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.