contract from the Government pledging the availability of sufficient insulin for them in the future?- Lord Roberts, Llandudno'As the noble Lord, Lord Roberts, says, all analogue synthetic human insulin comes from outside the UK. The Government have already warned us that ports such as Dover and Folkestone will have greatly reduced capacity for at least six months if we crash out of the EU, and the stockpiles mentioned by the Minister will last six weeks—certainly not six months. In the circumstances of a looming shortage of life-saving medication, how do the Government plan to ration insulin? How will they decide who gets it and who does not?' - Baroness ThorntonDebate in the Lords, 24th January, 2019 Brexit: Insulin SuppliesWhat is the membership body that represents NHS Trusts, with respect to contracting and competition - NHS Confederation - saying about the UK Government's planning process for Access to Medicines in the event of a No Deal Brexit?'First, to endorse that point, there is no doubt in our minds from every quarter that no deal is a real disaster, certainly in the short to medium term. A lot of people have talked about the supply chain issues. We have never had a situation where supply chains were disrupted possibly for a period of up to, say, six months. You might have a short or limited restriction in supply, but this would be serious indeed'Niall Dickson, Chair of NHS Confederation, and the Brexit Health Alliance, which brings together industry, the NHS and academia in this area, 15th January, 2019 Oral evidence - Budget and NHS long-term plan - 15 Jan 2019What is the membership body that represents NHS clinical service providers to Government – NHS Providers - saying about the UK Government's planning process for Access to Medicines in the event of a No Deal Brexit?'We would all be abrogating our responsibility if we did not plan for every scenario, because it is absolutely critical. We might be saying there could be no problem, but, fundamentally, we have to plan for that problem, whatever happens. We know that the supply chain, the workforce and all the issues across the NHS, are so interdependent'Evidence to Health and Social Care Select Committee upon the Impact of a No Deal Brexit on 23rd October, 2018 – Saffron Cordery, Deputy CEO, NHS Providers,'The increasing possibility of a no deal Brexit carries great uncertainty. This is a risk to NHS trusts and the way they carry out services for patients.Trusts are currently doing all they can to minimise any potential disruption. The NHS is used to planning for difficult situations. Trusts are following advice from government closely, but at this stage, they urgently need more clarity'Saffron Cordery, Deputy CEO, NHS Providers, 30th January, 2019What are NHS Trusts saying about the UK Government's planning for Access to Medicines in the event of a No Deal Brexit?University Hosptials Birmingham Trust'In terms of the potential for major operational impact and severe and widespread risks to patient safety, for far the greatest concern is the availability of medicine. Devices and clinical supplies. The DHSC guidance says that a central exercise has been undertaken to identify all those medicines and consumables with an EU manufacturing touchpoint, but the findings of that exercise have not been made available so it is not possible for NHS trusts to know which products are at most at risk ...… DHSC guidance continues to expressly forbid stock-piling. We are assured that pharma companies and other suppliers will hold six weeks of stock in country … we are not able to assure the Board that the supply of medical stocks will be adequate for are operational needs. Indeed, there are already credible reports that pharmacies are experiencing greater supply problems, with a doubling of medicines in the 'shortage of supply list' …… One of the regrettable hallmarks of Brexit uncertainty is that there is little verified data about the consequences of exit, especially one in which there is no deal ...… There are other, well informed and non-political NHS sources who indicate a likelihood that the supply of goods from Europe across the Channel could be reduced to between one third and one fifth of currently daily volumes for a period of at least some months …… In the event of a chaotic, no deal exit, many NHS trusts could quickly run out of vital medical supplies. It is difficult to predict and control what goods will be available in this scenario and where and when shortages will occur ...… It is difficult to prepare detailed predictions or plans for such unpredictable concerns, however it is difficult to see any scenario whereby a no deal or other chaotic Brexit does not significantly impact our ability to safely treat our patients. It is important that the Board discusses these issues and takes a view on the overall approach to guide both whatever planning can be undertaken and the operational responses to the situation on the ground as the situation develops'Memo written by Dr David Rosser, chief executive of University Hospitals Birmingham Trust dated 24th January, 2019 - https://www.uhb.nhs.uk/Downloads/pdf/Bod0119ChiefExecMemoBrexit.pdfWhat are UK Clinicians saying about the UK Government's planning for Access to Medicines in the event of a No Deal Brexit?'As senior leaders in epilepsy concerned with safeguarding patients, we do not have confidence in the current arrangements to ensure the continuity of life-saving medications for people with epilepsy.Epilepsy affects 600,000 people in the UK. There are 21 epilepsy-related deaths each week, many in the young, many avoidable, and deaths have been rising.Many people with epilepsy are also on other medications, and any changes require careful management because of interactions between medicines.Recently, there was public concern after reports from the Royal Pharmaceutical Association about the scale of current medicine shortages.The government has included serious shortage protocols as part of planning for a potential no-deal Brexit on 29 March.On 14 January, the secretary of state and Department of Health of Northern Ireland made the Human Medicines (Amendment) Regulations 2019.This provides a new permanent power for ministers to manage serious shortages of medicines in any part of the UK.From 9 February it will allow medicines to be issued by pharmacists, without prescription. This sidesteps existing legislation that safeguards patients and has happened without the normal processes of formal public consultation and scrutiny by parliamentarians.A letter was sent to the secretary of state for health and social care for England in December, about our urgent concerns, but no response was received.We are concerned that these government plans could increase the risk of avoidable deaths of people with epilepsy. We urgently call on the government to intervene to stop any risk to patients’ health and to make explicit safeguards for the continuing supply of medications for people with epilepsy. Time is of the essence, as we near the 29 March Brexit deadline'Letter to the Guardian, signed by NHS Consultants, Epilepsy charities and patient advocacy groups, 30th January, 2019 - No-deal Brexit poses a potentially fatal risk to those with epilepsy | LetterWhat are those who are saying that Access to Medicines will not be a problem in the event of a No Deal Brexit saying? Is it relevant? On what basis are they making their statements and with what knowledge?Lord Lamont, 24th January, 2019‘My Lords, first, is it not the case that the main manufacturer of insulin, to which the noble Lord, Lord Roberts, referred—the Danish company Novo Nordisk—has four months’ supply in this country already?Secondly, is it not the case under the WTO pharmaceutical tariffs elimination agreement, which applies to everybody, that there are no tariffs on medicines? This applies to 10,000 different products and covers 90% of the world’s trade in pharmaceuticals.Given what was announced today by the head of Calais port in this morning’s newspapers about extra flows and flow being maintained as normal in Calais, is it not ridiculous to think that we are going to obstruct things that we need or that the Europeans are going to obstruct things that they want to sell to us?’- Lord Lamont, Debate in the Lords, 24th January, 2019 Brexit: Insulin SuppliesJacob Rees-Mogg, MP‘On preparations for leaving without a deal, he said a lot of it was “our decision” and criticised news reports that we couldn’t import medicines after Brexit:“Who decides what imports come into this country once we’ve left the EU? We do. Are we really going to stop imports of medicines that we need in our hospitals just out of stubbornness?”Whilst he praised the Department for Transport for being “way ahead” with contingency planning, he said the Treasury had a lack of enthusiasm for making such preparations’- Jacob Rees-Mogg, Brexit Central 23rd June, 2018 Rees-Mogg: EU isn't prepared for 'no deal' Brexit and UK should not hand cash to Brussels without a trade deal | BrexitCentralBoris Johnson, MP, 8th January, 2019“I have made one confident prediction that under any circumstances this country will be amply provided for, not only with Mars bars, not only with drinking water, but also with cheese and onion crisps.”The confusing question all stemmed from comments Mr Johnson made yesterday in his Telegraph column blasting fear-mongering about a no-deal Brexit.He claimed that the Government has become “hysterical” about the idea of the UK leaving the EU with no deal and that the public sees through this.He added that even if short-term shortages were to occur, it is a small price to pay for being out of the EU.Mr Johnson said: “Yes, people can well imagine that there will be bureaucratic and logistical challenges.“Yes, they know that not everything will operate in exactly the same way as before.“But if they are told that it is a choice between a temporary shortage of say, cheese and onion crisps or a permanent subjection of this country to the EU, with no say in EU law-making, the public is now grimy determined to make do - hunkering down with prawn cocktail until such time as cheese and onion comes back on stream.”The Brexiteer heavyweight mocked Project Fear’s apparently long list of products we could become short of in the case of a no-deal Brexit.He said: “In no particular order, it seems that Britain will run out of Mars bars and drinking water and ornamental horticulturists.There will be a desperate shortage of cheese and electricity and vital medicines such as Viagra.“Our restaurants will lack cleaning staff. And tea. And carrots.”Boris Johnson, Daily Express, 8th January, 2019 - BIZARRE Boris Johnson Newsnight interview - 'Brexit won't affect cheese and onion crisps'Andrew Bridgen, MPDover and other Channel ports face disruption for up to six months if the UK leaves the EU without a deal, ministers have said.The “worst-case scenario” warning comes after analysis of likely traffic flows, if customs checks are delayed.Lorries carrying medicine could get priority at ports and planes used to fly in drugs, ministers said.But Tory Brexiteer Andrew Bridgen said it was "Project Fear on steroids," ahead of Tuesday's big Brexit vote.He told the BBC: "It's the last throw of the dice from the prime minister who is desperate to get MPs to vote for her withdrawal agreement."- Andrew Bridgen, MP, BBC News, 7th December, 2019 - 'Six months of jams' under no-deal Brexit

My Dream organization is based on Business to Business model (B2B) rather than Business to consumer model(B2C) in health industry.Problem StatementThe reduction in sales fraud at the time of taking the policy is need of the hour considering the present scenario. Sales fraud is superset of many sub problems out of which ,we will focus on only the following –• Mis-selling of Policies - There are two approaches to selling the policy.Need based approach-This involves agents understanding the needs of the customer and hence providing the best possible option.Target Based Approach-In this, agents often indulge in malicious activities in order to achieve their personal targets.Customers and even agents are not completely aware of terms and conditions which becomes a source of discrepancies in this process of fair trade putting not only consumer’s satisfaction but also company’s reputation on line.• Hospitals overcharging - Hospitals often take advantage of customers by various means to be on profit side. Higher tariffs for insured patients lead to a higher payout for the insurance companies which, in turn, leads to higher premiums. The increase is more than the rise in the cost of medical care. Another issue is the misuse of group insurance by hospitals and patients• Over smart Customers - Many people are hospitalized for an illness that does not require it. Another issue is that they take a policy after a disease has been diagnosed. Health insurance does not cover pre-existing diseases. Also, patients do not read the policy document and expect all expenses within the limit of the cover to be reimbursed.What do we do?In order to overcome this problem, we propose a solution which may help to add this so called sinister to the list of obsolete items.We can give the insurance companies a dashboard to analyze the doctors who do the medical tests and approve the sales cycle and at the same time to ensure that hospitals don’t overcharge, hospital should update the insurance portal with the patient history and discharge summary.Our MissionOur mission is to eradicate fraudulent cases in health insurance sector and provide a profitable environment for all the stake holders.StakeholdersThese stakeholders are decided on the basis of process flow with main focus on point of sale insurance (here) agent and subsequent journey by the policy while getting approved. These stake holders have definite stake at some point of time. Let us take following cases to understand the whole scenario of stakeholders.Industry landscape and trend-The Indian healthcare Industry is estimated to grow to ~ $280 billion by 2020, up from $79 billion in 2012. With over 70% ‘out-of-pocket’ expense burden on the consumers, the market is ripe for health insurance entities including global players.It is estimated that the penetration of health insurance in India is only 2 per cent of the population. However this figure is expected to rise to a penetration of almost 20 per cent in the next five years keeping in mind the high growth seen in disposable income of the Indian families. Though this figure is the country's average, the percentage of insured visiting urban private setups even now is in the range of 20- 60 per cent of the hospital admissions.CustomersInsurance companies-Almost every health insurance company in India is running massive losses. So in order to overcome this, companies are willing to step up to bring this sector on the profit margin along with others. But the main concern for them remains the lack of awareness among the customers and availability of records in proper format so as to avoid any delay in decision making processHospitals-In order to get the complete details from patients, Hospitals need a product that can facilitate this process in a simplest possible way. A simple Database of each patient would do the trick. Hospitals need to support insurance companies to attract more people .So they have no choice but to move along with the flow of fair trade practice.Bargaining PowerCustomer:Customer in this case would be insurance company. Insurance company has a huge setup and a large no. of levels of hierarchy which will make their bargaining power more. Insurance company would be willing to purchase as it would provide an insight to their customers and their respective risk factor. Bargaining power would be huge as they have an established setup.Supplier:Supplier in this case would be hospitals and patients (in turn customers of hospitals and companies). Suppliers would encash the probability of lower premiums for the honest and higher from people not willing to share data initially. This would also set an attractive selling points to penetrate into the population with better offers in terms of cost, transparency and coverage.ChallengesOne of the biggest challenges would be development of a proper management hierarchy to adopt the solution . Insurance companies need to persuade the hospitals to follow the protocols.Lower penetration of health insurance in Indian market is also a problem.Rivalry-As there are many players in this sector but most of them have end users as their potential customers. This implies that their main focus is primarily on access of hospital records for doctors and person concerned at the time of need .While our focus is on health insurance sector with objective of reducing the fraudulent cases. This model would ensure incentive for all the stakeholders involved with main focus on health insurance sector.ProposalThe Digitized data can be used by patients to keep track of their health records .Hospitals can manage the records to keep track of patient’s health and update them as and when required to get a well-established health status of the patient. The move is expected to help healthcare providers adopt standard operating procedures and free patients from needless expenditure necessitated by infection, wrong diagnosis and surgical errors.As we can see from the above diagram, if patient opts out of health insurance, the necessary details of patient can be fed into portal through a unique ID for future reference. On the contrary, if the patient opts for health insurance, the digitized data can be shared among the participantsWho will be required?Requirement of good management professionals and technical professionals with expertise in data science techniques can strike wonders.Why will it be successful?a. Increasing Affordability – With rising income levels across the population, as well as increasing insurance coverage, the number of patients accessing health services will rise. The fact is reflected more strongly in the rural and urban middle class clusters. Social insurance coverage under RSBY and state schemes will likely to increase over the next plan period.b. Increasing awareness of disease,prevention & treatment -Rising Awareness of health and related outcomes, and the rising perceived need for health insurance will lead to more patients exhibiting care seeking behavior, especially if covered by insurance.Private insurance penetration has increased from 4 percent to 7 percent over the past decade and trend is expected to continue.c. Non-Communicable Disease - NCDs represent an important high-volume and high-value opportunity. These accounted for nearly 53 percent of mortality in 2009-2010. Average bill size of NCD hospitalization was nearly 50 percent higher than the remaining in 2004-2005. For the hospital, the ‘Lifetime Value’ of the patient will go up at no incremental capexIn the end I would like to conclude with SWOT analysis to understand advantages and disadvantagesStrength :• Our strengths lie in addition of a feature into existing or creating an altogether new system to maintain health records which would help insurance companies gain an insight while dealing with the fraudulent or probably fraudulent cases at the time of approving the policy itself.•This would enable more penetration as it assures a sure basket incentive for those who comply with our solution•Also with slight changes this idea finds its validated applicability in plethora of other sectors like medical records at the time of emergency, medical records to track personal growth or latest trends etc.Weakness:•Major sources of weaknesses lie in the already available solutions in the market.• Also the present size of industry which is very small in terms of penetration in Indian health insurance market poses a great weakness in itself• Smaller markets would limit the present scope of idea to a very limited few no. of people.Opportunities:• Since the demography in India favors youngsters who would largely contribute to upcoming middle class. These people would be concerned a lot about their health expenses.• The solution could be easily integrated with an incentive model. This would enable to increase penetration. Increasing penetration is where our focus would be.As just merely 100 basis points increase in penetration would imply millions getting added into the sector thereby improving balance sheets of major players in this sectorThreats:• Potential threats are denial of permissions to share and use the data from hospital. Customer may not prefer to share the data with an altogether new solution.• The customers may face discrimination in case they fail to understand the technology and process involved in updating the data on the solution.• Another aspect of threat is existence of solutions from existing players in India and abroad. They may be technologically advanced and their respective interface would be better than ours and well tested to various flaws as well.References1. Health Insurance in IndiaHealth insurance in India2.Health insurance awareness in Indiahttp://www.irda.gov.in/ADMINCMS/cms/Uploadedfiles/INSURANCE_AWARENESS_insdie_report_final_for_mail.pdfPage on iosrjournals.org3.Health Insurance Fraud in IndiaPage on ficci.comFraudulent Health Insurance Claims