Monday, 29 December 2014

It is a catastrophe

Here we go. It is winter and it is getting cold, freezing cold, shiver your timbers cold. It  is winter. That is what I expect in winter.  But when I read the newspapers or watch television you would not think so. Now is the time for headlines. Winter is no longer sufficient. It has to be 'record low temperatures', 'lowest since records began', 'the big freeze'. It isn't of course. It is winter, and when I look at the story under the headline we find that it is the lowest temperature recorded in some obscure part of the Britain.

Headlines. We live by them. There is that phrase I hear used often 'the headline figure'. Beware of them is what I say.  It is all designed to make us feel that something awful is happening, when it is simply winter.

Now this isn't to say I don't believe it when we are told that environmental change is causing changes in weather patterns - more stormy weather, more floods, more heat waves, more...snow. Winter. Since records began is a wonderful phrase. I have no idea what it means. Sometime ago they started recording somewhere, and things have changed ever since.  It is the wettest, it is the driest, it is the coldest, it is the warmest, it is the worst, since records began.  Hardly anything is better. It is worse - worse than when 'records began'. But when did records begin? That differs depending on the story. Where did records begin? That differs depending on the story. It is a catastrophe, it is a disaster. Catastrophic is a wonderful word. Of course it is. But what does it mean? An event causing great and usually sudden damage or suffering; a disaster. It is winter. It is the New Year. Well, almost.  We like to look back on the year past as the 'worst on record'.

Some newspapers have totted up the number of aged rock stars who have died. Apparently this year has been the 'worst on record' for that. One after the other, we lost them.  Of course we did. And next year will be the worst on record. And eventually none of them will be left - and that will be a catastrophe.

Friday, 19 December 2014

Doctors under stress

A recent survey conducted by Pulse magazine found that four in 10 GPs have taken or expect to take time off from work as a result of increased workloads. 12 per cent had taken time off in the past 12 months, with 29 per cent reporting that they thought they would probably need time off in the next 12 months. 

Today the General Medical Council publishes a report on Doctors who commit suicide while under GMC fitness to practice investigations. 

Responding to today’s [Friday] report from the General Medical Council (GMC), BMA council chair, Dr Mark Porter, said:

“Doctors’ first priority is their patients' care, but we must not forget that they can face the same physical and mental health issues as everyone else, and it is vital that vulnerable doctors undergoing fitness for practice investigations are fully supported."

Previous GMC research revealed doctors’ views of the investigation process and it is clear that more needs to be done to understand the wider implications on doctors’ mental health, and the care they feel able to deliver.

Many doctors are already facing high levels of stress, with one survey of GPs showing that four in 10 are facing burnout, and a recent BMA survey highlighted how morale is plummeting at a time when workloads are becoming increasingly unmanageable. None of this is good news for patients or the NHS in general. The BMA has warned of the NHS at breaking point. 

As Dr Mark Porter says

“It is in the interests of both doctors and patients that, where appropriate, concerns can be raised and that these are thoroughly investigated. But this process must be fair and offer adequate protection to ensure the system itself does not cause harm.

“The BMA provides counselling and support services for all doctors but believes more must be done to help vulnerable doctors who find themselves going through what can be a prolonged and arduous process.

“We are pleased that the GMC has acknowledged this and is putting in place measures to provide the right support.”

Wednesday, 17 December 2014

Cameron's democratic conundrum.

I am not at all impressed by the simplicity of 'English votes for English laws'.  Introducing a rule in parliament that says only MPs representing English Constituencies can vote on matters affecting the English doesn't solve the problem of how we move forward with the United Kingdom. On the contrary it hammers yet another nail into its coffin. But my main argument against it is that it denies, yes denies, the same level of democracy that voters in Scotland or Wales etc would have. Far from solving a problem it creates a new anomaly.  If I were then to be a voter in Scotland I would have the opportunity to split my vote - I might for example vote SNP (well I wouldn't but that is a different matter) for the Scotland Parliament but would vote Tory (certainly wouldn't but then this is an example) in the UK wide vote.  If I lived in England I would not have these opportunities. I would have to choose the same party to represent me in England as UK wide.

Now you might ask why a voter might wish to do that. But that is often what voters do. In local elections they will often vote for a different party than they would in a general election. The same is the case in European elections. Voters it seems are more sophisticated than 'English votes for English Laws'.

The British Constitution is an odd make up of conventions and statute. It has its anomalies. Some might argue that it is these anomalies that give it value. After all, if we are talking about democracy and votes counting, then why should someone born into a particular family have any greater say in our affairs than any other person? That of course is so with the monarchy. It is also the case with  hereditary peers. If Cameron really believed in democracy he would surely have abolished the remaining hereditary peers and finished the reform of the House of Lords. He won't of course.

Our 'democracy' is neither perfect nor thoroughly bad. To pick on one particular problem and elevate it above all the others is simply party politics. The West Lothian question is not the most vital issue in politics. It is a conundrum.  If Cameron wants to 'save the union' then he had better come up with something better.  He should stop playing for party advantage following the Scottish referendum. In doing so he puts the Union at risk.

I have no doubt that some kind of federal settlement is required. But that will require proper devolution of powers in England - or perhaps I should say 'to England'.

BMA support banning smoking in cars with children

Responding to the regulations laid before Parliament today that propose banning smoking in cars containing children under 18, Professor Sheila Hollins, BMA board of science chair, said:

“The BMA strongly supports a ban on smoking in cars when children are present, as it is an important step in reducing tobacco harm by restricting the prevalence of second hand smoke in private vehicles.

“Children are still developing physically and biologically and compared to adults they breathe more rapidly, absorb more pollutants and have less developed immune systems. As a result, they are more susceptible to the harmful effects of second hand smoke and are less likely to be able to choose to move away from it.

“Adults who smoke in the presence of children are not acting in the children’s best interest; therefore it is encouraging that the government has brought forward these regulations in order to protect them.”

Friday, 12 December 2014

Brand shows a new brand of politics

I am no great fan of Russell Brand. His brand (no pun intended) of humour doesn't appeal to me. But his appearance on BBC Question Time last night demonstrated one salient lesson. There is everything to be gained by confronting UKIP directly rather then pandering to the fears they stoke up about migration.  The Tory, Labour and Liberal Democrat strategy of trying to outpace UKIP on this key issue simply tells voters that UKIP have got it right. Russell Brand demonstrated how to challenge UKIP on their own turf.  The audience responded. Yes, it was a divided audience but I had the impression of a sense of release that UKIP had finally been challenged and found wanting.

Brand's style cuts through the usual heavily nuanced political debate around a centre ground that is the size of a pin head.  One of the reasons why voters are turned off politics is that there are few people out there who now make a bold statement that might represent their views, and there are precious few who will try to lead and persuade.  They argue instead about small detail. It runs on the lines of 'yea there is this problem, and yes the Tory party propose the following, but we will do more'. The policies are essentially the same but differ in degree rather than substance. Or so it seems. And if it seems so, then politicians have an up hill battle.

How many time do we hear, as we did last night the arguments over a tiny detail?  Under Labour 5% of NHS services were 'contracted out', now we were told by the Tory minister 6% is. So is the real difference between Labour and Tory simply 1%? The answer to that is no, but the debate last night didn't reveal that. The truth is the substance, nature and motive behind that 6% contracted out is substantially different which is why the BMA this week warned about 'creeping privatisation'.  But why does it matter? It matters because it shifts funds away from NHS departments and if NHS department budgets fall then the ability of the NHS to provide the services expected will diminish. The need for more contracted services will increase, and this is why the BMA warned it was a 'creeping privatisation'

On the program last night we were told of a considerable number of Tory MPs who will gain from such contracting out. This needs further investigation and exposure. The whole process is ethically compromised.

Nigel Farage's trick of damning every other politician was exposed last night. He looked increasingly like an emperor without clothes. It was not a pretty sight.  He expects to go on these programs and have all other politicians pandering to his issues. Last night was different. Brand showed the way. Dare I say it was a new brand of politics - and that pun was intended.

NHS Crisis, Crisis, Crisis!

The BMA has issued its starkest warning yet on the 'crisis' facing the NHS.

Commenting on the publication of NHS England’s 'winter health check' which shows record numbers of patients waiting longer for treatment in emergency departments, and emergency admissions at the highest they've been since records began over a decade ago, Dr Mark Porter, BMA council chair said:

“Patients should be treated on the basis of clinical need rather than an arbitrary target, but these figures point to a system cracking under extreme pressure, leading to unacceptable delays in care.

“While the NHS is used to seeing a spike in demand during winter months, this year it’s experienced a spring, summer and autumn crisis as well, leaving no spare capacity in hospitals as we hit winter.

“This is not just a crisis in emergency care – bed shortages and high numbers of patients inappropriately in hospital beds are now major stress factors on the system, leading to unacceptable delays in treating and discharging patients. Outside of hospitals, GP surgeries are struggling to cope with unprecedented levels of demand.

“Front-line staff are working flat-out but the system can’t cope with the sheer number of patients coming through the door. So far there has been a total failure by government to come up with a meaningful plan to deal with this – funding announced recently to tackle winter pressures is simply recycled money, taken from other overstretched services.

“To alleviate pressure on the system we need to ensure people are better supported to self-care where appropriate, and that they get the right advice first time round on where to seek treatment so as to avoid unnecessary trips to A&E. An effective out-of-hours telephone service is crucial to this, yet NHS 111 is still falling short of the mark because it isn’t clinician-led. We also need a system-wide approach which addresses the flow of patients across the NHS.

“There is no getting away from the fact that the NHS needs more investment to ensure there are enough staff and resources to meet rising demand, and part of this means taking urgent action to address the high number of staff vacancies in emergency medicine as well as general practice.”

They are all 'cutting the deficit' now — but do they make any sense?

There is nothing more annoying than hearing politicians of all parties telling us 'we must cut the deficit'.  It is annoying because they never explain what they mean by it, let alone how they would do it.  It should come with a health warning, or some kind of caveat that tells you they are talking nonsense. There is no 'must' about cutting he deficit.  It is not in itself a 'must'. It is only a 'must' in the right economic context. Mr Osborne says he has cut the deficit by a third. Mr Cameron often repeats this. What they mean by cutting the deficit varies depending on what message they really want to get across.

Are they talking about the current account deficit, or are they talking about the underlying, or structural deficit? They don't tell you. They simply say 'deficit'. By doing so they give the impression that all kinds of deficit are equally problematic. They are not. You might think the deficit is 'the deficit'. Some politicians are fond of referring to household budgets for an analogy.  You can't go on spending beyond your means.  Well, no, you can't. But we often do. We often spend what we expect to pay later. We borrow. Now there are different kinds of borrowing.  For example, borrowing to pay of existing debts isn't 'good' borrowing. Borrowing to buy a car to use for work is probably, depending on the circumstances, an example of 'good' borrowing. Without the car you would have no income. So you might 'run a deficit' for a while, covered by borrowing. That kind of deficit isn't 'bad'.

We might regard the economy in the same way. The government might choose to run a deficit covered by borrowing in order to 'grow the economy'.

 In the calendar year 2007, the Labour government borrowed £37.7bn, of which £28.3bn was invested in big projects (the balance of £9.4bn represents the current budget deficit).  Last year the Coalition borrowed £91.5bn, with just £23.7bn invested (budget deficit was £67.8 bn).  So not all the deficit is 'bad'.

Let's look at this another way with another set of interesting statistics.  Let's look at debt as % of GDP.  In 1997 debt was 40% of GDP. At the start of the recession in 2007/8 debt had fallen to 36.4% of GDP. Yet this was despite increased government spending. Government spending increased enormously under Labour. The Tories are always telling us, so it must be right. So how was this achieved? The answer of course is by growth and increasing revenue.  Revenue can be key to cutting the deficit but politicians don't like going there because it is to do with taxes!

Let's also put it into another perspective. Debt as a percentage of GDP was much higher in the 1950s when according to Harold MacMillan, we had 'never had it so good'. Even as he said this, UK national debt was over 200% of GDP!  You might say, ah yes but that was because of the war. Indeed, no doubt it was, but the same argument can be applied now in relation to debt at 60% of GDP - 'ah yes , that is because of the financial crash'.  Indeed it is.

So, when we hear politicians talking about cutting deficits we need to be sure what deficit they are talking about, what they would do to cut it, and three whether what they propose makes any real sense. About that we can make no judgements because we have no idea what they would do to 'cut the deficit'. When they say 'we will cut the deficit' they are being disengenuous and frankly talking a load of bollocks.


Wednesday, 10 December 2014

BMA finds creeping privatisation of NHS

Figures released by the BMA today show the extent of creeping privatisation in NHS under Health and Social Care Act

The investigation by the BMJ found that a third of NHS contracts have been awarded to private sector providers since the Health and Social Care Act came into force.

Responding to the findings the BMA council chair, Dr Mark Porter, said:

“These figures show the extent of creeping privatisation in the NHS since the Health and Social Care Act was introduced. The Government flatly denied the Act would lead to more privatisation, but it has done exactly that.

"Enforcing competition in the NHS has not only led to services being fragmented, making the delivery of high-quality, joined-up care more difficult, but it has also diverted vital funding away from front-line services to costly, complicated tendering processes.

"What's worse is that there isn't even a level playing field as private firms often have an unfair advantage over smaller, less well-resourced competitors, especially those from the NHS and social enterprises. To undo this damage we need an honest and frank debate about how we can put right what has gone wrong without the need for another unnecessary and costly top-down reorganisation.”

We might think this doesn't matter provided the services are provided. But consider that if funding is heading for private sector providers it won't be available in a cash-strapped NHS. Departments in the end will close and more and more services will be outsourced.


Monday, 8 December 2014

The politics of poverty

How can we sleep at night when all around us are vulnerable people going hungry? What kind of greedy people are we that would not wish to stop this madness of food shortage amidst food plenty? How can we approach Christmas with 'goodwill to all' whilst we give little goodwill to those who have born the brunt of cuts. Our greed, or at least the bankers greed, brought this about, and yet the government is busy stoking up the same uncontrolled, housing led boom that became unsustainable.

We need a social contract that says that people should not be forced to work for poverty wages. We need a living wage. We need education policies that give realistic opportuities to our children and young people to acquire the skills they need for skilled jobs. We need a housing strategy that provides decent homes for people at affordable rents. We need a decent transport system that enables hard working people to get to work without spending thousand in fares. We need a government that will be bold enough to off the country a real choice.

In this season of goodwill, let us not let our 'charity' be dictated by a silly song for band aid. Let not the poor be dependent on charity. Let it be a matter of political choice that people should not be poor in our country. When we come to the election next May I can guarantee that no party will put the poor at the heart of our economic policy. All parties will dance on the pin head of the 'squeazed middle'.  The poorest won't matter if you want to get the middle income voters. I am afraid the poor will go on relying on charity. Jingle bells and all that fun. Let them know its Christmas nonsense. Please Lord don't let me feel guilty about it all.

Wednesday, 3 December 2014

Don't believe a word of it - cuts are cuts

Jobs, that is what it comes down to, and wages, and taxes. The reason for the coalition, the coming together of the Liberal Democrats and the Tories was to clear the deficit — so they said. They are failing, and failing miserably. Why? The answer was always there.  The best way to clear the deficit is to get people working for decent wages. The reason the deficit is not shifting is not because of profligate government spending. It is because of falling revenue. The premise that simply cutting spending will cut the deficit is what it is — simple.

Now you could go on cutting and cutting spending in the hope that the deficit will turn around. But the more you cut the more likely it is that you impact on revenue. Surely that is the lesson to be learned. But it isn't a new lesson. It is what several economist warned four years ago.

The problem with cuts is that it  begs the question of what to cut and that produces conflict about political priorities. The Tories will say they couldn't cut enough because the Liberal Democrats wouldn't let them. The Liberal Democrats will say look the Tories would have cut more savagely — 'we have held them back'.  Neither really gives an answer.

Another erroneous assumption runs on the lines that there is 'inefficiency' and we can cut without cutting front line services. I have no doubt there is inefficiency or 'red tape'. "Let's cut the red tape! they declare. It is a common theme and most people who hear it approve. Well, of course they do. Nobody likes red tape. So what then is the problem. The problem is 'red tape' doesn't come in a box labelled 'red tape'. So cutting it is difficult without also affecting the 'front line'. And this leads me to the next problem - the 'front line'. It is a politically expedient term and also has some erroneous assumptions.

The worst of these assumptions is that 'front line' can somehow be separated from the 'back room'. But it can't. 'Front line' staff often complain of excessive 'form filling' or 'paper work'. "if only they can get on with their jobs!' Again it is to simplistic an assumption.

Imagine the police operating without 'paperwork'. Would any prosecution succeed? I doubt it. Unfortunately paperwork is necessary. It is just as necessary in clinical services. Imaging being treated without your doctor having access to any of your notes.

No, the problem with 'paperwork' is that much of it is necessary. Of course a lot of it is not, but deciding what is and what is not is difficult. Furthermore it doesn't come in a box labeled 'necessary paperwork'.

This is why I am always sceptical of politicians who sell cuts on the grounds of 'efficiency' or 'cutting red tape' - not because I don't want 'efficiency' or to cut 'red tape'. It is that they don't really know what they are talking about when they use those terms and neither do I. I can of course come up with examples but, and it is a big but, all these examples don't fit together into a clear comprehensive policy that will achieve very much in relation to the deficit.

The government said that they would protect the NHS. But the NHS has had £20 billion of cuts. The government says these are 'efficiency savings'. But we see the result of these so-called 'efficiency' cuts - a health system which the BMA has warned several times is on the precipice.

There is no quick or easy fix to the deficit. It needs an economic strategy beyond the bounds of electoral timetables. Now the Chancellor is pushing spending because of the election, not because it is the right thing to do for the economy. We are in political and not economic decision making.

Sunday, 30 November 2014

NHS crisis is government created

It is increasingly difficult to see a coherent government strategy for the economy.  Dealing with the deficit has now given way to 'doing whatever is politically expedient to win the next general election'. The NHS is high in list of voters' concerns.

The 'extra' £2 billion for the NHS announced today in the Chancellor's autumn statement is welcome. But it is too little and very late. The government has been warned over the past four years of cuts that the NHS is 'on a precipice' and would have difficulty meeting needs. Mr Cameron promised that the NHS would be 'ring fenced' and protected from the cuts, but so-called efficiency savings have eaten into NHS budgets to the tune of £20 billion.

Responding to the announcement today by the chancellor that NHS services are to receive £2 billion in extra funding, BMA Council Chair, Dr Mark Porter said:

“There is little doubt that the NHS is under unprecedented pressure from a combination of rising patient demand and contracting budgets. Doctors and other healthcare professionals are working hard to deliver first rate patient care to the public, but they are being undermined by a lack of resources and staff."

The BMA has also welcomed the designated investment in GP services.

“The chancellor’s announcement that more funding will be allocated to the NHS is an encouraging step forward as it does appear that politicians of all parties are starting to get the message about the dire state of the NHS finances. We are particularly pleased that policymakers have listened to the BMA and confirmed that £250 million will be allocated annually for the next four years to invest in GP premises and out of hospital infrastructure.  Many GP facilities have been starved of investment for decades with the result that a number of GP practices are too small and inadequate to cope with the number of patients coming through the surgery door."

But the crisis in the NHS is more than simply funding.  It is a crisis created by the government. We  recall the promise that there would be no 'top down' extensive reorganisation of the health service. Yet this is exactly what has happened against advice of doctors' bodies such as the BMA. This has put an extra pressure on scarce front line resources.  The reorganisation was senseless and unnecessary particularly in a time of recession.

There have been more than 38,000 'exit packages'  for NHS managers agreed since 'reforms' began. Yet some 4,000 of those  have been  rehired.  There is something ludicrous about managers taking lucrative redundancy deals only then to be recruited once more as consultants! The cost of redundancy payments for NHS managers has hit almost £1.6bn since the coalition came to power. The government's handling of the NHS has been at best inept.

As Mark Porter warns

“Despite this announcement, the NHS continues to face a number of challenges, with staff shortages, especially in emergency care, remaining a cause of concern.  We need this announcement to be the start of a long term programme of investment in the NHS that is backed by all policymakers so that patients continue to get the care they deserve and need.”

Saturday, 29 November 2014

Beware UKIP education policies

Imagine a National Health Service that had selection criteria on the basis  'we will only treat certain people we regard as worth saving'.  Now imagine a state school system based on the premise that only advantaged children will go to the 'good' schools.  Now take a look at this statement:

'Existing schools will be allowed to apply to become grammar schools and select according to ability and aptitude. Selection ages will be flexible and determined by the school in consultation with the local authority.'

The result of such a strategy would be to entrench a two tier system in our state schools. The 'good' schools will select on 'academic ability'. We have of course been here before in the old system of  Grammar and Secondary Modern Schools. Some might argue that it is as good idea because it ensures a good education for the brightest pupils. It will condemn those deemed less academically gifted to second rate schools.

You will note that the policy as stated doesn't say 'we will ensure that ALL pupils have the opportunity for education at the highest standards. It simply wants to restore the old system. It does say that selection ages will be flexible. But does anyone doubt that most selection will take place at 11? Of course it will, because that is the age at which most pupils move to secondary education.

It is extraordinarily silly to take a day in the life of a child at aged 11 and on that date determine their 'aptitude'.  Children develop at different rates not just in intellectual ability and understanding but in maturity. That is what was so wrong-headed about selection at 11.

New statistics released by Buckinghamshire Grammar Schools, the body which represents the county’s 13 selective schools is very instructive. It shows that only 16% of children from Aylesbury Vale – Bucks’ poorest district – passed the test, compared to 37% in the Chilterns – the county’s richest. There was a 64% pass rate for children in private education and only 4% for children on free school meals. Do we really think this reflects their true learning potential? Or do we suppose it reflects a pre-existing social and economic advantage?  I know which of these is likely to be the answer.

To push for Grammar Schools and selection on grounds of 'ability' will simply entrench  inequality of opportunities. It entrenches unfairness which affects the life chances of a generation.

So whose policy does this article give. You might assume it gives the Conservative Party policy. It doesn't. It gives UKIPs policy on secondary education.

It is often difficult to pin UKIP down on policy details. This one however is entrenched on the UKIP website under the heading 'What a UKIP government will do.'

UKIP will entrench the unfairness that exists in educational opportunities for our children and thus their life chances.

Friday, 4 July 2014

Jake the peg diddle diddle

The Rolf Harris conviction for sexual abuse leads me to ask a question. Does 'evil' or wrong-doing wipe out any 'goodness' we have once seen in an individual? I ask this not to 'forgive' Harris but to address a significant ethical question. Do we like or enjoy Rolf Harris's songs any the less because of his conviction? Are they indeed different when we listen to them.

I have had Jake the Peg buzzing round in my head for days now. It won't go away, and as I conjure up the image of Harris performing it I still smile - perhaps now a kind of guilty smile. We are told there are two sides to Rolf Harris - one being the dark side. But does the dark side really diminish the joy of the light side?

Cilla Black I think summed it all up when asked to comment on the news of Harris's conviction. "I'm disappointed." Yes and I am disappointed too. We have been let down by another 'hero'. We build people up and put them on a pedestal and expect the epitome of goodness. Yet, the truth is they are human with human frailties. Nothing excuses what he did, but does it really diminish his art? I understand the portrait he painted of the Queen has gone missing - nobody seems to know its location. All that is very odd and frankly hypocritical if they have hidden it away because of the conviction. If it was good enough to display before the conviction then it must surely be good enough after.

Rolf Harris is not the only artist to have had a hidden murky side. There has been speculation that Lewis Carroll was a paedophile. It is of course difficult to answer such speculation. But does the possibility render his work unreadable?

It might be said, indeed it has been said, that what makes Rolf Harris' crime worse is that he abused his position. Well all paedophiles do that. It was opportunistic - so too is much sexual abuse.

Now I want to be clear I am not asking for us to render Harris' crime to be less than it was. It was appalling. I am just wanting to know if it really renders everything he did 'bad'. I am still thinking about the answer.

Saturday, 24 May 2014

Farage doesn't have a mask

No surprise that UKIP did well in the local elections. It was anticipated. It would be wrong to dismiss it as a 'simple' protest vote - something is afoot. Old party loyalties are being broken. What is striking is how easy it has been for Tory voters to switch to UKIP. The worry for Cameron is that, according to a YouGov survey so many of them will not return for the general election next year - well we will see.

Labour should be worried too but their result in the local elections has been better than many had thought in large part because they did well in London where UKIP did badly. On the basis of the local election results, and that should always be treated with caution, the Lib Dems would lose about 20 seats in the general election - hardly the stuff of what Nick Clegg likes to call 'a party of government'.

Nick Clegg has said that Nigel Farage's 'Mask has slipped'. Frankly Farage doesn't have a mask which is why he is appealing to voters who believe that politicians don't tell it straight. And even if he does and the mask slips the problem for the Tories, Lib Dems and Labour is that too many voters like what they see.

UKIP is tapping into some genuinely felt discontent. Unless the main parties address that then normal politics won't be resumed for some time, even supposing it would be a good thing.

Essentially Farage and UKIP are in a win-win situation. If they are dismissed as racist then it appeals to a deeply felt concern that immigration is challenging local communities and identities. The reality of statistics doesn't make any difference. If people feel 'threatened' there is no point in telling them they have nothing to fear. It simply adds to the feeling of disconnection of politicians at Westminster.

For many 'multiculturalism' is synonymous with their own communities and culture being challenged. They feel 'swamped' whether it is statistically correct or not. In politics 'feeling' matters.This is why Farage's use of statistics works no matter how barmy. If people feel there is a 'threat' from massive EU migration then that is what they feel and frankly they don't believe it when they are told they are wrong. This is one reason why Farage bested Clegg in the debates - statistics were irrelevant and Mr Farage knows it. When he said that over 400 million EU citizens could move to the UK he was strictly speaking correct no matter how absurd the notion that they would. What people are concerned about is that they could not that they necessarily would - and there you have the conundrum for Cameron, Clegg and Milliband. Many people feel that the UK is 'an overcrowded island' and that immigration is a problem. It isn't easy to persuade them otherwise when their children cannot afford to buy a home.

The left in British politics need to square the circle. It can't go on ignoring the issues. But the key question is how - that is not easy to answer!

Friday, 23 May 2014

Lack of funding undermining primary medical care

General practice cannot reached its full potential in the face of continuing under-investment in the profession, the cutting of MPIG funding, the problems recruiting and retaining GPs and the lack of investment in premises, GP leaders have warned.

Backing a motion1 at the annual Local Medical Committee’s conference in York, GPs said that general practice can be the solution to many of the current problems facing the NHS, but was held back by the serious damage being done to the profession.

The calls come weeks after the British Medical Association launched its ‘Your GP cares’ campaign to support GPs and calls for long term, sustainable investment to be made in GP services across the UK, to:

· Expand the overall number of GPs to attract, retain and expand the number of GPs and ensure patients are given the time, care and services they deserve

· Expand the numbers of other practice staff so each practice has enough nurses and other staff to meet the increasing needs of especially older and vulnerable patients

· Improve and bring up to scratch the premises GP services are provided from and ensure local practices have the resources they need to sustain current high levels of care

Commenting, Dr Chaand Nagpaul, Chair of the BMA’s General Practitioners Committee, added:

“As GPs we care immensely about our patients and we are as concerned as they are by the constraints impacting on services, which are undermining our ability to do the best for them.

“GPs are constantly fire-fighting to provide the services their patients need in the face of increasing workload pressures2, the worsening state of GP premises and the rising number of vulnerable patients3 and those living with a chronic condition4 for whom the standard 10 minute appointment is simply not enough. We are also now increasingly providing services that had previously been delivered in hospitals, which is raising demand for services further.

“This can all have a detrimental effect on the services practices are able to provide, leaving patients frustrated as more are left waiting for appointments. It is vital that we address this issue, which is why the ‘Your GP cares’ campaign aims to bring to people’s attention the true picture of general practice.

“General practice can be a key solution to managing the increasing pressure on the health service, but only if its receives the long-term, sustainable investment in the things that will make a real difference to patients – more GPs, more practice staff and fit for purpose premises.”

Tuesday, 20 May 2014

GP workload 'crisis' harming patients

Many of us are finding it difficult to get appointments to see a GP and the time a doctor can spend with a patient is ten minutes. GPs are struggling to provide the first line care their patients need. 

Now a new survey by the doctor's representative body, the British Medical Association concludes that overstretched GP practices do not have the time, support or information to explore new ways of collaborative working that could help practices deliver more effective, efficient care to their patients. .

The BMA’s Practice Collaboration Survey asked GPs their views on collaborative working including forming GP federations or networks where practices come together to pool resources and plan local services.

Results from the survey of 1,555 GPs include:

· 7 out of ten (69 per cent) cited workload pressures as a barrier to establishing a network or federation, while close to seven out of ten (66 per cent) also cited a lack of time.

· Almost half (45 per cent) were not clear or convinced about the benefits of forming a federation or network.

· Despite this lack of awareness, a third (35 per cent) are considering joining a network or federation, while one in five (22 per cent) are already part of this arrangement.

The responses underlined the need for more support for GPs wanting to explore these options. Two thirds (66 per cent) would find further guidance helpful, six out of ten (60 per cent) would be interested in legal advice and four out of ten would like HR (43 per cent) and project management support (44 per cent).

· Almost two in three (63 per cent) wish to develop a network in order to bid for enhanced primary care services, e.g. sexual health and contraceptive services, smoking cessation services, drug dependency services etc, commissioned by clinical commissioning groups (CCGs).

Speaking about the survey Dr Richard Vautrey, Deputy Chair of the BMA’s GP Committee, said:

“As highlighted in the BMA’s “Your GP Cares” campaign1, general practice is under massive strain from a combination of an unsustainable rising workload and fewer resources. In this environment, we need to look at new ways of working that might enable practices to get the most out of limited resources and work more effectively together.

“Forming federations or networks is certainly not the solution for every practice and there is no ‘one size fits all’ model that would be suitable for every area, but it could offer real opportunities for many practices in really difficult situations.

“It is deeply disappointing that the very problems that are spurring the need for more collaborative working are preventing GP practices from putting in place proper solutions. As this survey shows, many GP practices simply do not have the time because of workload pressures to even explore the benefits that working in a network might offer. There is an urgent need for resources to give GPs the breathing space to enable them to plan for the future.”

Dr Beth McCarron-Nash, GPC lead for Commissioning and Service Development, added:

“As the Local Medical Committee (LMC) Conference will hear later this week2, GPs are calling for much more support and information so they are enabled to make an informed decision about whether forming a federation or network is best for them.

“The BMA has already produced guidance for GPs with advice on how to take this process forward.3 As a result of the views expressed in this survey, we will be developing further resources to support GPs in the near future. But we do need the Government to listen to the BMA’s “Your GP Cares” campaign and start supporting general practice properly so that practices are able to innovate and provide services in the best possible way for their patients.

“Due to several years of funding cuts and spiralling workloads, practices are simply running to keep up with the extra demand. Many feel collaborative working would benefit their patients, but unless we see a substantial increase in core funding, practices will not have the capacity or support they need to develop services in the way many have said they want or need to.

“There is also clear evidence from this survey that there is a real need for high quality legal, HR and project management to enable GPs to explore collaborative ways of working, and practices should be properly supported with these resources.”

Saturday, 17 May 2014

Peer review gobbledygook

There was more fuss in the media this week about the politics of the science of global warming. A paper by a group of researchers headed by Professor Lennart Bengtsson, a University of Reading research fellow, was turned down for publication by Environmental Research Letters. The Times had a front page headline 'Scientists in cover up of 'damaging' climate view' suggesting that the paper had been rejected for political rather  than scientific reasons. 

Yesterday the publishers of Environmental Research Letters fought back  by publishing the peer reviewers comments in full. What it reveals is more interesting than the story itself - the sloppiness of the peer review process. Consider this bit of nonsense from one of the reviews:

"The comparison between observation based estimates of [warming] … and model-based estimates is comparing apples and pears, as the models are calculating true global means, whereas the observations have limited coverage."  (my emphasis)

What on earth is a 'true global mean'? How do you distinguish it from an 'untrue' one? I don't know what makes a mean 'true' in any sense other than it is a calculation which must also be the case for 'observations'.  I don't understand how an 'estimate' can be 'true' other than in the sense that the estimate was made. I have no idea what the 'truth' is. An estimate may approximate the 'true' figure but it is still an estimate! 

Science as we know uses 'observations' - i.e. measurements. This review regards model 'estimates' as better than 'measured' ones. But this can only be true if the model is fit for purpose and that depends on the validity of the assumptions used in creating the model. 

I am making no judgement about the right and wrong of the rejection of Lennart Bengtsson's paper but the peer review process is not revealed in a good light by this saga. There is no example here of a rigorous process. On the contrary it appears very sloppy indeed. 

Scotland 'no' is too negative.

I am in two minds about Scotland's Independence from the UK. On the one hand I can understand why they would wish to break free from Westminster. The politics of Scotland is a far different landscape than that represented in London - they don't get the governments they vote for. They have been out of sorts with the Tory party for some time. Independence from Westminster is attractive - a fresh start, a new politics shaping their own destiny. There are a lot of good reasons to say 'yes' to  independence. But I would like them to say 'no'. I would like Scotland to stay part of the United Kingdom and my reason is simple. It is because I believe that as part of the United Kingdom Scotland can help us change the geopolitics of the country and of Westminster. It is a somewhat selfish reason - I want Scotland to stay and help prevent continuous Tory-led government from Westminster. Also I am proud of the Scottish contribution to our culture.

The problem with the 'No' vote campaign in Scotland's referendum is that it has been far too negative. Simply telling the voters what they would 'lose' with Independence isn't going to work. Better to tell them what is gained by Scotland moving forward in the Union. It would also be better to tell the Scots how we feel which is that on the whole we don't want to lose them. We must say if you stay we will change.

When we talk about devolution and change in the distribution of political power, our politicians rarely address the problems of England.  But England needs a solution too. In one sense England is over-represented in Westminster but in many other ways it is poorly represented. Britain needs a new political settlement and whether the Scottish people vote to stay in or out of the UK it is time we considered the shape of that reform. We cannot simply go on as before. The Scotland referendum should be a starting point to major political reform for the United Kingdom.

Wednesday, 7 May 2014

Fallen idols and lost innocence

We must stop investing so much in celebrities. A person who comes to prominence through some endeavor, be it artistic, sporting or some other regarded action is not endowed ipso facto with other qualities we like to project onto them - kindness, charity, forgiveness, love, goodness. This is true even where the celebrity does 'wonderfully good' charitable acts. These are all part of the 'being' for a celebrity.

It is a media circus - the building up of celebrity status. The subsequent fall from grace where it might occur is also part of the media circus. The once idolized become demonized - gone the smiling, kind photographs substituted now for those that show the 'evil' person. These are media choices. For one fallen idol recently a news program thought it important to show a photograph of them taken when charged - he looked like a criminal was the message.

So many in the media now suggest the 'knew' there was something 'wrong' about Jimmy Saville. But here is the classic example of someone elevated to 'goodness' personified status by the very media that now demonizes him. Jim 'fixed' it for so many people. Now we know he fixed it in more ways than we would have liked he is now the personification of 'evil'. One by one former idols are tested -  some probably unjustly, some to meet justice head on. One by one they come to stand in front of the cameras and address the media.

It is painful to watch. It gives little pleasure to see these idols fallen from grace. Innocence is a victim - our innocent assumptions about the goodness of those we 'like'. It would be better if we did not invest so much naivete in the status of celebrity.

Wednesday, 23 April 2014

The real cost of alcohol

What is the cost of a bottle of whisky or beer? No I don't mean the price I mean the cost. The real cost has to take account of the effects of alcohol consumption. Alcohol consumption is linked to more than 60 medical conditions. The total cost of alcohol harm has been estimated as £20 billion in England, £680 million in Northern Ireland, £3.6bn in Scotland and £1bn in Wales. These figures include more than £2bn in healthcare costs. That is a big price to pay! The £20 billion in England would be enough to fill the gap in NHS funding. 

The BMA has a campaign to increase the price of alcohol. Now a new study by Cardiff University has highlighted the link between the price of alcohol and the fall in violent crime.


Commenting on the findings of study, Professor Sheila Hollins, Chair of the BMA's Board of Science, has said:

"A drop violent crime is positive news, especially if linked to changes in drinking habits.

"With the costs of alcohol related harm estimated at £25bn across the UK, of which more than £3bn is on healthcare, there are clear economic, social and public health cases for tackling problem drinking.

"We know there is a link between the cost and consumption of alcohol, highlighted again in this study, which is why the BMA is calling for a minimum unit price of at least 50p per unit to tackle problem drinking.

"This makes the government's U-turn on minimum pricing, as well as their decision to scrap the alcohol escalator and reduce beer duty, all the more worrying.

"Alcohol misuse places serious strain on a number of already overstretched public services which is why doctors, the police and emergency services all support minimum unit pricing.

"Prevention is better - and cheaper - than cure, and if the government is serious about tackling alcohol related harm, it needs review its position on minimum unit pricing, which would reduce harm amongst the heaviest drinkers while leaving responsible drinkers largely unaffected."

Here are some sobering facts about alcohol consumption:

More than 10 million adults in England are drinking more than the recommended daily limit.
80% of purchases are made by 30% of the population.
Alcohol-related deaths in the UK doubled from 4,023 in 1992 to 8,790 in 2010.

Excess alcohol consumption costs lives. That is the true cost. 

Thursday, 17 April 2014

When we should die?

The craziest proposal from the government on pensions is that everyone will be given 'advice' on their life expectancy. This is an absurd misjudgement about the nature of health science. The idea that data obtained and applicable at a population level can be given for an individual is wide of the mark. Not only is it crazy, it is also from an insurance point of view highly dangerous. It begs also the question of who will give this advice and on what it will be based. Frankly I doubt if the medical profession would touch it with a barge pole.

Unless someone has a particular condition with a particular prognosis a GP would be unable to judge for any of their patients how long they will live. Of course an average life expectancy for the population is available together with relative risks from smoking, poor diet, lack of exercise and so on. But it is all somewhat guesswork for any given individual.

So the government having made the decision to 'allow' people to spend their retirement savings as they wish discover it is potentially a dangerous policy. Now they want to tell us how long we may expect to live in retirement. Next they will want to tell us when we should die, and then...It is all a very dangerous state of affairs.  

Thursday, 10 April 2014

Maria Miller's lack of ethical compass

The Culture Secretary Maria Miller has resigned. She is yet another self inflicted wound. But how does it happen? Is there something wrong with the way of thinking that gets politicians trapped in this way?  I think the answer is yes. It is an inability to distinguish between what might be 'legal' and what might be ethical.

I didn't do anything wrong is the line taken by the former Culture Secretary. It was also the line taken by Mr Cameron. She didn't do anything 'wrong'. What he meant of course was that she 'followed the rules', and where she may have made a 'mistake' she has apologised. It is all a misunderstanding, and everything really is rosy in the garden, except for the lingering smell of rotting vegetation.

Sadly it indicates that they have no ethical compass. There is nothing in their thinking that asks whether something is ethical rather than simply 'following the rules'. There it is - the problem.

And what are these 'rules'. Essentially without an ethical compass, it is whatever they can get away with that doesn't constitute a breach of the law. As long as they feel that they can say 'I did nothing wrong' then they also conclude that what they do is right. Ethics isn't following rules - it is making some kind of judgement about the right course of action.

One golden rule on this is that you should be able to taste whether something isn't right. You wouldn't eat a stale banana. It would make you sick. And so it should be with expenses claims. If it doesn't taste good then it probably isn't. But in this case it won't just make Maria Miller sick, it will make the public sick - sick of the endless feeding from the trough without regard to ethics.

Thursday, 3 April 2014

No sense prevails on badger cull


New plans to eradicate bovine TB in England unveiled by DEFRA today. 

There were many experts who warned that the badger cull would not work. An independent report now confirms the worst fears. That many badgers were killed inhumanely with many badgers taking longer than 5 min to die.  The cull failed to reach its effective target. Yet the Environment Secretary Owen Patterson ploughs on regardless. 

A comprehensive Strategy to "achieve TB free status in England by 2038" has been announced by Environment Secretary Owen Paterson today.

This includes continuing to strengthen cattle movement controls, a grant-funded scheme for badger vaccination projects in the ‘edge area’ at the frontier of the disease, and improvements to the four-year badger cull pilots in Somerset and Gloucestershire.

DEFRA say that following recommendations from the Independent Expert Panel that assessed the badger cull pilots last year, a series of changes will be made to improve the effectiveness, humaneness and safety of culling. "These changes will be monitored to assess their impact before further decisions are taken on more badger cull licences next year."

Environment Secretary Owen Paterson says:

"The four year culls in Somerset and Gloucestershire are pilots and we always expected to learn lessons from them.

It is crucial we get this right. That is why we are taking a responsible approach, accepting recommendations from experts to make the pilots better.

Doing nothing is not an option. Bovine TB is a terrible disease which is devastating our cattle and dairy industries and causing misery for many people in rural communities. We need to do everything we can, as set out in our Strategy, to make England TB free."

But the scientific evidence before the badger cull was at best equivocal and at worst indicated that a cull was likely to make the problem of TB spread worse not better. Owen Patterson with an eye on the farming lobby ignored the evidence and went ahead with the pilot culls. 

He now says:

"Improvements to the pilot culls will include more extensive training for contractors carrying out the cull, better planning by the licensed companies to ensure culling is spread evenly across all land available and better data collection to assess progress. The changes being introduced will help increase the effectiveness of the culls by removing more badgers in a safe and humane way.

There will be a trial of a new service in Somerset and Gloucestershire to provide farmers with bespoke advice on how to better protect their farms from disease. This service will be available to all farmers within the licensed cull areas."

 The truth is Owen Patterson fails to learn from the lesson of the pilot culls. Killing badgers won't work. 

Farage bests Clegg in TV debate

What surprised me about the Nigel Farage - Nick Clegg debate was that Clegg made no real attempt to extol the positives of EU membership. His arguments were defensive not of our EU membership but of his own position. They were also negative rather than positive.

What is odd about the outcome is that Clegg's opening statement was good. In my view better than Farage. Clegg was being positive, but then it all changed.

Clegg attacked Nigel Farage, trying to ridicule his opponent instead of countering Farage's arguments. Clegg missed the opportunity to say why the Liberal Party supports membership of the EU. It was a missed opportunity.

Clegg spent several minutes not arguing about the EU but about Syria! It was a side issue. The debate Mr Clegg was about the EU! A wasted opportunity.

It is therefore no surprise that Nigel Farage came out on top. Even the Liberal spin doctors found it difficult to spin a win for their man. In short, Farage wiped the floor with Mr Clegg and got away with calling Mr Clegg a liar. The reason he got away with that is because Mr Clegg also took the decision to attack Mr Farage. He should have dealt with the issues - he didn't and Farage came out on top.

Debating with Farage was always something of a gamble. It was a gamble and Clegg lost. You cannot debate facts with a man who appeals to gut instinct - and you can't do it by underestimating your opponent. Ridiculing Farage is to ridicule many voters who agree with the main thrust of his argument. It is the classic mistake. Mr Clegg for all his skill was simply angry. His undoubted skill in debate deserted him. He floundered. It was not a pretty site.

Tuesday, 1 April 2014

Cable's idiotic defence on Royal Mail

The Business Secretary Vince Cable has that unfortunate demeanour of somebody who got it right. He would have us believe that he got it right in predicting the financial collapse. He didn't of course but legends are often allowed to grow in politics. Now he insists he got it right over the sale of the Royal Mail despite criticism from the financial watchdog, the National Audit Office, that the Royal Mail was sold off too cheap.

Vince Cable defends his decision saying that the sale achieved its objective of selling the company and 'reducing the risk to taxpayer'. It is a bizarre defence. Selling the company for 1p would also have achieved that objective. What he failed to do was to get the best deal for the British taxpayer. But Vince Cable knows best. It is an idiotic defence.

Monday, 31 March 2014

Older Women want babies too!

Don't you love it when the media uses words such 'soars'! The best one is 'more than doubles'. It sets the heart beating faster. two multiplied by 2 is 4. Now depending on context four is not a big number and nor is five, but 'more than doubles' is 'massive'! And so we have the headline for the numbers of women over 50 having babies.

It has 'soared' according to a headline in the Guardian - and they know what soaring is. It has indeed 'more than doubled' from 69 in 2008 to 159 in 2012. Then of course we get the speculation. It will continue to rise at the same rate. And then we get the doom and gloom. It will all be very bad and put pressure on scarce resources. Older women have more complications in child birth. Indeed they do - but not all older women. In truth there are more younger women having children than older women and some of them have complications too!

It is all part of this scare tactic about pregnancy. We are led to believe that these older women are in some way being careless or even selfish in wanting children at that age. In truth they are being no more or less selfish than any younger woman wanting children. Of course there are risks but women know that and quite frankly they still want the happiness and fulfilment of having children. They are not selfish - they are human and the Obstetricians can handle it!




Politicians are failing the NHS


Remember how the NHS was supposed to be 'safe' in Cameron's hands. Remember how the NHS was supposed to be 'ring-fenced' from the effects of austerity? Yes we remember. But we see an NHS starved of funds. But do the politicians care sufficiently to act?

The NHS Confederation’s survey of politicians has highlighted  that seven out of 10 MPs believe there is insufficient political will to meet the challenges facing the NHS.

Responding to the report, Dr Ian Wilson, Chairman of the BMA’s Representative Body, has said:

"The government must not risk the NHS' core value of being based on need, not ability to pay, purely because they are unwilling to take action and make the changes they admit are desperately needed.

"It is unbelievable that while eight out of 10 politicians agree change is essential, almost seven out of 10 say there is insufficient political will to allow this to happen.

"The reality is that the NHS is under intense pressure from a combination of rising patient demand and declining funding. Politicians must confront these challenges head on in order to ensure we can continue to deliver a high standard of care while remaining free at the point of use.”

We have been here before. It is no coincidence that the last time the Tories were in power the NHS was failing patients with unnecessary reform - remember the internal market? 

Cameron said there would be no top down reform of the NHS. He broke that promise!

Osborne and Cameron said the NHS would be ring-fenced. They broke that promise. The NHS has faced billions of pounds of cuts. It is not the NHS that is failing. It is the politicians  


Saturday, 22 March 2014

It is not 'insulting' to be concerned about pensioner finances

As the analysis of Osborne's budget unfolds there is concern that the changes to pension funds will leave pensioners vulnerable in relation to financial decisions. This has been dismissed by government spokepersons as being 'insulting' to the ability of pensioners to make decisions. This must be one of the most absurd statements of the week. I would not call it insulting. In the light of so much recent legal action on mis-selling of financial products and inappropriate marketing I would call it sensible concern.

Unless the market is regulated and appropriate safeguards put in place the I think we will all be vulnerable. It is clear that this has not been thought through. There will be a host of new and difficult to understand financial products flooding the market. It will be a mess.

Osborne has taken a bold decision but he appears to have taken it without proper regard for the consequences.

Friday, 21 March 2014

Osborne's budget headline unravels ?

As with a lot of budgets from Osborne the day after the night before looks less good. The rabbit he pulled out of his hat on pension pots is beginning to look less like a good deal in the cold light of analysis.

It is a good idea in principle to allow those retiring to invest or spend their pension savings how they wish. Certainly annuities are a bad deal with interest rates so low. Pensioners have suffered with their incomes falling.  It has a good ring about. It fits the 'being in control' on ones own finances. But how will these complex decisions be made and how do we avoid unscrupulous exploitation of pensioners?

I can see headlines in 30 years time about mis-sold investment schemes. There will be a mad scramble of financial companies creating difficult to interpret 'products' with difficult to read small print. It will be a mess.

Wednesday, 19 March 2014

BMA: 'Shameful' Budget does nothing for NHS shortfall


Calling today's budget presented by the Chancellor 'shameful' the BMA has condemned it for doing nothing to address the NHS funding shortfall. 

Responding to the Budget today Dr Mark Porter, Chair of BMA Council says

“Despite claiming the economy is on the up, today's budget does nothing to address the crippling funding shortfall in the NHS.

"While the Government claims the NHS budget is protected, in reality it's suffered £20bn of cuts, billions of which have come from a sustained attack on staff pay.

"If growth forecasts are rising it’s even more shameful that the Government won’t even agree to a 1 per cent uplift, as recommended by an independent pay review body, for all front-line NHS staff.

"Doctors and other staff face increasingly challenging, high pressured and stressful work environments. Cuts to budgets and rising workloads are leading to a recruitment and retention crisis in many parts of the NHS, and we're already seeing the effect of this on emergency medicine. The announcement by the Chancellor to continue with pay restraint and more public sector cuts, if re-elected in the next parliament, will only compound this.

"If, as the Chancellor has said, growth is higher than expected then the Government needs to consider additional funding for the NHS. Without the investment needed to meet rising patient demand and put the NHS on a sustainable financial footing the Government need to face up to the reality that patient care, and indeed the very future of the NHS, will be at risk."

Commenting on tobacco and alcohol duty Professor Sheila Hollins, Chair of the BMA's Board of Science, said:

“The Government is giving with one hand and taking with another, with a step forward on measures to reduce smoking but backward on tackling alcohol related harm.

“The announcement to extend the tobacco escalator is an important and welcome one. It will reduce the affordability of cigarettes, which is key to deterring children from starting to smoke. With half of smokers dying from a smoking related disease anything that makes it less attractive is a step in the right direction.

"Scrapping the alcohol escalator and reducing beer duty, coupled with the Government's U-turn on plans to introduce a minimum unit price, shows the Government has abandoned any serious efforts to tackle alcohol related harm.

"With the costs of alcohol related harm estimated at £20bn in England alone, of which £2bn is on healthcare, there is a clear economic as well as a public health case for why urgent action is needed.

"The BMA will continue to call on the Government to introduce a minimum unit price. We know that minimum pricing reduces alcohol related harm amongst the heaviest drinkers while leaving responsible drinkers largely unaffected. This is because virtually all pub drinks, as well as the majority of shop-bought beers, wines and spirits would not be affected by a proposed 50p threshold.”

Expect the unexpected

Today is budget day - expect the unexpected! Much of what will be in the budget has already been trailed in the media, but there will most likely be a rabbit of some sort that the Chancellor of the Exchequer will pull out of the hat. There is an election next year - indeed there are elections this year too. There will be the waving of order papers and cheering from the coalition back benches.

I will not and cannot speculate on what the rabbit will be. It will be some kind of give-away that will please the bulk of middle Britain and appease disgruntled Tory backbenchers.

There will be lots of talking about how solid the recovery is and what kind of recovery. Unemployment is tumbling and growth is strong - and there are more clear skies. Spring is bursting out all over. People will begin to feel better, and the Scots are more likely than not to vote to stay as part of the United Kingdom. That will make people feel better - won't it?

The coalition - or at least Cameron, Clegg and Osborne - are making plans for life after the election. The Guardian newspaper will no doubt once again find some reason to urge its readers to vote Liberal Democrat - oh yes, I think it will. They will put it together in some neatly considered editorial all about how 'on balance' - nice phrase, neat phrase, useful phrase - the coalition has been a success.  There has been no change of substance in the way we elect our representatives - hardly mentioned now by the Liberal Democrats, neatly forgotten - and no reform of the House of Lords. So we meander on as we did before.

Postscript

So what was the unexpected? It was the fundamental changes in the rules governing what you can and can't do with pension pots.

Monday, 17 March 2014

A diplomatic solution must take account of the wishes of the people of Crimea

The resolve of the US and EU to ignore the wishes of the Crimean people is arrogant and inconsistent. I am no fan of Mr Putin or Mr Putin's Russia. Far from it. But my view of the Russian regime does not blind me to the clear expression of the overwhelmingly Russian-speaking people of Crimea to be part of Russia. To ignore that is to have a very one-sided view of what William Hague and others call 'legitimacy'. If it is legitimate for an uprising in Kiev to overthrow the regime in Ukraine then it must surely be so for the crowds of people who are now celebrating the outcome of their referendum in the Crimea. 

President Obama says he wants a diplomatic solution to the Ukraine crisis. But a diplomatic solution will have to take account of the genuine concerns of Russia about the instability on its doorstep where it has major strategic interests. 

There is something unfortunately vague about the British foreign secretary's stance on the events in Crimea. He knows that a diplomatic solution must take account of the wishes of the people of Crimea. We may not wish to be where we are now. The fact is we are, and to ignore those wishes would be to deny the people of Crimea the rights that should be upheld by international bodies. 

Sunday, 16 March 2014

Crowd power, referendums and legitimacy in Ukraine

It is odd this talk by the EU and the US of 'legitimacy' or its absence in relation to the referendum in Crimea. As I write the result of the poll is being announced. An overwhelming majority in favour of the proposition that the Crimea be once again part of Russia. William Hague says the referendum is illegitimate. But is it any the less legitimate than crowds of protesters in Ukraine leading to the overthrow of a democratically elected President?

What it demonstrates more than an argument about legitimacy is an interest. The Russian interest in the Crimea and the outcome of the changes in Ukraine are palpable. The interests of the USA and the EU are opportunistic and full of bluster.

They talk of 'consequences' and 'costs' that will flow if the referendum goes ahead. The referendum has gone ahead. The one thing Putin knows is that the 'consequences' and 'costs' are a lot of hot air - minor restrictions aimed at certain individuals in Russia.

Saturday, 15 March 2014

Tony Benn, Thatcher and New Labour

One aspect of left-wing politics that irritates me is the propensity for those on the left to assume that theirs is the only moral position on the big issues of the day and in particular war and peace - everyone else is a war criminal or traitor to the cause. The same of course applies to right-wing politicians. There is an implied and often explicit distaste for those of the middle ground. What the left and right cannot accept is compromise. They talk about standing on principle - and we tend to admire more those who 'stand by their beliefs'.

Yet practical politics is the art of compromise. I have little doubt that Bevan was right in the compromises he made with the birth of the National Health Service - and compromises he made in dealing with the then opposition of the medial professions. Now, nobody believes that Bevan was not a man of great passion and principle. Indeed, when he could no longer compromise, as over the imposition of prescription charges, he resigned from the government - and Wilson also followed suit. Bevan also stood on principle when he argued that unilateral nuclear disarmament would be wrong - but then of course the left would rather put that aside as an aberration.

Harold  Wilson was of course noted later for, as he saw it, the virtue of pragmatism. The truth is that a bit of pragmatism goes a long way in getting things done. It was Wilson's pragmatism more than those of us marching in protest, that enabled him to say no to President Johnson's repeated requests for British troops on the ground in the Vietnam war. Few these days will applaud Wilson as being 'a man of beliefs' - and yet he was, just as surely as was Tony Benn. It serves little purpoe to distort history in creating the divide between 'those who stood by their principles' and those who compromised to get things done! Governing involves more than simply standing your ground.

Tony Benn and others of the Left were willing not only to oppose the Wilson and Callaghan governments but also to undermine them as traitors that didn't do what they said they would do. This of course is true if you accept their interpretation of what it was they were supposed to do! But I believe the achievements of the Attlee, Wilson and Callaghan governments are much greater than given credit at the time and certainly by those on the left. Increasingly, Wilson's premiership, at the time dominated by financial crises, is seen as advancing socially, particularly in spending on housing, social welfare, health and education.

My criticism of Tony Benn then is that he failed to support those and work with those who also wanted to change society for the better. His was an attitude of mind that said that only what he thought was right. On that he was wrong, no matter how much we grew to love him. That 'love' was increasingly proportionate to his remove from power, government and influence.

I know that this is not going to be liked by my left wing friends. But what I cannot accept is that in not speaking ill of the dead we must distort history. Arguably, the likes of Tony Benn did more than most to ensure 18 years of Thatcher governments and the birth of New Labour.

Ukraine crisis trapped in history?

Talks between the US Secretary of State, John Kerry, and the Russian Foreign Secretary, Sergei Lavrov, have failed to 'break the deadlock' on the Ukraine crisis. This is no surprise. Once again the main players are trapped by historical precedent. 

Russia has a genuine interest in the Ukraine, but to say that all sounds like Hitler's claims to the Sudetenland. Yet, if there is to be a diplomatic resolution to the crises there is not doubt that Russia's concerns will have to be - dare I say it? Appeased. 

It serves little purpose declaring the referendum in the Crimea unconstitutional. It begs the question of which constitution has legitimacy, and in the end the US and the EU will have to accept it. The Russians are not going to give way on it no matter what 'the costs', to use the phrase of the US and the EU. 'The costs' are rarely spelled out. It is a vague threat and has little substance to it. 

And so the tension increases with the possibility that Russia may move to 'protect' Russian speakers in East Ukraine. 

If there is to be a diplomatic solution, then let it not be hidebound by historical analogies. Given that a diplomatic solution is the only real alternative to conflict then this may be a time when 'appeasement' works!

Thursday, 13 March 2014

BMA Condemn Government pay cut for NHS staff

David Cameron once promised that the NHS was safe in Tory hands. But then he also said there would be no top down reorganisation. On both counts his lips say one thing, the government's deeds say another. The one thing we can do without in the NHS is a demoralised staff, yet this is what we have. We have an NHS struggling to make ends meet with cuts of billions of pounds from budgets taking their toll. Now we have an insulting pay increase to NHS workers.

Thursday's announcement from the Government that doctors will be subject to another real terms pay cut highlights its abject failure to find a fair and sustainable solution to the funding crisis imposed on the health service the doctors union, the BMA says.

The decision to yet again penalise doctors devalues and disrespects the vital role of frontline staff in the NHS.

Jeremy Hunt has said that the continued erosion of staff pay is ‘not sustainable’ yet he has chosen to ignore his own advice. Despite the Government announcing that staff will receive a 1% pay rise, the reality is the vast majority of doctors face another real terms pay cut, with some not receiving any uplift for up to three years.

Commenting, Dr Mark Porter, Chair of BMA Council, said:

“NHS doctors have now seen their real terms pay cut for the fifth year in a row. Despite how the government have tried to present it, doctors are being left worse off, year on year.

“This comes at a time when demand but also productivity across the NHS is rising, and demonstrates just how little the Coalition Government values its NHS staff given the fact they seem determined to balance the NHS budget on the backs of those working on the frontline.

“While the BMA understands the economic constraints the NHS faces, the continued erosion of pay undermines the excellent work and dedication to patient care from doctors and other NHS staff, and only goes to highlight the Government’s failure to find a meaningful and sustainable solution to the funding crisis imposed on the health service.

“At a time when doctors are working harder than ever before to meet rising demand, it is not surprising that doctors’ morale is going down when today’s announcement means that staff are once again bearing the brunt of the Government’s cuts.

“Overstretched doctors are covering for a recruitment crisis. In hospital emergency departments, severe doctor shortages combined with underfunding has produced the perfect storm – a crisis in patient care.

“The continued chipping away of pay means consultant pay is now, in real terms, lower than it was over a decade ago. GPs will also be unfairly hit. Despite delivering substantial efficiency savings while at the same time facing ever increasing workload pressures and patient demand, today’s announcement will continue to see practice income eroded as practice expenses increase disproportionately to income.

“How can the Government expect to engage constructively with doctors on pay and conditions when it continues to devalue them year on year?

“The Government has set itself the target of reducing the NHS budget by £20 billion but has so far found no realistic plan to achieve this except for punishing those on the frontline by chipping away at their pay and dressing this up as ‘efficiency savings’. Jeremy Hunt has said that the continued erosion of staff pay is ‘not sustainable’ yet he has chosen to ignore his own advice. “What message does it send to our hard-working doctors, nurses and other frontline staff when NHS managers have enjoyed a rise of 13 per cent since 2009 and yet doctors’ pay is being outstripped by inflation year after year? If we are going to meet the challenges the NHS faces head on the Government should be working with, not against, those doctors on the ground with the values, knowledge and professional judgement best placed to drive innovation and deliver real savings while all of the time protecting patient care.”

Thursday, 6 March 2014

Low saturated fat diets don’t curb heart disease risk says expert

I gave up on diets a long time ago - or at least I gave up on the formulated ones. There is nothing wrong with 'eating healthily' and taking exercise. But diet fads can be a menace.  At my local book shop I can sit and have a cup of coffee and a Danish pastry surrounded by the shelves of books. One shelf always strikes me as being full of contradictory dietary advice. There is a lot of money in publishing diet books it seems. 

For dietary advice from health care professionals we might expect a great deal more evidence base. The British Heart Foundation emphasise the importance of the type of fat we eat. Essentially the mantra is that saturated fats are bad. 

But in a new article in the journal Open Heart Dr James DiNicolantonio suggests that the dietary advice to switch saturated fats to carbohydrates or omega 6 fats is based on flawed and incomplete data from the 1950s.

DiNicolantonio points out that the demonisation of saturated fats dates back to 1952, when research suggested a link between high dietary saturated fat intake and deaths from heart disease.

But the study author drew his conclusions on data from six countries, choosing to ignore the data from a further 16, which didn’t fit with his hypothesis, and which subsequent analysis of all 22 countries’ data, disproved, says DiNicolantonio.

Nevertheless, the 'bad boy' image stuck, particularly after US President Eisenhower had a heart attack in his 50s, points out DiNicolantonio in an accompanying podcast.

And it prompted the belief that since these fats increase total cholesterol—a flawed theory in itself, says DiNicolantonio— they must also increase heart disease risk. And as foodstuffs with the highest calorie density, the thinking was that reduced saturated fat intake would naturally curb obesity, diabetes, and metabolic syndrome.

But the evidence, which continues to mount, suggests otherwise, he says.

There is now a strong argument in favour of the consumption of refined carbohydrates as the causative dietary factor behind the surge in obesity and diabetes in the US, he says.

And while a low fat diet may lower ‘bad’ (LDL) cholesterol, there are two types of LDL cholesterol. And switching to carbs may increase pattern B (small dense) LDL, which is more harmful to heart health than pattern A (large buoyant) LDL, as well as creating a more unfavourable overall lipid profile, he says.

Furthermore, several other studies indicate that a low carb diet is better for weight loss and lipid profile than a low fat diet, while large observational studies have not found any conclusive proof that a low fat diet cuts cardiovascular disease risk, he says.

But in the race to cut saturated fat intake, several dietary guidelines recommend upping polyunsaturated fat intake.

However, a recent analysis of published trial data shows that replacing saturated fats and trans fatty acids with omega 6 fatty acids, without a corresponding rise in omega 3 fatty acids, seems to increase the risk of death from coronary heart and cardiovascular diseases.

“We need a public health campaign as strong as the one we had in the 70s and 80s demonising saturated fats, to say that we got it wrong,” urges DiNicolantonio in the podcast.

The best diet to boost and maintain heart health is one low in refined carbohydrates, sugars and processed foods, he recommends.

And anyone who has had a heart attack should not be thinking of replacing saturated fats with refined carbs or omega 6 fatty acids—particularly those found in processed vegetable oils containing large amounts of corn or safflower oil, he says

So here we have it - another set of dietary recommendations to chew on. 

Wednesday, 5 March 2014

Accountability of town and parish councils

I discovered something disturbing about our local governance arrangements. I should have known, but I didn't and it surprised me. We can complain to the Local Government Ombudsman about the behaviour of a whole range of public authorities including fire and rescue authorities, national park authorities and a host of other public bodies whose decisions affect our lives.

You would think that you could complain to the local government ombudsman about the behaviour of all local councils. But you would be wrong. The ombudsman does not consider complaints about town or parish councils. So, should we be concerned? I think we should.

Town and Parish councils will soon be able to take a range of decisions that affect our lives - arguably they can already take such decisions. But they are soon to get a larger role in planning. It is all part of the governments 'localism' agenda. But woe betide you if you think decisions of your town or parish council have been taken inappropriately. You have no clear body of accountability to refer it to.

Monday, 3 March 2014

The press should stop speculating on Michael Schumacher

It is inevitable that the Media should speculate on Michael Schumacher's condition. But it would be better I think if neurologists not directly involved in the care of Michael Schumacher were not asked to speculate on the possible outcome. It was made clear at the outset that health care workers and family would make announcements if there was significant change in his condition and that they didn't want to deal with speculation. Quite right, and this should be respected. It serves little purpose to speculate, and Neurologists should say so if they are approached for their opinion.

It is natural for fans of the former Formula 1 champion (including me) to want to know how he is progressing. But clearly day by day commentary would serve little purpose on a process that can take months. Only when that process is completed will we know the extent of any functional damage. Let's wish him and his family well and be patient for news.

Friday, 28 February 2014

'Popular' uprisings are not necessarily popular

We should not make the mistake of assuming that 'popular' uprisings are popular. Or at least we shouldn't assume they represent the overwhelming interests of all the population.

It is instinctive for us to align ourselves with 'velvet' type revolutions - the toppling of oppressive regimes through the shear determination and will of the people expressed through civil disobedience. But the situation in Egypt and now as it develops in Ukraine should tell us that not all outcomes are good. A power vacuum has to be filled and it is often followed by an equally abhorrent regime with equal determination to have its will obeyed.

We now watch the situation as it develops in Ukraine with growing concern. The 2012 election was marred, and with a key opposition leader in prison it was rightly condemned by international observers. But the deposed president was not without popular support. There is a growing unease that Ukraine may split. Prevention of this will require political compromise.  Russia may move to 'protect' the Russian speaking population.

A symbol of this uprising in Western media has been the toppling of statues of Lenin. We should recall that Lenin came to power through a 'popular' uprising. But what is significant in Ukraine is that there isn't a coherent opposition leader around whom the people can rally.

We have learned that all is often not as it seems with 'velvet' revolutions. The 'orange' revolution in Ukraine soon turned sour with political corruption. Most of us have little idea of those who 'lead' the opposition in Ukraine. I doubt we will see a more robust democracy as a result of the events as they have unfolded.

Thursday, 27 February 2014

Did Zoo follow guidelines when it killed Marius?

Remember Marius the giraffe? Copenhagen's scientific director, Bengt Holst, said Marius's genes were too similar to those of other animals in the European breeding programme, and he risked introducing rare and harmful genes to the giraffe population if he had been allowed to breed. This is nonsense. I challenge Mr Holst to tell us what 'harmful' genes Marius had. I doubt if he can. I also challenge him to tell us how he defines these 'harmful' genes.

Nor did Copenhagen's zoo follow fully the guidelines laid down by EAZA, the European Association of Zoos and Aquaria. The guideline specifically states that

a post-mortem examination should be performed and biological material preserved for research and gene conservation. The results of the post-mortem should also be passed to the relevant programme coordinator, and full records of any results and outcomes should be archived. 
Marius was simply cut up and fed to the lions.

Now I must emphasise that I am not against culling animals kept in herds for preservation purposes. This is clearly necessary else the herd will get too big and also it becomes difficult to look after sick and ageing animals.  Inbreeding in a herd could also become a problem. But we need honesty in the reasons for a given cull.

The EAZA guidelines also state that each case must be considered on its merits and alternatives should also be considered. In this case other zoos had offered to take Marius. This alternative was rejected.

Wednesday, 26 February 2014

New English Language Tests for Doctors

Responding to the publication of the General Medical Council’s consultation on introducing English language tests for doctors working in the UK from the European Economic Area, Dr Vivienne Nathanson, BMA Director of Professional Activities, has said:

"The BMA supports the introduction of English language checks for European doctors and new plans from the General Medical Council to set the bar higher for all overseas doctors having to take the tests.

"It is vital for patient safety that all doctors, whether from the European Economic Area or otherwise, have an acceptable command of English to communicate effectively to ensure the safety of their patients.

"Since 2002 the BMA has called for language skills to be made a pre-requisite for any doctors wanting to practice in another EU member state, and while we support freedom of movement it is important that patient safety is paramount at all times."

We all expect our GPs to have good enough English to communicate and understand what we say. A crucial part of a consultation is taking a history, but a history isn't simply a list of symptoms or episodes in a life. It is understanding the patient's narrative. The way people express their emotions or feelings will often be couched in nuances and cliché. Understanding is more than language.

Of course another way of saying this is that language is more than simply words. It is cultural.

Under current legislation, the GMC can assess overseas doctors applying to work in the UK, but not those from other countries within the European Union.

The changes will require doctors from other European countries to provide evidence of their English skills or undergo a language assessment, if the GMC has concerns about his or her ability to communicate effectively with their patients.

This has to be a good move. As Niall Dickson, GMC chief executive says 'these new measures to ensure doctors from other European countries can communicate in English, combined with the higher test score requirements, will help us strengthen protection for patients."






Sunday, 23 February 2014

It Wasn't Always Late Summer

My novel, It wasn't Always Late Summer, is a powerful story of Mary, a single teenage mother living on a housing estate plagued with predatory abuse and prostitution, and Annie, an innocent girl whose ghostly presence links the central characters over two generations, bringing the events that led to her death, the loss of innocence and the unfolding story to a dramatic, thrilling conclusion.

It is a long held view that child abuse is rooted in the cultural heritage of denigrating children  and that most abusers are repeating child rearing patterns they themselves experienced as children.  It wasn't Always Late Summer, explores this thesis in the context of predatory sexual abuse. But it isn't intended to be an academic thesis.



It is a mystery-suspense thriller. It explores through the characters the psycho-social dynamics of the culture of sexual abuse and grooming. Some readers have said they find it compulsive and engaging but they do find it difficult. They put it aside several times. There is a vulnerability in all the characters that creates a sense of trepidation. It is a deeply disturbing story. I can understand the readers difficulty. I cried several times in writing it.

It is a ghost story too. But I didn't set out to write a ghost story as such. In many ways Annie represents the lost innocence that runs through the narrative. It is a story with an interesting twist. 



Friday, 21 February 2014

Rural GP practices under threat


Changes to the way GP practices are funded in England could threaten the future of at least 98 GP practices, including some that provide vital services to thousands of rural patients, GP leaders have warned today.

Last year the Government decided to begin phasing out the minimum practice income guarantee (MPIG) from April 2014. MPIG provides an important financial lifeline to many smaller GP practices by guaranteeing a minimum level of funding that is not dependent on the number of patients a GP practice has on its practice list.

NHS England have idenitified 98 GP practices that will lose substantial levels of funding that could place their long term survival in question. In addition to the 98, there are a significant number of other practices that will be severely affected. This is compounded by the Government's failure to put in place a national plan to help support the practices affected.

Dr Chaand Nagpaul, Chair of the BMA’s GP committee said:

“The government has seriously misjudged the potential impact of its funding changes, especially on rural GP services. It is likely that a few hundred practices will lose noticeable levels of funding, with 98 practices identified by NHS England as being at serious risk from severe cuts in their financial support that could threaten their ability to remain open. This comes at a time when GP practices are already under pressure from rising workload and declines in overall levels of funding.

“The government has not confirmed where these practices are or the extent of their financial difficulty, however some will be smaller GP practices in rural communities with comparatively small number of patients registered with them. These GPs provide vital services to patients in areas where accessing healthcare is already not easy because of the large distances patients have to travel to get to their local NHS services. If these practices were to close it could leave large geographical areas without a nearby GP practice.

“The situation has not been helped by NHS England’s decision to devolve responsibility for this issue to local NHS managers without a framework on how these GP practices should be supported. We are without a national plan of how to tackle this problem and safeguard GP services.

“Ministers have to get a grip on this problem urgently given these funding reductions are just weeks away from being implemented. We need to ensure no practice closes and that there is a coordinated approach to deal with this issue.”

One of the GP practices that is concerned about these changes is a Cumbrian practice run by Dr Katharina Frey.

Dr Frey said:

“My practice is a very small one that cares for just under 1,000 patients in a rural South Cumbrian area. We have for many years provided a real family orientated service for patients and I believe we are a really vital service for our local community.

“We are under real financial pressure already and cant, because of the current funding climate, afford to employ a practice nurse. We are also having to think very carefully about how we replace senior staff. This situation will become even more pressurised when we lose the MPIG support that currently accounts for our around a third of our current core funding. We are already working at full capacity with declining resources: I just don’t know how we will cope with this additional financial blow.”

 

Read Ray'a Novel: It wasn't always late summer