Saturday, 31 October 2015

Headline grabbing initiative on 7 day NHS 'no benefit to patients' says BMA

Last year the Prime Minister, David Cameron, pledged to deliver a 7 day a week GP service by 2020. It was one of those pledges typical of Prime Ministers when they avoid the real problem - funding. In his announcement Mr Cameron said:

"Our plans for a truly 7-day NHS will transform services for millions of patients. It will offer hardworking taxpayers and families the security of the care they need at a time that is convenient to them. I want to pay tribute to the fantastic work of GPs and indeed all NHS staff across the country."

Frankly, it was an ill-thought through, headline grabbing statement.

The problem for patients in accessing a GP are not solved by opening all hours including Sundays. The problem is lack of funding and GPs under pressure to deliver in an overstretched system. There is little evidence that opening on Sundays would help alleviate the problems GPs face, or that it would improve patient care.

Now a report on pilot opening on Sundays shows that there is little enthusiasm from patients for such access.

Back in October 2013, the Prime minister announced a new £50 million Challenge Fund to help improve access to general practice and stimulate innovative ways of providing primary care services. 20 pilot sites were selected to participate in the Challenge Fund, covering 1,100 general practices and 7.5 million patients. Each scheme chose its own specific objectives, innovations and ways of organising services.

In the independent report on outcomes from the first wave of these pitot initiatives it was found that where Sunday opening was provided there was little uptake and concludes:

"Given reported low utilisation on Sundays in most locations, additional hours are most likely to be well utilised if provided during the week or on Saturdays (particularly Saturday mornings). Furthermore, where pilots do choose to make some appointment hours available at the weekend, evidence to date suggests that these might best be reserved for urgent care rather that pre- bookable slots."

In other words, there is no major benefit from GP Sunday opening. Furthermore, it needlessly stretches resources.

Responding to the findings, Dr Chaand Nagpaul, BMA GP committee chair, said:

“GPs have always been committed to improving patient access and already provide a seven day round the clock service. How we deliver further benefits to the public needs to addressed, but this independent evaluation of the challenge fund pilots raises serious concerns about the value and expense of the government’s inflexible approach to seven day services for general practice.

“There was extremely poor demand from patients for appointments on Sundays, and in many cases on Saturday afternoons, resulting in precious NHS resources being wasted on keeping near empty practices open and staffed. The cost of providing care during these hours was significantly higher than routine GP practice appointments during the week. While some areas showed a slight decrease in minor illness attendances at A&E, there was no reduction in hospital admissions, and any cost saving would need to be balanced by the considerable expense of running these pilots."

GP services are struggling to cope extreme pressures. An ageing population with complex health conditions has increased the burden on front-line services at a time when social care services have been cut. Cuts in social care has a huge impact on the NHS, where each year £669m is being spent because older people are finding themselves trapped in hospital for days or even weeks. It also increases pressure on front-line general practice. Since 2010 funding for social care has been cut by 25% leaving a massive deficit in meeting a growing need. Families are left unsupported.

General practice is currently facing a tough financial climate. Since 2008, General Practice income has declined by 11% whilst the cost of running a practice (including the amount spent on keeping GP practice buildings in good shape, energy bills for GP practices and the amount spent on GP staff, including practice nurses and receptionists) has risen. As Dr Nagpaul says:

“At a time of extreme pressures on GP services, with many practices struggling to cope with patient demand and falling resources, the government needs to learn the lessons from its own pilots. A number of those areas taking part decided to stop providing weekend sessions owing to lack of demand. Two thirds of the funding for this project was actually spent on worthwhile schemes of benefit to all patients across the week, such as improving digital infrastructure and measures that enhance collaborative working between GP practices."

The government needs to ensure that GP services have the resources to meet the 'incredible demands' being placed on them and not be distracted by headline grabbing initiatives which do not deliver benefits to patients.



Friday, 30 October 2015

Tories are chasing their tails on the economy.

The trick continues. Mr Cameron's inability to give assurances that nobody would be worse off from any changes in working tax credits left him floundering and blustering in the House of Commons. But slowly the defence has been mounted outside parliament and it is the usual trick, tainting those who receive benefits as 'work-shy' and 'on the take'.

The first line of argument was that it is necessary to cut welfare in order to cut the deficit, but why should hard working people on low pay be made to pay for the deficit?  That fairness question is difficult to answer.

They do try of course. 'The £30 billion cost of tax credits', they say is 'too big'.  But welfare is big because wages of the poorest workers are too low.  The bill is big because millions have been forced into low payed insecure jobs.

But that £30 bn isn't the real cost.  The real cost would subtract the costs of unemployment if these people were not in work.   Tax credits keep people in work.  That is what they are for. It makes work pay.  But it wasn't designed for the creation of so many low paid jobs.

It is right that the government should address the problem of low pay and part time work.  Recent surveys show that the majority of people on low pay and with part-time work want to work more hours.  The scandal of employment under the coalition was that the recovery was predicated on pushing people into low paid jobs with low hours and with poor contracts.  This is why reducing unemployment has cost so much.  It is the cost of driving people into low pay and insecurity.  It is a cost of the government's own making.  Nobody envisaged working tax credits would end up costing so much. This is because is never envisaged so many being pushed into low pay by such a long recession.  It is also a result of the wrong tactic: deficit reduction rather than growth.

Insecure, low-paid jobs have left record numbers of working families in poverty, with two-thirds of people who found work in jobs for less than the living wage.  That is the scandal. That is the trick.  The government systematically created a low payed work force.  Millions are trapped on low wages. 

According to research by the Joseph Rowntree Foundation, nearly 1.4 million people are on the controversial zero hours contracts that do not guarantee minimum hours, most of them in catering, accommodation, retail and administrative jobs. Meanwhile, the self-employed earn on average 13% less than they did five years ago.  The truth is that the tax credits problem is one of the Tory government's making.  The bill has risen because of the madness of their economic strategy.  A strategy to 'tackle the deficit' which has failed.  It created the very increase in spending that makes it difficult to cut the deficit. It is a failed economic strategy, and now the government are chasing their tails trying to square the circle of deficit reduction.  

The truth is we are an underemployed country.  Sluggish productivity growth continues. Tax credits need to be replaced by real jobs with a living wage. But cutting tax credits won't in itself achieve that.  The government should only cut tax credits when a real living wage is in place. The government got it the wrong way round.

The reason they got it wrong is because they saw only one objective, to cut the welfare bill.  Ideologically, they don't really believe in a 'living wage'. They pinched it from Labour to establish a background for welfare cuts and declare themselves a party for the workers. This is why they got it the wrong way round.  Cutting welfare for the Tories has priority over the 'living wage'.  It is a trick that has caught them out.

Austerity is presented as the only viable alternative. This is another trick the Tories have been good at. Economic credibility was predicated on accepting this. Labour made the mistake under Miliband of doing so.  The alternative would have been a strategy of real investment for growth - reducing the deficit by increasing revenue.  Indeed, I would argue that this is the only way to effectively tackle the deficit and pay down the debt.  Tragically,  the Tories won the argument by default.  Labour failed to present the alternative.  They allowed a false narrative to gain credibility - that the deficit was the problem that led to the financial crisis. That narrative led to economic madness - a madness the Liberal Democrats helped along.

This is why we need a new narrative, a realistic narrative on the economy.  It makes sense from a number of angles. Without social objectives, economic objectives are meaningless and self defeating.


Thursday, 29 October 2015

NHS crisis: Government ignores real problems facing GPs.

When governments run out of ideas or wish to avoid major funding decisions they introduce measures that sound good but in practice do little to address the real problems.  The Secretary of State for Health has announced the introduction of 'Osted-style' ratings for GP practices in England.

The announcement received a no-nonsense response from the BMA. Dr Chaand Nagpaul, BMA GP committee chair, said:

“We do not believe that simplistic Ofsted style ratings will lead to any improvement in patient care or give an accurate picture of services in local areas. The Secretary of State needs to also listen to the report from the Health Foundation, which he himself commissioned, which advised strongly against composite indicators which mask the details of quality of care, and which he is proposing now to introduce.”

An ageing population with complex health conditions has increased the burden on front-line services at a time when social care services have been cut.  Cuts in social care has a huge impact on the NHS, where each year £669m is being spent because older people are finding themselves trapped in hospital for days or even weeks.  It also increases pressure on front-line general practice. Since 2010 funding for social care has been cut by 25% leaving a massive deficit in meeting a growing need.  Families are left unsupported.  

Age UK estimates there are more than 1 million left struggling each day without proper support and the numbers continue to grow as cuts in funding leave local authorities struggling to meet needs. A report published by adult social care chiefs (Association of Directors of Adult Social Service (ADASS) earlier this year warned of £1.1bn budget cuts to the sector. Additional funds, it said, are urgently needed to protect services after "almost unendurable" cutbacks in the past five years. Spending on the NHS has remained static at best, whilst funding for social care has been cut by 10.7%. It is a false economy.

This demand is likely to increase as the number of people aged over 65 is predicted to reach 15.7 million by 2031.  We need to fundamentally rethink how this can be met. But we need also to bite the bullet that it will require more and sustainable funding.  The GP crisis is the front line of this deeper problem.

General practice is currently facing a tough financial climate. Since 2008,  General Practice income has declined by 11%  whilst the cost of running a practice (including the amount spent on keeping GP practice buildings in good shape, energy bills for GP practices and the amount spent on GP staff, including practice nurses and receptionists) has risen.

When we hear about GP incomes being high we should take account on one sobering fact.  The cost of running a practice now accounts for 61.6 per cent of total GP income. 

Little wonder then that many GP practice buildings have not seen serious investment for many years, leaving many facilities cramped and inadequate to meet the demands of patients.  A recent survey by the BMA found that  four out of ten GP practices feel that their current facilities are not adequate to deliver basic GP services to patients.

The number of GPs per head has declined from 62 per head in 2009 to 59.2 in 2012 whilst the demand for services increases.   In some parts of the country it is difficult to recruit sufficient GPs to meed local needs. 

As Dr Nagpaul of the BMA has warned,  "GP practices are struggling to deliver enough consultations to their patients because of the unprecedented strain from rising patient demand, falling resources and staff shortages."

The government continues to bury their collective head in the sand in face of this crisis with their false objective of deficit reduction.  It ignores the real issues.  It tinkers at the edges of the NHS and social care problem in England.  Ofsted-style assessment will by like cutting off the legs of a donkey and seeing how it walks.


Friday, 23 October 2015

The nonsense of Tory economic madness

Taking the Tory narrative on the economy you would be forgiven for thinking that current problems with the economy are due to 'out of control' spending on welfare.  It is a false narrative. It is a dangerous narrative because it means we are not learning from history.

The Tories set up this narrative of welfare spending so that they can do what they are ideologically good at doing - cutting social investment.  But it is more sinister.  It is a political trick that shifts the burden of the financial crisis to the poorest and enables the government to 'keep taxes low'. It aims at 'middle England'.  

But it is a false narrative. If you want to see graphically what went wrong you can do no better than consider household debt.  The massive and rapid increase in household debt as percentage of incomes fuelled an unsustainable boom.  


Household debt-to-income shot up over the course of a decade to 170% of household income before the financial crash.  In large part it fuelled, and was in turn fuelled by rising house prices. 


Not only was more and more money pumped into the housing market, house price inflation was fuelled by the growing shortage of housing.  It was also a 'boom' fuelled by an unfettered market. Distorted market economics pushed housing increasingly out of reach of first-time buyers.  This was a social crisis. 

In the three decades following the war, construction of local government housing increased supply. It took people out of slums and provided affordable housing. It was a critical factor in the welfare state and in providing opportunities for hard working families. Home builds reached over 400,00 a year in the late 1960s. However,  with the advent of 'free market' politics from the 1980s, the government retreated from building houses, leaving it to the private sector, with only a small contribution from housing associations.  The consequences are now stark.  Families are forced now into inadequate rented homes in a relatively unfettered rented sector.  Landlords income have been fuelled by the need to support such families with rent allowances.

The Tory government seeks to solve this, not by building more social housing but by trying to force people to move with the 'bedroom tax' or simply putting a cap on rent allowance making it impossible for families to go on living in the areas where they have jobs.  

No, it isn't public investment that brought about the crisis. It was the lack of it. Welfare bills rise because more and more people are forced into low paid jobs often on zero hour contracts. The welfare bill is high because rents are high and pay is low. Yet the government seeks to solve this by cutting welfare.  As well as being socially unjust, it is economic madness.



Simply cutting the deficit is a poor economic goal

It is relatively easy to create an economy that works for the rich but it is difficult to create one that works for the poor.  But it isn't rocket science. The huge public investments in health, education and housing in the three decades following world war two demonstrated it can be done, lifting people out of poor housing and providing them with opportunities in education and work inconceivable before the war.

The Tories and the Tory government, as did the Tory-LibDem coalition have instead targeted the deficit. They have not learned from history.  Despite Britain being bankrupted by the war, and inspire of massive national debt, both Labour and Tory governments invested in social infrastructure and welfare - more so did Labour.  As the economy grew, the national debt fell precipitously. A healthy workforce became a more productive one; a skilled workforce become a more adapted one.



Yet, now, cutting down the deficit has become an objective for a 'strong' economy with robust growth, but it is growth predicated on making the disadvantaged poorer.  The government hails middlingly small growth as a sign the it is working.  It isn't. Not for the poor it isn't  Furthermore it is poor economics whether or not you care about the poor.

 This is why we need a more balanced economic strategy. Growth is necessary, but not sufficient as an answer.  We need also a social strategy.  Simply putting the nations finances 'in order' is not in itself an answer. A family could have a healthy balance in the bank but if the roof leaks it is more damaging than if the family had borrowed money to repair the roof.

Putting the nations finances in order is also used by the Tory government as a cover for an ideological attack on the poor, but not on poverty.  First they create a narrative of the 'undeserving', 'work-shy' poor.  The Secretary of State for works and pensions has used this language time and again.  They also talk of 'helping the poor help themselves'.  The truth is that the vast majority of those receiving benefits are in work.

Another part of the narrative is what is called 'welfare dependency' as if those on benefits are on a kind of benefits drug from which they have to be weaned with cold turkey.  And so it is with working tax credits.  Government ministers say that somehow this will miraculously increase wages.  Yet, there is no process in any economic text I know that demonstrates this principle. The one I do know is that if you cut benefits to the poorest without lifting their wages then they will be pushed deeper into poverty.  They won't be able to afford their rents and so are more likely to become homeless, their health will deteriorate and we end up with a poor, unproductive, unskilled workforce.  It is simply bad, bad, bad economics.

The government has no social agenda other than that of a Victorian era of 'self help'. But even the Victorians began to understand the importance of public health and invested in infrastructure to promote it.  This government has lost sight of the social goals of good governance.  To create health and wellbeing. It follows bad economics for bad social reasons. It pushes the poorest deeper into poverty for the sake of the illusive goal of 'cutting the deficit'.   Cutting the deficit is a poor economic goal.

 

Thursday, 22 October 2015

Adam Smith Institute says tax credits best form of welfare.

Opposition and criticism of the governments proposed cuts to working tax credits is coming now from across the political spectrum.

It has been widely reported in the newspapers that he right-wing think tank, the Adam Smith Institute has criticised the governments proposed cuts in tax credits.  In a press release the ASI said:

"Working tax credits are the best form of welfare we have, and cutting them would be a huge mistake. The government has long claimed to want to make work pay for everyone, but cutting tax credits would disincentivise work and hurt those at the bottom of society.

"Contrary to the government’s claims, the National Living Wage will do little to help those affected by these cuts and, according to the Office for Budget Responsibility, it risks adding insult to injury by pricing tens of thousands of workers out of the labour market altogether.

There is little evidence that tax credits ‘subsidise’ employers, except to the extent that they make more people willing to work in the first place, creating a larger pool of workers. The politics of this looks dangerous, too: when it’s working families at the bottom of the income distribution that are being hit hardest, it’s hard to say that we are ‘all in this together’. We urge the Chancellor to rethink these cuts and find savings elsewhere instead."


The ASI further recommend that the best way of providing a 'living wage' would be to raise income tax and national insurance allowances to the level of the full time, full year, minimum wage. This the government could do immediately. 

The ASI also challenge the view that working tax credits 'subsidise' employers.  In a working paper published this week they claim It isn’t greedy employers, but greedy government, that is keeping people in in-work poverty; without tax on low earnings even workers on the 2015 minimum wage would earn a living wage. 

The main critisism of the government strategy on cuts in working tax credits is that it puts the cart before the horse.  Mr Cameron put the argument in his reply to the Leader of the Opposition at PMQs that the cuts a mitigated by the move to a living wage and increase in tax thresholds, but it assumes that those who gain on the roundabouts and also those that lose on the swings.  Figures from the Institute for Fiscal Studies demonstrates that the poorest will lose most even taking account of other changes. 

Now the Adam Smith Institute argues that instead of imposing a mandatory National Living Wage, it would be  better to for the Chancellor to  remove taxes from the lowest paid, giving workers a similar level of post-tax income while forgoing the 60,000 higher unemployment and £1.5 billion lower GDP that the Office for Budget Responsibility predicts will accompany his plans. 

The ASI say that government should not have as its objective cuts in working tax credits, but to cut poverty. the title of their briefing is provocative  Abolish the poor.  

Monday, 19 October 2015

The financial crash was triggered by middle class dependency not welfare dependency.

The biggest beneficiaries of public spending over time has been the middle class not the poor. Yet it is spending on the poorest that is cut through  Tory austerity.   The middle class has been largely protected. Votes count.  The Tories have targeted the poorest.

First they created the myth that the poor are work-shy. They used the language of 'welfare dependency', as if welfare was a drug on which the poor were hooked and a dose of cold-turkey was in order.  The work and pensions secretary, Iain Duncan Smith said that cuts would be 'good for them'.  It was as if the single mother with a disabled child living on £14,500 a year had brought this on herself - if only she could be weaned off welfare, the narrative goes, she would then be able to miraculously 'stand on her own feet'.  Not only was this narrative a distortion, but the greatest beneficiaries of public funding support are not the poor but the middle classes.  But we don't call the middle class feckless. We don't set up a discriminative stereotype of dependency - and yet the middle class are dependent on pubic spending and dependent on being protected from austerity.



The Institute for Fiscal Studies (see figure) calculate that changes to tax credits will hit three million families, which are likely to lose an average of £1,000.  The worst affected will lose an average of £1,300 per year.  The working mum highlighted by Labour Leader Jeremy Corbyn in his question to the prime minister will lose a staggering £1,800 per year.  The IFS graph demonstrates how those on middle incomes have been protected. 

When pressed on the government talks about 'changes in the round'. What they don't say is that most of these changes 'in the round' benefit the middle income groups the most.  The poor lose on the swings whilst the rich benefit on the roundabout.  Most real incentives are targeted on middle income voters.  Their 'dependency' has been protected. 

Over a ten year period to 2013, the relief on income tax and National Insurance Contributions totalled a staggering £358.6 billion. The middle classes benefited from tax exemption through personal equity plans and ISAs in which they were able to accumulate savings with tax free interest. The huge expansion of higher education from the 1960s onwards created educational opportunities for their children on an unprecedented scale, whilst the opportunities for the poorest were restricted. University education remains to this day largely a middle class preserve.

The middle classes benefited from child allowances and expansion of nursery school provision. Until it was abolished by Gordon Brown in 2000, the middle classes benefited from mortgage tax relief. Gordon Brown referred to it as the 'middle class perk'. The largesse and opportunities distributed to the middle classes have been substantial.

Middle income groups are the biggest beneficiaries of the NHS, they have also benefited over time from scheme after scheme to help them buy their own home or incentives to save such as tax-free ISAs. They have benefited through schemes that helped them develop pension pots.  Above all they benefited from spending on education and universities.  If they had to bear the full cost of education they would realise why they are so dependent on state funding.  Even private education is on the whole supported by charitable status which cuts tax payable and reduces fees. 

I put this perspective not to suggest that this public spending or incentive has not been beneficial, or that it should be removed. But we do need a more balanced perspective on the deficit. The poorest are being made to pay for the largesse to the middle class.  The least able are being made to pay for the financial crisis created by overzealous and irresponsible lending by the banks.  Since the 1980s governments transferred public debt to private debt in staggering amounts and with tax incentives for that transfer.  Borrowing went up and up and became unsustainable.  This was not the fault of the poor. It was in large part triggered by an unfettered housing market and public funded incentives to buy.  It was triggered by middle class dependency not welfare dependency. 







Sunday, 18 October 2015

Tory ideological attack on the poor.

With the storm raging over the cuts in tax credits it appears some Conservative MPs are getting a little nervous of this being Cameron's Poll Tax debacle.  It probably isn't but it has some similar trade marks: the government doggedly carrying on regardless of the consequences.  Their argument is that the tax credit system is cumbersome and expensive and 'out of control'.  This simply means that the cost is big.  Yes, it is, but it is the result of promoting a low pay economy.

The tax credits help lift people out of poverty but they are also a massive subsidy to business. The reason the cost is getting 'out of control' is because millions have been forced into low paying and insecure jobs. The real reform needed is to move to 'living wage' economy.

The real idiocy of the government's approach is that they are putting the cart before the horse.  First you should introduce a living wage and ensure that it is implemented and only then should they start cutting tax credits. Indeed they would have little need to cut them because fewer will need them. But instead they insist on cutting the tax credits first pushing millions into difficulty.  It is rather crazy.

So the Prime Minister will have to justify the case after case of those adversely affected.  He flies in the face of the independent Institute of Fiscal Studies who show that on average those on tax credits will lose £1,300 per year from their income.  The Prime Minister generalises in response by saying what you lose on the swings will be gained on the roundabouts.  The problem with that is that those on the swings are not necessarily on the roundabouts - so they lose, lose, lose.  The Prime Minister is using the trick of averages. On average, the average person will gain on average. But Mr or Mrs average doesn't really exist.

Those who do exist are like the lady referred to in Jeremy Corbyn's question to the Prime Minister: a nursery manager on £14,500 per year who is set to lose £1,800 per year. She is a hard working mother with a disabled child. No amount of averaging will help her plight.

The Tory tactic has been a strategy of creating a stereotype of the undeserving poor. First paint them as workshy and responsible for their own poverty. Then point to the heavy cost of the benefits system and start hacking away at it.  Voters they hope will not care too much that the 'undeserving' poor are pushed deeper into poverty. Sadly it is a trick that has worked.  They say it is to cut the deficit. It isn't. It is an ideological position against welfare.

But Labour would be wrong now to say it would reverse the changes.  It shouldn't simply reverse Tory policies. It needs its own clear strategy on welfare and the economy.  This should involve a clear commitment to a true living wage.  Jeremy Corbyn is right to lead Labour away from supporting austerity.  Austerity doesn't work.  The national debt has grown not fallen.

There is nothing inherently contradictory between welfare and a sound economy, but it must be welfare that doesn't support inefficient business and exploitation. It must not simply support a low wage economy.  During the years after 1945 with the development of the welfare state, unemployment fell with reasonably sustainable growth, and the national debt fell.  There are lessons to be learned from that.  You don't set your target aa cutting the deficit, you set your target on sustainable growth from which all can benefit. You set your targets on creating a fairer and more healthy society and a fitter workforce.

Austerity cannot do that. It simply pushes people down when they should be lifted up. It is not surprising that the education debate under the Tories turns to how you can promote privilege in schools through selection rather than how to provide support and opportunities for all children. Time and again the debate turns backwards to 'Grammar schools'.

All around us there is growing poverty and inequality.  A one percentage point increase in taxes would do more to cut the current account deficit than the attacks on the poorest.  If the government were really focused on getting the deficit down, then that is what they would do because the reason they are failing in deficit reduction is due to falling tax revenues.  More people may now be in work but their low pay means less tax revenue.  That is the problem with a low pay economy. And meanwhile the major companies exploiting that low wage are not paying their share of tax in the UK.

This is why it is disingenuous for the Tories to continue with the mythology of 'deficit reduction'.  The truth is more sinister.


Saturday, 17 October 2015

Mr Cameron lied to voters on tax credits.

This week  the Tories were on the back foot over impending cuts in working tax credits. It demonstrated the effectiveness of Jeremy Corbyn's approach to PMQs. His use of a question from a real person demonstrating the impact of the cuts produced a response that hoisted the Prime Minister on his own petard.

The leader of the opposition planted a ticking bomb which put the government on the back foot through the week. The Labour leader repeated his PMQs tactic of asking questions submitted by the public, saying he had received 2,000 emails about tax credits. One was from a single mother who he said would be £1,800 worse off under the government's changes to tax credits.

Sure enough, the bomb exploded with an emotional intervention from a member of the BBC Question Time audience again illustrating the real impact, in this case on someone who had voted Conservative and feels betrayed.

Cameron had promised in the general election that there would be no changes to working tax credits.

Ironically Mr Cameron made his pledge on BBC Question Time election special in April. He was asked by Jenny in the audience whether it was true the Tories had plans to cut working tax credits.

He then gave an unequivocal reply.

"No, I don't want to do that. This report that's out today is something I rejected at the time as Prime Minister and I reject it again today."

The host David Dimbleby then pushed him on the detail, saying some people were clearly worried.

The PM replied: "Child tax credit we increased by £450."

"And it's not going to fall?" asked the presenter.

The PM confirmed: "It's not going to fall."

This was no slip. It was the Tory leader giving an unqualified response.

Now the government have been forced once again to give a response.

A spokesperson for Mr Cameron has said: “It’s worth remembering with tax credits ... they have increased over the years and so the spend on tax credits has gone up and up and up. If we’re going to tackle the overall welfare budget and try to move away from being a high welfare country to a low welfare country, then this is something we have to look at.”

They justify the cuts on the grounds that the bill for tax credits is too high. This is disengenuous. No doubt the bill is high, but that was as true in April before the election as it is now. There is only one conclusion we can draw. Mr Cameron knew he was giving a false answer in April. He lied.

It is also disingenuous in another way. Unemployment has fallen in large part by a massive increase in part time jobs and in those in work like the lady on question time. She set up her own small business - a nail parlour. She relies on tax credits. The government has forced many into low payed jobs and on tenuous contracts, or no contracts at all.

There are now more than 5 million people in low payed jobs. A recent report showed that workers in Britain were more likely to be low paid than workers in comparable economies like Germany and Australia.

So what is the truth on tax credits.  One in five of the lowest paid workers will be worse off. That is the bottom line.  Hard working families will be pushed into poverty. That is the incontrovertible truth.  It means that a hard working mum on £14,500 a year with a disabled child will lose £1,800 per year in support. That is the bottom line.  So who are these people?

Those who will suffer will not  be simply some statistic on a spreadsheet. They will be real people such as nursery nurses.  They will be real people such as carers. They will be many of the 5 million hard working people in low paid jobs.  That is the reality, and it is as disgraceful as it is unnecessary.


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Friday, 9 October 2015

Failing social care - the savage cost of austerity.


The news that the NHS is seriously in deficit is not surprise. One major reason is the failure of the social care system leading to added burden on the NHS. Cuts to local authority budgets have had a huge impact on the care system, and we are now witnessing the devastating effects. Meanwhile care costs are hitting families struggling to provide care for their loved ones. AgeUK has warned that the care system in England is in crisis.

In 2011 the Dilnot Commission called for a cap of £23,000 on the costs to be born by an individual. This would have meant that when the care costs had reached that threshold then state funding would kick in. Next year the Government will set a cap of £72,000 - three times that recommended by Dilnot. This will leave individuals in considerable difficulty.

Local authority funding is varied across the country, leaving a post code lottery for public funding of social care and hundreds of thousands are missing out on support for care costs. The root cause of the problem is cuts in government funding to local authorities.

We need a properly funded national care system to work in parallel with and integrated with the National Health Service.

Age UK estimates there are more than 1 million left struggling each day without proper support and the numbers continue to grow as cuts in funding leave local authorities struggling to meet needs. A report published by adult social care chiefs (Association of Directors of Adult Social Service (ADASS) earlier this year warned of £1.1bn budget cuts to the sector. Additional funds, it said, are urgently needed to protect services after "almost unendurable" cutbacks in the past five years. Spending on the NHS has remained static at best, whilst funding for social care has been cut by 10.7%. It is a false economy.

Cuts in social care is having a huge impact on the NHS, where each year £669m is being spent because older people are finding themselves trapped in hospital for days or even weeks.

Most of the care is being provided by some 6 million unpaid carers - partners, parents, siblings. The burdens of such care mean that many of these are unable to stay in work and it may also lead in turn to health issues. The cost to the economy of people dropping out of work to care is estimated to be a massive £1.3 billion a year through foregone taxes and benefits for carers.

Tory promises on NHS meaningless.



Some years ago now Prime Minister David Cameron assured voters that the NHS was 'safe' in Tory hands.  It was in 2006 in his speech bringing to end the Tory Party conference that year.  And here is the irony.  Not only did he say it would be safe in his hands but he also said this:

"When your family relies on the NHS all of the time - day after day, night after night - you know how precious it is.

"So, for me, it is not just a question of saying the NHS is safe in my hands - of course it will be. My family is so often in the hands of the NHS, so I want them to be safe there."

And then he promised this: "no more pointless and disruptive reorganisations". Instead, change would be "driven by the wishes and needs of NHS professionals and patients".

Fast forward to 2015 and his governments have imposed a pointless and disruptive reorganisation of the NHS and starved it of funding.  They have brought the NHS to crisis and with junior doctors hitting the streets in demonstrations. 

The crisis has been brought home by the revelation today that NHS trusts in England have accumulated almost £1 bn of deficit in just three months of the financial year.   The NHS is almost on its knees and on course for an annual deficit of £2 bn and the impact on the ground is devastating with  waiting time targets missed.  

Meanwhile the consequences of falling morale and difficulty in staffing levels has led to a soaring bill for agency and other temporary employees.

Today the BMA, the doctor's representative body has issued a stark warning that the NHS faces a crisis 'the like of which we have never seen' and highlighted the £22 bn funding gap and warned of the potential for a winter crisis stretching beyond that  with which the NHS is now able to cope.  

Dr Ian Wilson, BMA representative body chair, said:

“Despite what politicians claim, NHS funding has not kept up with rising patient demand and the increased cost of delivering care. The extra funding promised by the government is barely enough for the NHS to stand still. The result is a health service that is bucking at the seams, relying on emergency bailouts and with no real solution to the £22bn funding gap facing it.

“With winter just around the corner, there is a real risk to the quality of patient care as pressure on services and staff will only intensify.

“The government must wake up and take action. The NHS is renowned as the most efficient health service in the world1, but it cannot continue to do more with less. We need a long-term funding plan rather than a short-term fixes in order to secure the future of the NHS and stop it from lurching from one crisis to another.”

Monday, 5 October 2015

The Cat is out of the bag: Austerity is not to cut the deficit.

So, the cat is out of the bag and it was Mr Jeremy Hunt the Health Secretary who let it out at a fringe meeting of the Tory Party conference today.  Cuts in benefits to the working poor are not to help draw down the deficit but to 'teach the poor a cultural' lesson. They must work harder.

The cat of course has never really been in the bag.  Austerity has had little to do with economics but a lot to do with political ideology and a cultural attitude to the poorest.  It began on day one of the previous Tory/LibDem coalition with the narrative of good 'workers' and bad 'scroungers' with the implication that those receiving benefits are the 'undeserving' poor; work-shy scroungers. This has been the narrative now given greater emphasis with the Tories freed from any Liberal Democrat constraint.  They are now rampant.  The nasty party is back.  It is the sequel to Thatcher.

So what is it that Mr Hunt has said.  What he said is that cuts in working tax credits are justified not simply to cut the deficit by to force those in work to work harder.  The implication is that the poorest working people are poor because they are less hard working than other workers. It is their own fault that they are poor.  If only they could be jolted out of this habit then all would be well.

The narrative has a purpose. It is to so brand the poor as lazy and undeserving so that the rest of Britain will turn a blind eye to the savage cuts to the poorest.  The poor are being made to pay for the bankers greed.  It is all the fault of the poor.

The rich created models for making money out of money, rather than out of real production, and when it all went wrong the poor have been made to suffer.  But it is worse.

Cut in NHS funding and social care has led to a crisis in the NHS. Once more we have lengthening waiting lists and times.  GPs are being induced not to refer cancer patients. This is the greatest indictment of the government.  The NHS is in a critical condition with 2/3 of NHS trusts in deficit.

Labour left an NHS in good condition.  The Tories have systematically starved it of funding and brought it to its knees.

The Prime Minister continues to insist that cuts in working tax credits will not leave hard working people poorer.  He does so in the face of expert advice that it will.  The independent Institute for Fiscal Studies says it will.  The government ploughs on regardless driving more families into poverty. Sadly the political truth is that it isn't the votes of the poorest that determine elections.

Thursday, 1 October 2015

Womb transplants get ethical approval in UK



Regulators have now given the go-ahead for Womb transplants. The UK Womb Transplant Research group has been granted ethical permission to begin an expanded series of 10 womb transplant operations.

As many as 50,000 women of childbearing age in the UK have no viable womb, a surprisingly high number, and affecting 1 in 5000 women, and 1 in 500 women of child bearing age who suffer from womb factor infertility.

In the UK adoption and surrogacy are the only options and the vast majority of children born to UK parents suffering this condition are born abroad. Surrogacy is only possible and legal in a few special cases in the UK. So how many women would be likely to benefit from womb transplantation in the UK?

Womb Transplant UK, the charity behind the research in the UK, say they currently have 104 potential patients who meet their criteria for a transplant.

Research in the UK on the potential for womb transplants has been undertaken for the past two decades. Each womb transplant will be labour intensive, requiring a team team of 12 for each operation; 5 for the retrieval of the donated womb and 7 for the transplantation. The donated womb would be the gift of a woman who has died. So how successful could it be?

There is a great deal of uncertainty about the risks and potential success.  This is why those involved will be moving forward cautiously.

The World’s first womb transplant was carried out in the Middle East some 10 years ago. The transplanted womb was viable but had to be removed after three months. Several years ago a successful transplant was carried out in Turkey and the recipient became pregnant but miscarried after a few weeks.

However, a Swedish team have undertaken nine womb transplants, with seven being successful (78% success rate). They officially reported the first live born child following uterine transplantation in September 2014. It has since been reported that a further three have delivered healthy babies whilst another has become pregnant resulting in a pregnancy rate of at least 71%. 

There is specific ethical concern because the transplant is not 'life saving'.  Some have referred to it as a 'luxury'. Whatever the argument, it is certainly life enhancing and life creating if successful. Furthermore, womb transplantation may become the only option for women who are unable to conceive for reasons such as cancers or infertility or in cultures where surrogacy is an unacceptable option for couples owing to religious or ethical reasons.

There are concerns about  the effects on the developing baby of immunosuppressive drugs required during the pregnancy to prevent rejection of the uterine transplant. However, there is  now extensive information regarding the effects of these drugs. Since 1954, over 15,000 successful births have occurred in women with other transplanted organs, and the evidence supports the safety of various immunosuppressive drugs.

Further information can be obtained from Womb Transplant UK.