Innovation or a Race to the Bottom? Trust Modernization in New Hampshire

[Excerpt] “Late last summer, Governor Lynch signed into law Senate Bill 465, designed to further update New Hampshire‘s trust law. This bill follows similar legislation in Alaska, Delaware, Nevada, and several other states. It adds major new provisions to the existing statutory framework for irrevocable trusts. The bill allows for the creation of so-called self-settled asset protection trusts or domestic asset protection trusts (DAPTs). DAPTs represent the latest chapter in our State‘s move away from traditional trust and estate principles towards a system of dynastic and (theoretically) creditor-proof trusts. This legislation results from New Hampshire‘s desire to retain and attract trust activity. Effective January 2, 2009, the new Qualified Dispositions in Trust Act allows beneficiaries to ―self settle‖ irrevocable spendthrift trusts—for example, put assets into trust for their own benefit, while placing those assets, in many circumstances, out of the reach of most creditors. This article will attempt to answer some questions about these trusts. Will RSA 564–D succeed in increasing New Hampshire‘s share of the domestic trust business? Will these new trusts prove to be effective against creditors? Finally, what are the policy implications of these new trusts?

Cross-sectional study of the provision of interventional oncology services in the UK

Objective: To map out the current provision of interventional oncology (IO) services in the UK. Design: Cross-sectional multicentre study. Setting: All National Health Service (NHS) trusts in England and Scottish, Welsh and Northern Ireland health boards. Participants: Interventional radiology (IR) departments in all NHS trusts/health boards in the UK. Results: A total of 179 NHS trusts/health boards were contacted. We received a 100% response rate. Only 19 (11%) institutions had an IO lead. 144 trusts (80%) provided IO services or had a formal pathway of referral in place for patients to a recipient trust. 21 trusts (12%) had plans to provide an IO service or formal referral pathway in the next 12 months only. 14 trusts (8%) did not have a pathway of referral and no plans to implement one. 70 trusts (39%) offered supportive and disease-modifying procedures. One trust had a formal referral pathway for supportive procedures. 73 trusts (41%) provided only supportive procedures (diagnostic or therapeutic). Of these, 43 (59%) had a referral pathway for disease-modifying IO procedures, either from a regional cancer network or through IR networks and 30 trusts (41%) did not have a referral pathway for disease-modifying procedures. Conclusion: The provision of IO services in the UK is promising; however, collaborative networks are necessary to ensure disease-modifying IO procedures are made accessible to all patients and to facilitate larger registry data for research with commissioning of new services

Clinical leadership in action

The nature, scope and potential for clinical leadership are explored by focusing on four cases. These were cross-boundary service redesign attempts for dementia and sexual health in London and Greater Manchester. Each case contained multiple organisations, including GPs and primary care trusts, acute hospital trusts, mental health trusts, local authorities and independent sector provider

Primary care groups - Modernising primary and community health services

Developing primary and community health services is a key component of the government's plans for modernising the NHS. Primary care groups and trusts have a vital part to play in overcoming the variability, fragmentation, and isolation that have been the weaknesses of primary health care in the NHS. Primary care groups and trusts have introduced initiatives to promote greater collaboration between general practices and to share expertise and resources. Improving access to care is an important feature of the modernisation plan, and most groups and trusts are actively promoting access, particularly for people who have been poorly served traditionally. Groups and trusts are tackling staff shortages by using clinical specialists and promoting extended roles for nurses and pharmacist

Change in viral bronchiolitis management in hospitals in the UK after the publication of NICE guideline.

BACKGROUND: Viral bronchiolitis is one of the most common causes of hospitalisation in young infants. It has previously been shown that many United Kingdom (UK) hospital Trusts were not compliant with many aspects of the National Institute for Health and Care Excellence (NICE) bronchiolitis guideline prior to its publication. OBJECTIVES: This study aimed to investigate changes in the management of bronchiolitis by hospital Trusts between 2015 (before NICE guideline publication) and 2017, after publication. STUDY DESIGN: We prospectively surveyed paediatricians at UK hospital Trusts on the management of bronchiolitis before (March to May 2015) and after (January to May 2017) the NICE bronchiolitis guideline publication in June 2015, using an electronic, structured questionnaire. RESULTS: In 2015 111 Trusts were represented and in 2017 100 Trusts. Significant improvements were seen in the use of nebulised bronchodilators and hypertonic saline and provision of parental written guidance. However, full compliance with the guideline did not change with 18% of Trusts compliant before publication of the guideline in 2015 and 19% fully compliant with the guideline in 2017. CONCLUSIONS: Overall there were modest but important improvements in the reported management of bronchiolitis after the publication of the NICE guideline

A descriptive analysis of general acute Trust star ratings

This paper examines the relationship between acute NHS Trust star ratings in England (generated by the Department of Health) in 2000/01 and 2001/02 with various other Trust characteristics and performance indicators from a Trust level database maintained by the Centre for Health Economics. The Trust star ratings system is a composite performance measure which places Trusts into one of four categories: from three stars, awarded to Trusts with the highest levels of performance to zero stars, awarded to Trusts showing the poorest levels of performance. We examine the descriptive statistics for the various variables in the dataset over the two years, according to each star rating as well as one-way Analysis of Variance (ANOVA) using zero star Trusts as the reference category and then least squares to fit a linear model to each of the variables in the dataset. Although zero star Trusts appear to perform better in terms of clinical outcomes such as death rates and readmissions, this is not statistically significant. However, zero star Trusts do worse than other Trusts across various patient satisfaction measures and financial and efficiency measures. Three star Trusts outperform others on two grounds fairly consistently: waiting times and financial balance suggesting either more efficient management or fewer capacity constraints. The labour market for consultants and nurses also appear to be utilised in different ways across the groups of Trusts. One hypothesis is that the different groups of Trusts focus on different elements of performance. The extent to which differences are due to exogenous factors or internal factors is a question for future research.analysis of variance (ANOVA), star rating, zero star Trusts

A Matter of Trust: Why Congress Should Turn Federal Lands into Fiduciary Trusts

The Forest Service, Bureau of Land Management, National Park Service, and Fish and Wildlife Service collectively manage well over a quarter of the land in the United States. Although everyone agrees that the lands and resources managed by these agencies are exceedingly valuable, the lands collectively cost taxpayers around $7 billion per year. Several Cato Institute studies have called for privatization of the public lands, but this idea is strongly resisted by environmentalists, recreationists, and other users of public land. An alternative policy that will both enhance the values sought by environmentalists and improve the fiscal management of the lands is to turn them into fiduciary trusts. Under this proposal, the U.S. would retain title to the lands, but the rules under which they would be governed would be very different. Fiduciary trusts are based on hundreds of years of British and American common law that ensures that trustees preserve and protect the value of the resources they manage, keep them productive, and disclose the full costs and benefits of their management. For trust law to apply, public land trusts must be based on a law written by Congress that clearly defines the trustees, the beneficiaries, and a specific mission or missions for the trusts. Congress should create two types of trusts. Market trusts would have a mission of maximizing revenue while preserving the productive capacity of the land. To achieve this mission, Congress should allow them to charge fair market value for all resources. Nonmarket trusts would have a mission of maximizing the preservation and, as appropriate, restoration of natural ecosystems and cultural resources on the public lands. Each pair of market and nonmarket trusts would jointly manage all federal lands in one of about a hundred ecoregions. Each ecoregion would have about 5 to 10 million acres of federal land that might include forests, parks, refuges, and other public lands. Trustees would be elected by a friends' association that anyone would be welcome to join. Trusts would be funded out of the user fees they collect, with some retained by the market trust and some given to the nonmarket trust. In some cases, excess user fees would be returned to the U.S. Treasury. The trust idea would significantly improve both fiscal and environmental management of the public lands. Congress should begin to implement this idea by testing it on selected national forests, parks, and other federal lands

Demystifying Income Trusts

Income trusts are one of the major investment vehicles for Canadians with an estimated 2004 market capitalization of $118.7 billion. This study aims to outline the nature of income trusts and the standing of trusts in the current financial environment. To that end, the study offers an overview of income trusts, discusses tax implications in a corporate, income trust and mutual fund structures, and reflects on recently proposed increase the dividend tax credit. The analysis shows that two most unique features of income trusts are their tax treatment and the high yield cash distributions. The recently proposed increase of the dividend tax credit may reduce the tax on dividends for a top earner and bring it in line with the current effective capital gains tax. However, these changes may be unevenly distributed across provinces and may distort investment decisions as different parts of the country react differently to different types of investment opportunities.income trusts, mutual funds, investment decisions, rating practices, dividend tax credit, capital gains tax, taxation