The Thin End

The government has announced extra money upfront to avoid a crisis in the NHS. That much is welcome news. But it comes with a further tranche of 'efficiency savings' of £22 billion. This is on top of the savings of £20 bn over the last five years. But what have been the consequences of these 'savings', and where has the money gone? If savings were made, then why are so many Trusts in financial difficulty? Last year the House of Commons Health Committee warned that the targets of these savings were 'unsustainable' after hearing evidence from NHS finance directors. The committee also criticised the Government's lack of transparency over how the money saved had been used, raising the issue that the Department of Health handed back billions of unused NHS budget to the Treasury each year. It certainly begs the question of why so many Trusts are in deficit when they have made such big efficiency savings.  What is the truth behind these savings? Efficienc...

George Osborne has missed the mark on tackling the growing social care crisis.  He has failed to provide a coherent analysis or strategy to deal with the problem. We need a national strategy. The crisis in social care funding was recognised by the Chancellor of the Exchequer  in his autumn statement today.  He announced that local authorities will be allowed to increase council tax by up to 2% to help meet social care needs.  This appears a good move. It is a step, but much more is needed. It is anticipated that the new social care "precept" in council tax of up to 2% will allow local councils to raise £2bn for social care. It is good that more money will be available,  but I anticipate a fundamental problem with this approach. Not only does need varying geographically, but those areas with the greatest needs are not those with the greatest potential for raising revenue. It may exacerbate the north-south divide in resourcing. Data from the ONS and ...

'Bed-blocker!' This is the new, dangerous and pejorative stereotype in the NHS - elderly people with nowhere to go, occupying hospital beds. Sadly, it has become an accepted story.  It is a cover for the reality of a shortage of beds and an NHS in crisis. In its simple form,  'bed-blocker' is an epithet used to suggest someone occupying a bed in a hospital unnecessarily,  preventing someone else receiving necessary treatment. It presupposes they are not ill and don't need treatment.  Yet evidence shows that many are sent home seriously ill.  Yet, 'Bed-blocker' has now entered our pejorative lexicon. Earlier this year it was revealed that more than one million hospital bed days were lost because of 'delayed discharges' during the preceding 12 months.  Now, that is a lot of hospital bed time! It represented an increase of 20 per cent in a year, and it is now at a record level with a cost to the NHS of £287m.  Headline news.  So what is the ...

The Tory government has pushed the NHS into a deficit crisis and sewn the seeds of its destruction. Am I being melodramatic? Possibly, but let's consider what has been happening in the NHS over the last five years. The NHS is under threat not simply from underfunding and deficits but also from a growing privatisation of its services. Figures released last year  by the BMA showed the extent of creeping privatisation in the NHS under the Health and Social Care Act 2012, and it is set to get worse. The investigation by the BMA found that a third of NHS contracts have been awarded to private sector providers since the Health and Social Care Act came into force. The BMA council chair, Dr Mark Porter, said at the time: “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 ha...

Since 2010 the Work Capability Assessment (WCA), has been used to assess the eligibility of claimants for out of work disability benefit.  In introducing WCA the government claimed it was a measure to get more people back into the workplace and help curb the government’s rising welfare bill, with the implication that many of those on benefits were 'shirkers'.  It was all part of the government's political narrative of 'workers' versus 'shirkers'. The government were warned by health professionals that the harsher assessments would have major impact on mental health. At the outset there were problems with the way fitness to work was being made and doubts that those making the assessments would have the necessary expertise and experience to make an assessment of how any particular mental condition impacts on the life of the claimant. Doctors and disability rights organisations have long voiced fears that use of the tough new criteria to measure incapacit...

George Osborne is ripping out the very fibre of our social being and selling it off to the highest bidder.   But as a business model, it stinks. Social care is a failing business.  Social care is in crisis. Earlier this year Age UK warned that the social care system in England is on the brink of a 'cataclysmic' collapse with cuts in funding leaving the system unsustainable.  They warned the government that the 'clock is ticking'.  As a result, many families will be facing unpalatable decisions about the support they will need, and where local authority provision fails, the vultures of a rampant private care system will hover.  You might think that all this could at least be ameliorated through careful planning, but many families find themselves in unforeseen situations when NHS care comes abruptly to an end.  When a relative goes into hospital in a critical condition, but there is little doctors can do so they are returned home with the anticipation...

Some of my recent blogs have been about markets. This is no exception. The point I make is that the neoliberal view of 'free markets' meeting needs is a myth.  Markets are neither 'free' and nor do they meet social needs or environmental health - the neoliberal view has no need for  'social need'. It speculates on the future without heeding the consequence. It simply considers social need as aggregate individual need. But as I pointed out in my previous articles, social need is more than the sum of aggregate individual need, and the problem with the 'free' market is that it has no 'social conscience' - there is no market measure or price for social need.  The neoliberal wants a 'reduced State' which means substantially reduced public spending.  Many are appalled at poverty levels increasing, yet there is no market for 'ending poverty'.  Growth without social provision won't meet social need. But let's take another exampl...

Consider this when next you pick up a bar of Cadbury's Fruit and Nut or a Mars bar, conveniently sold cheaply at your supermarket checkout, the amount it costs you is the amount the cocoa picker gets for a whole day's work. In 2014 total global sales of chocolate confectionery reached a staggering $100 billion - an increase of 20 billion from 2012 ( Euromonitor International ). Very little of this money reaches the cocoa farmers and pickers who receive around 1.25 dollars a day for their efforts. They work a whole day for the price of a chocolate bar in the UK or USA. While the profits of multinational chocolate companies have increased since the 1980s, the world market price for cocoa beans has declined by half with the cocoa producers receiving less and less of the massive turnover. Nevertheless, the cost of cocoa can fluctuate in an insecure market affected by weather and harvests. With an increasing demand for chocolate globally most recently chocolate producers h...

Neoliberalism has been the dominant creed in recent times. In one form or another it has underlined economic strategies followed in the UK by both Labour and Tory governments. New Labour embraced and worked with it. It seemed that global capitalism had won the day in the post-war conflict of ideas, and despite the banking crisis, it continues as the dominant influence. If measured by the accumulation of wealth and the developments of new technologies it might be regarded as a success. But the cost of that success has been a heavy price. Socially it has failed, and the cost of that failure has damaged the environment increased inequalities. But who benefits from it? Who is it for? Some 3 billion people live on less than $2 a day whilst 86 percent of the world’s resources are consumed by the world’s wealthiest 20 percent. That is the success of the neoliberal myth. When government chooses not to ‘intervene in the market’ it is making a political not an economic decision. The ...

What does it take to get this government to realise the suffering they are inflicting on those reliant on benefits.  Failing to get his way with cuts in Tax Credits it is now suggested that the Chancellor, George Osborne has now his sights on cutting the new universal credit. Apparently, the Work and Pensions Secretary has threatened to resign if the Chancellor cuts the new benefit. Universal credit was launched by Mr Duncan Smith  with great fanfare in 2013, combining previous means-tested benefits such as jobseekers allowance, tax credits and housing benefit into a single payment which is currently being phased in across the country. It is a controversial scheme, not least because it makes the assumption that benefit need is uniform and not specific to circumstance such as mental health. Universal Credit will mean people with mental health issues will no longer have their claims supported by a specialist health assessment but instead through meetings with a gene...

In a previous article I laid out the background to my own political compass. The belief that there is  something fundamentally wrong with a society predicated on vast inequalities, not just in the distribution of wealth, but also of opportunities.  For too many decades we have accepted that the interests of the poorest are inextricably woven into making the wealthy richer. Rather than being appalled by the enormous wealth concentrated in the hands of so few, we are asked to reify it - cast it in political stone. There is a kind of impossible dream scenario that holds because some people become rich everyone else could too 'if they tried' or put their mind to it, or became entrepreneurial. There is a minimum of truth in the tale, but it is a false prospectus. It is a prospectus that holds the poor responsible for their own poverty. In recent decades we have worshipped those who make money rather than those who create things, or at best we have left  unquestioned the way...

BMA responds to Guardian story on Jeremy Hunt's offer to junior doctors It is reported in the Guardian today that Health Secretary, Jeremy Hunt is to  offer junior doctors an 11% pay rise in a last-minute bid to stop them going on strike just as the NHS is preparing for its most pressured time of year. Responding to the Guardian's story the BMA, the doctor's representative body,  has said that it has not been given any information other than that being released 'piece meal' to the media and challenges the government to provide reasonable assurances and details rather than engaging in "megaphone diplomacy".  The BMA has told the Government that it wants to work with them to agree a new contract, but that it needs a number of concrete assurances in order to do so. These assurances are: withdraw the threat to impose the new contract proper recognition of unsocial hours as premium time no disadvantage for those working unsocial hours compared t...

Prime Minister, David Cameron, has backed off presenting a vote in the House of Commons  on military action in Syria in face of clear opposition from the Labour party.  With some sceptical of the value of military action on his own side, he would likely lose such a vote. But the Foreign Affairs Committee has also warned that any benefits of air strikes in Syria would be more than outweighed by the risks of  "legal ambiguity, political chaos on the ground, military irrelevance, and diplomatic costs". The Committee concludes that 1) while intervention would be welcomed by the UK's military allies, in particular the USA which is now putting in boots on the ground in a limited capacity,  it would be likely to have only a "marginal effect" on the conflict.  2) The UK risks "further reputational" damage unless it can make a clear legal case for action, with a UN mandate the clearest basis.  3) It is unclear what the outcome would be and it is ...