Tumgik
#Cash flow specialists in New Zealand
vncglobal · 2 years
Text
Cash Flow Vs Profit: The Difference
There's a familiar adage in bookkeeping that goes: "benefits are an assessment, cash is a reality." What this implies is that while being beneficial is significant in the long haul, having sufficient money to work every day — that is, having a positive income — is a prompter, squeezing concern.
As an entrepreneur, it's vital to figure out the contrast between income and benefit, and how both elements into business achievement. In spite of the fact that it's unreasonable, a productive business could be constrained due to unfortunate income. Likewise, a business could be income positive, yet be losing cash. To avoid such scenario, consult VNC – one of the most distinguished Cash flow specialists in Australia.
So what's the distinction between income and benefit? All the more critically, how might you ensure that you're both productive AND have positive income?
Tumblr media
What is Cash Flow?
Basically, income alludes to the progression of cash into and out of a business during a set timeframe. Income bookkeeping records exchanges exactly when cash enters or leaves your financial balance, as opposed to when a receipt is sent or gotten.
Dissimilar to a Profit and Loss explanation, income incorporates cash development that isn't rigorously benefit, similar to capital infusions from proprietors or financial backers, or cash from the offer of a resource. Essentially, it does exclude credit from providers, cash owed from clients, or cash you as of now have in the bank.
Positive income implies that you have more money approaching than active at some random moment, and you're meeting all your monetary commitments as they emerge. It's a measurement frequently used to gauge the strength of a business, and can show banks, investors, and financial backers how well an organization is doing every day. Streamline your business cash flow with one of the excellent Cash flow experts in New Zealand, VNC.
What is Profit?
Profit, otherwise called Income, is how much amount remaining when you deduct costs from the revenue. There are two primary kinds of profit:
Profit = Total Revenue – Total Expenses
Not at all like with income, a month to month or quarterly Profit and Loss explanation considers what you owe, and what you are owed for the period. Along these lines, it's a decent pointer whether your business is getting more cash than it spends generally speaking — yet won't let you know whether you presently have sufficient cash in the bank to take care of the bills.
The Difference Between Cash Flow and Profit
Set forth plainly, a Profit and Loss explanation shows whether your business is procuring more than its spending, while a Cash Flow proclamation shows when you'll have cash close by. Benefit is about the master plan, while income centers around everyday reasonability.
For a business to find lasting success, it needs a decent net revenue and positive income.
Great Profit, Poor Cash Flow
Selina possesses a little, local area centered pastry kitchen that serves great cakes to a nearby group.
A companion of hers posts an image of her smash hit chocolate croissants to Instagram, and interest in her bread shop gets. In a little more than a month, interest for croissants duplicates, and Selina winds up routinely running unavailable.
To stay aware of interest, she puts resources into new gear, and duplicates her ordinary request of provisions.
Tragically, albeit the new income would more than cover the costs in a couple of months' time, Selina is in the red when it comes time to pay her providers. She is compelled to take out an exorbitant loan to meet her obligations, driving her further into the red.
Regardless of sound overall revenue, unfortunate income stops Selina's development plans from really developing. Never let your business stop from developing, consult VaderanCo – one of the top Cash flow experts in Australia.
Great Cash Flow, Poor Profit
Parita possesses a development organization, zeroing in on building high-thickness, reasonable lodging. She's constantly highly esteemed paying her laborers, providers, and bills on time.
Parita works carefully, keeping away from credits at every possible opportunity, timing approaches and outgoings so she can constantly meet her commitments. In spite of her emphasis on reasonableness, the business has consistently turned a clean benefit.
What she doesn't expect anyway are the increasing expenses related with production network interruption. The pandemic creates setbacks and increments costs across the business, and Parita's business is the same. Since contracts were at that point set up with purchasers for her assembles, the expenses eat into her all around thin overall revenues.
Parita's business remains income positive all through the monetary year, yet the absence of benefit implies her plan of action is at this point not viable.
The Right Balance
Johnny is a performer, with a genuinely enormous global following. In line with his fans, he's arranging his very first abroad visit.
He and his supervisory crew rapidly resolve that a visit is possible, yet Johnny needs more money in the bank to pay forthright costs like setting recruit, sound and lighting professionals, ticket administrations and so on.
They set up a financial plan for the excursion, and make a gauge investigating the number of tickets that they'd need to offer to repay a bank credit. They likewise take a gander at a most dire outcome imaginable, in which they sell 20% less tickets than they expect. They find what is going on, they can in any case take care of their expenses and create a gain in the event that they track down less expensive convenience, and take public vehicle between urban communities.
Equipped with this data, Johnny can unhesitatingly apply for a bank credit. The visit goes off effortlessly, and Johnny winds up selling out a large portion of his shows. The bank credit is reimbursed on time, and Johnny and his supervisory group leave with a robust benefit.
Step by step instructions to Ensure Good Profit and a Healthy Cash Flow with VNC Edge
Overseeing income and overall revenues implies estimating, observing, and making an arrangement to meet your objectives. The simplest method for doing the above is all to make a monetary figure. This is where VNC Edge can help.
VNC being one of the most trusted Cash flow specialists in New Zealand offers you a three-way gauging programming to project your future income, spending plan, and benefit and misfortune, so you can remain ready for whatever lies ahead. You can likewise make a scope of situations and assembled a strategy for various possibilities.
In particular, you can utilize VNC Edge to guarantee ideal overall revenues, and distinguish times of low income so you can repay likewise. It's like having the option to investigate the monetary future — without the problem of a precious stone ball.
3 notes · View notes
gvkfinancenz · 2 months
Text
Understanding Asset Finance: A Comprehensive Guide for Kiwi Businesses
Introduction to Asset Finance
In the bustling world of business, having the right tools and equipment is crucial for growth and success. However, acquiring these assets can often be a significant financial burden. This is where asset finance comes into play. As a small New Zealand business ourselves, GVK Finance understands the unique challenges faced by Kiwi businesses. We tailor our asset finance packages to meet your individual requirements, ensuring a seamless and supportive process.
What is Asset Finance?
Asset finance is a financial solution designed to help businesses purchase essential assets without the need for large upfront payments. Whether you need commercial trucks, business vehicles, plant and equipment, or machinery, asset finance provides flexible options to support your business growth. Essentially, it allows you to fund up to 100% of the asset being purchased, freeing up your working capital for other critical business needs.
How Does Asset Finance Work?
The process of asset finance is straightforward. First, you identify the asset you wish to purchase. Then, you approach a finance specialist like GVK Finance, where we will assess your business needs and tailor a finance package accordingly. Our fast turnaround time for approvals ensures that you can acquire your assets promptly. Moreover, our applications are simple, and we keep you informed throughout the process, ensuring you remain in control.
Benefits of Asset Finance
Asset finance offers numerous benefits to businesses of all sizes. Here are some key advantages:
Improved Cash Flow: By spreading the cost of the asset over time, you can manage your cash flow more effectively.
Flexible Repayment Options: Tailored finance packages allow you to choose repayment terms that suit your business needs.
Access to Up-to-Date Equipment: Stay competitive by acquiring the latest equipment and technology without the financial strain of large upfront costs.
Preserve Working Capital: Use your working capital for other business operations, such as marketing, expansion, or payroll.
GVK Finance: Your Trusted Partner
At GVK Finance, we pride ourselves on being commercial finance specialists for small to medium-sized businesses. Our strength lies in our ability to understand and cater to the unique requirements of our clients. Here’s why you should consider us for your asset finance needs:
Personalised Service: We provide personal attention to every client, ensuring that each package is tailored to your specific needs.
Local Expertise: As a New Zealand business, we understand the local market and business environment.
Mobile Service: We are mobile and conduct business on-site, providing convenience and flexibility.
Comprehensive Coverage: We finance assets of almost any size and value, supporting diverse business needs.
Asset Finance Offerings
GVK Finance offers a range of asset finance solutions to help your business thrive. Our offerings include:
Truck Finance: Finance for commercial trucks and trailers.
Plant & Equipment Finance: Funding for earthmoving and contracting equipment, plant, and machinery.
Working Capital Finance: Solutions to enhance your working capital.
Commercial Vehicle Finance: Finance for business motor vehicles and light commercials.
Conclusion
Understanding asset finance is essential for Kiwi businesses looking to grow and remain competitive. With flexible options and tailored packages, asset finance can provide the financial support needed to acquire essential assets. At GVK Finance, we are committed to helping you achieve your business goals with personalised and efficient service. Reach out to us today to learn more about how we can support your business with our comprehensive asset finance solutions.
0 notes
lizseyi · 2 years
Text
Almost All Small Businesses ‘Lose Money At Least One Month A Year’ - TS Partners
New research was undertaken by a leading professional services company, and the accounting software specialist Xero has made alarming discoveries on the subject of many firms’ tendency to lose money for much of the year.
Among those findings was that 94% of small businesses have at least one month during the typical year when their costs are higher than their income, meaning they are effectively shedding money. 
In fact, the research found that the typical small firm loses money for a third of the year. Almost one in four (23%) small businesses have monthly outgoings higher than their revenues for more than six months a year. 
“Persistent and systemic” challenges with cash flow for many small companies 
The researchers scrutinised the money that entered and left the accounts of 200,000 small firms with annual revenues of below £6.5 million, and which made use of Xero software in the UK, Australia, and New Zealand during 2021. 
Xero’s chief customer officer, Rachael Powell, commented: “The report reveals just how persistent and systemic these cash flow challenges are for small businesses. Healthy cash flow is essential to a thriving business, yet our research shows that the vast majority of small businesses are having cash flow issues at least once a year.” 
Significant numbers of larger firms continue to pay their suppliers late 
Another longstanding source of frustration for many small businesses is the difficulty of ensuring they get paid for their services provided to larger companies. 
It is hardly encouraging news, then, that according to the Xero research, more than half (55%) of large organisations have been paying their small business suppliers later than the agreed payment terms in the last 12 months. 
And yet, 78% of such firms admitted they knew full well the potential impact of this on the business of the supplier. 
As for the reasons for small firms being paid late, the large businesses quizzed cited inaccurate invoice details as the primary factor. This was followed in the list by it being company policy to prioritise sending payments to larger suppliers first, and there was also evidence that large firms were making a conscious decision to conserve cash by not paying immediately. 
More than four fifths of the large businesses questioned said that if “late payments” were renamed as “unapproved debt”, this would cause them to consider paying suppliers on time. 
With regard to the small firms’ opinion on this issue, 82% of them said that the Government needed to put more effort into tackling the problem. 
In the words of Alex von Schirmeister, a Xero managing director: “There must be appropriate incentives for large businesses to pay their suppliers on time, and stricter penalties when it comes to paying late to prevent further cash flow instability. 
“Larger companies have been let off the hook for too long. Just imagine how economically productive our small business economy could be without the toil and stress of chasing payments.” 
As for if your own firm would appreciate specialised and informed help with Xero in Newton Abbot, Plymouth, or Wellington to support your efforts to keep on top of your business’s finances, you are welcome to enquire to the Xero-certified TS Partners team today via phone or email. 
Tumblr media
0 notes
Text
Professional accounting & tax specialist in New Zealand
Every successful business needs to be strategic especially when making financial decision and you can get professional advisory from an accountancy firm. The accountants are knowledgeable and understand different business environments, tax and even financial statements. They can even help you with insurance and business expansion, so you make decisions that are bound to grow you as a business.
This is another great service your business can enjoy from the professionals. They can assist you become more efficient with income tax and capital gains tax and other tax related solutions. You basically can get the help you need with tax planning and tax compliance so you reduce overall tax burden and obey the tax laws that are in place. The size of your business will determine the tax planning activities necessary. The accounting firm will additionally assist you with tax deductions you might know nothing about. Small business support services NZ
The best firms are those offering a broad range of services, which can be customized to suit the client's needs as things change. For example, it's common for sole traders, somewhere down the line, to go into partnership together, or establish themselves as a limited company. An accountant firm that specializes in personal tax returns and business start-ups, but also offers an expert service in VAT registration and corporate tax returns, is the ideal find.
Some new business owners may feel it's worth having a part-time accountant or bookkeeper from the word go, which offers the benefits of continually updated books and regular finance reviews. The alternative is sending everything off to an accountant firm at the end of the tax year. However, many new businesses simply don't have the finances to employ extra members of staff, and sourcing to an outside agency offers them a host of benefits. For a start, the service generally costs less than employing someone in-house, and the level of service is a lot higher. A good accountant firm will have a highly professional team of certified, licensed experts who are familiar with all aspects of tax law. In the case of accounting software, the firm will be able to maintain secure books online, with advanced software developed in-house. The charges may vary according to the level of complexity and personnel involved, but with a good accountant at the helm, a business will always recoup those fees with the tax savings which are made. Body corporate management solutions New Zealand
It is one of the most common accounting services and its role is to ensure that your financial books and information are accurate and in order. Auditing takes many levels from simple financial statement preparations to actual audits for accuracy purposes.
Another very important aspect of a business and accounting firms can help you through. Basically the accountants ensure your records remain in order and prepare necessary reports for year end taxes. QuickBooks data entry also makes part of what the experts can do to help you manage your business finances. It is easy to remain in control when you know channels through which your money is going out.
View More:- Cash flow consulting services NZ
1 note · View note
fspfinancial · 3 years
Text
Get Everything On The Process To Register New Zealand Finance Company
The best game-plan in Forex probably could be to have a seaward Forex license. In spite of the way that cash can surely be made in Forex it very well may be lost moreover. The extended length champ is Forex is the expert.
The eminent saying rings a bell. "Precisely when everybody is searching for gold it is an ideal opportunity to sell picks and scoops." With an offshore Forex license and understanding merchant seller license prerequisites you or your company could collect commissions and charges on trading a market that trades up for $4 Trillion consistently. For setting up licensed forex company and register new zealand finance company you need the help of specialists that are educated about this.
Tumblr media
                         Register new zealand finance company
Public banks, institutional sellers, and currency assessors trade consistent. Some benefit and some lose. The most dependable benefits in Forex or different business areas are the commissions paid to the transporter. It is feasible to get a seaward Forex representative's license in various expense advantaged, financially discrete wards.
The Forex brokerage firm necessities to have an expert business programming wrap set up which is expected to lead the Forex business. There are various issues that should be viewed as like highlights of the thing and the stuff plan of the specialist expected to support the thing.
Insignificant ownership of a Forex delegate protections seller license for set up licensed forex company award may not ensure a constant flow of customers. The firm requirements to utilize propelling systems subject to a useful publicizing plan to register new zealand finance company. Utilizing a pleasant showing affiliation could be one choice whether it costs cash for publicizing and gaining ground for the forex trading business.
0 notes
itsthehives-blog · 5 years
Text
Grow Your Business with The Hive
Are you looking for an experienced Accounting Consultant Rotorua? Contact The Hive and get the best help from Accountants Rotorua. No matter you have an existing business or you just want to start out, you can always rely on The Hive. This team of accounting professionals has a mission to deliver an authentic personalized tax, accounting and consulting service. With this company, you will be able to grow your business and enjoy the best ever results. Accountants Rotorua are at your disposal to give you the right advice and very practical solutions that cater to all your business needs.
The Hive prides itself on having the most professional specialists who stand out due to their wealth of experience. Once you deal with The Hive, you will not only get the services you need but you will also build a perfect future for your business. It is because these accountants will become your genuine partners that help you reach your lifestyle goals. The Hive is also dedicated to meeting your budget and building a financially successful business. With many years of practical experience, The Hive uses cloud accounting software, New Zealand’s own internationally recognised Xero. This ensures that your business will grow and operate more efficiently. The Accounting Consultant Rotorua is always at your disposal and you can be sure that you can get in touch with them any time and any day.
There are various accounting packages available for you. You can opt for Lite, Growth or Custom packages as per your business needs and goals. The Lite package costs $199 per month which is quite an affordable price. It includes bank reconciliation, business income tax return, annual financial statements, tax return reminders, cash book coding, and IRD management. You will also enjoy unlimited support and advice via phone and Email. The next package is Growth which comes at $289 per month. This package not only brings the above-mentioned services but it also includes GST returns and management reports (quarterly). However, if you need a tailored approach, you can count on Custom package. The price of this offer mainly depends on your needs. If your business has specialised needs, do not hesitate to contact The Hive and get a tailored package based on your business goals. Everything will be catered to your needs and you can enjoy the advantages of comprehensive reporting, cash flow forecasting, strategic planning and regular meetings. You should just call these experts, discuss your requirements and they will build the right approach which suits your business.
Do not hesitate to get help from the Small Business Accountants Rotorua because they have the needed skills and can handle your accounts successfully. The specific team at Hive is ready to navigate the market and work with commitment. These Small Business Accountants Rotorua understand how your small business is important for you and they strive to deliver the best value for your investment. You won’t regret putting your trust in this team because they will get your business right on the track in an effective and safe way. Just Hire the experts at The Hive and allow them to develop the full potential of your business. The Hive looks forward to working with you!
Tumblr media
0 notes
sanchesheitor8 · 5 years
Text
Microsoft Characteristics GP
Microsoft Dynamics GP, or Microsoft Great Plains is popular mid-market generic ERP. It can be utilized as ERP platform for several vertical markets. In this little post we’ll explain normal automobile car dealership network automation. 
 Worldwide car manufacturer has dealerships throughout the USA and Canada and in their case they had Great Plains Dynamics 6.0 on MS SQL Server/MSDE. Each dealership is independent business, so each has its own Great Plains license 
 - Dealership exclusive software application. Car dealership is conventional organisation and it had a number of generations of computer system organisation systems. Client information, related to the cars and truck and VIN, work provided for the vehicle, parts, related to the particular design, works pricelist and specialist accessibility-- this info is kept in DOS based organisation management system. 
 - Microsoft Dynamics GP-- accounting back end. Each deal monetary info goes to be saved in Great Plains Standard. Natural option to utilize basic accounting application as the backend-- it can manage United States and Canadian dollars variation, plus it can manage sales tax (USA) and VAT/GST (Canada, Australia, New Zealand). 
 - Financial Reporting. Microsoft Great Plains has FRx monetary reporting: Balance Sheet, Profit & Loss (P&L), Cash Flow Statement-- all these reports must be originating from basic accounting plan, such as Microsoft Dynamics GP. 
 Great Plains Dynamics 6.0 had tradition VBA/Modifier combination, utilizing ADO to link to dealer proprietary database and incorporate with it. As we move to Microsoft Dynamics GP (or Microsoft Great Plains Standard 9.0)-- the accent will be altered to Object Integration SDK (eConnect with XML web services adapters, so we can release Visual Studio.Net C# or VB, nevertheless the requirement for the SQL kept treatments need to be anticipated). 
 It will be tending to avoid one or 2 variations upgrade, as we have in this case: customer avoided upgrade from Great Plains Dynamics 6.0 to Microsoft Great Plains Dynamics 7.0 and Great Plains Standard 7.5. Existing strategy is to update GP Dynamics 6.0 to Microsoft Great Plains 8.0 and then in 2007 or 2008 GP 8.0 to Microsoft Dynamics GP 10.
0 notes
jamieclawhorn · 5 years
Text
2 dividend stocks I think will pay you for the rest of your life
If you’re investing in shares to help fund your retirement, then I believe dividend income is an important requirement. I’d also suggest that you want to look for businesses that will carry on performing reliably for many years. That’s certainly what I’m aiming for.
Today I want to look at two stocks which I think should provide reliable dividends and growth for the foreseeable future.
An essential ingredient?
Tate & Lyle (LSE: TATE) is a familiar brand, but the Tate & Lyle-branded products you buy at the supermarket are probably made by American Sugar Refining, which bought Tate’s European sugar business in 2010.
Although the company does still produce some bulk ingredients, such as starch and corn fructose syrup, its main growth focus is specialist ingredients used by food producers.
Many of these products are used by major food brands. They are generally harder to substitute with cheaper alternatives than commodity-type ingredients like granulated sugar. This makes them more profitable.
Another very profitable area of the group’s business is its Sucralose sweetener division, whose main brand is Splenda.
Long-term opportunity
I’ve pulled some numbers from last year’s results so you can see how the group’s profit margins vary across its business:
Division
Adjusted operating profit
Adjusted operating profit margin
Food & Beverage Solutions (speciality ingredients)
£137m
16.1%
Sucralose (e.g. Splenda)
£55m
37.6%
Bulk ingredients (e.g. starches)
£166m
9.7%
In my view, this points to a long-term opportunity. Higher profit margins in the speciality ingredients and Sucralose businesses mean that if sales rise, profits will rise more quickly than they would from bulk ingredients sales.
Even if that doesn’t happen, I think Tate & Lyle has the qualities needed for a long-term investment. The group hasn’t cut its dividend for 21 years. Profits margins are fairly stable and cash generation is good, with only a limited amount of debt.
The stock also looks affordable to me, on 14 times 2019 earnings with a 4.2% dividend yield. I’d be happy to buy these shares today and never trade them again.
We can’t get enough
My second pick also comes from the food industry, which I see as a good defensive option for the long term. After all, whatever else happens, we can’t stop eating.
And it seems that one food we can’t get enough of is meat. Hilton Food Group (LSE: HFG) specialises in producing meat products for supermarket chains in the UK and other developed markets.
Hilton’s share price has risen by 80% over the last five years and by 430% since its flotation in 2007. Over the last five years, sales have risen by 50%, while pre-tax profits have risen by 72%.
More to come?
Management isn’t stopping there. The last two years have seen significant investment in the business. The acquisition of seafood supplier Seachill helped to expand the group’s product range into new markets. Meanwhile, new plants are expected to open in New Zealand and Australia in 2019 and 2020, supporting further growth.
One risk for investors is that most of the group’s sales come from just a handful of big customers. The shares aren’t cheap either. As I write, they trade on 21 times 2019 forecast earnings and offer a dividend yield of just 2.4%.
However, I see this as a good business that’s well run. For long-term investors, I think this could be a fair price to pay.
Investing For Income?
If you’re looking to supplement your salary or pension with regular dividends, then this special free investing report could be a great place to start! ‘A Top Income Share From The Motley Fool UK’ profiles a company that you’re bound to have heard of … but what you may have overlooked is the current near-6% yield on offer that our Motley Fool analyst believes is “comfortably covered by profits and by the firm’s cash flow”. Click here to claim your free copy now!
More reading
2 FTSE 250 growth stocks I have on my 2019 ISA shortlist
Roland Head has no position in any of the shares mentioned. The Motley Fool UK has no position in any of the shares mentioned. Views expressed on the companies mentioned in this article are those of the writer and therefore may differ from the official recommendations we make in our subscription services such as Share Advisor, Hidden Winners and Pro. Here at The Motley Fool we believe that considering a diverse range of insights makes us better investors.
0 notes
bobbynolanios88 · 6 years
Text
Evaluating blockchain and distributed ledger use for the NHS
Evaluating blockchain and distributed ledger use for the NHS
© iStock-LeoWolfert
Dr Stewart Southey weighs the potential benefits of blockchain and distributed ledger technology in the NHS
The past few years have seen a veritable frenzy wherever the term blockchain has been used. Touted as the silver bullet that will save every industry, billions of euros of venture capital and crowdfunded money has been poured into new projects. Though there are many exciting new start-ups promising to revolutionise healthcare, there are significant challenges ahead before we will know exactly how helpful a distributed ledger can be. This article explores these issues in the context of the UK’s National Health Service (NHS).
An overview of the National Health Service
It’s a bit of a misnomer to think of the NHS as a national organisation. Though funded centrally (almost exclusively through tax contributions), co-ordination of healthcare is performed by a myriad of semi-autonomous and partially competing entities.
One of the largest employers in the world, the NHS treats 1.4 million patients every 24 hours. 207 clinical commissioning groups (CCGs) help channel funds to more than 7,400 GP practices, 135 acute non-specialist trusts and other organisations in England alone. There are 853 for-profit and not-for-profit independent sector organisations providing care to patients from 7,331 locations.1 It is therefore fair to say that the flow of money and data is at best complicated but more likely indecipherable for any single individual.
An attempt to centralise IT services (Connecting for Health, National Programme for IT) famously failed after overspending by an estimated 440-770%.2 There have been many reasons proposed for this failure which are not relevant to the scope of this article. The take home message is clear, however. Centralised projects of this scale cannot work without complete autocracy.
In spite of this colossal flop, the need for integrated care records, prescribing systems and performance management solutions persists. Poor communication and data integrity concerns account for a significant percentage of medical errors and deaths annually. Privacy and accessibility of medical information continue to be of great concern for many patients and clinicians. Financial transparency is almost impossible, and the perceived extent of wasteful practices is frequently in the headlines.
It would be unfair to paint such a dismal picture of the NHS without balancing it with some positive truths. In comparison with the healthcare systems of ten other countries (Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and USA) the NHS was found to be the most impressive overall by the Commonwealth Fund in 2017. This achievement was in spite of the fact that health expenditure in the UK was 9.75% of GDP in 2016 where others have significantly higher percentages and expenditure per capita.
Clinical outcomes were unfortunately not quite as stellar, though measuring quality in healthcare is a complex business.
The ‘quadruple aim’ of healthcare3 is to improve the patient experience, improve the health of the population, reduce per capita costs and reduce staff burnout. The addition of the latter aim is important. Whilst there are many proposed reasons for this worrying trend, one widely held view is that the administrative burden placed on doctors is partly to blame: “It is no coincidence that the spike in burnout rates has come at the same time as the broad adoption of [electronic health records (EHRs)]. Someday, EHRs may revolutionise healthcare by dramatically increasing our ability to share and review patient information. But today, EHRs are turning many physicians into clerks.”4
Improvements to the quadruple bottom line require multiple approaches. Managing the supply-demand relationship of healthcare is complex, as is balancing the conflict of quality and choice versus cost and efficiency. One thing remains true though – decisions should not be based on flawed data. We can only fix what we can identify.
The case for blockchains
No single technology will transform any healthcare system, and it would be naïve to believe blockchain is the exception. Even combined with AI, big data analytics and the other newly spawned hopefuls, distributed ledgers are not entirely capable of addressing the political and economic nuances that influence how care is delivered.
That all said, there is something rather unique about what is being promised. It is not so much the technology per se, as it is the fundamental philosophy underlying it that is so intriguing.
When Bitcoin was launched in 2009, individuals were for the first time able to send electronic cash peer-to-peer across the planet without any central authority permission. This censorship-free value exchange, secured through algorithmic consensus mechanisms and crypto-economic incentives, made dishonest activity economically unviable.
The network effect means that the more participants there are sharing a common trust-brokering infrastructure, the more valuable the platform becomes.
Translating this to healthcare is a bit of a leap of faith, and the technology is nascent to say the least. But, knowing that we can create a virtually unbreakable transaction log and a common communications channel that permits value exchange without third party intermediation is certainly exciting.
Every time the blockchain is added to, the new ‘state of being’ is replicated across the network. All participants can trust the ledger’s integrity and the data is permanently recorded, fully auditable and unalterable.
Whilst this does not guarantee the quality of the data input, it is transparent and there is clear accountability through public key cryptographic signatures. Leaving the importance of oracles and how to ensure the veracity of inputs for another time, it appears that employing distributed ledger technologies may narrow the trust and communication gaps in healthcare significantly.
The NHS evidence base
As we have seen, the NHS is a monolithic tangle of disparate entities – some privately run, others public, but most existing in isolation of one another. Communication cracks between these parties contribute significantly to the inefficiencies observed.
The 2017/2018 NHS England Annual Report5 identifies ten areas of focus for improvement:
Freeing up hospital bed capacity
Improving staff productivity, including further action on temporary labour costs
Leveraging the NHS’s procurement opportunities
Securing best value from medicines and pharmacy
Reducing avoidable demand and meeting demand more appropriately
Reducing unwarranted variation in clinical quality and efficiency
Action on estates, infrastructure, capital and clinical support services
Cutting the cost of corporate services and administration
Improving cost recovery from non-UK residents
Ensuring financial accountability and discipline in all NHS organisations
Closer examination of these areas might provide the basis for testing distributed ledger technology use cases for those aspiring to act.
In addition to this, Lord Holmes published a report in 2017 which examined the potential benefits of distributed ledger technology for improving healthcare in the UK.6 Some of the findings include opportunities lost because of data duplication and fragmentation. Access to medical records, pharmaceutical supply chain integrity, and patient and employee identification mechanisms were also found to be lacking.
Significantly, the report suggests that the use of distributed ledger technology may improve health data and the lives of patients if deployed in these areas.
It’s not a straight line connecting the goals of improvement with the opportunities promised by blockchain. But with self-verifiable data integrity, an accountable log and near real-time state replication at the core, distributed ledger technology might just make agile and informed decisions a realisable reality.
There is of course the issue of interoperability and the fact that blockchains aren’t good for data storage. Nobody believes that legacy systems will be replaced overnight. Yet if trusted, traceable access to these systems can be granted whereby operational decisions can be made, the efficiency could improve dramatically.
The road ahead
Clearly there is much work to be done. Proof-of-concept (PoC) trials with the quadruple aims in mind will need to be conducted before benefits can be claimed. Which blockchain type (public, permissioned or consortium), whether or not a cryptocurrency is required in a semi-trusted environment and the need to comply with regulations (GDPR and many more) all influence the choices ahead.
The burning questions that remain, however, are these:
Who will fund these trials and how do we get potentially conflicting stakeholders to engage in a sharing economy?
Far more challenging than the technological barriers are the political and economic paradigms that need to be questioned. How can we convince individual hospitals with constrained budgets to build a shared infrastructure with a private provider, a local pharmacy group and the surrounding GP practices?
Can co-opetition models work where competing private sector incumbents battle for contracts with the public purse?
Who (not what!) will block the path to data sharing, and how can this be mitigated?
Future outlook of distributed ledgers
Reorganising the NHS for 66.57 million people is a gargantuan task. But we should not be dissuaded – the appetite for change and improvement is high. The overall benefits to patients and doctors may far outweigh the costs. In fact, the potential revenue for the UK economy may be significant.
Imagine these scenarios:
Several major UK pharmaceutical companies collaborate with research institutes, CCGs and the major teaching hospitals across the UK. Each is a shareholder in the new joint venture, the purpose of which is to mine national level health data for insights into cancer treatment. Any intellectual property derived is shared, as are the financial returns from new product development. All parties win, patient health improves, and the NHS has additional revenue for reinvestment
All NHS hospitals share doctor credential data with each other (permissions granted by the doctor of course). The Disclosure and Barring Service, General Medical Council, royal colleges and universities also share in these common communications channels. Now a doctor can move freely within the system nationwide if his/her CV matches requirements for work. It doesn’t take months of compliance checks or the costs associated with duplicating those tasks. Matching of supply and demand reduces the need for expensive agency intermediaries. The savings are used to improve doctor pay and improve patient care
NHS trusts join forces with procurement bodies, the supply chain stakeholders (including equipment companies) and the CCGs. Real-time enterprise resource planning with full track and trace facilities creates a responsive and efficient ecosystem. Savings once again are shared, with patients and listed companies sharing in the spoils.
Whilst this all sounds dreamy, unrealistic and perhaps threatening to some, it represents a paradigm shift in business models where profit and the sharing economy can coexist.
Data silos emerge when information sharing costs the company money. Data collaboration on the other hand brings economies of scale and scope, a shared cost base and a percentage share of a potentially much bigger prize.
Naturally, there are no guarantees. But perhaps, with all the other emerging technologies and the combined resources of the public and private sectors, there may well be an opportunity to achieve that quadruple aim.
And if the PoC trials demonstrate positive returns, the burning question will then be: who will block the path or make it happen?
About the author
Dr Stewart Southey MBBCh FRCA MBA MSc (Digital Currencies, in progress) is a senior NHS consultant, healthcare strategist, founder of Catena Consulting and chief medical officer at Biohax International. He is passionate about any medtech and healthcare innovation that promises to improve the delivery of care.
References
https://ift.tt/XNCARo
https://ift.tt/2El5Bh8
https://ift.tt/2E83exa
https://ift.tt/2EjwfGZ
https://ift.tt/2E83f4c
https://ift.tt/2zGdXdj
Dr Stewart Southey Founder Catena Consulting Tweet @docsouthey https://catena.mba/
This article will appear in issue 8 of Health Europa Quarterly, which will be published in February 2019.  
Source link https://ift.tt/2E6PBhM
0 notes
Text
Evaluating blockchain and distributed ledger use for the NHS
Evaluating blockchain and distributed ledger use for the NHS
© iStock-LeoWolfert
Dr Stewart Southey weighs the potential benefits of blockchain and distributed ledger technology in the NHS
The past few years have seen a veritable frenzy wherever the term blockchain has been used. Touted as the silver bullet that will save every industry, billions of euros of venture capital and crowdfunded money has been poured into new projects. Though there are many exciting new start-ups promising to revolutionise healthcare, there are significant challenges ahead before we will know exactly how helpful a distributed ledger can be. This article explores these issues in the context of the UK’s National Health Service (NHS).
An overview of the National Health Service
It’s a bit of a misnomer to think of the NHS as a national organisation. Though funded centrally (almost exclusively through tax contributions), co-ordination of healthcare is performed by a myriad of semi-autonomous and partially competing entities.
One of the largest employers in the world, the NHS treats 1.4 million patients every 24 hours. 207 clinical commissioning groups (CCGs) help channel funds to more than 7,400 GP practices, 135 acute non-specialist trusts and other organisations in England alone. There are 853 for-profit and not-for-profit independent sector organisations providing care to patients from 7,331 locations.1 It is therefore fair to say that the flow of money and data is at best complicated but more likely indecipherable for any single individual.
An attempt to centralise IT services (Connecting for Health, National Programme for IT) famously failed after overspending by an estimated 440-770%.2 There have been many reasons proposed for this failure which are not relevant to the scope of this article. The take home message is clear, however. Centralised projects of this scale cannot work without complete autocracy.
In spite of this colossal flop, the need for integrated care records, prescribing systems and performance management solutions persists. Poor communication and data integrity concerns account for a significant percentage of medical errors and deaths annually. Privacy and accessibility of medical information continue to be of great concern for many patients and clinicians. Financial transparency is almost impossible, and the perceived extent of wasteful practices is frequently in the headlines.
It would be unfair to paint such a dismal picture of the NHS without balancing it with some positive truths. In comparison with the healthcare systems of ten other countries (Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and USA) the NHS was found to be the most impressive overall by the Commonwealth Fund in 2017. This achievement was in spite of the fact that health expenditure in the UK was 9.75% of GDP in 2016 where others have significantly higher percentages and expenditure per capita.
Clinical outcomes were unfortunately not quite as stellar, though measuring quality in healthcare is a complex business.
The ‘quadruple aim’ of healthcare3 is to improve the patient experience, improve the health of the population, reduce per capita costs and reduce staff burnout. The addition of the latter aim is important. Whilst there are many proposed reasons for this worrying trend, one widely held view is that the administrative burden placed on doctors is partly to blame: “It is no coincidence that the spike in burnout rates has come at the same time as the broad adoption of [electronic health records (EHRs)]. Someday, EHRs may revolutionise healthcare by dramatically increasing our ability to share and review patient information. But today, EHRs are turning many physicians into clerks.”4
Improvements to the quadruple bottom line require multiple approaches. Managing the supply-demand relationship of healthcare is complex, as is balancing the conflict of quality and choice versus cost and efficiency. One thing remains true though – decisions should not be based on flawed data. We can only fix what we can identify.
The case for blockchains
No single technology will transform any healthcare system, and it would be naïve to believe blockchain is the exception. Even combined with AI, big data analytics and the other newly spawned hopefuls, distributed ledgers are not entirely capable of addressing the political and economic nuances that influence how care is delivered.
That all said, there is something rather unique about what is being promised. It is not so much the technology per se, as it is the fundamental philosophy underlying it that is so intriguing.
When Bitcoin was launched in 2009, individuals were for the first time able to send electronic cash peer-to-peer across the planet without any central authority permission. This censorship-free value exchange, secured through algorithmic consensus mechanisms and crypto-economic incentives, made dishonest activity economically unviable.
The network effect means that the more participants there are sharing a common trust-brokering infrastructure, the more valuable the platform becomes.
Translating this to healthcare is a bit of a leap of faith, and the technology is nascent to say the least. But, knowing that we can create a virtually unbreakable transaction log and a common communications channel that permits value exchange without third party intermediation is certainly exciting.
Every time the blockchain is added to, the new ‘state of being’ is replicated across the network. All participants can trust the ledger’s integrity and the data is permanently recorded, fully auditable and unalterable.
Whilst this does not guarantee the quality of the data input, it is transparent and there is clear accountability through public key cryptographic signatures. Leaving the importance of oracles and how to ensure the veracity of inputs for another time, it appears that employing distributed ledger technologies may narrow the trust and communication gaps in healthcare significantly.
The NHS evidence base
As we have seen, the NHS is a monolithic tangle of disparate entities – some privately run, others public, but most existing in isolation of one another. Communication cracks between these parties contribute significantly to the inefficiencies observed.
The 2017/2018 NHS England Annual Report5 identifies ten areas of focus for improvement:
Freeing up hospital bed capacity
Improving staff productivity, including further action on temporary labour costs
Leveraging the NHS’s procurement opportunities
Securing best value from medicines and pharmacy
Reducing avoidable demand and meeting demand more appropriately
Reducing unwarranted variation in clinical quality and efficiency
Action on estates, infrastructure, capital and clinical support services
Cutting the cost of corporate services and administration
Improving cost recovery from non-UK residents
Ensuring financial accountability and discipline in all NHS organisations
Closer examination of these areas might provide the basis for testing distributed ledger technology use cases for those aspiring to act.
In addition to this, Lord Holmes published a report in 2017 which examined the potential benefits of distributed ledger technology for improving healthcare in the UK.6 Some of the findings include opportunities lost because of data duplication and fragmentation. Access to medical records, pharmaceutical supply chain integrity, and patient and employee identification mechanisms were also found to be lacking.
Significantly, the report suggests that the use of distributed ledger technology may improve health data and the lives of patients if deployed in these areas.
It’s not a straight line connecting the goals of improvement with the opportunities promised by blockchain. But with self-verifiable data integrity, an accountable log and near real-time state replication at the core, distributed ledger technology might just make agile and informed decisions a realisable reality.
There is of course the issue of interoperability and the fact that blockchains aren’t good for data storage. Nobody believes that legacy systems will be replaced overnight. Yet if trusted, traceable access to these systems can be granted whereby operational decisions can be made, the efficiency could improve dramatically.
The road ahead
Clearly there is much work to be done. Proof-of-concept (PoC) trials with the quadruple aims in mind will need to be conducted before benefits can be claimed. Which blockchain type (public, permissioned or consortium), whether or not a cryptocurrency is required in a semi-trusted environment and the need to comply with regulations (GDPR and many more) all influence the choices ahead.
The burning questions that remain, however, are these:
Who will fund these trials and how do we get potentially conflicting stakeholders to engage in a sharing economy?
Far more challenging than the technological barriers are the political and economic paradigms that need to be questioned. How can we convince individual hospitals with constrained budgets to build a shared infrastructure with a private provider, a local pharmacy group and the surrounding GP practices?
Can co-opetition models work where competing private sector incumbents battle for contracts with the public purse?
Who (not what!) will block the path to data sharing, and how can this be mitigated?
Future outlook of distributed ledgers
Reorganising the NHS for 66.57 million people is a gargantuan task. But we should not be dissuaded – the appetite for change and improvement is high. The overall benefits to patients and doctors may far outweigh the costs. In fact, the potential revenue for the UK economy may be significant.
Imagine these scenarios:
Several major UK pharmaceutical companies collaborate with research institutes, CCGs and the major teaching hospitals across the UK. Each is a shareholder in the new joint venture, the purpose of which is to mine national level health data for insights into cancer treatment. Any intellectual property derived is shared, as are the financial returns from new product development. All parties win, patient health improves, and the NHS has additional revenue for reinvestment
All NHS hospitals share doctor credential data with each other (permissions granted by the doctor of course). The Disclosure and Barring Service, General Medical Council, royal colleges and universities also share in these common communications channels. Now a doctor can move freely within the system nationwide if his/her CV matches requirements for work. It doesn’t take months of compliance checks or the costs associated with duplicating those tasks. Matching of supply and demand reduces the need for expensive agency intermediaries. The savings are used to improve doctor pay and improve patient care
NHS trusts join forces with procurement bodies, the supply chain stakeholders (including equipment companies) and the CCGs. Real-time enterprise resource planning with full track and trace facilities creates a responsive and efficient ecosystem. Savings once again are shared, with patients and listed companies sharing in the spoils.
Whilst this all sounds dreamy, unrealistic and perhaps threatening to some, it represents a paradigm shift in business models where profit and the sharing economy can coexist.
Data silos emerge when information sharing costs the company money. Data collaboration on the other hand brings economies of scale and scope, a shared cost base and a percentage share of a potentially much bigger prize.
Naturally, there are no guarantees. But perhaps, with all the other emerging technologies and the combined resources of the public and private sectors, there may well be an opportunity to achieve that quadruple aim.
And if the PoC trials demonstrate positive returns, the burning question will then be: who will block the path or make it happen?
About the author
Dr Stewart Southey MBBCh FRCA MBA MSc (Digital Currencies, in progress) is a senior NHS consultant, healthcare strategist, founder of Catena Consulting and chief medical officer at Biohax International. He is passionate about any medtech and healthcare innovation that promises to improve the delivery of care.
References
https://ift.tt/XNCARo
https://ift.tt/2El5Bh8
https://ift.tt/2E83exa
https://ift.tt/2EjwfGZ
https://ift.tt/2E83f4c
https://ift.tt/2zGdXdj
Dr Stewart Southey Founder Catena Consulting Tweet @docsouthey https://catena.mba/
This article will appear in issue 8 of Health Europa Quarterly, which will be published in February 2019.  
Source link https://ift.tt/2E6PBhM
0 notes
vanessawestwcrtr5 · 6 years
Text
Evaluating blockchain and distributed ledger use for the NHS
Evaluating blockchain and distributed ledger use for the NHS
© iStock-LeoWolfert
Dr Stewart Southey weighs the potential benefits of blockchain and distributed ledger technology in the NHS
The past few years have seen a veritable frenzy wherever the term blockchain has been used. Touted as the silver bullet that will save every industry, billions of euros of venture capital and crowdfunded money has been poured into new projects. Though there are many exciting new start-ups promising to revolutionise healthcare, there are significant challenges ahead before we will know exactly how helpful a distributed ledger can be. This article explores these issues in the context of the UK’s National Health Service (NHS).
An overview of the National Health Service
It’s a bit of a misnomer to think of the NHS as a national organisation. Though funded centrally (almost exclusively through tax contributions), co-ordination of healthcare is performed by a myriad of semi-autonomous and partially competing entities.
One of the largest employers in the world, the NHS treats 1.4 million patients every 24 hours. 207 clinical commissioning groups (CCGs) help channel funds to more than 7,400 GP practices, 135 acute non-specialist trusts and other organisations in England alone. There are 853 for-profit and not-for-profit independent sector organisations providing care to patients from 7,331 locations.1 It is therefore fair to say that the flow of money and data is at best complicated but more likely indecipherable for any single individual.
An attempt to centralise IT services (Connecting for Health, National Programme for IT) famously failed after overspending by an estimated 440-770%.2 There have been many reasons proposed for this failure which are not relevant to the scope of this article. The take home message is clear, however. Centralised projects of this scale cannot work without complete autocracy.
In spite of this colossal flop, the need for integrated care records, prescribing systems and performance management solutions persists. Poor communication and data integrity concerns account for a significant percentage of medical errors and deaths annually. Privacy and accessibility of medical information continue to be of great concern for many patients and clinicians. Financial transparency is almost impossible, and the perceived extent of wasteful practices is frequently in the headlines.
It would be unfair to paint such a dismal picture of the NHS without balancing it with some positive truths. In comparison with the healthcare systems of ten other countries (Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and USA) the NHS was found to be the most impressive overall by the Commonwealth Fund in 2017. This achievement was in spite of the fact that health expenditure in the UK was 9.75% of GDP in 2016 where others have significantly higher percentages and expenditure per capita.
Clinical outcomes were unfortunately not quite as stellar, though measuring quality in healthcare is a complex business.
The ‘quadruple aim’ of healthcare3 is to improve the patient experience, improve the health of the population, reduce per capita costs and reduce staff burnout. The addition of the latter aim is important. Whilst there are many proposed reasons for this worrying trend, one widely held view is that the administrative burden placed on doctors is partly to blame: “It is no coincidence that the spike in burnout rates has come at the same time as the broad adoption of [electronic health records (EHRs)]. Someday, EHRs may revolutionise healthcare by dramatically increasing our ability to share and review patient information. But today, EHRs are turning many physicians into clerks.”4
Improvements to the quadruple bottom line require multiple approaches. Managing the supply-demand relationship of healthcare is complex, as is balancing the conflict of quality and choice versus cost and efficiency. One thing remains true though – decisions should not be based on flawed data. We can only fix what we can identify.
The case for blockchains
No single technology will transform any healthcare system, and it would be naïve to believe blockchain is the exception. Even combined with AI, big data analytics and the other newly spawned hopefuls, distributed ledgers are not entirely capable of addressing the political and economic nuances that influence how care is delivered.
That all said, there is something rather unique about what is being promised. It is not so much the technology per se, as it is the fundamental philosophy underlying it that is so intriguing.
When Bitcoin was launched in 2009, individuals were for the first time able to send electronic cash peer-to-peer across the planet without any central authority permission. This censorship-free value exchange, secured through algorithmic consensus mechanisms and crypto-economic incentives, made dishonest activity economically unviable.
The network effect means that the more participants there are sharing a common trust-brokering infrastructure, the more valuable the platform becomes.
Translating this to healthcare is a bit of a leap of faith, and the technology is nascent to say the least. But, knowing that we can create a virtually unbreakable transaction log and a common communications channel that permits value exchange without third party intermediation is certainly exciting.
Every time the blockchain is added to, the new ‘state of being’ is replicated across the network. All participants can trust the ledger’s integrity and the data is permanently recorded, fully auditable and unalterable.
Whilst this does not guarantee the quality of the data input, it is transparent and there is clear accountability through public key cryptographic signatures. Leaving the importance of oracles and how to ensure the veracity of inputs for another time, it appears that employing distributed ledger technologies may narrow the trust and communication gaps in healthcare significantly.
The NHS evidence base
As we have seen, the NHS is a monolithic tangle of disparate entities – some privately run, others public, but most existing in isolation of one another. Communication cracks between these parties contribute significantly to the inefficiencies observed.
The 2017/2018 NHS England Annual Report5 identifies ten areas of focus for improvement:
Freeing up hospital bed capacity
Improving staff productivity, including further action on temporary labour costs
Leveraging the NHS’s procurement opportunities
Securing best value from medicines and pharmacy
Reducing avoidable demand and meeting demand more appropriately
Reducing unwarranted variation in clinical quality and efficiency
Action on estates, infrastructure, capital and clinical support services
Cutting the cost of corporate services and administration
Improving cost recovery from non-UK residents
Ensuring financial accountability and discipline in all NHS organisations
Closer examination of these areas might provide the basis for testing distributed ledger technology use cases for those aspiring to act.
In addition to this, Lord Holmes published a report in 2017 which examined the potential benefits of distributed ledger technology for improving healthcare in the UK.6 Some of the findings include opportunities lost because of data duplication and fragmentation. Access to medical records, pharmaceutical supply chain integrity, and patient and employee identification mechanisms were also found to be lacking.
Significantly, the report suggests that the use of distributed ledger technology may improve health data and the lives of patients if deployed in these areas.
It’s not a straight line connecting the goals of improvement with the opportunities promised by blockchain. But with self-verifiable data integrity, an accountable log and near real-time state replication at the core, distributed ledger technology might just make agile and informed decisions a realisable reality.
There is of course the issue of interoperability and the fact that blockchains aren’t good for data storage. Nobody believes that legacy systems will be replaced overnight. Yet if trusted, traceable access to these systems can be granted whereby operational decisions can be made, the efficiency could improve dramatically.
The road ahead
Clearly there is much work to be done. Proof-of-concept (PoC) trials with the quadruple aims in mind will need to be conducted before benefits can be claimed. Which blockchain type (public, permissioned or consortium), whether or not a cryptocurrency is required in a semi-trusted environment and the need to comply with regulations (GDPR and many more) all influence the choices ahead.
The burning questions that remain, however, are these:
Who will fund these trials and how do we get potentially conflicting stakeholders to engage in a sharing economy?
Far more challenging than the technological barriers are the political and economic paradigms that need to be questioned. How can we convince individual hospitals with constrained budgets to build a shared infrastructure with a private provider, a local pharmacy group and the surrounding GP practices?
Can co-opetition models work where competing private sector incumbents battle for contracts with the public purse?
Who (not what!) will block the path to data sharing, and how can this be mitigated?
Future outlook of distributed ledgers
Reorganising the NHS for 66.57 million people is a gargantuan task. But we should not be dissuaded – the appetite for change and improvement is high. The overall benefits to patients and doctors may far outweigh the costs. In fact, the potential revenue for the UK economy may be significant.
Imagine these scenarios:
Several major UK pharmaceutical companies collaborate with research institutes, CCGs and the major teaching hospitals across the UK. Each is a shareholder in the new joint venture, the purpose of which is to mine national level health data for insights into cancer treatment. Any intellectual property derived is shared, as are the financial returns from new product development. All parties win, patient health improves, and the NHS has additional revenue for reinvestment
All NHS hospitals share doctor credential data with each other (permissions granted by the doctor of course). The Disclosure and Barring Service, General Medical Council, royal colleges and universities also share in these common communications channels. Now a doctor can move freely within the system nationwide if his/her CV matches requirements for work. It doesn’t take months of compliance checks or the costs associated with duplicating those tasks. Matching of supply and demand reduces the need for expensive agency intermediaries. The savings are used to improve doctor pay and improve patient care
NHS trusts join forces with procurement bodies, the supply chain stakeholders (including equipment companies) and the CCGs. Real-time enterprise resource planning with full track and trace facilities creates a responsive and efficient ecosystem. Savings once again are shared, with patients and listed companies sharing in the spoils.
Whilst this all sounds dreamy, unrealistic and perhaps threatening to some, it represents a paradigm shift in business models where profit and the sharing economy can coexist.
Data silos emerge when information sharing costs the company money. Data collaboration on the other hand brings economies of scale and scope, a shared cost base and a percentage share of a potentially much bigger prize.
Naturally, there are no guarantees. But perhaps, with all the other emerging technologies and the combined resources of the public and private sectors, there may well be an opportunity to achieve that quadruple aim.
And if the PoC trials demonstrate positive returns, the burning question will then be: who will block the path or make it happen?
About the author
Dr Stewart Southey MBBCh FRCA MBA MSc (Digital Currencies, in progress) is a senior NHS consultant, healthcare strategist, founder of Catena Consulting and chief medical officer at Biohax International. He is passionate about any medtech and healthcare innovation that promises to improve the delivery of care.
References
https://ift.tt/XNCARo
https://ift.tt/2El5Bh8
https://ift.tt/2E83exa
https://ift.tt/2EjwfGZ
https://ift.tt/2E83f4c
https://ift.tt/2zGdXdj
Dr Stewart Southey Founder Catena Consulting Tweet @docsouthey https://catena.mba/
This article will appear in issue 8 of Health Europa Quarterly, which will be published in February 2019.  
Source link https://ift.tt/2E6PBhM
0 notes
courtneyvbrooks87 · 6 years
Text
Evaluating blockchain and distributed ledger use for the NHS
Evaluating blockchain and distributed ledger use for the NHS
© iStock-LeoWolfert
Dr Stewart Southey weighs the potential benefits of blockchain and distributed ledger technology in the NHS
The past few years have seen a veritable frenzy wherever the term blockchain has been used. Touted as the silver bullet that will save every industry, billions of euros of venture capital and crowdfunded money has been poured into new projects. Though there are many exciting new start-ups promising to revolutionise healthcare, there are significant challenges ahead before we will know exactly how helpful a distributed ledger can be. This article explores these issues in the context of the UK’s National Health Service (NHS).
An overview of the National Health Service
It’s a bit of a misnomer to think of the NHS as a national organisation. Though funded centrally (almost exclusively through tax contributions), co-ordination of healthcare is performed by a myriad of semi-autonomous and partially competing entities.
One of the largest employers in the world, the NHS treats 1.4 million patients every 24 hours. 207 clinical commissioning groups (CCGs) help channel funds to more than 7,400 GP practices, 135 acute non-specialist trusts and other organisations in England alone. There are 853 for-profit and not-for-profit independent sector organisations providing care to patients from 7,331 locations.1 It is therefore fair to say that the flow of money and data is at best complicated but more likely indecipherable for any single individual.
An attempt to centralise IT services (Connecting for Health, National Programme for IT) famously failed after overspending by an estimated 440-770%.2 There have been many reasons proposed for this failure which are not relevant to the scope of this article. The take home message is clear, however. Centralised projects of this scale cannot work without complete autocracy.
In spite of this colossal flop, the need for integrated care records, prescribing systems and performance management solutions persists. Poor communication and data integrity concerns account for a significant percentage of medical errors and deaths annually. Privacy and accessibility of medical information continue to be of great concern for many patients and clinicians. Financial transparency is almost impossible, and the perceived extent of wasteful practices is frequently in the headlines.
It would be unfair to paint such a dismal picture of the NHS without balancing it with some positive truths. In comparison with the healthcare systems of ten other countries (Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and USA) the NHS was found to be the most impressive overall by the Commonwealth Fund in 2017. This achievement was in spite of the fact that health expenditure in the UK was 9.75% of GDP in 2016 where others have significantly higher percentages and expenditure per capita.
Clinical outcomes were unfortunately not quite as stellar, though measuring quality in healthcare is a complex business.
The ‘quadruple aim’ of healthcare3 is to improve the patient experience, improve the health of the population, reduce per capita costs and reduce staff burnout. The addition of the latter aim is important. Whilst there are many proposed reasons for this worrying trend, one widely held view is that the administrative burden placed on doctors is partly to blame: “It is no coincidence that the spike in burnout rates has come at the same time as the broad adoption of [electronic health records (EHRs)]. Someday, EHRs may revolutionise healthcare by dramatically increasing our ability to share and review patient information. But today, EHRs are turning many physicians into clerks.”4
Improvements to the quadruple bottom line require multiple approaches. Managing the supply-demand relationship of healthcare is complex, as is balancing the conflict of quality and choice versus cost and efficiency. One thing remains true though – decisions should not be based on flawed data. We can only fix what we can identify.
The case for blockchains
No single technology will transform any healthcare system, and it would be naïve to believe blockchain is the exception. Even combined with AI, big data analytics and the other newly spawned hopefuls, distributed ledgers are not entirely capable of addressing the political and economic nuances that influence how care is delivered.
That all said, there is something rather unique about what is being promised. It is not so much the technology per se, as it is the fundamental philosophy underlying it that is so intriguing.
When Bitcoin was launched in 2009, individuals were for the first time able to send electronic cash peer-to-peer across the planet without any central authority permission. This censorship-free value exchange, secured through algorithmic consensus mechanisms and crypto-economic incentives, made dishonest activity economically unviable.
The network effect means that the more participants there are sharing a common trust-brokering infrastructure, the more valuable the platform becomes.
Translating this to healthcare is a bit of a leap of faith, and the technology is nascent to say the least. But, knowing that we can create a virtually unbreakable transaction log and a common communications channel that permits value exchange without third party intermediation is certainly exciting.
Every time the blockchain is added to, the new ‘state of being’ is replicated across the network. All participants can trust the ledger’s integrity and the data is permanently recorded, fully auditable and unalterable.
Whilst this does not guarantee the quality of the data input, it is transparent and there is clear accountability through public key cryptographic signatures. Leaving the importance of oracles and how to ensure the veracity of inputs for another time, it appears that employing distributed ledger technologies may narrow the trust and communication gaps in healthcare significantly.
The NHS evidence base
As we have seen, the NHS is a monolithic tangle of disparate entities – some privately run, others public, but most existing in isolation of one another. Communication cracks between these parties contribute significantly to the inefficiencies observed.
The 2017/2018 NHS England Annual Report5 identifies ten areas of focus for improvement:
Freeing up hospital bed capacity
Improving staff productivity, including further action on temporary labour costs
Leveraging the NHS’s procurement opportunities
Securing best value from medicines and pharmacy
Reducing avoidable demand and meeting demand more appropriately
Reducing unwarranted variation in clinical quality and efficiency
Action on estates, infrastructure, capital and clinical support services
Cutting the cost of corporate services and administration
Improving cost recovery from non-UK residents
Ensuring financial accountability and discipline in all NHS organisations
Closer examination of these areas might provide the basis for testing distributed ledger technology use cases for those aspiring to act.
In addition to this, Lord Holmes published a report in 2017 which examined the potential benefits of distributed ledger technology for improving healthcare in the UK.6 Some of the findings include opportunities lost because of data duplication and fragmentation. Access to medical records, pharmaceutical supply chain integrity, and patient and employee identification mechanisms were also found to be lacking.
Significantly, the report suggests that the use of distributed ledger technology may improve health data and the lives of patients if deployed in these areas.
It’s not a straight line connecting the goals of improvement with the opportunities promised by blockchain. But with self-verifiable data integrity, an accountable log and near real-time state replication at the core, distributed ledger technology might just make agile and informed decisions a realisable reality.
There is of course the issue of interoperability and the fact that blockchains aren’t good for data storage. Nobody believes that legacy systems will be replaced overnight. Yet if trusted, traceable access to these systems can be granted whereby operational decisions can be made, the efficiency could improve dramatically.
The road ahead
Clearly there is much work to be done. Proof-of-concept (PoC) trials with the quadruple aims in mind will need to be conducted before benefits can be claimed. Which blockchain type (public, permissioned or consortium), whether or not a cryptocurrency is required in a semi-trusted environment and the need to comply with regulations (GDPR and many more) all influence the choices ahead.
The burning questions that remain, however, are these:
Who will fund these trials and how do we get potentially conflicting stakeholders to engage in a sharing economy?
Far more challenging than the technological barriers are the political and economic paradigms that need to be questioned. How can we convince individual hospitals with constrained budgets to build a shared infrastructure with a private provider, a local pharmacy group and the surrounding GP practices?
Can co-opetition models work where competing private sector incumbents battle for contracts with the public purse?
Who (not what!) will block the path to data sharing, and how can this be mitigated?
Future outlook of distributed ledgers
Reorganising the NHS for 66.57 million people is a gargantuan task. But we should not be dissuaded – the appetite for change and improvement is high. The overall benefits to patients and doctors may far outweigh the costs. In fact, the potential revenue for the UK economy may be significant.
Imagine these scenarios:
Several major UK pharmaceutical companies collaborate with research institutes, CCGs and the major teaching hospitals across the UK. Each is a shareholder in the new joint venture, the purpose of which is to mine national level health data for insights into cancer treatment. Any intellectual property derived is shared, as are the financial returns from new product development. All parties win, patient health improves, and the NHS has additional revenue for reinvestment
All NHS hospitals share doctor credential data with each other (permissions granted by the doctor of course). The Disclosure and Barring Service, General Medical Council, royal colleges and universities also share in these common communications channels. Now a doctor can move freely within the system nationwide if his/her CV matches requirements for work. It doesn’t take months of compliance checks or the costs associated with duplicating those tasks. Matching of supply and demand reduces the need for expensive agency intermediaries. The savings are used to improve doctor pay and improve patient care
NHS trusts join forces with procurement bodies, the supply chain stakeholders (including equipment companies) and the CCGs. Real-time enterprise resource planning with full track and trace facilities creates a responsive and efficient ecosystem. Savings once again are shared, with patients and listed companies sharing in the spoils.
Whilst this all sounds dreamy, unrealistic and perhaps threatening to some, it represents a paradigm shift in business models where profit and the sharing economy can coexist.
Data silos emerge when information sharing costs the company money. Data collaboration on the other hand brings economies of scale and scope, a shared cost base and a percentage share of a potentially much bigger prize.
Naturally, there are no guarantees. But perhaps, with all the other emerging technologies and the combined resources of the public and private sectors, there may well be an opportunity to achieve that quadruple aim.
And if the PoC trials demonstrate positive returns, the burning question will then be: who will block the path or make it happen?
About the author
Dr Stewart Southey MBBCh FRCA MBA MSc (Digital Currencies, in progress) is a senior NHS consultant, healthcare strategist, founder of Catena Consulting and chief medical officer at Biohax International. He is passionate about any medtech and healthcare innovation that promises to improve the delivery of care.
References
https://ift.tt/XNCARo
https://ift.tt/2El5Bh8
https://ift.tt/2E83exa
https://ift.tt/2EjwfGZ
https://ift.tt/2E83f4c
https://ift.tt/2zGdXdj
Dr Stewart Southey Founder Catena Consulting Tweet @docsouthey https://catena.mba/
This article will appear in issue 8 of Health Europa Quarterly, which will be published in February 2019.  
Source link https://ift.tt/2E6PBhM
0 notes
teiraymondmccoy78 · 6 years
Text
Evaluating blockchain and distributed ledger use for the NHS
Evaluating blockchain and distributed ledger use for the NHS
© iStock-LeoWolfert
Dr Stewart Southey weighs the potential benefits of blockchain and distributed ledger technology in the NHS
The past few years have seen a veritable frenzy wherever the term blockchain has been used. Touted as the silver bullet that will save every industry, billions of euros of venture capital and crowdfunded money has been poured into new projects. Though there are many exciting new start-ups promising to revolutionise healthcare, there are significant challenges ahead before we will know exactly how helpful a distributed ledger can be. This article explores these issues in the context of the UK’s National Health Service (NHS).
An overview of the National Health Service
It’s a bit of a misnomer to think of the NHS as a national organisation. Though funded centrally (almost exclusively through tax contributions), co-ordination of healthcare is performed by a myriad of semi-autonomous and partially competing entities.
One of the largest employers in the world, the NHS treats 1.4 million patients every 24 hours. 207 clinical commissioning groups (CCGs) help channel funds to more than 7,400 GP practices, 135 acute non-specialist trusts and other organisations in England alone. There are 853 for-profit and not-for-profit independent sector organisations providing care to patients from 7,331 locations.1 It is therefore fair to say that the flow of money and data is at best complicated but more likely indecipherable for any single individual.
An attempt to centralise IT services (Connecting for Health, National Programme for IT) famously failed after overspending by an estimated 440-770%.2 There have been many reasons proposed for this failure which are not relevant to the scope of this article. The take home message is clear, however. Centralised projects of this scale cannot work without complete autocracy.
In spite of this colossal flop, the need for integrated care records, prescribing systems and performance management solutions persists. Poor communication and data integrity concerns account for a significant percentage of medical errors and deaths annually. Privacy and accessibility of medical information continue to be of great concern for many patients and clinicians. Financial transparency is almost impossible, and the perceived extent of wasteful practices is frequently in the headlines.
It would be unfair to paint such a dismal picture of the NHS without balancing it with some positive truths. In comparison with the healthcare systems of ten other countries (Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and USA) the NHS was found to be the most impressive overall by the Commonwealth Fund in 2017. This achievement was in spite of the fact that health expenditure in the UK was 9.75% of GDP in 2016 where others have significantly higher percentages and expenditure per capita.
Clinical outcomes were unfortunately not quite as stellar, though measuring quality in healthcare is a complex business.
The ‘quadruple aim’ of healthcare3 is to improve the patient experience, improve the health of the population, reduce per capita costs and reduce staff burnout. The addition of the latter aim is important. Whilst there are many proposed reasons for this worrying trend, one widely held view is that the administrative burden placed on doctors is partly to blame: “It is no coincidence that the spike in burnout rates has come at the same time as the broad adoption of [electronic health records (EHRs)]. Someday, EHRs may revolutionise healthcare by dramatically increasing our ability to share and review patient information. But today, EHRs are turning many physicians into clerks.”4
Improvements to the quadruple bottom line require multiple approaches. Managing the supply-demand relationship of healthcare is complex, as is balancing the conflict of quality and choice versus cost and efficiency. One thing remains true though – decisions should not be based on flawed data. We can only fix what we can identify.
The case for blockchains
No single technology will transform any healthcare system, and it would be naïve to believe blockchain is the exception. Even combined with AI, big data analytics and the other newly spawned hopefuls, distributed ledgers are not entirely capable of addressing the political and economic nuances that influence how care is delivered.
That all said, there is something rather unique about what is being promised. It is not so much the technology per se, as it is the fundamental philosophy underlying it that is so intriguing.
When Bitcoin was launched in 2009, individuals were for the first time able to send electronic cash peer-to-peer across the planet without any central authority permission. This censorship-free value exchange, secured through algorithmic consensus mechanisms and crypto-economic incentives, made dishonest activity economically unviable.
The network effect means that the more participants there are sharing a common trust-brokering infrastructure, the more valuable the platform becomes.
Translating this to healthcare is a bit of a leap of faith, and the technology is nascent to say the least. But, knowing that we can create a virtually unbreakable transaction log and a common communications channel that permits value exchange without third party intermediation is certainly exciting.
Every time the blockchain is added to, the new ‘state of being’ is replicated across the network. All participants can trust the ledger’s integrity and the data is permanently recorded, fully auditable and unalterable.
Whilst this does not guarantee the quality of the data input, it is transparent and there is clear accountability through public key cryptographic signatures. Leaving the importance of oracles and how to ensure the veracity of inputs for another time, it appears that employing distributed ledger technologies may narrow the trust and communication gaps in healthcare significantly.
The NHS evidence base
As we have seen, the NHS is a monolithic tangle of disparate entities – some privately run, others public, but most existing in isolation of one another. Communication cracks between these parties contribute significantly to the inefficiencies observed.
The 2017/2018 NHS England Annual Report5 identifies ten areas of focus for improvement:
Freeing up hospital bed capacity
Improving staff productivity, including further action on temporary labour costs
Leveraging the NHS’s procurement opportunities
Securing best value from medicines and pharmacy
Reducing avoidable demand and meeting demand more appropriately
Reducing unwarranted variation in clinical quality and efficiency
Action on estates, infrastructure, capital and clinical support services
Cutting the cost of corporate services and administration
Improving cost recovery from non-UK residents
Ensuring financial accountability and discipline in all NHS organisations
Closer examination of these areas might provide the basis for testing distributed ledger technology use cases for those aspiring to act.
In addition to this, Lord Holmes published a report in 2017 which examined the potential benefits of distributed ledger technology for improving healthcare in the UK.6 Some of the findings include opportunities lost because of data duplication and fragmentation. Access to medical records, pharmaceutical supply chain integrity, and patient and employee identification mechanisms were also found to be lacking.
Significantly, the report suggests that the use of distributed ledger technology may improve health data and the lives of patients if deployed in these areas.
It’s not a straight line connecting the goals of improvement with the opportunities promised by blockchain. But with self-verifiable data integrity, an accountable log and near real-time state replication at the core, distributed ledger technology might just make agile and informed decisions a realisable reality.
There is of course the issue of interoperability and the fact that blockchains aren’t good for data storage. Nobody believes that legacy systems will be replaced overnight. Yet if trusted, traceable access to these systems can be granted whereby operational decisions can be made, the efficiency could improve dramatically.
The road ahead
Clearly there is much work to be done. Proof-of-concept (PoC) trials with the quadruple aims in mind will need to be conducted before benefits can be claimed. Which blockchain type (public, permissioned or consortium), whether or not a cryptocurrency is required in a semi-trusted environment and the need to comply with regulations (GDPR and many more) all influence the choices ahead.
The burning questions that remain, however, are these:
Who will fund these trials and how do we get potentially conflicting stakeholders to engage in a sharing economy?
Far more challenging than the technological barriers are the political and economic paradigms that need to be questioned. How can we convince individual hospitals with constrained budgets to build a shared infrastructure with a private provider, a local pharmacy group and the surrounding GP practices?
Can co-opetition models work where competing private sector incumbents battle for contracts with the public purse?
Who (not what!) will block the path to data sharing, and how can this be mitigated?
Future outlook of distributed ledgers
Reorganising the NHS for 66.57 million people is a gargantuan task. But we should not be dissuaded – the appetite for change and improvement is high. The overall benefits to patients and doctors may far outweigh the costs. In fact, the potential revenue for the UK economy may be significant.
Imagine these scenarios:
Several major UK pharmaceutical companies collaborate with research institutes, CCGs and the major teaching hospitals across the UK. Each is a shareholder in the new joint venture, the purpose of which is to mine national level health data for insights into cancer treatment. Any intellectual property derived is shared, as are the financial returns from new product development. All parties win, patient health improves, and the NHS has additional revenue for reinvestment
All NHS hospitals share doctor credential data with each other (permissions granted by the doctor of course). The Disclosure and Barring Service, General Medical Council, royal colleges and universities also share in these common communications channels. Now a doctor can move freely within the system nationwide if his/her CV matches requirements for work. It doesn’t take months of compliance checks or the costs associated with duplicating those tasks. Matching of supply and demand reduces the need for expensive agency intermediaries. The savings are used to improve doctor pay and improve patient care
NHS trusts join forces with procurement bodies, the supply chain stakeholders (including equipment companies) and the CCGs. Real-time enterprise resource planning with full track and trace facilities creates a responsive and efficient ecosystem. Savings once again are shared, with patients and listed companies sharing in the spoils.
Whilst this all sounds dreamy, unrealistic and perhaps threatening to some, it represents a paradigm shift in business models where profit and the sharing economy can coexist.
Data silos emerge when information sharing costs the company money. Data collaboration on the other hand brings economies of scale and scope, a shared cost base and a percentage share of a potentially much bigger prize.
Naturally, there are no guarantees. But perhaps, with all the other emerging technologies and the combined resources of the public and private sectors, there may well be an opportunity to achieve that quadruple aim.
And if the PoC trials demonstrate positive returns, the burning question will then be: who will block the path or make it happen?
About the author
Dr Stewart Southey MBBCh FRCA MBA MSc (Digital Currencies, in progress) is a senior NHS consultant, healthcare strategist, founder of Catena Consulting and chief medical officer at Biohax International. He is passionate about any medtech and healthcare innovation that promises to improve the delivery of care.
References
https://ift.tt/XNCARo
https://ift.tt/2El5Bh8
https://ift.tt/2E83exa
https://ift.tt/2EjwfGZ
https://ift.tt/2E83f4c
https://ift.tt/2zGdXdj
Dr Stewart Southey Founder Catena Consulting Tweet @docsouthey https://catena.mba/
This article will appear in issue 8 of Health Europa Quarterly, which will be published in February 2019.  
Source link https://ift.tt/2E6PBhM
0 notes
Text
Share Your Expertise. Go The World
With places of work in Eire, the Uk and Poland, sourcing in long term, momentary and deal work with multinationals, early phase and neighborhood indigenous businesses, providing an unrivaled and proven recruitment service for our candidates and customers alike.When HRIS is employed for recruitment procedures, it can crack down partitions. Organizations are capable to simply put up hiring requirements so that they are viewable by present workers as well as outside the house candidates, eliminating the favoring issues that crop up when professionals explain to only specified staff about an open up situation. Workers are also ready to check out and apply for available positions without having the level of competitors that was frequently present in the earlier.A new emptiness exists for an knowledgeable Deckhand/ Dive Master to join a 90m+ personal motor ... There will be times when you will come to feel extremely bleak about your marriage. You willGetting a advisor signifies working with a great deal of different consumers, often in a lot of diverse industries. To get operate in the subject, you require to be capable to offer your abilities to company house owners and supervisors. This also indicates doing work with a range of folks with quite a few backgrounds. If networking in such a fashion arrives normally for you, thats a large phase toward being effective as a advisor.Up or Out not with Consileon. We let you to modify in between operational and management roles. Persuade oneself that careers can be planned separately even inside the consulting department. Marketplace major multi-countrywide wellness-treatment company primarily based in the South East are currently recruiting for an Automation Engineer.Hello to all DONs in South Dublin / Wicklow region! An Italian style, medium dimension nursing house in Bray is seeking for a new Director. Fascinated? Click on under for entire specifics:Kiwis STAT A recruitment organization for locum doctors and allied health professionals, with placements in New Zealand, Australia and the British isles. JobCafe A site that matches work seekers' skills with existing vacancies in a vast range of fields.Wholeoranges Consulting A company that recruits staff for executive, managerial and administrative enterprise providers assist positions.We are in search of a relief 2nd Engineer to sign up for a tall ship sailing charity. The profitable candidate ... We have a opportunity for a Product sales Person to join a organization dependent in Co Laois that supply components, timber fencing, gates and outside engage in tools too the general community, the farming market and builder's suppliers. YouTubeWe have a chance for a Shop Man or woman to sign up for a company primarily based in Co Laois that provide components, timber fencing, gates and outside perform equipment way too the standard general public, the farming industry and builder's providers. We are searching for Senior Marketing Revenue Executives to join our Guardian Employment crew.A main lights distributor in the Irish market now call for a Graduate Lights Designer, Cork metropolis . Make contact with Felicity 086 7821714Blackboard The Defeat Enroll & Pay Dykes Library Educational Calendar More Pupil Services Make sure you e-mail your CV, alongside with a letter indicating why you are fascinated in this placement and the work reference number (RESP-EAC-03-eighteen) to:Our Shopper a foremost distributor are searching for to Recruit a knowledge HR/H&S Manager on website with consumer primarily based in Kildare:Make sure your read a task advert quite carefully. Only if you feel you have the appropriate expertise or have the potential to create into the part, just take the time to utilize. Dont waste anyones time by implementing for In case you have any kind of concerns relating to where and also tips on how to use Executive search, you possibly can email us in our webpage. unsuitable employment. If in doubt, contact your Advisor for a a lot more casual discussion prior to applying so that you can make an knowledgeable selection to use. "Jay Abraham is scientific. Jay Abraham is a maestro. Much more especially and I cant emphasize it enough times Jay Abraham is a marketing genius. What Jay does greater than any other human currently being on the globe is get what you presently have and use it to generate income flow swiftly. Jay has developed phenomenal final results for major journals, big brokerage companies, billion greenback insurance policies firms, mutual resources, and commodities firms, to name but a couple of. Jay Abraham can occur up with more interesting, revenue creating suggestions in an hour than the typical marketing and advertising specialist can create in a year. In my view, he is the foremost marketing and advertising genius in the United States and the Totally free globe these days. In effect, Jay Abrahams services value totally absolutely nothing instead, he can make his customers cash!"There are so several issues that can destroy a evening in a resort. Below are some of the kinds that tend not to get thought about (theyre also philosophical): a single might come to feel anxious or baffled. A single may possibly be lonely. 1 may possibly have an argument with types wife or husband. One particular may well feel disconnected from the lifestyle of the region all about. Typically, resorts dont feel these type of troubles belong to them. They restrict their emphasis to the soap and the bed. In other words, theyre forgetting the total selection of implicit guarantees theyve manufactured to their clients: you will be happy with us.No subject in which you are on the transformation journey, we can help. Our consultants know enterprise and they know technological innovation they can help you:
0 notes
cleopatrarps · 6 years
Text
Investors seek cover as trade battles rattle world markets
LONDON (Reuters) – Investors have sharply increased their use of hedging strategies, signaling concerns that the intensifying trade battle between the United States and China might hit economies from Germany to South Korea.
Traders work on the floor of the New York Stock Exchange (NYSE) in New York, U.S., June 27, 2018. REUTERS/Brendan McDermid
Money managers say that mounting barriers to trade between the United States and trading partners — Washington’s latest proposal for tariffs on $675 billion of Chinese goods is expected to elicit a response from Beijing — is prompting them to look for ways to protect profits in the event equity markets take a dive after years of growth.
That includes bets against declines in equity indexes and currencies as well as dividends and bonds.
“Only now have trade war concerns grabbed the spotlight for investors after bubbling away in the background for most of this year, prompting the rush for such hedging trades,” said Gerard Fitzpatrick, London-based chief investment officer for Europe Middle East and Africa at Russell Investments, which has nearly $300 billion of assets under management.
Trade isn’t the only issue weighing on investors’ minds. European growth has lost steam, oil prices are near $80 a barrel while the U.S., European and many emerging central banks are tightening monetary policy.
And politics could exacerbate any downturn, with Germany’s coalition in uproar over migration, and Italy’s new government flirting with a big-spending, possibly eurosceptic, agenda.
Hedging strategies also carry risk, however, namely that an anticipated market fall does not materialize.
Despite rising concerns among investors, the world economy is on a strong footing, with the global economy expected to grow 3.9 percent this year and next, according to the International Monetary Fund.
While many investors are reducing their exposure to equities, most remain reluctant to completely move away from stocks. As a result, demand has risen for investment positions aimed at offsetting potential losses, according to money managers, market indicators and data.
That includes trades such as “put” options on certain indexes – allowing them to sell at a preset price if the index falls below a certain level in exchange for paying a premium – or short selling the bonds of highly indebted companies.
Short selling is when hedge funds and other investors borrow securities and sell them, betting the price will fall so they can buy them back later at a lower price for return to the lender.
Investors also appear to be seeking more options market protection against currency losses, especially on trade-sensitive currencies such as the Australian dollar or the Chinese yuan, via purchasing put options on these currencies in the $5.1 trillion a day foreign exchange markets.
“Some of these trades are an extension to what we have been seeing from earlier this year but there is no doubt that there is increased nervousness now reflected in markets,” said Eugene Philalithis, a portfolio manager at Fidelity International, which manages $2.4 trillion assets under management globally.
“CRASH INSURANCE”
Shifts in the costs of derivatives indicate hedging demand has picked up since trade concerns intensified.
For instance, the cost of hedging against falls in Germany’s DAX index .GDAXI, highly exposed to exports to the United States and China, has increased sharply in the past week, according to Mathilde Richardot, a derivatives strategist at BNP Paribas based in London.
The Euro Stoxx 50 Volatility Index skew – a measure that derivatives markets look at to gauge demand for protection against volatility spikes – hit an all-time high as investors bought protection against sharp drops in equity prices for July and August. Similar moves were seen in U.S. stocks. .SKEWX
Some market specialists say out-of-the-money put options are increasingly popular; they are typically cheaper and provide protection in the event of larger price drops.
Investors have also purchased options that hedge against a drop of 10 percent or more in U.S. indexes, according to UBS strategists.
Open interest – or the value of such options outstanding and a gauge of demand from investors – on put options on the S&P 500 index .SPX falling around 10 percent from current levels maturing in the next two weeks is far greater than on other options, according to Thomson Reuters data.
Such is the demand for such “crash insurance” that James Purcell, head of alternative and sustainable investments at UBS Global Wealth Management said they are advising clients to look at other markets such as Hong Kong and South Korea to hedge equity market downside risks.
Edmund Shing, head of global equity derivatives at BNP Paribas says “the whole point of insurance is you should buy it if it’s cheap.”
Such trades are attractively priced because volatility, despite the souring environment, remains low, a phenomenon some put down to central bank liquidity supporting asset prices.
A gauge of expected S&P500 volatility is half the level of highs hit in February .VIX.
For graphic on stock correlations indices and VIX June 28 click reut.rs/2N357gx
Interest by investors in dividend hedging is also on the rise. While bumper shareholder payouts alongside buybacks have driven much of the equity bonanza in recent years, logic dictates that any glitch in the corporate cycle will cause dividends to be cut.
Investors often buy dividend futures, or contracts that allow them to bet on companies’ future payouts.
But “puts” on Eurostoxx 50 dividend futures are drawing more interest, according to Societe Generale and BNP Paribas, banks that dominate Europe’s equity derivatives business.
When the global economy is doing well, companies are comfortable paying out dividends to their investors but at the first sign of market stress, companies want to conserve precious cash flow so “dividends suffer a lot more,” said Charles de Boissezon, deputy head of global asset allocation strategy at Societe Generale.
Once the preserve of hedge funds, mainstream asset managers and pension funds increasingly use dividend futures, he added.
The Euro Stoxx 50 dividend futures index .SX5EDFT, which aggregates dividend futures contracts, is down 2.1 percent year-to-date, after six consecutive years of gains, suggesting investors expect dividends to decline.
Away from derivatives, outright short interest in emerging market equities has picked up on concerns that this sector would be worst hit should a trade war break out. Short interest measures the number of short positions not yet closed out.
Short bets in emerging market equities scaled a post-crisis high of $110 billion in early June, with China, Hong Kong, Taiwan and New Zealand among the most shorted markets, according to data from IHS Markit.
BOND MARKETS
Bond markets have not been spared. Investors have built a notional $55 billion of short positions in U.S. dollar-denominated investment-grade corporate debt, according to IHS Markit. Short positions are up $8 billion this year and rose more than $2.3 billion since the end of April, IHS Markit data shows.
High-grade bonds have performed poorly this year; this and the short bets are down to companies’ high debt levels — almost all U.S. sectors’ leverage ratios were above their 20-year average as of end-2017, Societe Generale estimates.
This makes companies vulnerable to rising borrowing costs as well as higher tariffs.
For graphic on US and HY debt click reut.rs/2tD3zBW
A trade war would darken the overall outlook but some currencies, including the Australian dollar or from emerging markets, are expected to suffer more than others.
Investors went long the dollar the week of June 18 against emerging currencies for the first time in eight months NETUSDEM=. Australia’s dollar AUD=D3 is near 1-1/2 year lows as the country boasts China as its biggest trading partner.
Derivative markets suggest investors are increasingly risk averse.
Three-month risk reversals on the Australian dollar AUD3MRR=, a ratio of calls to puts, is near 2018 lows. A similar gauge on the Swiss franc CHF3MRR=, a perceived safe-haven in the currency markets, indicates bullish positions on the franc at near two-month highs.
For graphic on euro usd positions click reut.rs/2tCeueZ
For graphic on flattening yield curves click reut.rs/2IxiAKg
Reporting by Saikat Chatterjee and Helen Reid; editing by Sujata Rao and Cassell Bryan-Low
The post Investors seek cover as trade battles rattle world markets appeared first on World The News.
from World The News https://ift.tt/2z7Qbe2 via News of World
0 notes
cool-cillian-murphy · 4 years
Text
Global Patient Lift Market: Intense Competition but High Growth & Extreme Valuation
The patient mechanical lift handling equipment market is expected to grow in the future due to the increasing demand for advanced technological equipment to handle patients with more care. Patient Mechanical Lift Handling Equipment has gained widespread acceptance by diverse departments such as orthopedics, neurology, rehabilitation, and bariatric surgeries, critical care units, etc. It provides the greatest contributions in assisting the patients from one place to another place.
Latest Research Study on Global Patient Lift Market published by AMA, offers a detailed overview of the factors influencing the global business scope. Patient Lift Market research report shows the latest market insights with upcoming trends and breakdown of the products and services. The report provides key statistics on the market status, size, share, growth factors, Challenges and Current Scenario Analysis of the Patient Lift. This Report also covers the emerging player’s data, including: competitive situation, sales, revenue and global market share of top manufacturers are Stryker Corporation (United States), Hill-Rom Holdings Inc. (United States), Invacare Corporation (United States), Guldmann Inc. (United States), Getinge Group (Sweden), Handicare Group AB (Sweden), Gainsborough Specialist Bathing (United Kingdom), Mangar International, Inc. (United Kingdom), Prism Medical UK (United Kingdom), Joerns Healthcare, Inc. (United States) and Stiegelmeyer, Inc. (Germany). Free Sample Report + All Related Graphs & Charts @ : https://www.advancemarketanalytics.com/sample-report/165124-global-patient-mechanical-lift-handling-equipment-market
The growing emergency units in the hospital and increasing demand for patient equipment devices in hospitals other healthcare units is mandatory nowadays. The Top leading firms are launching their innovative device for easy tasking of hospitals and patients as well. There are also some mergers and acquisitions are taking place to enhance the business strategies of firms. Research Analyst at AMA estimates that United States Players will contribute to the maximum growth of Global Patient Mechanical Lift Handling Equipment market throughout the predicted period.
Market Trend
Technological     Innovation in Patient Mechanical Lift Handling Equipment
Market Drivers
Increasing Number of     Musculoskeletal Injuries
Rising Incidence of     Chronic Conditions and Trauma Injuries
Opportunities
Improvement in     Healthcare Infrastructure by Various Government Initiatives
Increasing Healthcare     Expenditure across the Globe
Growing Safety Concerns     in Hospital units
Restraints
Lack of Proper Budget     Allocation
High Cost of the     Equipment
Challenges
Dearth of Awareness     among Patients mostly in Developing and Under-Developed
The Global Patient Lift Market segments and Market Data Break Down are illuminated below: by Type (Stand Up & Raising Lifts/Aids, Overhead/Ceiling Lifts, Floor-Based Lifts, Gantry Lifts, Powered Sit-To-Stand Lifts, Bath Patient Lifters, Others), Application (Long Term Care, Bariatric Care, Acute and Critical Care, Wound Care, Fall Prevention, Others), End User (Hospital, Home Care Settings, Elderly Care Facilities, Others)  Region Included are: North America, Europe, Asia Pacific, Oceania, South America, Middle East & Africa
Country Level Break-Up: United States, Canada, Mexico, Brazil, Argentina, Colombia, Chile, South Africa, Nigeria, Tunisia, Morocco, Germany, United Kingdom (UK), the Netherlands, Spain, Italy, Belgium, Austria, Turkey, Russia, France, Poland, Israel, United Arab Emirates, Qatar, Saudi Arabia, China, Japan, Taiwan, South Korea, Singapore, India, Australia and New Zealand etc. For Early Buyers | Get Up to 10% – 25% Discount on Various License type of this Premium Version of the Report: https://www.advancemarketanalytics.com/request-discount/165124-global-patient-mechanical-lift-handling-equipment-market Strategic Points Covered in Table of Content of Global Patient Lift Market:
Chapter 1: Introduction, market driving force product Objective of Study and Research Scope the Patient Lift market
Chapter 2: Exclusive Summary – the basic information of the Patient Lift Market.
Chapter 3: Displaying the Market Dynamics- Drivers, Trends and Challenges & Opportunities of the Patient Lift
Chapter 4: Presenting the Patient Lift Market Factor Analysis, Post COVID Impact Analysis, Porters Five Forces, Supply/Value Chain, PESTEL analysis, Market Entropy, Patent/Trademark Analysis.
Chapter 5: Displaying the by Type, End User and Region/Country 2015-2020
Chapter 6: Evaluating the leading manufacturers of the Patient Lift market which consists of its Competitive Landscape, Peer Group Analysis, BCG Matrix & Company Profile
Chapter 7: To evaluate the market by segments, by countries and by Manufacturers/Company with revenue share and sales by key countries in these various regions (2021-2026)
Chapter 8 & 9: Displaying the Appendix, Methodology and Data Source Finally, Patient Lift Market is a valuable source of guidance for individuals and companies in their decision framework. Data Sources & Methodology The primary sources involves the industry experts from the Global Patient Lift Market including the management organizations, processing organizations, analytics service providers of the industry’s value chain. All primary sources were interviewed to gather and authenticate qualitative & quantitative information and determine the future prospects. In the extensive primary research process undertaken for this study, the primary sources – Postal Surveys, telephone, Online & Face-to-Face Survey were considered to obtain and verify both qualitative and quantitative aspects of this research study. When it comes to secondary sources Company's Annual reports, press Releases, Websites, Investor Presentation, Conference Call transcripts, Webinar, Journals, Regulators, National Customs and Industry Associations were given primary weight-age. Get More Information: https://www.advancemarketanalytics.com/reports/165124-global-patient-mechanical-lift-handling-equipment-market What benefits does AMA research studies provides?
·        Supporting company financial and cash flow planning
·        Latest industry influencing trends and development scenario
·        Open up New Markets
·        To Seize powerful market opportunities
·        Key decision in planning and to further expand market share
·        Identify Key Business Segments, Market proposition & Gap Analysis
·        Assisting in allocating marketing investments
Definitively, this report will give you an unmistakable perspective on every single reality of the market without a need to allude to some other research report or an information source. Our report will give all of you the realities about the past, present, and eventual fate of the concerned Market.
Thanks for reading this article; you can also get individual chapter wise section or region wise report version like North America, Europe or Asia. About Author:
Advance Market Analytics is Global leaders of Market Research Industry provides the quantified B2B research to Fortune 500 companies on high growth emerging opportunities which will impact more than 80% of worldwide companies' revenues.
Our Analyst is tracking high growth study with detailed statistical and in-depth analysis of market trends & dynamics that provide a complete overview of the industry. We follow an extensive research methodology coupled with critical insights related industry factors and market forces to generate the best value for our clients. We Provides reliable primary and secondary data sources, our analysts and consultants derive informative and usable data suited for our clients business needs. The research study enable clients to meet varied market objectives a from global footprint expansion to supply chain optimization and from competitor profiling to M&As. Contact Us:
Craig Francis (PR & Marketing Manager) AMA Research & Media LLP Unit No. 429, Parsonage Road Edison, NJ New Jersey USA – 08837 Phone: +1 (206) 317 1218 [email protected]   Connect with us at https://www.linkedin.com/company/advance-market-analytics https://www.facebook.com/AMA-Research-Media-LLP-344722399585916 https://twitter.com/amareport
0 notes