---

       T R O U B L E D   C O M P A N Y   R E P O R T E R

                          E U R O P E

          Friday, January 8, 2021, Vol. 22, No. 1

                           Headlines



N E T H E R L A N D S

VINCENT TOPCO: S&P Alters Outlook to Negative, Affirms B- ICR


R U S S I A

VNESHPROMBANK: Moscow Court Extends Ex-Owner's Asset Sale Process


S P A I N

PROMOTORA DE INFORMACIONES: S&P Downgrades ICR to 'SD'


U N I T E D   K I N G D O M

EASYJET PLC: To Suspend Voting Rights of Non-EU Shareholders
FONTWELL II SECURITIES: Fitch Assigns BB+ Rating to Class B Debt
MITCHELLS & BUTLERS: Plans to Raise Money from Investors
ONEWEB: Expects to Clinch US$400MM Fundraising This Month
VEDANTA RESOURCES: Unit to Issue US$400MM Notes to Oaktree

[*] UK: 4,000 Financial Services Firms at Risk of Collapse


X X X X X X X X

[*] BOOK REVIEW: Hospitals, Health and People

                           - - - - -


=====================
N E T H E R L A N D S
=====================

VINCENT TOPCO: S&P Alters Outlook to Negative, Affirms B- ICR
-------------------------------------------------------------
S&P Global Ratings revised the outlook to negative from stable and
affirmed its 'B-' long-term issuer credit and issue ratings on
Dutch caterer Vincent Topco BV (NL) (Vermaat), Vincent Bidco, and
the first lien term loan.

The '3' recovery rating on the debt is unchanged but our round
estimate has been revised down to 55% from 60%.

S&P expects the pandemic to continue to disrupt operations in the
coming years, with various impacts across each business segment.
About 65% of sites were significantly affected by the first
lockdown, due to either reduced capacity or complete closure.
Revenue declined to about 20% of 2019 levels during the highest
level of social distancing measures in the first lockdown, but
rebounded strongly in the hospital and leisure segments as lockdown
measures eased during the summer months. Corporate revenues
rebounded to around 40%-50% of 2019 levels following the pandemic's
onset. With the second wave of restrictions in the Netherlands
imposed over the past few weeks, revenue is expected to be hit, but
not to the same degree as the first lockdown, according to
management. The company does not expect a significant rebound until
a vaccine is widely available and restrictions ease. It has also
indicated that travel segments are unlikely to fully rebound to
2019 levels until 2023 and corporate sector recovery will need to
be supported by new contract wins to fully offset the effects from
increased working from home (WFH) over the long term.

The company has undertaken a number of cost-cutting initiatives to
counteract lower volumes.   Vermaat initiated restructuring efforts
to reduce its staff base and cater to lower volumes. It expects
about EUR34 million of cost savings in 2021, having seen
significant progress in this initiative to date. In addition, the
company has negotiated cost savings with suppliers and clients,
providing more flexibility through the height of the pandemic, and
utilized government support on labor payments to retain most of its
workforce. Given restructuring costs in 2020, S&P expects minimal
positive EBITDA this year. However, as restructuring costs reduce
and volumes recover in the coming years, it anticipates that EBITDA
will recover in 2022.

Vermaat has received lender approval to waive the financial
covenant and support small acquisitions.   The company has received
lender approval to waive the springing financial covenant until
mid-year 2022, temporarily replacing it with a minimum liquidity
covenant until then. S&P said, "We expect this will support
liquidity in the coming months as a result. In addition, to
supporting business flexibility, it will allow Vermaat to make
small tuck-in acquisitions of up to EUR20 million to support
international and business segment expansion. We expect any
acquisitions undertaken by Vermaat to fit with the original
strategy to build market share in the Netherlands and seek
expansion into new international markets. The recent announcement
of the strategic cooperation agreement with Jumbo Group Holdings
reinforces Vermaat's leading positions in the Netherlands.
Bridgepoint will provide equity of EUR10 million to support this
amendment."

S&P said, "We expect credit metrics sustained at the weaker end of
the highly leveraged category, but significant improvement in the
coming years.  We expect leverage will remain high, with S&P Global
Ratings-adjusted debt to EBITDA trending below 10x by 2022. We also
forecast negative free operating cash flow (FOCF) until 2021, but
recovery in business operations should mean a return to positive
territory in 2022. Given the hit to credit metrics in the coming
years, we have revised the outlook to negative to reflect increased
risk of a downgrade on a greater-than-expected impact from the
pandemic."

S&P Global Ratings believes there remains a high degree of
uncertainty about the evolution of the coronavirus pandemic.  
Although the early approval of a number of vaccines is a positive
development, countries' approval of vaccines is merely the first
step toward a return to social and economic normality; equally
critical is the widespread availability of effective immunization,
which could come by mid-year 2021. S&P said, "We use this
assumption in assessing the economic and credit implications
associated with the pandemic. As the situation evolves, we will
update our assumptions and estimates accordingly."

Environmental, social, and governance (ESG) credit factors for this
credit rating change:  

-- Health and safety

S&P said, "The negative outlook reflects the increased possibility
that we could lower the rating if Vermaat's recovery is slower than
expected in the coming years, causing the company's cash flow and
leverage metrics to underperform our base case, which could
pressure liquidity or the capital structure.

"We could downgrade the company if operational performance weakens
more than expected amid a prolonged impact from COVID-19. Lower
discretionary spending could reduce demand across various segments,
which might further strain credit metrics and lead to greater
negative FOCF, tightening liquidity, and in turn a lower rating. In
addition, we could consider a downgrade if we deem the capital
structure unsustainable, with leverage sustained above 10x.

"We could revise our outlook to stable if the company's operations
outperform our expectations, providing more certainty on stabilized
revenue and EBITDA that supports sustained positive cash balance.
We would also expect the company to have sufficient liquidity and
continue to deleverage."




===========
R U S S I A
===========

VNESHPROMBANK: Moscow Court Extends Ex-Owner's Asset Sale Process
-----------------------------------------------------------------
Global Insolvency, citing for RASPSINews.com, reports that the
Moscow Commercial Court has again extended the procedure of sale of
assets of Vneshprombank former co-owner Georgy Bedzhamov, charged
with large-scale embezzlement for 6 months, according to court
records.

Previously, the bankruptcy proceedings were extended in July,
Global Insolvency notes.  

Mr. Bedzhamov was declared bankrupt in July 2018, Global Insolvency
recounts.  In 2016, Mr. Bedzhamov was put on the international
wanted list on embezzlement charges, Global Insolvency discloses.

Investigators believe that ex-Vneshprombank president Larisa Markus
along with her brother Georgy Bedzhamov, who once co-owned the
bank, created an organized crime group to siphon money from the
bank, Global Insolvency relays.  The group including Glushakova
allegedly granted loans to sub-companies and did not refund money
to Vneshprombank, Global Insolvency recounts.

Allegedly, from May 2009 to December 2015, conspirators managed to
embezzle about RUR114 billion, Global Insolvency states.

In March 2016, the Moscow Commercial Court declared Vneshprombank
bankrupt, Global Insolvency discloses.

Vneshprombank was one of the top 40 by assets before it lost its
license in January of the same year, according to Global
Insolvency.




=========
S P A I N
=========

PROMOTORA DE INFORMACIONES: S&P Downgrades ICR to 'SD'
------------------------------------------------------
S&P Global Ratings lowered its issuer credit rating on Promotora de
Informaciones S.A. (Prisa) to 'SD' (selective default) from 'CC'.

On Dec. 31, 2020, Prisa signed a previously announced agreement to
amend its term loans and issue about EUR110 million of super senior
debt, after receiving consent from all debtholders.

S&P said, "The downgrade stems from our view, in line with our
criteria, that the recent transaction is tantamount to a default
because, absent this new financing, the group would likely have
faced a conventional default.   The group has issued about EUR110
million of super senior debt, bringing total super senior debt to
EUR225 million (EUR145 million term loan and the currently undrawn
EUR80 million RCF); repaid about EUR400 million of the term loans
toward EUR750 million; revised maturity dates and interest rates;
and implemented new financial covenants. We view this transaction
as distressed rather than opportunistic since, absent this new
financing, the group would likely have faced a conventional default
over the near term, due to reducing liquidity. Prisa would also
have breached covenants unless it obtained a revision of covenants
as part of the transaction. In addition, the issuance of new
secured debt alters the ranking of the original debt, increasing
its subordination without adequate compensation to the debtholders,
in our view. The transaction and amendments to the existing credit
agreement, which were approved by all of Prisa's debtholders,
include modifications to covenants and some tighter restrictions on
permitted payments, which are beneficial for lenders. The super
senior debt will have lower cash interest and a higher
payment-in-kind (PIK) interest component than for the term loans.
We consider the consent fee that existing lenders will receive to
be minimal (75 basis points in the form of PIK accrued in 2020)."
Overall, the transaction comprises the following:

-- The issuance of EUR110 million in debt that increases the
super-priority debt in the capital structure to EUR225 million.

-- Extension of the maturity date of loans by slightly over two
years to March 31, 2025, with super senior debt maturing three
months before the term loans.

-- Removal of the previous amortization schedule for the term
loans.

-- Revised interest rates for existing term loans, incorporating
additional PIK interest from 2022 and a 0.5% cash-pay interest
increase in 2023-2025 for the term loan. The all-in yield on the
super senior debt will also increase by approximately 0.5%-1.0%
over the life of the loans.

-- Revised covenants, including net leverage and minimum
liquidity. Prisa is required to post net leverage of below 11x in
December 2021, reducing to 8.1x by the end of 2022. In addition,
there is a minimum liquidity test of EUR100 million as of March,
31, 2021, which reduces to EUR80 million by the end of 2021,
including some intrayear swings of EUR60 million-EUR80 million.

-- The debt-service covenant stipulating coverage of at least 1x
is suspended until March 31, 2024.

-- The repayment of over EUR400 million of syndicated loans from
the gross proceeds of Prisa's sale of Santillana Spain for EUR465
million (including EUR53 million of net debt) and Media Capital
Group.

-- S&P said, "We intend to review our ratings on Prisa over the
coming days.   In doing so, we will incorporate our forward-looking
opinion of the company's creditworthiness. In our assessment, we
will include our view on Prisa's operational performance, as well
as the potential impact from the pandemic, the recent sales of
Santillana Spain and Media Capital, and the revised capital
structure."

Environmental, social, and governance (ESG) credit factors for this
credit rating change:

-- Health and safety




===========================
U N I T E D   K I N G D O M
===========================

EASYJET PLC: To Suspend Voting Rights of Non-EU Shareholders
------------------------------------------------------------
Sarah Young and Laurence Frost at Reuters report that EasyJet has
begun moves to suspend the voting rights of some non-EU
shareholders to comply with post-Brexit airline ownership rules,
the UK airline said on Jan. 4.

According to Reuters, European Union rules state that EU airlines
must be owned and controlled by EU nationals or else lose their
licenses.  EasyJet has held an Austrian operating license since
2017 to retain its EU flying rights despite Britain leaving the EU,
Reuters notes.

But the airline is currently 52.65% owned by non-EU shareholders,
meaning it must make changes to meet EU rules following the end of
the Brexit transition period on Dec. 31, Reuters discloses.

By restricting voting rights, easyJet and competitors such as
British Airways owner IAG, Wizz Air and Ryanair all hope to
overcome the Brexit ownership headache, Reuters states.

However, concerns persist that the compliance efforts may be
unsustainable or open to legal challenge by competitors, Reuters
notes.

EasyJet said on Jan. 4 that investors from outside the EU would be
restricted to controlling 49.5% of its shares, and as such it was
sending out notices to shareholders holding more than 3% of shares
to suspend some of their voting rights, Reuters relates.

The investor register will also be kept under review, easyJet, as
cited by Reuters, said, saying that if non-EU ownership remains
over the 49.5% maximum for a sustained period it could start to
force those shareholders to sell their shares to EU nationals.


FONTWELL II SECURITIES: Fitch Assigns BB+ Rating to Class B Debt
----------------------------------------------------------------
Fitch Ratings has assigned Fontwell II Securities 2020 Designated
Activity Company final ratings as per the list below.

   DEBT                     RATING                 PRIOR
   ----                     ------                 -----
Fontwell II Securities 2020 DAC

Class A CLN          LT  BBB-sf  New Rating      BBB-(EXP)sf
Class B CLN          LT  BB+sf   New Rating      BB+(EXP)sf
Class Z CLN          LT  NRsf    New Rating      NR(EXP)sf
Retained Tranche A   LT  NRsf    New Rating      NR(EXP)sf
Retained Tranche B   LT  Asf     New Rating      A(EXP)sf
Retained Tranche C   LT  A-sf    New Rating      A-(EXP)sf
Retained Tranche D   LT  BBB+sf  New Rating      BBB+(EXP)sf
Tranche A            LT  BBB-sf  New Rating      BBB-(EXP)sf
Tranche B            LT  BB+sf   New Rating      BB+(EXP)sf
Tranche Z            LT  NRsf    New Rating      NR(EXP)sf

TRANSACTION SUMMARY

The transaction is a partially funded eight-year synthetic
securitisation referencing a static portfolio of secured loans
granted to UK small and medium-sized enterprises in the farming and
agriculture sector. The loans were originated by Lloyds Bank plc
(A+/Negative/F1) via its wholly owned subsidiary, Agricultural
Mortgage Corporation plc (AMC). Proceeds from the class A, B and Z
credit-linked notes are used to fund a cash deposit account at
Lloyds.

The ratings of the tranches address probability of claims under a
financial guarantee while the ratings of the class A & B
credit-linked notes address interest and principal repayment in
accordance with the terms and conditions of the documents.

KEY RATING DRIVERS

Static Portfolio; High Interest-only Share (Positive):
Interest-only loans make up 63% of the portfolio, with lower
payments during the life of the mortgage than capital repayment
mortgages, but refinancing risk at maturity. However, only 8% have
maturity dates prior to the scheduled maturity of the transaction.
The high interest-only share also results in limited amortisation
and scheduled deleveraging during the eight-year financial
guarantee period.

Low Probability of Default (Positive): Fitch assigns an annual
average probability of default (PD) of 2% to all borrowers in the
portfolio. The annual average PD is derived from a long history of
data, which covered the stress period of the foot-and-mouth crisis
in 2001. The transaction's annual PD is lower than the UK SME
sector's 2.5% and is supported by low default rates in the
originator's farming book.

Single Industry (Negative): All the borrowers in the reference
portfolio are exposed to the UK farming and agriculture sector. In
view of the low volatility from 25 years of arrears data from AMC's
farming book, Fitch applies a bespoke correlation of 10% such that
the portfolio's default rate at the 'B' rating stress is aligned
with the worst cumulative eight-year default rate.

Low Loan-to-Value Ratio (Positive): The current weighted average
loan-to-value (WA LTV) ratio of the portfolio is low at 39%. The
majority of the collateral is on agricultural land, contributing to
a favourable base-case recovery rate of 97.7%.

Collateral Dilution Risk (Negative): Additional borrowing by
borrowers with mortgages in the portfolio can dilute the collateral
share of the referenced loans. The eligibility criteria and the
originator's policies set the maximum LTV at 60%, calculated on a
borrower basis. Taking into account the low LTV at closing and
limited dilution in Fontwell I, Fitch has stressed each loan's LTV
to the maximum of the current LTV and 50% to address the collateral
dilution risk, resulting in a WA LTV of 51%.

Granular Portfolio (Positive): The portfolio is diverse and
comprises 6,738 loans. The largest obligor and top 10 obligors
contribute to about 0.26% and 2.58% of the portfolio balance,
respectively.

RATING SENSITIVITIES

This section provides insight into the model-implied sensitivities
the transaction faces when one assumption is modified, while
holding others equal. The modelling process uses the modification
of these variables to reflect asset performance in upside and
downside environments. The results below should only be considered
as one potential outcome, as the transaction is exposed to multiple
dynamic risk factors. It should not be used as an indicator of
possible future performance.

Factors that could, individually or collectively, lead to positive
rating action/upgrade:

-- Reducing 25% of the mean default rate at each rating level,
    and increasing the recovery rate by 25% would lead to upgrades
    by two to three notches across the structure.

-- Upgrades may occur if the portfolio performance is better than
    initial expectation and the transaction's deleveraging leads
    to higher credit enhancement to cover for losses in the
    remaining portfolio.

Factors that could, individually or collectively, lead to negative
rating action/downgrade:

-- Increasing 25% of the mean default rate at each rating level,
    and reducing the recovery rate by 25% would lead to downgrades
    by three to five notches across the structure.

-- Downgrades may occur if the build-up of credit enhancement
    following portfolio amortisation does not compensate for a
    larger loss expectation than initially assumed due to
    unexpectedly high levels of credit deterioration.

Coronavirus Baseline Sensitivity

Fitch observed that farming has been less affected by the pandemic
as evidenced by the low uptake of capital repayment holidays
compared with other SME portfolios Fitch rates. Further, the stress
on recovery by modelling collateral dilution provides a cushion of
three notches at closing, supporting the Stable Outlook across the
ratings. While the originator may advance more lending and can thus
increase the LTV, Lloyds has not done so in Fontwell I since 2016.
As such, Fitch deems that the stress applied based on the criteria
in assigning the rating is sufficient for the baseline
sensitivity.

Coronavirus Downside Sensitivity

Fitch has added a sensitivity analysis that contemplates a more
severe and prolonged economic stress caused by a re-emergence of
infections in the major economies, before halting recovery begins
in 2Q21. The downside sensitivity incorporates an increase of 25%
of the base-case default rate to each rating level, and a reduction
of 25% to the recovery rate. Under this scenario, the rating will
be three to five notches lower across the structure.

BEST/WORST CASE RATING SCENARIO

International scale credit ratings of Structured Finance
transactions have a best-case rating upgrade scenario (defined as
the 99th percentile of rating transitions, measured in a positive
direction) of seven notches over a three-year rating horizon; and a
worst-case rating downgrade scenario (defined as the 99th
percentile of rating transitions, measured in a negative direction)
of seven notches over three years. The complete span of best- and
worst-case scenario credit ratings for all rating categories ranges
from 'AAAsf' to 'Dsf'. Best- and worst-case scenario credit ratings
are based on historical performance.

USE OF THIRD PARTY DUE DILIGENCE PURSUANT TO SEC RULE 17G -10

Form ABS Due Diligence-15E was not provided to, or reviewed by,
Fitch in relation to this rating action.

DATA ADEQUACY

The portfolio loan by loan data as of 17 December 2020; delinquency
data of AMC's book from 1995 to 31 July 2020; and repossession data
from 2013 to 4 December 2020 are provided by Lloyds. Fitch reviewed
the results of a third-party assessment conducted on the asset
portfolio information, and concluded that there were no findings
that affected the rating analysis.

ESG CONSIDERATIONS

Unless otherwise disclosed in this section, the highest level of
ESG credit relevance is a score of '3'. This means ESG issues are
credit-neutral or have only a minimal credit impact on the entity,
either due to their nature or the way in which they are being
managed by the entity.

MITCHELLS & BUTLERS: Plans to Raise Money from Investors
--------------------------------------------------------
BBC News reports that pub group Mitchells & Butlers says it is
examining raising money from investors because it is unclear how
long current restrictions will last.

According to BBC, each month closed loses the business up to GBP40
million, plus it has to meet GBP50 million debt costs each
quarter.

It added that it had not yet made a decision about the timing,
size, or terms of the fund raising, BBC notes.

On top of that, it has to meet the next quarterly payment date for
debt service of GBP50 million on March 15, BBC states.

All pubs in England are now closed until late-February at the
earliest under the latest lockdown, BBC discloses.

The company said trading in the three months to Jan. 2, which
included the November lockdown in England and the Christmas period,
was 67% below 2019's levels, BBC relates.

M&B operates about 1,700 pubs across the UK, including brands such
as All Bar One, Nicholson's and O'Neill's.


ONEWEB: Expects to Clinch US$400MM Fundraising This Month
---------------------------------------------------------
Peggy Hollinger, Arash Massoudi and Jim Pickard at The Financial
Times report that OneWeb, the satellite internet group recently
rescued from bankruptcy, is expecting to clinch a US$400 million
fundraising this month, its executive chairman said as the company
marked a return to business with the launch of 36 satellites.

Sunil Bharti Mittal, the Indian telecoms tycoon who with the
British government has taken control of OneWeb for US$1 billion,
said two satellite operators and a financial group were in late
stage discussions about investing, the FT relates.

But even with an extra US$400 million, that leaves a further GBP1
billion to be raised either from new investors or through debt in
order to complete a constellation of about 650 low earth orbit
(Leo) satellites that will deliver a global broadband service to
the most remote areas of the planet, the FT states.

The UK's investment in OneWeb, against the advice of senior civil
servants, has been controversial with critics questioning both the
due diligence that was done on the company, as well as its
viability, the FT notes.

As reported by the Troubled Company Reporter-Europe on Nov. 24,
2020, Reuters related that satellite operator OneWeb said on Nov.
20 it has emerged from Chapter 11 bankruptcy protection with US$1
billion in equity investment from a consortium of the UK Government
and India's Bharti Enterprises, the new owners of the UK-based
company.  OneWeb, founded in 2014 by entrepreneur Greg Wyler, filed
for bankruptcy protection at the end of March after its biggest
investor SoftBank Group Corp pulled funding, Reuters recounted.


VEDANTA RESOURCES: Unit to Issue US$400MM Notes to Oaktree
----------------------------------------------------------
Global Insolvency, citing Bloomberg News, reports that a unit of
Vedanta Resources will issue US$400 million in notes to an entity
under Oaktree Capital Group, as the mining conglomerate looks to
meet liquidity needs.

The notes will be partly secured by shares in Mumbai-listed unit
Vedanta Ltd., Global Insolvency, relays, citing separate exchange
filings from Vedanta and the U.S. hedge fund.

The new deal with Oaktree comes after Vedanta Resources sold US$1
billion of securities earlier last month, at one of the highest
yields for a dollar bond in Asia this year, Global Insolvency
notes.

That debt issuance was to fund a tender offer for securities due
2021, Global Insolvency states.

According to Global Insolvency, the holding company, controlled by
billionaire Anil Agarwal, aims to simplify the group's corporate
structure and ease Vendata Resources' access to cash after a failed
attempt to delist Vedanta Ltd. in October.

                     About Vedanta Resources

Vedanta Resources Limited operates as a diversified natural
resource company. The Company extracts and process zinc, lead,
aluminum, iron ore, copper, and silver, as well as focuses on oil
and natural gas. Vedanta Resources serves clients worldwide.

As reported in the Troubled Company Reporter-Europe, Moody's
corporate family rating for Vedanta Resources Limited was at B2 as
of Dec. 29, 2020. S&P Global Ratings assigned its 'B-' long-term
issue  rating to Vedanta 's proposed guaranteed senior unsecured
notes on December 8, 2020.

[*] UK: 4,000 Financial Services Firms at Risk of Collapse
----------------------------------------------------------
Holly Williams and Scott Reid at The Scotsman report that as many
as 4,000 financial services firms were at a "heightened" risk of
collapse due to the pandemic even before the second wave struck,
the City watchdog has warned.

The Financial Conduct Authority (FCA) said a survey of 23,000 firms
found that, at the end of October, 4,000 had low financial
resilience and faced a greater risk of failure, The Scotsman
relates.

According to The Scotsman, the FCA said around 30% of these firms
-- mainly smaller businesses -- had the potential to cause harm if
they failed.

But the watchdog urged caution over the data, stressing that the
survey was carried out before the recent furlough scheme extension,
vaccine rollout and the latest lockdowns and restrictions, The
Scotsman relays.

"At end of October we've identified there are 4,000 financial
services firms with low financial resilience and at heightened risk
of failure, though many will be able to bolster their resilience as
and when economic conditions improve," The Scotsman quotes Sheldon
Mills, executive director of consumers and competition at the FCA,
as saying.

"Our role isn't to prevent firms failing but, where they do, we
work to ensure this happens in an orderly way.

"By getting early visibility of potential financial distress in
firms, we can intervene faster so that risks are managed and
consumers are adequately protected."

The poll was undertaken to check on the resilience of UK financial
services firms to the crisis, The Scotsman notes.  It showed that
insurance intermediaries and brokers, payments and electronic
money, and investment management firms suffered a drop in so-called
liquid assets, such as cash, which is key to their resilience amid
a crisis, The Scotsman discloses.

It did not cover the 1,500 largest firms across the sector, which
are regulated by the Bank of England's Prudential Regulation
Authority, The Scotsman says.




===============
X X X X X X X X
===============

[*] BOOK REVIEW: Hospitals, Health and People
---------------------------------------------
Author: Albert W. Snoke, M.D.
Publisher: Beard Books
Softcover: 232 pages
List Price: $34.95
Order your personal copy today at
http://www.beardbooks.com/beardbooks/hospitals_health_and_people.html

Hospitals, Health and People is an interesting and very readable
account of the career of a hospital administrator and physician
from the 1930's through the 1980's, the formative years of today's
health care system. Although much has changed in hospital
administration and health care since the book was first published
in 1987, Dr. Snoke's discussion of the evolution of the modern
hospital provides a unique and very valuable perspective for
readers who wish to better understand the forces at work in our
current health care system.

The first half of Hospitals, Health and People is devoted to the
functional parts of the hospital system, as observed by Dr. Snoke
between the late 1930's through 1969, when he served first as
assistant director of the Strong Memorial Hospital in Rochester,
New York, and then as the director of the Grace-New Haven Hospital
in Connecticut. In these first chapters, Dr. Snoke examines the
evolution and institutionalization of a number of aspects of the
hospital system, including the financial and community
responsibilities of the hospital administrator, education and
training in hospital administration, the role of the governing
board of a hospital, the dynamics between the hospital
administrator and the medical staff, and the unique role of the
teaching hospital.

The importance of Hospitals, Health and People for today's readers
is due in large part to the author's pivotal role in creating the
modern-day hospital. Dr. Snoke and others in similar positions
played a large part in advocating or forcing change in our hospital
system, particularly in recognizing the importance of the nursing
profession and the contributions of non-physician professionals,
such as psychologists, hearing and speech specialists, and social
workers, to the overall care of the patient. Throughout the first
chapters, there are also many observations on the factors that are
contributing to today's cost of care. Malpractice is just one
example. According to Dr. Snoke, "malpractice premiums were
negligible in the 1950's and 1960's. In 1970, Yale-New Haven's
annual malpractice premiums had mounted to about $150,000." By the
time of the first publication of the book, the hospital's premiums
were costing about $10 million a year.

In the second half of Hospitals, Health and People, Dr. Snoke
addresses the national health care system as we've come to know it,
including insurance and cost containment; the role of the
government in health care; health care for the elderly; home health
care; and the changing role of ethics in health care. It is
particularly interesting to note the role that Senator Wilbur Mills
from Arkansas played in the allocation of costs of hospital-based
specialty components under Part B rather than Part A of the
Medicare bill. Dr. Snoke comments: "This was considered a great
victory by the hospital-based specialists. I was disappointed
because I knew it would cause confusion in working relationships
between hospitals and specialists and among patients covered by
Medicare. I was also concerned about potential cost increases. My
fears were realized. Not only have health costs increased in
certain areas more than anticipated, but confusion is rampant among
the elderly patients and their families, as well as in hospital
business offices and among physicians' secretaries." This aspect of
Medicare caused such confusion that Congress amended Medicare in
1967 to provide that the professional components of radiological
and pathological in-hospital services be reimbursed as if they were
hospital services under Part A rather than part of the co-payment
provisions of Part B.

At the start of his book, Dr. Snoke refers to a small statue,
Discharged Cured, which was given to him in the late 1940's by a
fellow physician, Dr. Jack Masur. Dr. Snoke explains the
significance the statue held for him throughout his professional
career by quoting from an article by Dr. Masur: "The whole question
of the responsibility of the physician, of the hospital, of the
health agency, brings vividly to mind a small statue which I saw a
great many years ago.it is a pathetic little figure of a man, coat
collar turned up and shoulders hunched against the chill winds,
clutching his belongings in a paper bag-shaking, tremulous,
discouraged. He's clearly unfit for work-no employer would dare to
take a chance on hiring him. You know that he will need much more
help before he can face the world with shoulders back and
confidence in himself. The statuette epitomizes the task of medical
rehabilitation: to bridge the gap between the sick and a job."

It is clear that Dr. Snoke devoted his life to exactly that
purpose. Although there is much to criticize in our current
healthcare system, the wellness concept that we expect and accept
today as part of our medical care was almost nonexistent when Dr.
Snoke began his career in the 1930's. Throughout his 50 years in
hospital administration, Dr. Snoke frequently had to focus on the
big picture and the bottom line. He never forgot the importance of
Discharged Cured, however, and his book provides us with a great
appreciation of how compassionate administrators such as Dr. Snoke
have contributed to the state of patient care today.

Albert Waldo Snoke was director of the Grace-New Haven Hospital in
New Haven, Connecticut from 1946 until 1969. In New Haven, Dr.
Snoke also taught hospital administration at Yale University and
oversaw the development of the Yale-New Haven Hospital, serving as
its executive director from 1965-1968. From 1969-1973, Dr. Snoke
worked in Illinois as coordinator of health services in the Office
of the Governor and later as acting executive director of the
Illinois Comprehensive State Health Planning Agency. Dr. Snoke died
in April 1988.



                           *********


S U B S C R I P T I O N   I N F O R M A T I O N

Troubled Company Reporter-Europe is a daily newsletter co-
published by Bankruptcy Creditors' Service, Inc., Fairless Hills,
Pennsylvania, USA, and Beard Group, Inc., Washington, D.C., USA.
Marites O. Claro, Rousel Elaine T. Fernandez, Joy A. Agravante,
Julie Anne L. Toledo, Ivy B. Magdadaro, and Peter A. Chapman,
Editors.

Copyright 2021.  All rights reserved.  ISSN 1529-2754.

This material is copyrighted and any commercial use, resale or
publication in any form (including e-mail forwarding, electronic
re-mailing and photocopying) is strictly prohibited without prior
written permission of the publishers.

Information contained herein is obtained from sources believed to
be reliable, but is not guaranteed.

The TCR Europe subscription rate is US$775 per half-year,
delivered via e-mail.  Additional e-mail subscriptions for
members of the same firm for the term of the initial subscription
or balance thereof are US$25 each.  For subscription information,
contact Peter Chapman at 215-945-7000.


                * * * End of Transmission * * *