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.