Wednesday, 25 February 2015

Prioritising people in nursing care.


There has been in recent years concern that care in the NHS has not been sufficiently 'patient centred', or responsive to the needs of the patient on a case basis. It has been felt in care that it as been the patient who has had to adapt to the regime of care, rather than the other way around. Putting patients at the centre of care means being responsive to their needs and supporting them through the process of health care delivery.  Patients should not become identikit sausages in a production line.

The nurses body, the Nursing and Midwifery Council has responded to this challenge with a revised code of practice reflection get changes in health and social care since the previous code was published in 2008.

The Code describes the professional standards of practice and behaviour for nurses and midwives. Four themes describe what nurses and midwives are expected to do:

prioritise people
practise effectively
preserve safety, and
promote professionalism and trust.

The revised Code  reflects the changes in health and social care since the previous code was issued in 2008 with new requirements on:

Fundamentals of care: This covers the essential aspects of caring for a patient, including making sure that a patient has adequate access to nutrition and hydration.

The duty of candour: Nurses and midwives should be open and honest with colleagues, patients and healthcare regulators when things go wrong.

Raising concerns: Nurses and midwives should raise concerns without delay if they are aware of a threat to patient safety or public protection.

Delegation and accountability: Nurses and midwives should make sure that they delegate tasks and duties appropriately and those they delegate to complete tasks to the required standard.

The professional duty to take action in an emergency: Nurses and midwives should take action in an emergency when off-duty, within the limits of their competence.

Social media use: Nurses and midwives should use social media responsibly, in line with our guidance.

The Code also makes clear that responsibility for those receiving care lies not only with the nurse or midwife providing hands-on care, but also with those nurses and midwives working in policy, education and management roles.

This new code is to be welcomed.

Good news for Health Care?


And so we turn full circle. Health care is once again being restored to local regional governance.  The announcement today that the £6bn health and social care budget for Greater Manchester will be taken over by regional councils under devolved NHS powers is in one sense good news.  Local control will allow more joined up health and social care that is responsive to local needs.  But there are concerns and these have been given by he BMA.

The Tories always have a desire to mess about with the organisation of the NHS. They most often do so in the hope that it will save money - that is 'cut' NHS funding.  For this reason I am always wary of moves to reorganise health care provision.  They fiddle with the deck chairs whilst the ship is allowed to sink, and then give as a reason the sinking of the ship.  It runs a bit like this. The ship is sinking so lets reorganise all the deck chairs so that it sinks more slowly.  The ship continues to sink and so the deck chairs are moved once again, trying to shift the ballast.  This is how it is with NHS reform, when the bottom line is really funding.  A well funded NHS is second to none.  But it isn't well funded, or at least not well enough.

Yet again it means a reorganisation of a health service still reeling from the impact of the unnecessary reorganisation imposed by the coalition government.   The Prime Minister, Mr Cameron,  promised no top down reorganisation of he NHS, yet immediately set about imposing confused and ill-judged reforms. He promised the NHS budget would be protected from the austerity cuts, yet £20 bn has been taken out of the NHS budget for England under he guise of 'efficiency savings'.  These efficiency savings have left a strain on overworked front-line staff.

Responding to the announcement that the health and social care budget for Greater Manchester will be taken over by regional councils, Dr Mark Porter, BMA council chair, said:

“There is no doubt that patients would benefit from more joined-up health and social care. However, any plans to do so would have to be underpinned by clear funding to ensure that an already dangerously over-stretched NHS budget isn't used to prop up a woefully underfunded social care budget.

“These wide sweeping changes will affect millions of people. We need to look carefully at exactly how they will affect the commissioning and delivery of services, and what the impact on patient care will be. We must also ensure clinicians have a central role in decisions over health care, something which was undermined by the Health and Social Care Act 2012.

“We need assurances on who is responsible if these changes go wrong. Doctors believe the secretary of state for health should have the duty to provide a universal and comprehensive health service, and must take responsibility for guaranteeing national standards in the of quality care across the country, especially if the delivery of care is to be devolved to local authorities.

“The NHS has just undergone unprecedented upheaval, there must be no more games with our health service and we need to avoid a situation where the NHS moves from being a national to a local political football.”

The reform is good in principle, but it must be put into effect with care. It must be made clear who is responsible for ensuring a universal and comprehensive health service across the country and how best this can be achieved.

Wednesday, 18 February 2015

Good news on the economy? Tell that to the poor.

With good news on the economy, with the headline rate of unemployment falling yet again in the latest figures, and with wages rising, we might all heave a sigh of relief.  Comparing October to December 2014 with July to September 2014, the number of people in employment increased by 103,000 (to reach 30.90 million), the number of unemployed people fell by 97,000 (to reach 1.86 million) and the number of people not in the labour force (economically inactive) aged from 16 to 64 increased by 22,000 (to reach 9.05 million).

But the government continues to wage war on the poor by cutting benefits. Just last month there were further cuts in housing benefits to the poor.  Housing costs are a major factor in pushing families into poverty.

A measure of a just society is how well the poorest do during a recession. Austerity has been unkind to the poor who have born the brunt of the cuts in welfare. Official statistics show that between 14 and 15 million people live in absolute poverty in the UK after housing costs are taken into account.  That is 23% of the population.  It is about 3 million more than before the recession and austerity.  It is a staggering figure.   What gives a lie to the idea that it is the 'feckless' and 'work shy' is that absolute poverty has increased most in working households with a significant impact on children living in poverty.

The poorest have been hit by the cost of housing. Yet, last month the government cut local authority budgets for discretionary housing payments by 24%, or £40 million (from £165m in 2014 -15 to £125m for 2015-16).  It is another example of how the poorest are made to carry the brunt of cutting the deficit.  Whilst wealthy tax dodgers get away scot free, the needy are forced deeper into poverty.
The government has instigated a systematic campaign against the poor. The bedroom tax, benefit cap and now cuts in local housing allowances — have left many families with a gap between their rent and housing benefit, which they cannot bridge.  These are hard working families. Families with at least one working member in the household, earning poverty wages to keep the wealthy rich. Even as we come out of recession the poorest are being squeezed.

We had the bedroom tax in an attempt to drive hard working families from their homes. We had flawed disability assessments driving the disabled to despair and, in some cases, suicide. The coalition has been a shocking government — a government without a moral compass.  It is time it stopped.  They have chased the poorest and allowed the wealthiest to get away with it.  The wealthy have become the 'untouchables'.  The poorest 10% in the UK  pay proportionately more tax than the wealthiest. The poorest 10% of households pay eight percent more of their income in all taxes than the richest – 43% compared to 35%.  That is something the tax dodging rich should be ashamed of.  Taxpayer's money subsidises the lifestyle of the wealthy.

We need to bring back into focus social justice at the heart of measuring outcome of economic strategy. To grow the economy is not in itself sufficient to ensure social justice. The rich simply get richer. Of course growth is important, but we must all have a stake in that growth. Currently the poorest do not.

Falling unemployment is good news.  But there is another story behind the frontline statistics.  More people are now 'self employed'.  Whilst this is good news in that they are at least earning a living, the income of those self employed has dropped by 22% during the recession.  That is a massive hit and many struggle at a time when benefits are being cut.  This is why the latest cut in discretionary housing benefit is so severe.   Opportunities for more secure employment with decent wages has fallen.  The increase in 'self-employed' is not a feature of 'entrepreneurship' but of people getting by in a fragile job market.




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

Monday, 16 February 2015

No More Games - BMA campaign

Doctors’ leaders have today unveiled a major new campaign ahead of the General Election calling for an open and honest public debate about securing the future of the NHS and an end to political game playing with the nation’s health.

The BMA’s campaign – No More Games – calls for:

No More Games with the public’s health
No More Games with NHS funding
No More Games with who’s providing patient care
The launch of the campaign comes as a new poll highlights a marked increase in public feeling that politicians are putting votes over patients, with 77 per cent believing political parties to be designing health policies to win votes, rather than focusing what is best for the NHS.

As part of the campaign, the BMA has today unveiled a new poster at thousands of sites to bring the campaign to the public’s attention. The poster, featuring a giant toy tower representing the NHS, will feature on billboards and bus shelters.

The BMA is now calling on the public to add their voices to those of doctors across the country in calling for all political parties to stop the game playing and have an open and honest public debate about securing the future of the NHS.

Commenting, BMA council chair, Dr Mark Porter, said:

“The NHS is one of the UK’s towering achievements, but for too long it has been used to play political games. With health the public’s number one election issue2, this game playing is on the rise with all political parties laying the blame for the current NHS crisis at each other’s door rather than facing the problem head on.

“Against the background of the worst A&E waiting time figures for a decade3,the public is being treated to claims and counter claims from political parties about ‘weaponising’ the health service4, ‘betraying’5 the public’s trust on the NHS. Caught in the middle are thousands of patients and NHS staff waiting for real, evidenced solutions.

“The BMA is calling for an open and honest debate in which all political parties come together with the public to ensure the long-term future of the NHS. We want to see a stop to the headline-grabbing such as 48-hour targets for GP appointments6, payments for dementia diagnoses7 and unfunded budget pledges8.

“It is not just doctors sounding this call – 77 per cent of the public believe politicians are designing health policies simply to win votes.

“The scale of the campaign just goes to demonstrate just how concerned doctors are, and we aim to ensure that every member of the public sees it and adds their voice to ours in calling for an end to the game-playing and the start of an open and honest public debate on how we create a long-term, sustainable plan for the NHS.”

 

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

Saturday, 14 February 2015

The politics of social justice

The poor pay disproportionately more to defend the rich.   The UK spends £36.4bn per year on defence.  The cost of tax evasion is £22 bn (Treasury estimate).  It seems the rich don't want to pay to defend Britain, or for British forces to play the world-wide role they do.  Yet, the rich will expect it and indeed they depend on it.  It is another example of the lack of a moral compass.  Whilst austerity hits the poorest, the wealthiest continue to benefit.  The poor subsidise the rich.  There is a dreadful dependency of the wealthiest on the poorest.  'Welfare dependency' is nothing compared to the dependency of the rich on keeping the poorest poor.

But why is there no political representation of this unfairness? Where is the anger and the movement for change? For all its benefits, New Labour brought into the wealth prospectus. It brought into the false notion that with wealth would come social justice. It shook hands with the wealthy elite. The rich get a bigger say in government.  They are the paymasters to major political parties.  Who dares challenge them?  And yet they must and should be challenged.

We are told we cannot afford a national living wage.  What that says is that we cannot (will not) pay a wage to the poorest workers on which they will be able to live.  The reason is because it will cut into the profit margin and the rich won't get as rich so quickly.  Their wealth is dependent on low wages. It is depended on exploitation.

Meanwhile the rich executives pay themselves immoral bonuses for 'success'.  There is nothing like 'success' to create 'success'.

I hope that when the next 'rich list' is published it will create shame for those listed. But I doubt it will. Some, no doubt, will be disappointed they didn't make the cut.

Why have we become so reluctant to attack the rich, to bring them to justify what they do? They make decisions that affect the lives of millions as that of any government. I think part of the answer to that is psychological.  We are told it is the 'politics of envy'.  We would all like to be stinking rich wouldn't we?

So this politics of 'envy' is turned on its head.  Instead we are expected to applaud success measured by wealth.  But success should not be measured by wealth, or at least not by wealth alone.  A successful society is not simply one that is 'rich'.  It is one where there is a reasonable balance in the distribution of wealth and privilege and where all have the opportunity to share in its success.   It is called social justice.  And that is the point. It isn't the politics of envy that leads us to question excesses in wealth. It is the politics of social justice.

I believe that entrepreneurship is vital to human development. I think it is vital to the creation of wealth and opportunity. But there is a difference between entrepreneurship and exploitation of others. There is a difference between entrepreneurship and making a quick buck at the expense of others. There is a difference between entrepreneurship and tax evasion.

Entrepreneurship should not be predicated on losing a moral compass.  Yes, I have no doubt that ethical decisions cost money.  There is a price for ethics. If entrepreneurs are not wiling to factor in that cost then they cannot be said to understand ethics or morality, or indeed business.

The point of business, of trade, of growth and development is not the concentration of wealth into the hands of the few.  The purpose of it is so that we can create a society where no child goes hungry; where every child has a decent chance of education; where every person has a chance of a decent job with a decent wage so they can feed their families.  This is not the world in which we live. Too many people are poor.  Success should not be measured by how many more we can add to the 'rich list'.  It should be measured by how well we treat the poorest and how well we can lift them out of poverty.

Success should be measured by wellbeing and not by wealth alone.


 

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

The rich are laughing all the way to the bank

UK Revenue and Customs loses billions in tax revenue each year due to tax avoidance and evasion. Meanwhile more than one in four of our children live in poverty,  that is  3.5 million children.  With an upward trend as a result of the coalition government's austerity policies this is expected to reach 4.7 million children by 2020. Millions of our children will go to sleep hungry whilst rich tax evaders feast themselves in some far away sun spot.

A lack of anti-avoidance tax law and cuts to public services are contributing to the UK's yawning tax gap.  The difference between the tax that should be paid in the UK if the tax system worked as parliament and HMRC intended, and the amount actually paid is a staggering  £119 bn.  I will repeat that:

£119 bn!

This is the figure produced by research commissioned by the Public and Commercial Services Union and published last year. Their research estimated  that in 2013 the UK lost £73.4bn to tax evasion. Evasion is when a person or company deliberately and unlawfully fails to declare income for tax purposes.  The official estimate is still a whacking £22.3 bn. 

£22.3 bn a year!

Whatever figure we chose to believe it is a shocking indictment.

During the last five years of austerity measures the government has pursued 'benefit cheats' with determination and in doing so it has cut benefits for the deserving working poorest in our community. The bedroom tax has been forcing families out of their homes.  The disabled have faced irresponsible assessments to determine their 'fitness to work'.  Meanwhile the rich have been laughing all the way to the bank - literally so as the HSBC scandal demonstrates.

It seems there is no moral compass. They show no distinction between what is 'lawful' and what is 'ethical'.

So what is the government doing to pursue the tax cheats?

Last year HMRC closed all of its 281 Face to Face Enquiry Centres, months after it had also announced the loss of 8,000 jobs this year.

There is a clear question to be put to the leaders of all main political parties in the coming general election: what are you going to do to ensure that the rich are paying the taxes that are due?


 

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

Friday, 13 February 2015

The poor subsidise the rich

'It's the same the whole world over...its the poor what gets the blame.' So the song goes. How true it is. Welfare 'cheats' are pursued mercilessly, the wealty tax dodgers hardly at all.  You would think that welfare cheats were costing us the earth. But they are not.

The State of the Nation report published in 2010 estimated the total benefit fraud in the United Kingdom in 2009/10 was approximately £1 billion.  Figures from the Department for Work and Pensions show that benefit fraud is thought to have cost taxpayers £1.2 billion during 2012–13,  Yet, a poll conducted by the Trades Union Congress in 2012 found that perceptions among the British public were that benefit fraud was high – on average people thought that 27% of the British welfare budget is claimed fraudulently.

Official UK Government figures put the level of fraud stands at 0.7% of the total welfare budget.  In contrast, it is estimated that tax fraud and tax evasion costs almost £69.9 bn per year. That lost through welfare fraud is a tiny fraction of that.

Chasing welfare 'cheats' is political. The failure to prosecute tax cheats is also political. It has suited this government drive to cut welfare to  allow the impression that somehow most recipients don't deserve it. They are bucking the system.  That has been the mood music - 'welfare scroungers'. We have had the stories of 'shirkers', people who don't work but claim benefits,  hiding behind closed curtains.  What a despicable falsehood it has been - a lie perpetrated by politicians with not a little help from the media.

All this has been a cover for 'austerity' along with the myth that 'we must cut the deficit'. Few challenge this story. Most buy into it. but it has been a prospectus of economic madness. It has delayed recovery so that we had the longest recession and greater suffering as a result. The bitter pill, we were told, had to be taken.  The medicine would be good for us. The 'scroungers' were pursued.

We had the bedroom tax in an attempt to drive hard working families from their homes. We had flawed disability assessments driving the disabled to despair and, in some cases, suicide. The coalition has been a shocking government — a government without a moral compass.  It is time it stopped.  They have chased the poorest and allowed the wealthiest to get away with it.  The wealthy have become the 'untouchables'.  The poorest 10% in the UK  pay proportionately more tax than the wealthiest. That is something the tax dodging rich should be ashamed of.  Taxpayer's money subsidises the lifestyle of the wealthy.

It is our money that pays for the training of the doctors and nurses that work in the private hospitals, not just the NHS. We train the doctors and the teachers - the teachers that teach their children. We pay for the roads on which they drive their limousines. We maintain the infrastructure that helps their businesses to grow so that they get richer. We, the taxpayer, and it is the poorest who shoulder the biggest burden of that tax.

The poor subsidise the rich. That is shameful.

 

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

Coalition government has damaged the NHS

The Tory party when in government always messes up the NHS. That is a given. We recall the crisis at the end of the last Tory government in 1997 with  long waiting lists and waiting times and with patients waiting on trollies in A&E because of a shortage of beds. Now we have the same long waiting lists, waiting times and patients waiting on trollies in corridors because of a shortage of beds. It is like Groundhog Day, a recurring nightmare. Tory governments should come with a health warning.

Now a damning report says that historians 'will not be kind in their assessment of the coalition government’s record on NHS reform'.

A major assessment of the coalition government's record on NHS reform by The King's Fund concludes that the upheaval caused by the Health and Social Care Act has been damaging and distracting.

We recall the promise that the NHS was 'safe' in Tory hands and that there would be 'no top down reorganisation'. The history seeks for itself. Not only has there been reorganisation, it has at best been fragmented and disjointed.

The new report highlights some positive developments as a result of the Act including closer involvement of GPs in commissioning services, giving local authorities responsibility for public health and the establishment of health and wellbeing boards. However, it criticises the decision to implement complex organisational changes at a time when the NHS should have been focused on tackling growing pressures on services and an unprecedented funding squeeze.

The changes have left the NHS organisation fragmented and without clear leadership.  Dispersing budgets formerly held by Primary Care Trusts between Commissioning Groups, NHS England and local authorities has created a situation where there  are no longer single population-based budgets for health care. At a time when it is more crucial to develop coordinated health and social care this has been counterproductive.

The coalition has left the NHS poorly funded, fragmented and unfit to meet the demands of coordinated health and social care.

 

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

Thursday, 12 February 2015

The poor pay more tax than the rich

In my last post I wrote that the rich should pay more tax. The balance of the tax burden in the UK is unfair on the poorest. The poorest 10% of households pay eight percentage points more of their income in all taxes than the richest – 43% compared to 35%.  Yet, when we talk of tax it is the wealthy who scream the most.  They have become the untouchables. We can't increase tax else they 1) won't pay it (increase in tax avoidance) and 2) it is a disincentive to the 'wealth creating' rich. And so it is that the poorest have shouldered the greatest burden of the recession and it is the poorest who have payed in taxes and cuts in benefit. Is that fair? No.  Does it feature in any of the key messages from the major political parties? No. This also is the problem.

We need to bring back into focus social justice at the heart of measuring outcome of economic strategy. To grow the economy is not in itself sufficient to ensure social justice. The rich simply get richer. Of course growth is important, but we must all have a stake in that growth. Currently the poorest do not.

More than one in four children is growing up in poverty in the UK today - 3.5 million children. But in some areas of the country it is between 50 and 70%.  Two-thirds  of children growing up in poverty live in a family where at least one member works.  This is unacceptable. But does any political party put it at the top of their strategy for dealing with the economy? Sadly, they do  not.

Labour has something to shout about. During the last Labour government child poverty fell. Child poverty reduced dramatically with 1.1 million children lifted out of poverty. This reduction is credited in large part to measures that increased the levels of lone parents working, as well as real and often significant increases in the level of benefits paid to families with children.  The recession and austerity has reversed that trend. The poor are getting poorer. It is an unfair prospectus and it is time we had a party speak up for them.

The current focus on tax avoidance by the richest is a good thing, but only if it now translates into a movement for fair taxation.




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

The rich should pay more tax

The rich should pay more tax. That would be fair. From the reaction of  business exectutives in recent days you would think that Labour were bent on some kind of socialist revolution.  "Red" Ed is said to be unfriendly to business. It is symptomatic of the vice-like grip the business world has on politics. You would think that the much needed redistribution of the balance of power and privilege in the UK was about to become a major political issue. It isn't. It will hardly feature in the election and the differences between the economic policies of the main political parties will be nuanced. That is not to say those nuances are unimportant, but they are hardly radical.

So what are these business executives screaming about?  Once again they hold politics to ransom, and British politics suffers as a result.  We cannot address the real issues of law pay and unfairness in work contracts - 'Anti-business' the top executives will cry, and Lord Mandelson will come out of the woodwork to 'warn' Labour to behave itself. Debate is stifled once again.

We cannot address the real unfairness in the tax system that taxes the poorest more than the wealthiest - 'Anti-business' they will cry, and Lord Mendelson will 'ride to the rescue' of Labour once again advising it to put forward a more positive 'business friendly' message.

A straight road has been defined and the political parties mustn't stray from it. We are locked into the politics of austerity with the three main parties signed up to some version of it.  The SNP has broken ranks to suggest that austerity should be abandon as a strategy. Most in the Labour party agree with them. I agree with them too. Of course it is opportunistic game play by the SNP, particularly as it plays for the wobbling Labour vote in Scotland. Labour should have been the anti-austerity party but that would be too much.

It is time we have a proper open debate about the unfairness in our society - the inequalities of opportunity that start at such a young age.  It is time we had a proper debate about taxation and how we make the rich pay their fair share. Perhaps with the revelations about 'dodgy' banking and tax evasion we may get it. The rich should pay more tax, the poorest should pay less.  But I don't hold my breath.

 

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

Tuesday, 10 February 2015

Stephen Fry asks the wrong question about God.

Stephen Fry asks the wrong question about God. He asks why a God would allow human suffering with diseases such as cancer.  By asking such a question he implies that the real answer is that there couldn't really be a God, or at least not a God that is benevolent.  His assumption is that if such a God existed then there would be goodness and no badness in the world.  It simply begs the question of what such goodness would be.  Goodness and badness is clearly a human viewpoint.

It is 'good' that there is a world of nature, but it is also 'natural' that it changes, grows, develops and reproduces, else the world about us would not exist other than as a permanent fixed entity, and we along with it would also be fixed - no thoughts, no human decision, no cultural development, no history,  no Steven Fry. The later would, I think be very bad.

All this doesn't suggest Stephen Fry is wrong to question the existence of a God. I do that also. But his question is misplaced because it doesn't answer the question in the way he clearly supposes. He asks it as a rhetoric which fails to provide the answer he thinks it does.

It presupposes an interventionist God. If such a god existed then what would be his priorities? Would he intervene in every detail? In which case there would be no 'free will' and Stephen Fry would not be able to ask his question, let alone answer it.

No, if God does not exist it is not because of the answer to Stephen Fry's rhetorical question. If God does not exist, whatever a 'god' is,  it will be because the proposition of a god is found to be unnecessary as an explanation.  I do not know whether that is so or not.


Are the rich a bunch of shits?

I have come to a conclussion that the rich are a bunch of shits. You might think two things about this: 1) how did it take so long for me to reach such a conclusion, and 2) surely I don't mean all those who are rich. In truth it didn't take me so long. It has just taken me so long to say it and 'austerity' brings it out.

The poor have been political fair game, particularly over the last five years of the coalition government here in the UK.  But somehow the wealthy have been 'ring-fenced'.  We have had the systematic attack on 'welfare scroungers' but little to root out wealthy tax scroungers, those who are arrogant enough to assume they owe society nothing. They are those who take but do not give back. They will make profit from other people's suffering.  They will send their children to the best schools money and privilege can buy but avoid paying for schools in general.  They will speed on our roads in their expensive, probably chauffeur driven automobiles but avoid paying for their maintenance or construction.  They will use our street lights but avoid paying for them. They are the real scroungers, and that is why I say they are a bunch of shits.

I still find more people who will complain about welfare cheats than about wealthy tax cheats.  What then is it that ring-fences them.   For the rich it is get away with what you can get away with - we all would if we could wouldn't we? And there lies the problem.  None of us want to be poor, so we blame the poor for their poverty.  Most of us want to be rich so we admire the rich, until they fall off their pedestal which happens occasionally.  The newspapers publish the rich list of the top 100 people in a given year. I haven't seen them publish a list of the 'top' poorest people. That of course would be difficult as there as so many more of them. The rich are fewer, yet their moral turpitude has the greater impact. The consequences of a rich man's cheating the system is far greater than that of a poor man. The rich have become the 'untouchables'.

It has been estimated that  £69.9 billion is lost on a yearly basis in what the Tax Justice Network call the "shadow economy."   Think of the deficit and the effects of austerity on the poorest. Think of the cash-strapped NHS at breaking point.  Think of the way this government has pushed to cut welfare while the rich have been laughing all the way to the...bank. I recall the declaration that 'we are all in this together' from Downing Street.  Now we must wonder who 'we' are.

Boots Chief Executive, Stefano Pessina, had the audacity to criticise Labour's tax policies. This is the billionaire boss of Boots who was criticised by the Business Secretary for not paying UK taxes.  Mr Passina is not resident in the UK and Boots moved its formal tax residence from Britain to Switzerland following Messina’s private equity-backed buyout in 2007.

We measure success by wealth not deeds.  The rich man in his castle the poor man at his gate is still the standard. The Thatcherite concept of the rich providing jobs for the poor leads to the false notion that there would be no jobs without the rich.  Let's not hurt the rich because they provide work for the  otherwise idle poor.  It is the trickle down concept.  The problem with it is that it is a false prospectus. There is little if any trickle down, and a lot of trickle up.  The poor make the rich richer.

If modern politics really reflected this the debate would be more meaningful. Sadly it doesn't.  We are no longer allowed to challenge the core concept about wealth.  Any politician to do so is immediately castigated in the media as a raging, dangerous loony. What that means is that it is lunacy to challenge the rich. Let's not redistribute wealth! it would hurt the rich and that would...lose jobs? Make people poorer?

The other problem is aspiration, or at least a prevailing concept of it.  According to this we all aspire to be rich.  We don't of course, but some of us do, and if there were no rich then there would be nothing to aspire to. Really? Would there be no good to be done? Could we not aspire to doing good in our communities? The problem is that we define success by wealth. Even our universities do it. Good research has become defined as 'research' that brings in oodles of funding or can be converted into wealth creation - a translational effect! We increasingly justify what we do by the wealth it creates. Universities have been encouraged to do this. They have appointed enterprise Tzars to encourage exploitation of research. Let's make oodles of money. Even the philosophy departments have to justify themselves in this way.  What is the point of history if it doesn't create wealth?

But lets get back to the cheats.  Let us hope that he HSBC revelation opens up to public and political scrutiny of the real cheats. The poorest didn't create the financial crisis form which they suffer. The rich did. It is time they payed the price.