Category Archives: NHS managers

Health Reform – Rationing for rare and complex conditions is wrong, and against the concept of a “mutual”.

In the Times this letter from many oranisations on 10th May 2017, under the title “HEALTH REFORMS PLEA” got little publicity because of the Media focus on Brexit. Health Reform – Rationing for rare and complex conditions is wrong, and against the concept of a “mutual”. Is the great thing about a democracy is that the citizens get what they deserve…..  or is it that the uninformed can be led by a right wing press? Governments ration covertly, and it is much more sensible to ration those whose votes count least. Its going to get worse I’m afraid… A Health Tax is a non starter, but so are Sticky Toffee Puddings.
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Sir, We want to see an NHS that provides high-quality care, support and treatment to everyone who needs it — and to ensure that our voice is heard during the general election campaign. In particular, we want all politicians standing for election to know of our deep concern with the reforms to the National Institute for Health and Care Excellence (Nice) that the government and NHS England implemented from April 1. These reforms stand to restrict and ration treatments for people with rare and complex conditions, and were implemented without the agreement of parliament.

With that in mind, we urge political parties to commit in their manifestos to reverse these recent reforms, and to guarantee that any future reforms will be considered by parliament before being implemented. We also ask that any decisions to restrict the availability of Nice-approved treatments are taken by democratically-elected politicians.
Deborah Bent, Charity Manager, Limbless Association; David Bickers, CEO, Douglas Bader Foundation; Kay Boycott, CEO, Asthma UK; Roger Brown, Chair, Waldenstrom’s Macroglobulinemia UK; Nic Bungay, Director of Campaigns, Care and Information, Muscular Dystrophy UK; Liz Carroll, CEO, The Haemophilia Society; Tanya Collin-Histed, CEO, Gauchers Association; Ann Chivers, CEO, Alström Syndrome UK; Genevieve Edwards, Director of External Affairs, MS Society; Sue Farrington, CEO, Scleroderma & Raynaud’s UK; Steve Ford, CEO, Parkinson’s UK; Kye Gbangbola, Chair, Sickle Cell Society; Deborah Gold, CEO, National AIDS Trust; Caroline Harding, CEO, Genetic Disorders UK; Tess Harris, CEO, The Polycystic Kidney Disease Charity; Dr Lesley Kavi, Postural Tachycardia Syndrome UK (PoTS UK); Anne Keatley-Clarke, CEO, Children’s Heart Federation; Caroline Morrice, CEO, GAIN; Allan Muir, Development Director and Type II Co-ordinator, Association for Glycogen Storage Disease (UK); Patricia Osborne, CEO, Brittle Bone Society; Jill Prawer, Founder and Chair, LPLD Alliance; Lynne Regent, CEO, Anaphylaxis Campaign; Richard Rogerson, Niemann-Pick UK; David Ryner, The CML Support Group; Timothy Statham OBE, CEO, National Kidney Federation; Laura Szutowicz, CEO, HAE UK; Paddy Tabor, CEO, British Kidney Patient Association; Jeremy Taylor, CEO, National Voices; Oliver Timmis, CEO, Alkaptonuria (AKU) Society; Gabriel Theophanous, President, UK Thalassaemia Society; Sarah Vibert, CEO, The Neurological Alliance; Dr Susan Walsh, Director, Primary Immunodeficiency UK

Chris Smyth reports a day later, May 11th: Hospital bosses demand another overhaul to sort minister’s mess

….new laws to overhaul the health service are likely to be needed by the end of the next parliament even though they are still struggling to implement the most recent changes…..One STP head said: “It’s a huge problem. Everything takes ages, but the difficulty with legislation is that it’s an implicit recognition that Andrew Lansley f***ed everything up.”…..Niall Dickson, chief executive of the NHS Confederation of senior managers, said: “It’s a no-brainer that you will need at some point a legislative underpinning for the structures….Senior Conservatives regretted the changes almost immediately, with one cabinet minister saying it was the coalition’s biggest mistake. The disruption distracted from the central task of making big financial savings and when Mr Lansley was demoted in 2012, his vision failed to take. Simon Stevens began reversing key elements of the reforms barely two years after they were completed.

Read the full article below..

Hospital bosses demand another overhaul to sort minister’s mess

The debate is puerile. There is no addressing the real issues..

Chris Smyth: Ageing population brings risk of stroke epidemic

Chris Smyth: Saving for dementia bill would take century

Andrew Harrap: This could be the health tax election

Sustainability and transformation (rationing) plans – surely STPs deserve a better acronym…

The Inefficient English Health Service is compared with the German one. Hypothecated Taxation with choice of provider?

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GP leaders to debate future of NHS, industrial action and ‘zombie GPs’. “GPs’ first priority must be their own health”..

The most important word any resilient GP needs to learn is how to say “No”. Our profession is well paid, and the argument is not about pay. The conditions of work, the restriction of choices, and the shape of the job have become so onerous that many feel like zombies. In a national incident such as a train crash the Drs need to ensure they are safe before treating the victims. They need to secure the site. They need to make decisions which perhaps amputate on site, or allow some victims pain killers only, whilst others are saved. The train crash which the UK health services are now having is similar. As Clare Gerada is correct; “we have to look after ourselves  first”.

Nick Bostock reports on GPonline 3rd May 2017: GP leaders to debate future of NHS, industrial action and ‘zombie GPs’

GP leaders at next month’s LMCs conference will discuss whether the NHS can survive chronic underfunding, whether GP contractor status has ‘reached the end of the road, and whether industrial action should be back on the table to defend the profession.

The conference in Edinburgh on 18-19 May could also discuss whether deceased GPs could be resurrected to ease the GP workforce crisis, and call for health secretary Jeremy Hunt to be sacked ‘for presiding over the worst time in the history of the NHS, missing targets, longer waiting lists and low morale’.

Pressure looks to be growing from the profession for a wide-ranging overhaul of GP funding, with LMCs set to warn that overall funding is too low, and that distribution through the Carr-Hill formula and other contract mechanisms is unfair.

Motions put forward by LMCs warn that no funding mechanism will deliver fair funding for GP practices until overall funding is increased. The GPC warned earlier this year that despite pledges to raise funding through NHS England’s GP Forward View, the profession remains underfunded by billions of pounds.

GP funding

But LMCs will question whether the existing funding formula gets the balance right between different priorities, with a motion put forward by Glasgow LMC warning that ‘careful consideration has to be given to the balance of the funding formula between deprived patients, remote and rural patients, elderly patients and those patients not in any of these groups who may face their funding being eroded’.

GP leaders will also call for a list of core GP services to be defined – a step the GPC has long opposed – in part to maintain services as new care models take shape across the NHS. The GPC has consistently argued that it is simpler to define non-core work, for example using its Urgent Prescription document to list services that practices should receive additional funding for.

The conference will also hit out at the rising cost of indemnity, warning that increased fees are driving GPs out of the profession. LMCs will argue for greater transparency from medico-legal organisations about risk criteria that can lead to sharp rises for individual GPs.

GPs will also warn that contract uplifts have not covered rising indemnity costs in full, and that direct reimbursement of costs would be a better option for practices than payments based on list size.

Locum GPs

Plans to improve communication with sessional GPs, with a proposal for a ‘national communications strategy to secure adequate communication of guidelines and patient safety communications to locums’ will also be discussed at the conference.

Broader ‘themed debates’ at the conference will discuss issues such as NHS rationing, independent contractor status, working at scale and workload.

One debate will look at whether the NHS can survive given overall underfunding, and whether co-payments for services should be considered. Another will consider whether independent contractor status has reached the end of the road and how it could be protected.

Further debates will look at whether GPs should remain within the NHS – in Northern Ireland GPs have suggested they will quit the NHS en masse if two thirds of practices hand in resignations – and whether there is ‘still a need to consider appropriate forms of action, and would this be effective or counter-productive’.

Another debate will encourage GPs to discuss whether the QOF has reached the end of its useful life – as NHS England chief executive Simon Stevens has suggested.

A motion put forward by Shropshire LMC, meanwhile, suggests ‘the urgent funding of a bioengineering program designed to immediately triple-clone all UK GPs, including the recently retired, in order to facilitate our prime minister’s glorious vision of a truly 24/7 health service’.

It adds: ‘The project should ideally extend to exploration of the resurrection of deceased general practitioners, though conference acknowledges that some health consumers might find zombie GPs unpalatable at first (assuming they even notice the difference.) However, we believe that public fears about human cloning and the walking dead could be swiftly allayed by the persuasive powers of the undisputedly veracious Mr Jeremy Hunt.’

Alex Matthews-King in Pulse 24th April reports: NHS England asks CCGs for rationing heads-up following media scrutiny

Isabella Laws on 2nd May reports Clare Gerada: GPs’ first priority must be their own health, warns former RCGP chair – GPs must put maintaining their own health above caring for patients and running their practices, former RCGP chair Dr Clare Gerada has warned.

It’s the shape of the GP’s job that needs to change. The pharmacist will see you now: overstretched GPs get help…The fundamental ideology of the Health Services’ provision. Funding of this type admits 30 years’ manpower planning failure

NHS ‘is like a train just before a crash’ (and it is now happennin g in slow motion)

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NHS managers still growing as GP posts fall

The Observer reports 15th April 2017: Number of NHS managers still growing as GP posts fall again – Doctors say ministers’ ‘bureaucracy busting’ shakeup has failed to switch resources and manpower to the front line

The number of NHS managers has grown by almost 18% in the four years since the government introduced a “bureaucracy-busting” shakeup of the health service, according to the latest official data.

The rise of about 4,650 in total management posts since April 2013, when the controversial Health and Social Care Act came into force, contrasts with an alarming fall in the number of GPs over recent months at a time of unprecedented demand for health care. The figures have drawn criticism from the British Medical Association (BMA), who say ministers are failing in their central objective of shifting more resources and manpower from back-office posts to the front line….

Managers are at odds over rationing, and management recognises the case, but the “rules” don’t allow them to speak out.

 

Scotland and Whistleblowing

NHSreality takes the view that since morale is so low, no internal assessment of a whistleblower is possible. Cultural change needs to come quickly, and the start of this is meaningful “exit interviews” by an independent HR company. This company should report in general publically, for a Region, but specifically, in private to Health Boards. Copies of reports should go to the Minister concerned, and should be released once they are not embarrassing to individuals concerned. Incognito exit interviews could then be possible, and done for all staff moving or leaving posts; in particular juniors. I have delayed this post for 3 months hoping there would be some good news follow up… Post will be updated if there is. Some “good news” – Hywel Dda Trust in West Wales have told the consultants that they will initiate exit interviews. At least they are recognising their importance – now they need to recognise the barriers to speaking honestly to their own HR, especially for those moving post within the Trust, but even for those at retirement. The Health Services are on fire… Interesting that the problem has been deferred to the Health and Sports committee… reminds me of “turfing”, or passing the buck in the House of God. (Sam Shemm 1978)

Update 15th March 2017 from 17th Feb 2017:

Hello, If you want to read the transcript of the Petitions Committee meeting where MSP’s quiz Edinburgh Council, Public Concern at Work (PCAW) and Unison on whistleblowing read it here and you can see the video here which last 45 minutes. The Council scheme comes over as having overcome the culture of fear around when I worked there and contrasts hugely with NHS arrangements. The Council reps pointed out that they’d had 53 reports in the 3 years since it was introduced compared to only 3 disclosures over 8 years prior. PCAW said NHS Scotland needed better arrangements but disappointingly said nothing  about the shortcomings of Scotland’s Board Champions, who can’t take or deal with reports (even though I’ve heard they think this is a problem). Unison didn’t really say anything. The next landmark will be on 2nd March when the NHS Scotland Chief Executive, Paul Gray, is called to account.

Important news – the Scotsman reported that “the Parliamentary Health Committee has commenced an enquiry to investigate how the NHS deals with whistleblowers amid concerns there is a culture of fear which discourages staff from raising patient safety issues. NHS staff are to be asked for their views as part of the inquiry launched by MSPs on Holyrood’s health and sport committee.”
More details can be found on the Parliament website “Call for written views on Inquiry into NHS Governance – Creating a culture of improvement” at http://www.parliament.scot/parliamentarybusiness/CurrentCommittees/103512.aspx The Committee is considering whether staff are managed in a fair and effective way.

 And on 5th March 2017:

Hello, The evidence submitted by the NHS Chief Executive, Paul Gray, to Petitions Committee on the 2nd March was underwhelming. The MSPs gave him an easy ride. You can view the 45 minute video here: http://www.scottishparliament.tv/20170302_public_pets?in=00:00:17&out=00:45:04 The transcription is here: http://www.parliament.scot/parliamentarybusiness/report.aspx?r=10824

I was surprised that the Chair brought up grievances at the beginning, ignoring the fact that staff only bring grievances after they feel they have been unfairly treated. Why did she not ask not ask directly for views on the petition? Indeed, it felt as if they’d rehearsed the whole discussion beforehand. There were no questions as to the efficacy of the whistleblowing champions – in having no staff-facing role, with no means to knowing how many (and when) concerns were raised.  At no point did the well-known victimised whistleblowers at Aberdeen, Forth Valley, Ayrshire & Arran and Lothian get a mention, and how they could have been better protected- and no mention of Robert Francis’s recommendations. The only point at which any MSP acknowledged they’d read any of the submissions was when Paul Gray was quizzed about the falling number of helpline calls – to which the Chief Exec answered that the “bottled-up” frustrations in 2013 had created a “spike” – and also, due to ongoing improvements, staff had less need – so there was little, on an ongoing basis, to worry about. There were no references by the MSPs to the staff survey showing fear at speaking up and no calls for it to be run again. Whilst it was acknowledged that an independent whistleblowing officer would be good, it sounded like another consultation was  likely in August – (although they already consulted on this a couple of years ago, so maybe this would be the precursor to a Parliamentary Bill).

Interestingly, the Scotsman managed to make the evidence look newsworthy- see “Health staff fear consequences of whistle-blowing, NHS Scotland chief tells MSPs” here.

Anyway, the Petitions Committee concluded that they would now refer the petition onto the Health & Sports Committee for consideration. We can only hope that they seriously consider what the petition proposes. At no stage did the Petitions Committee express a view on the petition. Sigh.

Thus my petition has followed its course. If it is to go anywhere now, that will depend if the Health Committee. Let’s hope they’ll really discuss the subject properly.

They are currently conducting an inquiry into NHS Governance – Creating a culture of improvement. Whistleblowing fits well. The call for evidence has another 9 days to go – please send something in if you can; I know a few of you have– you can do it confidentially, if you wish.

So I won’t be sending you any more “Update” emails, unless you want updates on the Health Committee’s conclusions. If you would like that, please let me know.

You can submit your evidence openly, anonymously or confidentially. But you only have until the 15th March, just four weeks, to do so. I’ll be writing in – hope any of you at the NHS (either past or present) with views will do too. This represents a real opportunity to call for change.

 

Peter Gregson wrote 4th December 2016:

The Petitions Committee considered the petition again on 24th Nov. The official (verbatim) report is here: https://shar.es/18jO8j

You can view their 6-minute deliberation on the webcast at http://www.scottishparliament.tv/Search/Index/1548bdac-8fee-42b8-8e00-d890656e9e1a – it starts 52mins 34 seconds in and runs onto 58.05. In a nutshell, the Committee now wants to hear from the Chief Exec of NHS Scotland and “representatives of whistleblower organisations”. They suggested the unions, especially Unison. The minute  of the meeting states “The Committee agreed to invite the Chief Executive of NHS Scotland and other relevant stakeholders including the City of Edinburgh Council, Public Concern at Work and trade unions, to provide oral evidence at a future meeting.”

I immediately wrote to the Chair of the Committee and the other four MSPs, suggesting that I could assist with whistleblowing organisations, individual whistleblowers (Rab Wilson, ex-nurse, of Ayrshire & Arran has offered) and asking they try again to contact the English Health trusts (there are 3 in all). No response yet.

I subsequently did some searching and found Whistleblowers UK who assist whistleblowers and give support at tribunals. They have been around a bit more than a year and their website is at http://www.wbuk.org/. They have a helpline for whistleblowers (and no – it isn’t like PCAW at all!). I spoke with their chief exec and she may be able to come up from London to the Scottish Parliament, or send in a submission.

A Scottish whistleblower has been in touch with me saying that if evidence could be taken with the webcam switched off, then they would like to attend to speak to Committee. If any of you feel the same way, please let me know and I will relay this to Johann Lamont.

If you have time, you might like to read the 10 submissions that have come in from Scottish NHS chief execs on the Parliament website here. Only one institution has been positive- the City of Edinburgh Council – and there is a negative one from Unison. A reversal of fortunes from three years ago, when each of these body’s positions were the opposite of what they are now, when I last petitioned for a hotline for local authority staff.

I urge you to read the Edinburgh Council submission that shows how their hotline actually works and the difference it makes- the link is here (I had also petitioned them too, back in 2013). I was also pleased Dr Peter Gordon wrote in – the support of clinicians is key to securing change. Finally, my comment on all the submissions was published as well (Petitioner letter of 9th Nov).

I think the Petitions Committee will revisit the petition with the NHS Chief Exec, probably in late January. I think that will be a very telling meeting – I’ll keep you posted.

 Other news- my FOI to Grampian Health Board on the costs of Professor Krukowski’s treatment has been refused again (see their response here ) so I have now submitted an appeal to the Information Commissioner.

Other news is that on 22nd Oct at their conference, the Scottish Green party adopted this motion, thanks to one of our campaigners:

The Trade Union Group conference identified that existing policy is not clear about the role of trade union representatives on boards. Experience has shown that partnership working between trade unions and management, for example on Health Boards, can be used to incorporate unions into the agenda of management. This motion is supported by SGP TUG.

 …For publicly funded bodies (such as the NHS, local authorities, education institutions, etc.), which have a distinct and particular responsibility to protect employees and those using the services they provide, such measures should include the establishment of a whistleblowing hotline, independently managed by an organisation invested with powers of investigation and disciplinary powers will provide an additional mechanism to ensure good practice is adhered to and wrongdoing is addressed.” 

Best wishes

Pete Gregson

www.kidsnotsuits.com/nhs-staff-whistleblower-hotline-parliamentary-petition/

HSJ implies Managers and Directors are now at odds with Politicians over rationing..

t seems that systematic rationing might become acceptable to managers (who run the HSJ). The Health Service Journal headline 10th March: “Exclusive: NHS England warns CCGs over ‘arbitrary rationing’” implies that whilst it is random rationing is not acceptable. What about systematic rationing? Are NHS England open to overt rationing yet? More importantly, are our politicians willing to say what will not be covered systematically (Nationally), and what would be acceptable locality rationing. This article is of interest to us all, but is only available if you subscribe… It implies that Managers and Directors are now at odds with Politicians over rationing..

NHS England has issued a warning to commissioning groups accusing some of “rationing” surgery using “arbitrary cut offs”, amid growing concern about the issue, HSJ can reveal.

 

 

 

Evidence basis is needed for all treatments – and confirmation by independent third party. Hospitals and pysicians collude to waste money.

The Crick Institute, with buildings at Mill Hill and in Central London, could be a useful tool in health rationing once rationing is overt. It’s evidence could be an additional source for NICE. However, the incentive for government keen to reduce costs is on questioning too much, and delaying, and the incentive for big Pharma is to sell more. The evidence for many drugs in common use should have been questioned more, and the alternative use of funds which might have been used on Pharma products needs more consideration. Only overt rationing can do this. Bisphosphonates such as Alendronate cost money, and it might be better spent elsewhere. The advertising and the sale pitch is on fear of fractures, and the misconception that X ray improvement of bone density correlates with less risk. Hospitals think they will reduce costs, and physicians want to do good, so they conspire/collude to waste money. Knowing this, Big Pharma is willing to pay us when it’s arm is twisted.. (Drug companies propped up NHS with £250m after cabinet’s threat)

Tom Feliden reports in the Times 1st March 2017: Osteoporosis drugs may make bones weaker

Drugs used to treat weak bones in elderly patients suffering from osteoporosis may actually make them weaker, research suggests.

Scientists at Imperial College London examined the bone structure of hip-fracture patients who had been treated with bisphosphonates.

They found evidence the drugs were linked to microscopic cracks, making bones more fragile and prone to break.

Osteoporosis affects three million people in the UK.

What is osteoporosis?

Losing bone is a normal part of the ageing process, but some people lose bone density much faster than normal. This can lead to osteoporosis and an increased risk of fractures.

Bisphosphonates – the main treatment for osteoporosis – are an extremely successful and commonly prescribed class of drugs that slow down the natural processes by which the body removes ageing or damaged bone.

But doctors have raised concerns about the number of fractures occurring among elderly patients who have been taking the drugs for a long time.

To find out why, the team led by Dr Richie Abel took samples of bone from 16 hip-fracture patients and studied them at the Diamond Light Source – the massive doughnut-shaped Syncatron or particle accelerator at the Harwell campus in south Oxfordshire.

“What we wanted to see was whether the bone from bisphosphonate patients was weaker or stronger than bone from untreated controls,” Dr Abel explained.

“Rather startlingly, we found the bone from the bisphosphonate patients was weaker. That’s a conundrum because the bone should be stronger.”

By bombarding the samples with X-rays 10 billion times brighter than the Sun, the team were able to generate images of the internal structure of the bones in unprecedented detail.

These showed microscopic cracks building up in the bones of patients treated with bisphosphonates.

Dr Abel said: “The drug is clearly working, but it also leads to the build-up of micro-cracks in the bone and that could increase the likelihood of a fracture.”

It’s a surprising result, but the study was small and the work is at an early stage.

Even so, Prof Justin Cobb, a co-author on the paper, says the discovery raises important questions about how we prescribe bisphosphonates for long-term conditions such as osteoporosis.

“There’s no hurry, but we should think about how long people are taking them for, and how we might monitor the development of these micro-cracks,” he said.

In the meantime the researchers say people should continue to take medications prescribed by their doctor.


Osteoporosis: Are you at risk?

If you answered: “Yes,” to more than one of these questions, then you may be more at risk of developing osteoporosis:

•Has anyone in your family ever been diagnosed with osteoporosis?

•Have you ever broken a bone after a minor bump or fall?

•Are you female and aged over 50?

•Do you drink more than three units of alcohol a day?

•Do you miss out on summer sunlight (through being housebound, avoiding the sun, always covering your skin or wearing sunscreen)?

•Do you miss out on doing at least 30 minutes of activity five times a week?

Source: National Osteoporosis Society

Medline Evidence on Osteoporosis

NICE pathways to Osteoporosis treatments

(Drug companies propped up NHS with £250m after cabinet’s threat)

No party is offering a credible alternative….. the future of the 4 UK Health Services may lie in social media

 

No party is offering a credible alternative….. the future of the 4 UK Health Services may lie in social media

Richard Vize in The Guardian 25th Feb 2017 offers: “The NHS is struggling. Labour must offer a credible health policy” , but as we know from NHSreality’s 4 years, none of the political parties is prepared to talk and answer questions honestly. There are occasional managed releases of “good news”, ( Portsmouth News 19th Feb 2017: Cancer charity welcomes NHS pledge on stem cell treatment ) whenever possible, but these are mere distractions. Management at the top recognises this, and hence is demoralised and allows errors such as letter, note, and data loss. It appears this was manual records, and IT systems could be much safer, as long as such were not managed and designed internally..Breach of security in national diagnostic indexes may follow…  No politician or party is offering a credible alternative to the current rules of the game: Everything for everyone for ever…..Therefore the future of the 4 UK Health Services may lie in the pressure built up by social media.

Image result for dishonest politics cartoon…and the perverse incentives may make patients lie as well. The post-truth medical world is really here in the UK today.

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….The manner of Labour’s defeat in Copeland is instructive. It took the most emotionally charged line possible, on an issue of great local sensitivity, on its signature issue of the National Health Service, and lost to the government.

Yet the defeat came as evidence mounts that all three of the drivers of current NHS policy – quality and efficiency improvements under the Five Year Forward View, reconfiguration of local health systems under the Sustainability and Transformation Plan (STP) process, and devolution, are in difficulty.

NHS accused of covering up huge data loss that put thousands at risk – Exclusive: More than 500,000 pieces of patient data between GPs and hospitals went undelivered between 2011 and 2016

Pithed politicians collude in unsafe care, ministers told

NHS data-sharing project scrapped – another opportunity missed..

Health service ‘at risk of sudden collapse’ – and the honest debate has yet to occur

Happy 2017: …politicians’ ‘persistent, blinkered denial’ – Say no to a post-truth health service

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