Jeremy Hunt’s Plan for the NHS


It may not look like it, but Jeremy Hunt DOES have a plan for the NHS – Caroline Molloy  First posted 23 October 2015 on openDemocracy/OurNHS

The Tories would have us believe that they are backing away from NHS privatisation.  In fact, they’re stealthily laying the groundwork for maximum profit opportunities – and comprehensive healthcare may be their first casualty.

Don’t worry about the fact that 82% of GPs are planning to leave or cut their hours in the next five years. Don’t worry that junior doctors aren’t any happier. And don’t worry that every week reveals another NHS hospital deeply in the red – even ones we thought were ok.

Don’t worry about any of that, because Jeremy Hunt has a plan.

It’s the NHS’s own plan, he repeats in every media interview. It’s the plan it would be a ‘disaster’ to deviate from, he told us before the election.

But what is this plan?

We’ll get to that in a minute.

First, let’s look at what we’re being told it’s not.

It’s not like that toxic Andrew Lansley stuff, the pro-competition 2012 Act, the “reorganisation so big you can see it from outer space”. No, that was Cameron and Osborne’s “worst mistake”, they’ve let it be known. It wasn’t really their fault, of course – they didn’t have “a clue” what the then Health Secretary was up to.

They were so cross with him, they made him a Lord. And he was such a fool, he’s just landed a job at private equity firm, Bain, advising on healthcare privatisation.

But let’s not worry about that. Lansley’s Act is “being ignored” anyway, the pro-market Health Services Journal tells us. Forget competition, forget the idea of external takeovers and internal dog-eat-dog competition between standalone trusts and powerful CCGs – under current Health Secretary Jeremy Hunt and NHS boss Simon Stevens’ plan, it’s all about collaboration now. Even KPMG (who’ve just poached another former Health Secretary, Steven Dorrellsay so.

So what is this plan? And, er, collaboration with whom?

Has Stevens – long-time Blair advisor and former United Health Vice President– really sent the private sector packing? And – after a few brand-damaging failures – have private health firms really scuttled away defeated from the £120bn “unopened oyster” of the NHS budget, deciding the NHS would be ‘shown some mercy’ after all?

It would be nice to think so. The more naïve sections of the liberal media have certainly bought that idea. When Simon Stevens launched his “Five Year Plan” last year, Andrew Rawnsley in the Observer said he had “only one fundamental objection” to the “generally excellent” plan – that it had the wrong picture on the cover. Polly Toynbee in the Guardian told us it was great because “the word competition doesn’t appear once in his 37 page document”. Shadow Health Secretary Andy Burnham appeared to sort of welcome the Stevens plan, then to sort of welcome it not quite so much.

Aside from this site, one of the few mainstream commentators to nail what the Stevens’ plan was really about was Fraser Nelson, in the Telegraph. “Like the best revolutions, it came carefully disguised,” Nelson observes. Yes, “the c-word didn’t appear once” but (like Nelson himself) Stevens still “firmly believes” in the competition/choice agenda – he’s just experienced enough to know that “the secret of successful radical reform is not to announce it with any fanfare.”

Nelson nails it when he says: “Stevens’ Grand Plan is to have no more Grand Plans but, instead, lots of smaller plans.”

So what are these smaller plans – and what do they mean for the future of the NHS?

Whilst even Jeremy Hunt and his regulator Monitor have tacitly admitted that standalone, competing Foundation Trusts aren’t working, Hunt and Stevens see more privatisation, not less, as the answer.

‘Collaboration’ turns out to mean hospital mergers into ‘chains’ – a theme developed in the Stevens report. The man tasked to develop the ‘chains’ plan, Sir David Dalton, has suggested it could lead to more private takeovers. Junior health minister Lord Prior wants private takeovers of hospital chains, too – and he also thinks they should close lots of beds.

As Circle have found in the UK with their disastrous Hinchingbrooke foray, at the moment it’s hard to make a profit from competing to provide full service local hospitals.

As United Health, Kaiser and others have found in the U.S. – profit opportunities are much bigger if you integrate both the purchasing and provisionof healthcare under private control or influence, enabling you to ration or deny more expensive healthcare interventions. And it’s much easier to do that if you use your control or influence to reorganise provision away from full service local hospitals, towards a chain of disparate community-based clinics and far-flung specialist centres. Of course you have to claim all the while that this is all about integration, prevention, empowerment, localism, personalisation, specialisation, reducing ‘variation’, and ‘care closer to home’.

Stevens is pushing this approach through a range of supposedly ‘integrated’ new ‘smaller plans’. Like the new multi-billion pound lead provider framework to ‘help’ with purchasing healthcare (which United Health subsidiary Optum has won a sizeable chunk of). And a ‘prime provider’ framework to ‘integrate’ purchasing and providing (which both Circle and Virgin have won contracts worth billions for already). Not to mention the the array of ‘local’ NHS ‘Vanguard’ projects, which Stevens explicitly suggests could be modelled on US firm Kaiser Permanante’s ‘Accountable Care Organisations’ or similar Spanish companies. The tech-heavy projects are full of private sector opportunities and partnerships – particularly outside of unprofitable acute care. Meanwhile, tariff cuts leave the sword of Damocles dangling over many local full service hospitals.

Profit opportunities also expand if firms set their own easily-gamed ‘outcome based’ success measurements. Out go what Stevens calls ‘mechanistic’measurements (like the requirement to have enough nurses, properly trained healthcare workers, and hospital beds).

Since the general election, Stevens and Hunt have been busy tearing up such requirements.

And in come easily gamed ‘outcome’ measures – exactly what we see in the new style contracts.

Profit opportunities also expand if co-payments (ie, patient charges) are permitted. The right are getting more confident in calling for such chargesLord Prior has tried to launch an inquiry to consider it – and the government has still not clearly disavowed such an inquiry. The growing number of exponents of charges and co-payments are usually keen to stress it would only be for freshly defined ‘non-core’ services which, if you look closely, turn out to mean things like a bed to recover in after your op (£75 a night please!).

And there are many other attempts underway to undermine the comprehensive, universal, publicly funded core values of the NHS, by bringing the ‘undeserving’ narrative from benefits, into the NHS. An early sign is the attempt to refuse people care if they smoke or are obese, for example (cavalier to the fact that it is poorer people who will be disproportionately hit by such clinically uninformed decisions). Whilst Devon’s attempt to do this failed, experts saw it as a sign of things to come.

Stevens has just given all of this a big boost by pushing integrated health and social care budgets (and indeed integrated benefits budgets in some devolved areas, like Cornwall). All of this may be nice in theory, perhaps, but it’s pretty terrifying in a climate of ‘austerity’, where social care users already can, and have to, top-up or co-pay for services (and benefits are already heavily conditional).

And integrated personal budgets – which Stevens has been pushing since day one in the job – are now being rolled out to millions. No-one has yet managed to explain how these are any different from the old Thatcherite voucher plan (which would basically finish the job of destroying the NHS).

Lastly, as a big bonus, once firms nabbing all these contracts have their hands on the patient data needed to commission healthcare (or obtained by delivering it ‘digitally’), they can also make a packet selling our information to data, insurance and pharmaceutical companies – or worse.

Of course this entire bureaucratic market nightmare costs a fortune to administer, though the scale of the fortune is a closely guarded secret. The Health Select Committee pointed all this out in 2010 (referring to earlier data – and we’ve had two or three more tranches of ‘marketisation’ since then).

So if that’s the Stevens plan, what’s our plan B to get out of this mess?

First, the NHS urgently needs a cash injection to get it through this current manufactured crisis (with the DoH handing billions back to the Treasury in ‘underspends‘ in recent years – ‘doh!’ indeed!).

Healthcare needs are not a bottomless pit, as the neoliberal ideologues claim – but the demands of health, insurance, pharmaceutical, data, consultancy and tech companies for profit streams, may well be.

Ultimately, all this destruction is possible, not because of Stevens himself, but because the Coalition government finally removed the duty to secure comprehensive healthcare which was offered to the nation in 1948 and persisted, just about, til 2012. We need to restore that duty.

And we need to recognise that hospitals have been brought low by a combination of PFI debt and the dog eat dog, beggar my neighbour nightmare of even the ‘internal’ market, let alone the external one. We need to get rid of that market – as Scotland has done.

The NHS Bill – sponsored by Caroline Lucas, signed by Jeremy Corbyn when he was a backbencher, and due for its second reading in March 2016 – is a serious attempt to do both.

The market, internal or external, disguised as ‘collaboration’ or not, is not an effective way to allocate healthcare – we’ve known that since the pioneering work of Nobel prize winner Kenneth Arrow in the 1960s. It forces hospitals to hammer down staff costs and offload unprofitable patients, and creates impossible choices between the bottom line and patient safety.

It’s only ideology and vested interests that would seek to persuade us that the answer is more of the same.

And if anyone – Tory, Labour, or ‘non-political’ – says they support the NHS, we need to ask – do you mean an NHS that is comprehensive, universal, publicly funded, high quality, timely and ethical?

If not, they are not defending the NHS as the public understand and love it. And that’s what we need to fight for.


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Winter is coming. How bad is the scale of the NHS financial crisis?


The NHS winter is coming – what’s the one thing all progressive politicians must do to save it?  by Caroline Molloy – Firsted posted 9th October 2015 at OurNHS


All week we’ve been waiting for the figures that would show just how bad the scale of the NHS financial crisis was.

The regulator, Monitor, had been ‘leaned on’ to delay publication til after the Tory Party Conference.

And no wonder.  The figures that were finally released today were bad.  Really bad.  NHS Trusts and Foundation Trusts have gone nearly a billion pounds in the red in just three months.  And patients are suffering as waiting lists are soaring.

Monitor said in today’s report that Foundation Trusts ‘could not go on like this’.

Health campaigners have reacted with anger – and a very clear message about the necessary way forward, urging politicians from across the spectrum who truly care about the NHS, to back the NHS Bill.  The Bill was developed with a team of campaigners led by Professor Allyson Pollock, and presented in parliament by Caroline Lucas MP in June – with backing from Jeremy Corbyn, John McDonnell and other Labour MPs, as well as the SNP, Plaid Cymru, and Lib Dem MP John Pugh.

The NHS Bill sweeps away the complex and expensive system of ‘autonomous’ Trusts forced into a game of ‘beggar my neighbour’, competing against each other for commissions, patients and dwindling funds.

“At what stage will those who advocated ‘standalone’ Foundation Hospitals, which have dominated health policy for 13 years, admit they were wrong?” asked Lord David Owen in response to today’s figures.

Owen – former health minister and leading critic of the Coalition Health & Social Care Act – told OurNHS that the way forward was clear:

“We have to return to an NHS that provides comprehensive care across each geographical area, as spelled out in the NHS Bill.  This Bill is now before the House of Commons in the name of Caroline Lucas and supported by Jeremy Corbyn.  The progressive alliance in Parliament now must be supported by all the Royal Colleges and anyone committed to evidence based medicine.  The evidence is now before us all that Foundation Hospitals have been a disaster.  The Health and Social Care Act must be changed and the NHS Bill is the way to do it.”

Caroline Lucas told OurNHS today, “Our fragmented, marketised NHS is in crisis.  This latest failure highlights the urgent need for a change in direction.  We need to return the NHS to its founding principles and reverse the creeping marketisation of the last 25 years.  That’s why I’m calling for MPs from across the political spectrum to be part of saving our health service by supporting my NHS Reinstatement Bill.”

Deborah Harrington, spokesperson for the National Health Action Party also weighed in with support for the bill, saying:

“It took a series of legislative changes to get us where we are today, on the brink of losing a precious and vital service available to us all.  We need legislation to restore it to health and end these daily reports of financial ‘failure’.  We need the NHS Bill tabled by Caroline Lucas.”

Harrington explained further:

“This is murder disguised as accidental death. If the public want to continue to have healthcare free of the fear of huge bills or insurance payments they need to stand up for an NHS back in public ownership and free of the threat of bankruptcy, a term which should never have been allowed to apply to our public services in the first place.”

Professor Sue Richards, Chair of Keep Our NHS Public, savaged Health Secretary Jeremy Hunt, saying his government was “responsible for massive mis-spending in bringing the market into the NHS”.

Richards highlighted how restoring the government’s duty to provide comprehensive healthcare across the whole country is a key feature of the NHS Reinstatement Bill that Keep Our NHS Public supports.  The duty to provide comprehensive healthcare was abolished in the 2012 Act, allowing the government to blame underfunded local hospitals for ‘local decisions’ when they make cuts or simply fail to provide quality, timely services.

Richards elaborated: “It is not just that Hunt is not up to the job.   It is also that he thinks the job of Secretary of State has been abolished by the Health and Social Care Act 2012, and that he can wring his hands and blame others, without having to step up and take charge.   MPs should call Hunt to account for the state of NHS finances and the deteriorating performance in patient care.  Let’s reinstate the Secretary of State’s responsibility for the NHS, and sack him if he continues to fail.”

GP Charles West – co-author of a rebel Lib Dem report into the true costs of running the NHS as a ‘market’ -accused the three main political parties of a “pathetic spectacle” at the May General Election, saying they were “falling over themselves to promise small amounts of additional money to the NHS whilst simultaneously weighing it down with expensive and unnecessary bureaucracy.  The pseudo-market imposed on the NHS has been reliably estimated to cost £20bn a year.  Even if George Osborne comes up with the £8bn he has promised it will not solve the problem, it will simply pour more money into the hands of the private providers and management consultants who are gathering like vultures round a corpse.”

West concluded: “There is a straightforward and simple solution to the problems faced by the NHS. It lies in the National Health Service Bill tabled in July.  Up till now the leaders of Labour, Conservative and Liberal Democrat Parties have preferred to administer larger and larger doses of the very medicine that has done so much harm to the NHS.  It will be interesting to see if recent changes of leadership will bring a new wave of common sense.”

Privately, many senior NHS campaigners express frustration that so far under the Corbyn opposition, there has been little shift in tone in Labour’s NHS message.  They will be hoping for a greater confidence soon from Labour (and indeed the Lib Dems and Nationalists) in being prepared to challenge the old mistakes and Blairite market arrangements.

There are a few encouraging signs around Corbyn’s willingness to talk about the Private Finance Initiatives that are costing the NHS dear.  Joel Benjamin of People Vs PFI said that it was “absurd” that the “5 year plan” for the NHS made “NO mention of PFI, even though NHS trusts will pay out close to £10bn in PFI repayments over this period, and 2/3 of NHS trusts in financial stress have PFIs.” 

The current predicament of Trusts and Foundation Trusts was entirely predicted by those who worked on producing the NHS Reinstatement Bill – and it’s suddenly more relevant than ever.  The Bill is due to be read in March 2016 – but is unlikely to get a proper hearing unless Corbyn, who signed it as a backbencher, can bring the full weight of his new leadership role into play behind it.

Winter is coming.  The NHS is dreading it.  Will politicians offer it some hope for the spring?


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Midwives Standing Together – When We Have Had #ENOUGH


There are many good people  in working reponsible roles in society. They are not earning a fortune; they are doing jobs because they care, careers they are proud of – because they want to make a difference.

But caring is not enough. Everyone derserves a life, a family, a home. The government’s treatment of our skilled health professionals, on whom we depend for our lives is appalling.  Staff are working long shifts with no mealtimes, with wages frozen and no prospects of improving conditions. Remember this is in  one of the richest countries in the world, one where where bankers have bonuses, where  global corporations hold democracy to ransom, and where they seek to silence dissent. We should be ashamed. Now it is time to say, “Enough”!

This plea from Hayley, a midwife,  is calling time on this government’s treatment of our workers, on the erosion of our public services. We will take no more.

A Midwife’s Call for An End  to Abuse of Good Will

By Hayley Huntoon

Twitter: @hayleyhuntoon

Yesterday a man came to me livid with frustration ‘this is not good enough’. He told me ‘my daughter has been waiting hours to be seen’ . He went on to tell me, ‘it isn’t you. It isn’t the other midwives – the care has been impeccable but the situation just isn’t good enough.’

I know. I agree. I have shed too many tears over a career I could not love more because there is nothing I can do. What he didn’t know was that heartbreakingly this is a daily occurrence in my life as a midwife. What he didn’t know was that actually yesterday was a rare Saturday off for me yet I had come into work so that my amazing colleagues could have a break from their 13 hour shift. A break they won’t be paid for whether they take it or not, but that they physically need as human beings. I had come into the unit so that women like his daughter could be seen. So that our unit could be open to women who needed our skills as midwives, doctors, health care professionals. Women who were in labour. Women who’s babies weren’t moving much. Women who were concerned about their own wellbeing.

5 maternity units in the north-west have been closed over the weekend. These women need our care. We are literally being worked to the ground. I am watching amazing midwives leave a profession they love because the workload and stress is too high.

Today is a rare Sunday off for me. But I will be spending it supporting our rights as workers. The NHS is run on good will. But there is only so much we can take. We joke at work that midwives don’t need to eat. To rehydrate. To empty our bladders. To sleep. Let us look after ourselves so that we can look after our women. Our future generation of children.

Earlier this year, our country voted for a government that said no to more midwives. The Conservative party have demonstrated five years of austerity, falling living standards, pay freezes and huge cuts to public services. They have threatened to make cuts to our night shift and weekend enhancements. Over the past 4 years I have missed Christmas days. New Years days. Family’s birthdays. Countless nights out. I had a good education and did very well at school. I am 22. I have held the hands of women through the most emotional times of their lives. I have dressed Angels we have had to say goodbye too. I have supported women to make decisions that empower them. I have been scared myself. Tired, stressed, emotional every day. Yet I am not and will not be paid well like my friends who have chosen business careers. I am not offered pay rises for my efforts or successes. I don’t care because I get something more valuable than that from what I do. I love what I do. I’m passionate about what I do that’s why I do it. But I do care that we are the ones who are being threatened with further cuts. Further strain.


So today I stand with doctors, midwives, nurses, teachers, firemen and many other amazing people to spread awareness of a situation that has gone too far. To share information that the general public are oblivious to because as midwives, we will not let these women be failed. I am regularly met by stunned responses from women and their partners to the situation they watch me working under. But Hayleytoday I say no. Enough is enough.

I have shed too many tears over a career I love. Missed too many meal breaks. Not physically been able to care for too many women the way I wanted to. Spent too many days off in work. Lost too much sleep over the stress I am under. Watched more of my colleagues than I could count (myself included) be signed off work with stress in the early years of their career. Watched too many good midwives leave careers they love. This is not humane.

Please let’s end this. Protect your NHS. Your children’s future. Your education system. The core foundations of Great Britain.

I have recently learned the world is a selfish place. But I have also learned that there are a lot of very good people in it. The NHS is run on good will and because of this we have been pushed too far. Let’s change this.

Further Reading:

The Battle to save the NHS


The crisis in the NHS grinds on inexorably.  In just the last day, former LD health minister, Norman Lamb warns that the healthcare system will crash in two years and says Tories are being dishonest over crisis.   Furthermore, NHS junior doctors have condemned a new contract imposed on them, fearing that it will cut their pay by up to 40%, force them to work more antisocial shifts and put some off becoming GPs or A&E medics.

They have pledged to resist the move by ministers, which they say is “bad for patients, bad for junior doctors and bad for the NHS”. The joint leader of the 53,000 junior doctors in England affected has indicated that they may even go on strike in protest.

Tony O’Sulivan sets out the current position in the piece below, re-posted from openDemocracy

The NHS stays centre stage as the political ground shakes

By Tony O’Sullivan – Consultant Paediatrician and member of Keep Our NHS Public and the Save Lewisham Hospital campaign.  First posted 14.09.15 openDemocracy

The English NHS is likely to stay centre stage in political fights.  New Labour leader Jeremy Corbyn’s first official visit as Labour Party leader was to Camden & Islington NHS Mental Health Trust yesterday.  His new shadow chancellor, John McDonnell, last night highlighted his opposition to the EU/US TTIP trade deal which many see as a huge threat to the NHS.  And – uniquely amongst leadership contenders,  Corbyn is a signatory to the NHS Bill 2015 – which aims to reinstate the NHS and was re-tabled in Parliament by Caroline Lucas, Green MP with cross-party support on July 1st.

Yesterday, Corbyn wrote

“We as a labour movement have to be strong enough to stand up and ensure that we have a system that prevents anyone falling into destitution, supports those going through mental health crises and ends the internal market and privatisation of our health service.”


Later today, parliament will debate a vote of no confidence in health secretary Jeremy Hunt, Health Secretary, after two petitions calling for such a debate attracted over 300,000 signatures – though the Government has relegated it down from the main chamber of the House of Commons, to the significantly more low-key Westminster Hall venue.  Doctors have been asked to ensure their MP attends this debate and to ensure the focus is on Hunt and his record.

NHS campaigners will be out in force to show the Government the depth of feeling for the NHS and against Conservative ideological direction at the Tory Party conference in Manchester on 3-7 October.

The greater openness of political debate, first in the Scottish independence referendum and now in the Labour Party leadership election, means that many more will be ready to get involved.  And we must be ready to respond to every anti-NHS argument.

The ideological untruths and practical assaults on the NHS and public sector that we saw under the coalition government are being ramped up under the new Tory government.

If a public service is starved of essential finance for long enough it will start to fail – and the NHS is no exception.  Just earlier this month, GPs in Worcestershire were told not to refer patients to local NHS hospitals for three months so that they could clear a backlog – and encouraged to pay private hospitals to take patients in the meantime.

The NHS is ‘broken’, wrote James Bartholomew in the Telegraph electing to place the NHS bottom of the pile of European health systems.  He concludes that the ‘failed’ NHS must be replaced by a compulsory insurance system, such as that of Switzerland.

In the UK of course, there is a compulsory contribution to the NHS from public taxation made in the UK.  The great difference is that the UK system is not run for profit and is free at the point of need.

This principle makes the NHS far more cost effective – out-performingSwitzerland in effectiveness and value for money according to a 2015 Commonwealth Fund report.

No doubt other systems have lessons that we can learn from.

But Bartholomew’s argument is a purely ideological one. Like the Government, he wants us to equate publicly funded health systems with failure.

His 2004 book The Welfare State We’re In was praised by Thatcher’s guru, Milton Friedman, as “a devastating critique of the welfare state”.  During the 2010 pre-election period, Bartholomew advocated the abolition of the NHS on Radio 4.

Our NHS has been amazingly effective despite ongoing underfunding compared to other advanced national health systems.  Just why is it that the NHS has lower number of doctors and acute hospital beds per 1000 population and second lowest number of MRI scanners per million compared to other advanced European health systems?  It is a failure of funding rather than a failure of the NHS.  It receives less funding than the OECD average and less than the European comparators.

Nonetheless, the Commonwealth Fund’s comparative analysis of 11 advanced national health services, using data and surveys from 2010-13, placed the USA bottom and the NHS top.  The NHS was best in 8 out of 11 criteria and was the most cost-effective national health system.

In fact, despite significant underfunding, the NHS has punched above its weight for three generations.

It is now under threat from cleverly disguised ideology, worsening cuts, PFI payments and privatisation, not from its ‘failure’.  The failure to adequately fund front-line NHS services over the last five years has increased waiting lists.  We need more GPs, hospital doctors, more nurses and therapists and better equipment.  Not an insurance based system such as the USA or Switzerland.  The USA spends double the UK on health but over 30% of that funding is wasted on private insurance administration and profit margins.  In insurance-based health systems, the incentive of profit regarding who gets investigations, procedures and treatments, can be a more powerful motive than what is bestfor the patient.

Efforts to privatise whole swathes of health services have failed to deliver more effective care and are proving more costly.  We now face a national health service increasingly without national coordination of standards, with shrinking resources and accelerating fragmentation.  This will devastate patient care pathways which rely on many services cooperating together (including social care).

We must get back the NHS.  In the example of New Zealand we can see the immediate benefits if we succeed.  New Zealand privatised their health service in 1993.  Perverse incentives dominated and costs escalated.  The new 1999 government looked this failure in the eye.  They made a political decision to act on the evidence and renationalised their health service in 2000 with clear benefits.  Following the calamitous Christchurch earthquake of 2010, public conclusions were that the privatised and fragmented health service would not have been able to respond to such magnificent effect as New Zealand’s reinstated NHS.

There is one category where the UK comes out close to bottom in international comparisons like the Commonwealth Fund (though still above the USA).

It’s ‘healthy lives’, a category which reflects more specifically health inequality: the effects of poverty, education and societal attitudes to promoting early child development (see the Marmot Review).

The greatest single determinant of health outcomes is of course poverty. The impoverishment of the British people through austerity, unemployment, low wages and zero hour contracts, the mental and physical stress that places on us, coupled with the assault on the funding of the NHS and escalating privatisation, means that the battle to save our NHS is more important than ever.

With additional reporting by Caroline Molloy.

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