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Does Jeremy Hunt wish to ‘save the NHS’? Most definitely not.



J Hunt

There is nothing more embarrassing than for hardworking clinicians in the NHS and practitioners in social care than to hear of Jeremy Hunt going to New York to lay the groundwork for a transatlantic trade deal or to go to international conferences to preach to others on patient safety. Whether the longest serving Secretary of State for Health chooses to admit or not, and he doesn’t, there is nothing to boast about in 20 hour trolley waits, or people being asked to sit in a toilet or corridor before being given a hospital bed. If the definition of patient safety is that nobody has died unnecessarily yet, then expectations are indeed very low. Indeed, Sir Robert Francis, whom Hunt used to quote all the time, now says another Mid Staffs is “inevitable”.

To be honest, this is the perfect storm which prominent campaigners, including junior doctors, themselves have been warning about. It might seem beyond ludicrous that Jeremy Hunt can shamelessly say that the performance of the NHS is ‘unacceptable’, but as far as he is concerned he is not responsible for the performance of the NHS. And the purpose of the 2012 Health and Social Care Act (2012) was not to promote the highest quality clinical care – symptomatic of that is the fact in the 500 pages of legislation the legislation found time to devote only one clause to patient safety, and that was to abolish the National Patient Safety Agency. The legislation instead was put in place to turbo-boost the transfer of NHS services to the private sector. This is – wait for it – the definition of ‘privatisation’. It also provided legislation for clinical commissioning groups, where is no statutory mandate for clinical skill. These clinical commissioning groups, which are even definite in size of population in law, are merely insurance entities which happen to reside in the public sector, assessing the potential risk of illness in a certain geography. In other words, this highly contentious Act of parliament, on which billions of £ were ultimately spent in a top-down reorganisation that nobody as such voted for, laid down the infrastructure for harmonisation between the public sector and the private sector for the ultimate piecemeal sell off of the NHS.

The ultimate issue that successive governments have had to face for the last three or four decades has been a desire not to go ‘public’ about transferring the NHS to the private sector, so that the NHS simply becomes a badge for the state deliverer of services, not the state provider. In an ideal world, Jeremy Hunt MP does not even want to be involved with anything to do with the NHS. Hunt, and many others of the same ideological ilk, would be perfectly happy for different providers, e.g. Capita, Virgin, G4S, in some corporate plutocracy to run the NHS using the NHS logo if need be.

Jeremy Hunt’s faux disdain at the performance of the NHS is completely understandable, if one realises that Hunt thinks the public will blame the fact the NHS is in the public sector rather than him for the poor performance of the NHS.  And, to be fair to him, there are people who ring up local radio phone shows to say that the problems of the NHS are entirely due to mismanagement, the fact that the general public take no responsibility for their own health (a completely irrelevant argument if someone is born with a congenital disease such as heart problem or lung problem). And, furthermore, more in the post-facts milieu, the hope is that nobody can discern fact from fiction. In other words, with the help of a compliant media, the general public can be manipulated into thinking that the root cause of the NHS being overloaded is entirely due to the immigrant population. There is no discussion of non-indigineous doctors or other healthcare professionals in this utopia, just ‘small talk’, albeit dangerous UKIP pillow talk, of an aspiration of Jeremy Hunt to reverse decades of the NHS being propped up by foreign clinicians to train ‘home grown’ doctors. Mainsteaming British Doctors for British patients has never been easier.

But back to the fundamental issue of why I believe Jeremy Hunt does not care about the performance of the NHS is that his thinking rests on three assumptions. And, whilst a sizeable number of people in parliament think the same way as him, the likelihood of a cross-party commission on the NHS will come to the conclusion that some form of privatisation of the NHS, whether in terms of co-payments, vouchers or full blown increase in capacity of private insurance providers, will occur, rubber-stamped by all the political parties (except for some this time). It might, for example, be seductive for irritable, cranky people to ‘charge drunk people for attending A&E’, but think about the actual practical implementation of this policy – by what measure would you define the tipping point from ‘quite tipsy’ to ‘quite drunk’? Is it, for example, either feasible or desirable that healthcare professionals, including GPs, to carry Visa card or passport readers in addition to their numerous other duties?

A number of assumptions can possibly be made about this current Government and recent ones too:

1. There is no distinction between private and public providers in the NHS.

2. The Government believes in a ‘small state’ and low taxation.

3. The NHS is expected to make efficiency savings in keeping with an austerity approach.

That there is no distinction between private and public providers in the NHS is why Jeremy Hunt resents being in a centre of a tsunami about junior doctors’ pay. In an ideal world, he would like there to be complete harmonisation between private and public sectors, so that doctors could come and go as they wish in terms of employment. This is entirely the drive for the 24/7 NHS, which is why Jeremy Hunt is do keen to promote any fake research news coming out of the BMJ to further his ideology. You do not need to be an expert in sophisticated mathematical modelling techniques to realise that if you were to stretch out the already woefully inadequate resources for a 5-day elective service into a 7-day one the consequences on patient safety would be diabolical. What, furthermore, is quite incredible is for the current Department of Health to be so oblivious to the fact there already exists a 7-day emergency service running at full throttle, hence their need to spend valuable resources in making further metrics to measure A&E performance by.

Where junior doctors can come and go as they please, like where consultants can come and go as they please, or where nurses come and go as they please, is a strategy which is the direct opposite to the public sector keeping its workforce loyal, wellbeing promoted and well educated, and being contained budget-wise in terms of salaries. We already know that the agency spend has become out of control, due to poor planning of the Department of Health over many years, and to the weird hybrid private-NHS market we currently have. And all this is to ignore completely that private providers take no responsibility for,  financially or otherwise, for the education and training of the workforce the vast majority of which start in the NHS. This is entirely in keeping in why Hunt is so intensely relaxed about applications for nursing training going through the floor after his devastating nursing bursary initiative – Hunt does not ideologically believe the Government should be safeguarding against a minimum body of doctors, nurses or allied health professionals in the workforce. The problem now of course for him now is #Brexit unless it looks like he can poach staff from the Asian subcontinent; but word is spreading fast how bad the working conditions of the English NHS are.

2. Unfortunately, the Conservatives and Liberal Democrats were able to converge on the ideology behind the Health and Social Care Act 2012 and the mirage that economic competition would drive up clinical quality because of the robustnesss in their belief in the small State. This does not envision the State to be a supportive thing to promote the health and wellbeing of its citizens, including so that they can be healthy enough to be in ‘gainful employment’ and be ‘productive’. This instead pre-supposes that everybody wishes to pay very low taxes, somehow living in a world where public services are still magically working well. But this falsehood is very easy to put in place if the main political parties are able to blame a ‘common enemy’ for all of their problems, e.g. immigrants. Such politicians want to divorce the link between improved public services and paying for them, which is why the Conservatives invest so much effort into depicting the Labour Party as incompetent (whereas the national debt under the 7 years of Conservatives has ballooned way above the previous 13 years of Labour).

Unfortunately, a hypothecated tax for the NHS would necessitate a debate about hypothecated taxes for everything else such as national security or education, and is well known to be yet another ‘zombie policy’ which won’t go away. Finally, whilst the Government gives the impression that the debacle in social care, causing delayed transfers of care from hospitals to care packages in the community, is seen as a ‘local authority’ not national problem, say for example through the ‘precept’ or the Surrey referendum, the impression is reinforced that social care is out of control, and its catastrophic state impacting on the performance of the NHS is nothing which can be reversed essentially.

3. Stephen Dorrell MP already has said that the NHS efficiency savings, first proposed by the management consultants, McKinseys have never successfully been tried before – and indeed many blame this drive for efficiency and for ‘foundation trust’ status to be at the heart of how disasters at Mid Staffs and other Trusts happened. It is a plain fact that if budgets are under enormous strain in providing a skeleton workforce (e.g. one junior doctor to cover all the medical wards in one large teaching hospital AND cover the cardiac arrest bleep), and to pay massive unconscionable private finance initiative payments (a form of a Corporate Wonga), something will have to give. There might be a temptation for such cuts to be hidden by commissioners and managers in mental health, despite all the Twitter infograms and rhetoric about ‘parity of esteem’ – unless of course there happens to be a spike in uncontrollable demand for mental health beds or suicides. So far, all the main English political parties have been very loyal to ‘efficiency savings’ – but this is essentially ‘austerity’, and a political choice for the NHS not an economic one.

If the ultimate aim is to increase transfer of public assets to private entities (the definition of privatisation), keeping the NHS at a low unsafe level of funding reinforces the impression the NHS is ‘unsafe in public hands’. That is why rolling coverage by the BBC of ‘specials’ of a NHS and social care system at breaking point might lead people to blame the public funding of the NHS, not Jeremy Hunt. This is of course fully intended, so that the green light can be given for a blatant privatisation of the NHS.

The correct conclusion, of course, is that the NHS has been chronically underfunded for years, and no Government wishes to admit they want to privatise the NHS as it’s so politically toxic.

 

@dr_shibley

 

 

Is having declining faith in Jeremy Corbyn a good place to be? A personal view.



Corbyn breakfast

 

Jeremy Corbyn was my first choice for leader of the Labour Party twice. I’ve always voted Labour, and I’m currently 42. I don’t consider myself a Euro-fanatic, but I voted ‘remain’ in Brexit. But I must admit when Corbyn said ‘Now the real fight begins’, I got genuinely scared – it had for me, as Emma Burnell opined, all the overtones of someone who doesn’t really believe in parliamentary democracy.

There are some people who believe that Jeremy Corbyn can do ‘no good’. I am not one of them. I have previously supported Corbyn to the hilt, and I think most of his principles in domestic policy are reasonably sound. We are both socialists. For example, I agree with Corbyn on cracking down on aggressive corporate tax a aoidance, and wishing to tackle head-on the crisis in social care and social housing. I agree that fundamentally the situation Labour finds itself is not as such Labour’s fault. I am not a ‘Blairite’ – there were some successes in the Tony Blair governments, and some failures. The history for me personally is that, in the last leadership election shortly after the referendum of June 23rd 2016, I found myself disagreeing with the views of Owen Smith MP and his supporters. I felt that that particular time was not the best time to having yet another leadership election when Corbyn had only just been democratically elected leader – and I felt that the behaviour of much of the Labour Party was pretty unconscionable. In fact, I blocked several Labour MPs on Twitter.

There was an unsaid deal that the parliamentary Labour Party would try to be more professional in experience, such as not briefing the media about offices which they should have vacated after publicly resigning, if the leadership machine communicated better with the PLP. There was an unsaid agreement that there would be at some stage much more useful detail about policies. Whilst not violently anti-Blairite, the spectacle of Anna Soubry MP and Alastair Campbell ganging up on John McDonnell (like Clive Lewis, a follower of mine on Twitter) beyond the pale.

Let’s be clear. Reversing corporation tax to fund the NHS and social care is not a policy in itself – nor is renegotiating the private finance initiative, important though that is. There is, however, an honest conversation to be had about how GPs feel themselves totally overwhelmed by the demand (and so do Accident and Emergency Departments), and, on the whole, people are living for longer with complex co-morbidities such as dementia. GPs will be the first to tell you that ‘ten minute appointments’ do not do their patients justice, and certainly insufficient for a frank discussion about psychological therapies for dementia compared to reaching for the prescription pad. The whole debate about integration has become engulfed in criticism about the sustainability and transformation plans; that there is insufficient money in both the NHS and social care is not in any dispute. On the other hand, for many long term conditions, the decision between ‘health’ and ‘social care’ is totally arbitrary and yet this has a profound impact for individuals in terms of their funding arrangements. The reality of ‘care at home’ is far from the rhetoric and yet the Department of Health is fighting its own battles such as with the junior doctors over their contract – whilst Jeremy Hunt is touring the world boasting about patient safety (neglecting to mention 20 hour trolley waits in England), and seeing if he can aggressively pimp NHS services to a New Trump US. We are all left exasperated wondering what it is that the UK is so desperate to sell to any country, dictatorship or otherwise, far flung or not.

Jeremy Corbyn’s stance is indeed ‘principled’ in that one half of the party faces one way (constituencies wishing to remain in European Union, such as Islington), and one half facing the polar opposite (constituencies wishing to leave the European Union, which as Hayes). But back to Nye Bevan’s old adage, ‘if you stand in the middle of the road, you are bound to get run over’. Corbyn’s political stance means inevitably he will end up annoying many on both sides, especially some in the 48% who oppose a ‘hard Brexit’. Whilst Keir Starmer and pals do not want to soil their lips with the words “hard” and “Brexit”, there is no other term for not being included in the single market, or giving up on the free movement of people. The ‘taking back control’ meme has become rampant, and it seems that every MP is entitled to justify voting like a robot even more on grounds of the fact that ‘this referendum result was delivered by the people’. The case against leaving the EU won’t go away, however, including the 40-60 Euro divorce fee, or the hit the economy will take when the City is not allowed to do EU passporting. But it is said that many Brexiters are prepared to take this hit. Indeed, many Corbyn voters who voted Brexit seem intensely relaxed about Jeremy Corbyn’s performance.

You’d be forgiven for thinking Britain has a bright future, despite the import inflation and problems in finding workers for certain sectors of the economy. For now, Scotland, which voted to remain in the EU largely, has been muzzled, but it will not be long before they ‘take back control’ again and ‘roar again’ as Alex Salmond put it. The Brexit vote has given fuel to Nigel Farage’s rantings on his radio show, having extra rocket fuel from the election of a bigot, sexist,  and racist elsewhere. The LBC phone lines are choc-a-bloc with racist and xenophobic rantings about how the ills of the world can be placed at the feet of immigrants. But such criticisms would be to shoot the messenger of this xenophobic racist rubbish rather than the message itself. A major ‘miss’ was there not being implemented a Migration Impact Fund, or Posted Workers Directive, to give areas of high migrant population additional financial support, or legislation to stop the undercutting of workers. But the solution to all this is not Amber Rudd MP, in the same way the immigration levels sky rocketed under Theresa May MP. Without any attempt to limit proportionately migrant numbers, and without funding public services, leaving the European Union is simply a smoke-and-mirrors exercise, and you can bet Nigel Farage will have long gone by then.

I do agree very much that it’s not all Jeremy Corbyn’s fault. There are many head winds in the opposite direction to Jeremy Corbyn. For example, Corbyn daily has to deal with a vicious media and there are rarely any positive noises coming out of the Guardian or Laura Kuenssberg about him. And also, there has been a relentless focus on the ‘Labour rebels’, and the three-line-whip from Corbyn (presumably because Corbyn does not want to be blamed for obstructing Brexit), but one really has to wonder what on earth has happened to those Tory MPs who reperesnt ‘remain’ consittuencies. It is entirely possible, of course, that the Liberal Democrats will take these seats, and then the critical question for 2020 will be who is the largest party. I have a hunch this will be the Conservatives, wishing to form a coalition with the Liberal Democrats, rather than Labour and the SNP forming a coalition (assuming that there is no sign of a turnaround in Scotland’s fortunes from Jeremy Corbyn and Kezia Dugdale).

Quite frankly, these are desperately stressful times for some people who want to vote Labour. There are some people who think that Jeremy Corbyn is utterly brilliant – and all power to their elbow. But there are also different people who believe Corbyn is overseeing the suicide of the UK Labour Party. Irrespective of your views on EURATOM or the ERASMUS scheme, what are we tell close friends of ours who are EU nationals and remain as ‘bargaining chips’ in the negotiation about to happen? The reality is that we do not know what the attitude of the European Union will be – but guaranteed the hyperbolic importance of England by Nigel Farage over Brexit is not matched by the column inches devoted to Brexit in the continental newspapers. I have a declining faith in Jeremy Corbyn, but my ‘faith’ is being put to the test. I don’t see any other saviour on the horizon, and a third leadership election might make him bullet-proof as far as the membership is concerned. I would feel a lot more reassured if we had more detail on domestic policy, but I understand the problems in predicting the state of the macroeconomy particularly with Brexit and Donald Trump looming on the horizon.

And of course the 2020 general election might be a very good one to lose, if you take away the possibility of Jeremy Hunt negotiating a UK-US trade deal which would kill off the NHS entirely.

 

@dr_shibley

 

 

Theresa May’s Diary



Theresa May's Diary

There are key differences between Theresa May and Bridget Jones.

For a start, Jones was single for a long time. And Bridget Jones always tended to look desperate.

The Labour Party is divided on Brexit – but they’re not the only ones, and it’s not Jeremy Corbyn’s fault. My late father used to tell me that there are some people who will love you whatever you do, some people who will hate you whatever you do, and some people who will always remain indifferent. Many parliamentary Labour MPs have criticised Jeremy Corbyn so much, that further criticisms of Corbyn now over Brexit would be completely hollow. To use an analogy, they have already ‘used up their lives’.

Let me pin my nails to the mast. I am in my early 40s, and was opposed to Brexit for the purposes of the June 23rd 2016 referendum. I don’t think this makes me a ‘remoaner’. I was always a bit concerned about the domestic abuse of the UK governments in state aid rules, and this is clearly of concern with the pre-meditated drastic, severe and chronic under-funding of the National Health Service and social care. I was similarly concerned about whether the EU en bloc with the US would become embroiled in TTIP, a transatlantic trade agreement, which would make it much easier for ‘free movement of capital’ ownership of ‘our NHS’. But I am told by various loud voices that what concerned many, stereotypically outside Scotland and London, was a free movement of workers, many unskilled, undercutting ‘home grown produce’. Unfortunately, some of this genuine concern got transformed into outright racism and abuse, as can be clearly seen in some of the vitriol aimed at Gina Miller.

I get the fact that there are some Labour MPs who represent constituencies representing populations who wanted to remain in the European Union. I also get the argument that you wouldn’t want, ideally, to sell your house, and make yourself homeless, and have nowhere to go to. But the idea that we will know much of the detail of the negotiations this early on is pie in the sky on the whole. Clearly, if it were the case that the European Union demanded forced repatriation of British citizens living in Europe, there would be a strong case not to start the chain of events culminating in us leaving the European Union; but this is quite unlikely, if only we don’t have a clear idea of which EU citizens are living in the UK for a start. It is pretty likely that, in the absence of strong free trade agreements elsewhere, our domestic economy would take a big hit if the UK was not included in the EU single market, but at this point this is a prophecy, and coud be right or wrong like every single other economic prediction.

I understand the need for Labour MPs to make it public that they cannot comply with a 3-line whip set by Corbyn, when their ‘conscience’ will not allow it (and nor will their local membership). We are where we are, however. The referendum, we all know by now, was only legally advisory according to the relevant Act of parliament, but unfortunately it is also the case that the non-binding yet forceful words dropped into every letterbox in the land: “that the Government will implement whatever you decide.” The case for re-running the referendum in some form of other on account of the outright lies is weakened by the fact that every single UK election has had a big degree of lying (remember ‘no top reorganisation of the NHS’ by Cameron prior to the 2010 general election?) Whilst a referendum is not the same as an election, it was David Cameron’s decision to put the issue to a referendum in his famous Bloomberg speech to defuse grumblings in his own party. What this inevitably has done has exposed a split opinion in the country at large, and it would be nonsense to believe that the splitting of opinion is simply confined to the Labour Party.

Whatever you dislike about Jeremy Corbyn MP, for example his famous terrorist ‘friends’ remark, his arguably somewhat patronising tone in giving interviews, his dress sense, his purported lack of patriotism when singing the national anthem, Jeremy Corbyn is in no way responsible for the split within the Labour Party on Brexit. Many of his MPs represent constituencies who do not see the ‘benefits’ of immigration. Many of his MPs represent the polar opposite viewpoint. In as much as the only certainties are ‘death’ and ‘taxes’, one thing is pretty certain in that Jeremy Corbyn MP as leader of the Labour Party would be unlikely to make everyone happy on Brexit. This is not the same as the Labour Party appearing ‘confused’ on Brexit, as constantly levelled at Emily Thornberry MP in media interviews. Quite the reverse, the ‘three line whip’, if anything, is Jeremy Corbyn showing the ‘strong leadership’ or ‘real leadership’ demanded of him by Angela Eagle MP and Owen Smith MP in their failed leadership bids.

Now that the Supreme Court had decided that there is insufficient mileage in the argument that the Royal Prerogative is sufficient to trigger Article 50, a Bill predictably has been laid before parliament, longer than the Bill giving women the vote. Labour and the Conservatives, unlike the SNP and Liberal Democrats, have taken national party lines of triggering exiting from the European Union. I feel that the need for MPs to comply with national policy comes less from the convoluted arguments of Edmund Burke on delegates versus representatives, often misquoted inaccurately, but the issue that otherwise MPs would be acting as independents. There are clearly massive problems down the line, if the US Congress decide to do a trade deal with the UK massively to the detriment of the UK for the political convenience of the governing parties of the UK and US. Or, there are issues if, to gain competitive advantage, the UK feels it must lower corporation tax rates even further to stop capital migrating, say, to Ireland, turning the UK effectively into a ‘bargain basement tax haven’ was warned in unison by Keir Starmer QC MP and Jeremy Corbyn MP. It is not immediately obvious what the UK has to sell in a trade deal to the US apart from its genius – but the rich pickings that would made of the NHS is not “scaremongering” but a genuine issue which lies in the national interest.

Exiting the European Union per se is the starting gun. The current Government has previously talked about repealing the Human Rights Act (ideologically consistent with leaving the jurisdiction of the European Court of Justice). There’s no guarantee that xenophobia in some parts of the UK ‘heavily hit by immigration’ will be alleviated short of mass deportation of citizens awaiting guarantees of permanent residence, or by a ‘migration transformation fund’ promised by Labour back in 2010. There’s no guarantee that total immigration levels will fall drastically. We do, however, already know that Indian and Australian Doctors do not feel it is their duty to plug the ‘skills gap’ in the NHS, given the torrential negative perception of the NHS given by its longest serving Secretary of State, Jeremy Hunt. But it would be political suicide if Labour unilaterally came out on the side of the 52% or the 48%. We know that countries of the European Union do not see the four freedoms, in people, capital, goods, and services, as anything other than an unitary package. It’s pretty unlikely that London, even if achieved outright devolution imminently, would be allowed to gain EU passporting rights maintaining a sectoral lifeline for the City.

It’s also pretty unlikely that a small number of revolting Labour MPs, SNP MPs and Liberal Democrat MPs (#seewhatIdidthere) will be sufficient to stop the triggering of Art. 50. Jeremy Corbyn MP, meanwhile, will have to do the best with the deck of cards he’s been handed. Keir Starmer QC MP is right not to get worked up about the semantics of the hard versus soft Brexit. The approach taken by Theresa May MP is substantially one of pragmatism, even if the rhetoric and mood music are more akin sometimes to euphoric Nigel Farage. Many of us reasonably minded like-minded people (or liberal snowflakes) want to reach for the sick bag as soon as we hear about the personal relationship or special chemistry between Theresa May and Donald Trump. Likewise, Jeremy Corbyn can only try to make the best of a bad deal, but, if he is held as being downright obstructive to Brexit, all hell will break loose. I think with import inflation, the skills gap in the UK, and societal discord, Brexit will pan out to be an unmitigated disaster. But it would be wrong to blame Jeremy Corbyn for that too.

And by the way… we know what happened to Bridget Jones in the end.

@dr_shibley

Is Paul Nuttall ‘the man of the moment’? Probably not.



Paul Nuttall

 

 

 

 

 

 

 

 

 

 

 

Some of my best friends quite like Paul Nuttall. They think of him as a bit of a “cheeky chappy” who is pretty affable.

There’s a rule in HR (Human Resources) – that past performance predicts future performance. On that basis, that Paul Nuttall MEP failed to win Bootle and numerous other seats previously, the current leader of UKIP may continue the losing streak in getting into the UK parliament.

But these are different times – where there are no facts or truth, and anything goes. For example, nobody really cares whether Paul Nuttall holds a Doctorate or not. It’s very rare for somebody to be elected into parliament on their academic prowess. Enoch Powell and Tristram Hunt both went to Trinity College, Cambridge, and both hold doctorates from the said University, but that did not make them into election-winning infallible machines.

Looking at the idea of targeting people for particular seats, one can see the logic of trumping up a LibDem candidate in a parliamentary seat such as Richmond in London which is predominantly anti-Brexit. Similarly, the constituency in Stoke is largely pro Brexit, so if there is someone in with a chance it’s Paul Nuttall MEP. When you add to this that Tristram Hunt only just won his seat, having been parachuted in with the help of senior Labour grandees, only just beating UKIP, the high risk strategy of Nuttall might indeed pay off.

Why is it high risk of Nuttall to go for this seat? It’s a very public fight. If he wins the seat, this could be a landmark victory for UKIP in a post Brexit vote or post Trump inaugural era. It may be now ‘acceptable’ to vote for Nuttall. There could be a plethora of shy Nuttalls, who aren’t ‘racist’ but who feel that immigration is out of control. They aren’t opposed to immigration per se, but can’t stand people from Eastern Europe stealing their jobs or living together in houses of ten.

To this extent, Paul Nuttall MEP is behaving exactly like a ‘disruptive innovation’. Typically a product, a disruptive innovation comes along, which, if adopted, offers some feature or value the other products don’t have. It’s easy to obtain this product, and completely scoops up the market. We’ve seen in roads in disruption from, say, the Apple iPod or Uber taxis.

The interesting thing is that with this added value, say the ‘beautiful’ design of the iPad or iPod, people are prepared to overlook the lack of certain other features (e.g. no record deck or minidisc). Paul Nuttall’s unique selling point is that he can plug into this sentiment that nobody cares about getting immigration levels down. And to that extent no amount of memes about his wish for certain types of capital punishment or privatisation of the NHS are relevant.

And the other thing is that, once Nuttall gets his foot in the door, nobody will ever look back – people will be hard pushed to imagine a market without iPods, iPads or Uber taxis. Similarly, we’ll all wonder how on earth we ever managed without UKIP in mainstream politics.

There are also externalities which might act in Nuttall’s in favour. One of them is the sheer effort and tenacity with which the parliamentary Labour Party has put into rubbishing the brand of the Labour Party, whether this involves criticising Jeremy Corbyn personally, or criticising his personal stance over a wide variety of issues (e.g. the pay differential, Trident etc.)

The Labour Party is like the country divided. The membership is said to be soaring, and yet certain MPs are thought to be seeking alternative employment ahead of the next general election (like Jamie Reed for example). The MPs are genuinely divided on a lot of policy, such as Brexit and Trident, but are generally well disposed to criticising with an united voice the crisis, humanitarian or not, in the NHS and social care.

Past performance is meant to be a predictor of future performance. Whilst it is roughly true that the one day of Trump as a president has been largely the same as Trump as the candidate, we know the Republican Party were loath to support Trump and Trump’s poll ratings are terrible.

So, the difficult transpires how we will know whether Labour will have a chance in Stoke or Copeland. If you take heed that nobody has ever come back from such terrible poll ratings, Jeremy Corbyn politically is already dead and buried. But he did also defy convention to be elected leader of the Labour Party twice, the second election being a ‘back me or sack me’ scenario.

The truth is that the Labour Party in parliament have limited options in rubbishing their brand, and some of it depends whether voters think they’d rather try a new political party rather than one of the incumbents. There may also be, unlikely though it is, shy Corbynites who will never admit to voting for Corbyn, a bit like fans of the pop group Bros, but who will go out and vote for him as it’s better than voting Tory.

It may be that despite all the faults people will vote for Labour or Nuttall whatever, in the same way that the sexual peccadillo or showering habits of Trump are not game changers. But these are strange times. If Nuttall wins, it could be, as Blair put it once, ‘a new dawn has broken’. But if he loses, as UKIP leader, the accusations will come thick and fast that UKIP have peaked, and that with the Brexit negotiations, this is ‘no time for a novice’.

Nuttall’s approach to be that, apart from a sense of libertarianism thinking the NHS could benefit from more privatisation making it more efficient, the ideology is sufficiently broad brush to appeal to anyone who hates immigration. But if he wishes to slay the sacred cow that is the NHS, especially at a time when the NHS is in crisis, it’s debatable about whether voters like him enough to make Nuttall an official member of the House of Commons? Is it beyond contempt to criticise the NHS as a member of the ‘working class’ (a broad category of people), or is Nuttall ‘seizing the moment’?

It could be that Paul Nuttall is not ‘the man of the moment’, but, as the Thick of It hold out, the “man for the moment”.

 

 

@dr_shibley

Should Jeremy Corbyn step down if Labour’s fortunes do not improve?



C M

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The ultimatum that Jeremy Corbyn should step down if Labour’s fortunes do not improve appears to have been handed down by somebody considered to be a loyal supporter of Corbyn – Len McCluskey, possibly one of the most well known ‘Union barons’.

Part of the problem is that we will not known for certain if Labour’s fortunes have improved. The Corbyn camp normally draw attention to the huge mass membership of Labour, attributed to a personal popularity of Corbyn himself, citing that Labour is at least one of the largest socialist parties in Europe. But we know that metrics can be unreliable. Donald Trump came to win ‘from behind’. He was even lagging in polling terms at the beginning of the night of the US election itself. Pollsters in the UK have likewise had a run of bad luck, in not being able to predict reliably the outcome of the 2015 general election (on the whole) and the EU referendum. But there were, arguably, runes to be read. For example, the wipeout in Scotland, which predates Jeremy Corbyn and which appears untouched by Kezia Dugdale, was expected. Likewise, a revival of Labour’s fortunes in Scotland in the next general election is not widely anticipated by many.

The traditional explanation of Corbyn’s bad poll ratings has been a protracted effect of the ‘coup’ that never was, or the ‘honeymoon’ experienced by Theresa May as a new Conservative Prime Minister in office. Or it could be the lack of support of what has boringly become the ‘mainstream media’ as a term of abuse, invariably sponsored by Rupert Murdoch in some form. And there is possibly some truth in this, in that the Labour Party visibly imploded, and appeared proud at doing so, in broad daylight in the aftermath of the referendum. Whatever the reasons are, apart from local rallies, or on Twitter, Jeremy Corbyn does not appear to be getting his message across with the longstanding Labour voters who have switched to UKIP.

Such new voters tend to say their decision is not out of any love for Nigel Farage, but some of them appear to loathe Corbyn, feeling that Corbyn has nothing to say on social housing (completely untrue). But the thorn in the side of some people who voted for Brexit, part of the ‘taking back control’ meme, is that there appears to be no immediate resolution to the thunderous immigration levels. But these levels have remained high even with Theresa May as SoS for the Home Department. The narrative still remains of people from Eastern Europe undercutting local workers, and claims and counterclaims remain. But the perception is that Jeremy Corbyn is friendly to the idea of free movement of people, and there is a sense from some that even if the UK economy implodes due to withdrawal from inclusion in the single market this is a ‘price well worth paying’ to misquote Norman Lamont, if immigration levels come down. For many, there is no discussion to be had about the value of migrant populations to the fabric of society or economy of the country, in the same way there is no longer a discussion about Labour is incompetent with the economy.

If Jeremy Corbyn were not to step down, it is unlikely that the current parliamentary party has the energy or inclination to host a third leadership election much as that might seem desirable. If Corbyn refuses to move, the best the parliamentary party is to try to work with a grassroots membership to sell Labour on the doorstep. But it is hard to get away from the genuine unease of some Labour grassroots in wanting to sell, for example, a Trident policy with which they may not necessarily agree. Not all will believe in the arguments of a minimum income, for example, either. But the tragedy is that Labour call ill afford such internal troubles mean that the UK withdraws seamlessly from the European Court of Justice which would bode well for the repeal of the Human Rights Act, or let the NHS and social care further implode. There is much agreement on the need to tackle industrial scale tax avoidance or the abuse of the gig economy, but there are serious doubts whether Jeremy Corbyn is necessarily the man who can appeal to the broad range of potential Labour membership. And this is not even to touch the concerns of some on Corbyn’s foreign policy, though this could well be small fry with what President-Elect Donald Trump has to offer imminently.

The only definitive way of knowing whether Corbyn will do a Trump, snatch victory from the jaws of victory, is to put it to the test. But of course it could all end badly yet again for Labour. If Labour fails, there will be plenty of people who will claim ‘I told you so’, but there will also be plenty of people who will think the daggers were out for Corbyn from the very start. The side-effect of the second Labour leadership election is that it effectively made Jeremy Corbyn bullet-proof. Admittedly, there is a substantial number of uncertainties, such as what the current Government wish to propose as ‘red lines’ in its exit from the European Union. However, whatever the feeling of what is ‘right’ for the economy or society, there’ll be some Labour longstanding voters flirting with UKIP who might be very angry that Labour didn’t wish to support Brexit really. Corbyn is essentially in a ‘no win’ situation, virtually impossible to triangulate out of, unless he makes the 2020 election a referendum on the running of the Conservatives’ Brexit, and who knows what would happen there. The danger of course is that Labour bins Corbyn just before the election, then has to bin the new leader after losing a 2020 general election.

@dr_shibley

Many Labour MPs are on suspended sentence – and they know it



jeremy corbyn

 

 

 

It’s impossible to escape the conclusion that the failed coup (and it wasn’t even that in the end) did quite a lot of damage to the perception of Labour. At a time when the UK was reaching an existential crisis, as to whether it should be a Union or part of it, Hilary Benn made himself into a political Archduke Ferdinand and precipitated world war within Labour. Benn Junior’s legacy was a real “* you” to the membership, given that it is ubiquitously accepted that the general public will always punish divided parties as a rule of Newtonian classical dynamics.

The post-truth era for Jeremy Corbyn had of course begun long before his second election as Labour’s elected leader. It’s no mean feat for Rafael Behr or James O’Brien to continue their boring whingeing about Corbyn all the time, but to give them credit they need to pay their mortgages. But other people need a Labour government. The meme ‘Britain needs a strong opposition’ laying the blame at Corbyn of course is completely laughable given the torrent of abuse at Corbyn from all of the mainstream media, whether it’s on the inclination of his bowing in official ceremonies, the lack of singing at the National Anthem, or the alleged refusal to kneel and kiss at the Privy Council inauguration ceremonies.

Corbyn does not have the Twitter following with the magnitude of Donald Trump. He would not wish to boast about ‘expanding his arsenal’ either (pardon the unintentional pun about the Holloway Road in Islington). Nor is he best friends with Vladimir Putin. Talking of which, all of the pseudo-commentators who were spitting bullets at Corbyn’s morality seem to have gone deadly quiet about Trump’s ‘locker room’ banter, did you notice?

For all the talk about strong leadership, Jeremy Corbyn is no Adolf Hitler, Donald Trump or Nigel Farage. It’s hard to disagree with his ten pledges, which include the ‘bread and butter’ for many of us on the left wing of politics. Take for example the pledge ‘full employment and an economy that works for all’. George Osborne’s legacy, possibly not meriting a CBE, was to produce one giant ‘gig economy’, with workers having desperately and deliberately poor employment rights, many on zero hour contracts, and many being topped up with ‘working tax credits’ (hence becoming the ‘working poor’). Unsurprisingly, this has done very little to tackle the poor productivity of the UK in general, and the poor tax receipts have been a shocker for running public services safely.

A second pledge is impossible to disagree with. That is, “Secure our NHS and social care”. The emphasis of the current Conservative government has been a traditional one of ‘getting more bang for your buck’ and the euphemistically termed “delivery”, but the crisis in social care has been due to a toxic combination of imposition of private markets and lack of funding matched to demand since 2010. Even Conservative MPs are concerned about the parlour state of social care, which is also having a cost in the economy in people of working adult working age being unable to lead independent lives because of the need to care for “dependents”, for example people living with dementia with substantial caring needs. For a very long time, A&E departments nationally have been unable to meet their targets, and delayed discharges have gone through the roof. But this is not headline stuff due to a corrupt mainstream media – hellbent on their character assassination of Jeremy Corbyn.

No poll, even up until the night of Donald Trump’s eventual election, had predicted accurately the scale of the Republican victory. The general public are continuously being told about the unelectability of Jeremy Corbyn, however, even though British pollsters have a formidably catastrophic recent polling record, for example in the EU referendum or the 2015 general election. No amount of fiasco is too large to displace the vitriolic attacks on Corbyn, whether that be the failure of privatised rail services, the corruption of captains of industry for well known high street brands, an ability to curb the excesses of unconscionably paid people, and so on. But Corbyn himself would be the last person to bank on a three full terms with him as Prime Minister. He is currently 67 – not being ageist, but he would be over 80 if he completed three full terms for Labour. The succession planning for Tony Blair was an unmitigated disaster, reputedly because many of the successors did not want to ‘succeed’ taking up profitable jobs elsewhere.

Talking of which, Jamie Reed is doing himself and Labour simultaneously a favour. There is more of a chance of a pig landing on Mars, than there is a chance of Reed winning in the strongly Brexit seat of Copeland. It is a fact that Labour cannot triangulate itself into making itself very pro European Union for the benefit of many in Scotland and London, while also being anti European Union for very many in England. Whilst there are a few with extreme opinions such as ‘send Muslims back’, there are some who hold the opinion that EU workers are ‘stealing the jobs’ of indigenous citizens due to being able to work at lower salary rates. Theresa May MP has been consistently unable to stick to immigration targets, and Hilary Benn MP would have been better off campaigning on this than sticking the political knife into Jeremy Corbyn? It’s pretty unlikely that Theresa May will be able to deliver on both exiting completely out of the single market and exempting itself from free movement of people, meaning that there’ll be a lot of disappointed people around.

The LibDems have already made their bed, which they intend to lie in. The possibility of another Tory-LibDem coalition beckons (particularly if Kezia Dugdale keeps up her triumphant work of Armageddon in the Scottish labour vote; this catastrophe long predates the Corbyn factor). They in case are not the party of the 52% or the 100%, but the 48%.

I suspect people who claim to want a ‘strong opposition’ want nothing of the sort. They are prepared to continue to undermine Jeremy Corbyn at all costs in 2017, and are fully prepared to see Theresa May secure a mandate for a hardline exit from the European Union.

Jeremy Corbyn for the time being has taken back control of the Labour Party, but his strategy has paradoxically been to make himself not dependent on others to the point of being isolationist. But the strength for Labour will be, as always, when the whole works for the collective good, and is larger than the sum of individual parts. If some people with big egos don’t feel they wish to suffer the indignity of losing under Corbyn for their own beliefs, and want to leave, that can only be interpreted as a good thing. If they can offer constructive criticism as leading Commons select committees, that I suppose is good potentially too. Strictly isn’t bad either.

But if they’re just going to whinge holding onto minor London seats, or larger, they’re better off getting out for the sake of all of us.

 

@dr_shibley

Hopson’s choice: accidentally destroying the NHS with parliament’s permission?



The starting point is here.

In May 2016, the need for increasing funding for the NHS was mooted powerfully by one of its former chief executives.

“Ministers must increase taxes to raise new cash for the NHS, a former chief executive of the health service in England has said, warning that no developed country would be able to cope with the spending squeeze inflicted on the health since the financial crisis of 2008.

Sir David Nicholson, who served as head of NHS England until 2014, said that last week’s record NHS hospital deficit figures were a symptom of the “serious problem” of NHS under-funding. His call for a boost for NHS spending via the taxation system was echoed by a senior NHS official, who said the only alternative to increasing taxes or national insurance contributions would be deeply unpopular new charges for NHS care.”

In the written evidence submitted by Chris Hopson, Chief Executive, NHS Providers (FIN0003), the following is mooted.

stark choices

Let’s look at the effect of these, shall we?

 

1. Reducing the number of strategic priorities the NHS is currently trying to deliver. Our members tell us that they are inundated with new initiatives they “must implement” ranging from seven day services and mental health and cancer taskforce recommendations to moving to a paperless NHS and a raft of new patient safety related initiatives. Whilst these are perfectly sensible individually, collectively they are impossible to deliver in the current environment;

It is already known that the NHS offers a seven day service for emergency care, and clinician have been vehement in their opposition to the ‘7 day service’ unless there are adequate resources to ensure patient safety.

The concerns are even reported to be widespread (this extract from August 2016).

“The health service has too few staff and too little money to deliver the government’s promised “truly seven-day NHS” on time and patients may not notice any difference even if it happens, leaked Department of Health documents reveal. Confidential internal DH papers drawn up for Jeremy Hunt and other ministers in late July show that senior civil servants trying to deliver what was a totemic Conservative pledge in last year’s general election have uncovered 13 major “risks” to it. While Hunt has been insisting that the NHS reorganise around seven-day working, the documents show civil servants listing a string of dangers in implementing the plan – as summarised by a secret “risk register” of the controversial proposal that has prompted a bitter industrial dispute with junior doctors. The biggest danger, the officials said, is “workforce overload” – a lack of available GPs, hospital consultants and other health professionals “meaning the full service cannot be delivered”, they say in documents that have been obtained by the Guardian and Channel 4 News.”

 

2. Formally rationing access to care in a more extensive way;

This has already been happening by the backdoor.

Nick Triggle writes for the BBC in 2012:

“Access to NHS care – including knee and hip operations – is being restricted, data from trusts in England suggests. The evidence, gathered under the Freedom of Information Act by GP magazine, showed 90% of trusts were imposing restrictions. The trend was blamed on cost-cutting by some, but the government says there was no justification for that assertion. NHS managers have defended the practice, saying there were instances when care had to be prioritised. Limits on cataract surgery were in place in 66% of trusts, while more than half of trusts were rationing weight-loss surgery and hip and knee operations Another survey published by Labour found similar patterns, prompting criticism of the trust’s actions from patient groups Clara Eaglen, of the Royal National Institute of Blind People, said: “People should not have to live with a reduced quality of life simply because PCTs are using arbitrary criteria to determine whether they get to keep their sight.””

Caroline Molloy, editor of Our NHS, writes in March 2016:

“Worrying news has emerged this week from the Midlands.

Cash-strapped local health bosses there have suggested that they may in future no longer fund a wide list of procedures on the NHS for many patients, including hearing aids, cataract ops, vasectomies, and hip and knee operations. Clinical Commissiong Groups (CCGs) in Wyre Forest, Bromsgrove and Redditch and South Worcestershire are currently consulting on the proposals, due to a £25million shortfall in government funding. Worcestershire CCG says baldly: “We do not have enough money to continue to buy all the services that we currently do in the same way as we have done before.” A couple of CCGs have already dipped their toe in the water of withdrawing such services – Essex announced in January it would no longer fund NHS vasectomies, and last October Staffordshire CCG started denying hearing aids for the first time in NHS history. The reductions in healthcare build on a longer tradition of short-term rationing fixes.”

 

3. Relaxing performance targets;

This would prevent the blushes of NHS managers missing A&E targets now virtually every month. “Relaxing performance targets” would help to cover up bad care.

Even in April 2015, the situation was known to be dire.

“Commenting on the latest NHS England figures published today (Tuesday) showing that the A&E waiting time target hasn’t been met for 26 consecutive weeks, UNISON Head of Health Christina McAnea said:

“Week in week out, for half a year now, the waiting times target has been missed. It’s bad enough that some sick and injured people were having to wait for more than four hours in the depths of winter – a time when demand on the NHS was at its peak. But for that still to be the case now that spring is here shows just how stretched A&E departments have become. Sadly this is where we are after five years of Tory mismanagement of the health service. The NHS, its patients and its staff need and deserve better.””

 

4 Closing or reconfiguring services;

This has already surfaced to public discourse.

This for example comes from August 2016:

“Plans are being drawn up that could see cuts to NHS services across England. The BBC has seen draft sustainability and transformation plans (STPs) which propose ward closures, cuts in bed numbers and changes to A&E and GP care in 44 areas.
There have been no consultations on the plans so far. NHS England, which needs to find £22bn in efficiency savings by 2020-21, said reorganising local services is essential to improve patient care. But the Nuffield Trust think tank said while STPs could lead to “fundamental changes”, many of the plans do not meet the financial targets set by the government and will face a “dauntingly large implementation task”.”

Also that month the Guardian carried further details:

“NHS England has divided England into 44 “footprint” areas, and each was asked to submit a cost-cutting “sustainability and transformation plan” (STP). The Guardian has seen the detailed plans for north-west London, while 38 Degrees, a crowdfunded campaign group, commissioned the consultancy Incisive Health to collate and analyse proposals from across the rest of England.

The picture that emerges includes:

In the Leicester, Leicestershire and Rutland region, there are proposals to reduce the number of acute hospitals from three to two.

In the Black Country region of the West Midlands there are proposals to reduce the number of acute units from five to four and close one of two district general hospitals.”

But there are already concerns that extensive cuts done this way are storing up massive problems for later.

“There are also serious concerns that cost-cutting on the scale envisaged under the plan could damage patient care. Jennifer Dixon, the chief executive of the Health Foundation thinktank, said the strategy risked a repeat of a care scandal of the scale of that seen at the Mid Staffordshire NHS Trust between 2005 and 2009. “Getting the balance right between carrot and stick is critical, as history tells us,” she said. “The Francis inquiry, published only three years ago, describes how radical steps by one NHS hospital – Mid Staffordshire – to improve its financial position had terrible consequences for patient care.””

 

5. Extending co-payments or changes;

The effects of copayments are well known, see for example here Colin Leys and Stewart Player:

“What has already occurred with dentistry, physiotherapy, podiatry and other services will start happening across the board. ‘Top-ups’ and ‘co-payments’ will become standard. Some treatments will cease to be available freely on the NHS and have to be paid for – if you can afford it. ”

Co-payments (and personal budgets) have the effect of rationing care at the individual level, making cuts much easier to get away with.

KONP comments:

“By the use of direct payments and/or ‘personal budgets’14 for an increasing range of conditions – patients are given a fixed sum to buy their healthcare themselves, from either the NHS or private providers. Personal budgets have been trialled since 2009 and are now being rapidly extended. By 2014 they will be rolled out to all patients receiving NHS continuing care. The experience from social care personal budgets here and healthcare in other countries is that risk is passed down to the patient, and state health providers can go under. Budgets often get progressively cut, leaving the individual to top up from their own pocket, or via insurance, if they can afford it.”

 

6. Reducing / more explicitly controlling the size of the NHS workforce which accounts for around 70% of the average trust budget. But, clearly, controlling the size of the workforce would have to be linked to some form of reduction in what the NHS is being asked to deliver.

The King’s Fund comments:

“Between 2000 and 2010 the nursing and midwifery workforce in the NHS in England grew by 26 per cent, an average of 2 per cent per year, the result of a concerted effort to reverse nursing shortages in the previous decade by increasing training places, improving staff retention and active international recruitment. However, the number of nurses on the Nursing and Midwifery Council’s UK register of all practising nurses, began declining in 2008 and continued to fall in the following three years, while the headcount of qualified nursing staff working in the NHS in England only began to reduce after reaching a high of 375,505 in 2009.”

But this is already an area of massive concern in terms of patient safety:

“The Government has suspended NICE (the National Institute for Clinical Excellence) from producing further guidance on safe staffing levels in the NHS and this is a cause of great concern.

Simon Stevens, Chief Executive NHS England says he has requested Jane Cummings, Chief Nurse NHS England, to incorporate nurse workforce planning into the 5 year forward plan initiatives. This is a serious backward step as NICE were commissioned to provide an independent review on safe staffing levels based on research and expert advice from the healthcare field. NHS England is not in a position to provide an independent view and the outcomes will be fragmented across its various initiatives with no standardized approach to staffing levels resulting in a serious risk to patient safety. (It is of interest that on the same day of the suspension, NHS Wales voted unanimously to pass a safe staffing to its second stage.)”

And it doesn’t stop there.

“Healthcare services and its professionals are “heading into an extremely difficult autumn”, the Royal College of Physicians (RCP) has warned as the latest workforce survey from the RCPCH revealed widespread staff shortages and rising rota gaps in the field. The survey, which has been collecting evidence since 2009, found that more than one in four general paediatric posts at senior trainee level are now vacant, with over half of paediatric units not meeting recommended staffing standards. To keep services running, consultants are increasingly providing unplanned cover in addition to covering their own roles. Perhaps even more worryingly, four out of five, or almost 90%, of clinical directors are worried about how services will cope in the next six months. Doctors argued children’s services are “at a breaking point, sustained by existing junior doctors and consultants struggling to plug vacancies”.”

The problem with NHS Providers putting so much effort into laying out these disastrous options is that they begin their negotiations from a starting of point of (unintentionally) destroying the NHS?  They should emphasise at all times this will only be solved by proper funding to both NHS and the social care.

The “zombie policies” keep on coming up again and again.

Caroline Molloy again, this time from 2013:

Taxation

Reform acknowledge that the last major review of NHS funding found that charges were “inefficient and inequitable” and that taxation was the most effective way of paying for healthcare, just as NHS founder Nye Bevan insisted when he dismissed means-testing, charging and insurance, saying:

“The means of collecting the revenues for the health service are already in the possession of most modern states, and that is the normal system of taxation.”

Taxation is – Reform admit – still the model of NHS funding “preferred by the public”.

But these days it’s surprisingly rare to hear a politician explicitly defending this core principle of the NHS. Cameron’s appointee as new NHS Chief Executive, former United Health chief Simon Stevens, wrote an essay for Reform last year that appeared to problematise the “the NHS’ tax-funding mechanism”.

Heavy lifting

There are other think tanks prepared to help Reform do the political dirty work – or ‘heavy lifting’ as it’s now known – to try and shift the public away from their commitment to a tax-funded comprehensive NHS towards one based on charges and insurance.

Reform cite a recent Kings Fund report to back their assertion that “attitudes to charging have begun to shift in recent years”. In fact the Kings Fund’s focus group strongly rejected NHS charging and preferred increased taxation if necessary. Only after two days of being brow-beaten with the “inevitability” of the NHS’s financial “crisis”, did attendees reluctantly concede that if they absolutely had to accept charging, they would prefer it applied to less vital procedures and to more irresponsible patients.

Reform also try to claim that GPs and the British Medical Association are shifting towards supporting charging – an attempt at co-option roundly rejected by both the BMA and the Royal College of GPs. Dr Chaand Nagpaul, chair of the BMA’s GP Committee said yesterday:

“This proposal undermines the core value of our NHS: universal access based on need, not ability to pay. If a charging system is introduced there’s a risk it would deter patients from seeing a doctor and getting the treatment they desperately need.””

 

Accidentally destroying the NHS with parliament’s permission?

It would be a disaster if Chris Hopson going into his negotiation had effectively given up on the notion of funding the NHS properly, and suggested effectively only a route for destroying NHS as a comprehensive and free at the point of use service.

Remember the ‘sustainability and transformation plans’ which have wrought widespread concern?

Chris Hopson again:

“We strongly support the current sustainability and transformation planning (STP) process to enable local health and care systems to chart a path to sustainability by 2020/21. But the problems the NHS faces are immediate. Trusts and CCGs must develop immediate plans that close the larger gap they will face from April 2017. Failure to do this now means the NHS will be unable to livewithin its 2017/18 budget.”

The original Hobson choice is described as following:

Hobson's choice

Or to bring up to date, Hopson’s choice, destroying the NHS with the permission of parliament?

I am certain Chris Hopson doesn’t intend this, to be clear.

@dr_shibley

Jon Ashworth MP has his work cut out. Things can only get better.



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It was a ‘badge of honour’ for some to remark ‘Never heard of him’ in response to Jon Ashworth MP’s elevation to Shadow Secretary of State for Health.

But if it’s any consolation – I doubt he’s heard of you either.

Whisper it gently, but there’s more to life in the health and social care services than the pages of the Health Services Journal or the lecture theatres of the King’s Fund.

His campaigning work on mental illness, breaking down stigma and prejudice, has been inspiring.

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But he is no ‘yes man’ – he railed against the mischievous use of slogans (a campaigning strand for Owen Smith MP over the summer for the Labour leadership).

From this starting point, I think Jon has form in being able to speak his mind, but withstand having his political career assassinated. He potentially might act as an important bridge for Corbyn’s “socialism for the twenty first century” and the halyçon days of “New Labour”.

When Tim Farron MP, leader of the Liberal Democrats, says like the Stone Roses he prefers the earlier work of New Labour, he presumably is referring to how when Labour came to office and power in 1997 the NHS was on its knees. Radical surgery had to be taken to the NHS, including Milburn’s NHS Plan.

The aim was also to put in real investment to the NHS – which worked – and to tackle burning issues of poor infrastructure.

Alan Milburn himself has said the tendency when you first come to the post of Secretary of State for health is ‘to want to do everything’, but as time passes progress slows down.

Tragically, Jon Ashworth MP is inheriting the NHS in a state of chaos and turmoil, but there are huge problems bequeathed by the current leadership of Jeremy Hunt: viz, inadequate monies to run the services, backdoor insidious rationing of services, morale of NHS staff (excluding management) at rock bottom, crippling PFI debts, a small number of NHS Trusts in ‘special measures’, widespread financial deficits, social care funding on its knees, A&E targets comprehensively missed, an IT programme which is badly behind, problems in recruitment in some specialties of the NHS, drastic cuts in mental health services, leaders of the NHS who refuse to quit despite catastrophic performance, disasters of outsourcing where nobody appears to wish to take responsibility, junior doctors repeatedly on strike with an imposed contract officially seen as not ‘imposed’, problems in recruitment, retention and workload of general practitioners, and so on.

And yet despite this, Theresa May MP, in my opinion probably one of the most dangerous Conservative Prime Ministers ever, insists ‘nothing to see here’.

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But, without pointing the finger of blame at the latter Blair years, the list of policy misfires is substantial, including unsafe staffing and rush to regulation which contributed to the Mid Staffs disaster, explosion in new PFI deals (PFI has continued under subsequent governments) with extremely poor value for the taxpayer, the consolidation of the market in the NHS and social care, the introduction of the ‘purchaser provider split’, moves to use of private sector due to failure in planning (termed euphemistically as ‘building capacity’) such as privatisation of NHS logistics, legislation such as the National Health Service Act 2006 and the Public Contracts Regulations 2006 which laid the foundations for the catastrophic Coalition Health and Social Care Act 2012. The 2012 Act saw turbo boosting of outsourcing and transfer of services to the private sector (aka “privatisation”). New Labour started to embed the notion that competition between providers would not only bring down costs but also improve quality, which was never borne out in other monopoly behaving industries such as the utilities – and this was a disastrous hangover for the Coalition Years 2010-2015 with the Conservatives and the Liberal Democrats finding synergy in free movement of capital. This all had paved the way for greater consolidation of competition economics governing the NHS from EU membership, as well as the threat of TTIP investor protector clauses.

And Ashworth needs to insist that the NHS and social care to run a decent service, when the current Government is using #Brexit as an all round ‘get out of gaol’ card. Without this money, Simon Stevens cherished ‘Five Year Forward View’ will run into deep problems. Governments and opposition parties have been shroud waving about integrating health and social care for decades, but progress on this has been generally poor apart from some islets of promise. Parity of esteem does not appear to be a reality, as even Andy Burnham MP had recently sloganised. Delayed discharges or delayed transfers of care, or ‘bed blocking’ as affectionately known in the predominantly right wing anti Corbyn media, have got worse under Jeremy Hunt’s watch too, breaking both the NHS and ASCOF outcomes for patient experience.

But Ashworth is an effective campaigner – and he needs to put those skills into good use, for example against the unconscionable poor value for money PFI deals, the catastrophic current operational performance of the NHS, and the disastrous funding situation of social care, the need for much better mental health services.

Simultaneously, Ashworth will have to convince the public of the long view of the need of a comprehensive, properly funded, NHS free at the point of use. A similar National Care Service has been the vision of many in the past, but never got off the drawing board. Maybe the Shadow Treasury will have some idea about prioritising this now, given the change in monetary policy from the current Government? Clinicians and patients/users converge on a desire for care planning and continuity of care. We know the Government has done its best to show wage restraint in some areas not others (e.g. of nurses but not of NHS managers), but addressing the funding gap will need to see an intelligent use of technology – not aggressive pimping and rent seeking to the private sector – and changing especially for the elderly, where polypharmacy and multi morbidity can be big issues, the direction of the supertanker towards being a ‘National Health and Care Service’ not a ‘Fragmented Health Service’.

Jon Ashworth MP definitely has his work cut out. It’s a monumental task where he does need to build up some momentum.

 

@dr_shibley

Some thoughts on Jeremy Hunt



Hunt

 

I’m a card carrying socialist. I don’t know whether I’m a Marxist Trot, but my views are in keeping in what most people would view as for the public good but not in a way dictated by markets free or otherwise.

Not that it matters, but I’ve always voted Labour. The defining event for me was in fact going to Margaret Thatcher’s last ever Prime Ministers Questions. I lived mainly in London in 1990, a stone’s throw away from Leicester Square – and I remember the Poll Tax riots and the tail end of the Thatcher government vividly. I remember the politics of the 1980s vividly, as a child, and I committed never to vote Tory again. I fulfilled that promise, as it happens.

It’s well known I’ve spent far longer as a NHS patient, with an adult onset physical disability as a result of meningitis in my mid 30s, than as a practising junior doctor, though I remember my time as a junior doctor with disproportionate affection. Hospitals for me provoke mixed emotions – I survived a six week coma in one, I saw my father have the cardiac arrest team around him before he did in the same hospital as it happens, and it’s one where I have much goodwill for their ‘dementia friendly’ approach given my current interest as an academic physician in dementia predominantly.

I am not a ‘celeb blogger’ – but then again I loathe the media, and the media hate me. I tweeted recently that ‘I don’t believe a word that Jeremy Hunt says’ – this is on the basis of how his legal team had emphasised he had never imposed the NHS #juniordoctors contract despite him saying on numerous occasions he was imposing it.

But the thing to remember for me is that Jeremy Hunt as such does not ‘act alone’. He went into Theresa May’s first cabinet reshuffle expecting to be dropped like a lead balloon – hence the lack of lapel on his jacket – but he emerged happily in situ. So Jeremy Hunt is fallible – he expected to be sacked.

He sincerely believes what he does – which I think is ‘liberalising the market’, ensuring that Mid Staffs never happens again, producing a workforce less dependent on immigration, and so on.

As it happens, I profoundy disagree with his view on the NHS. I dislike the fact he rarely comments on the idea that provider competition has not improved quality in the NHS, how he has a total blindspot for the social care profession, how he seems in total denial about the catastrophic finances of the NHS, how his electronic IT programme is way off track, and so on.

But again I wonder to what extent this lack of trust in him is entirely his fault. For example, I don’t think the BMA acted par excellence, and I myself wondered how on earth these strikes were not impacting on patient quality or safety. But then again if it’s the case that NHS Providers and NHS hospitals can send out strongly worded letters with impunity then that is that.

The General Medical Council don’t appear to wish to comment much on rota gaps, and general morale, or how #juniordoctors might refuse to sign a contract if they feel uncomfortable, and so on. I’m not in fear of the Council, it’s just I have nothing much to do with them. My personal view is that they could have been far more respect and responsive of the patient safety views of doctors, that’s all.

It says in our code of conduct that if we feel uncomfortable about resources we should say so. Some of us have repeated this ad nauseam  – so now what?

I like James Titcombe hugely. I find the story of Joshua incredibly fertile in what we could do for learning from mistakes from the future. But, despite the best will in the world, if Katrina Percy refuses to resign having won once a HSJ award that’s where we are. If I can live with a mistake for the rest of my life, and others don’t, so be it.

I like Deb Hazeldine equally hugely. I can’t even begin to imagine what she feels everyday.

I enjoy my work which is basically advocating for people with dementia. As a carer myself, I am interested in that too. But I know my boundaries. Me ‘hating’ Jeremy Hunt will achieve nothing – he is doing his job albeit with a workforce some of which want to emigrate.

Cuts and low morale I think are a threat to patient safety – but if the General Medical Council feel comfortable with that in their remit, nor with giving proper support to Chris Day’s whistleblowing case, there’s not much many of us can do about it.

I don’t actually ‘hate’ Jeremy Hunt. He MUST, I’m sure, know that the NHS and social care need more money, the workforce largely don’t trust what he says, doctors in India no longer wish to work in the UK whether or not he needs them, and so on.

But it’s Jeremy Hunt – too surreal to fail.

A clear mismatch between Hansard and the High Court regarding Jeremy Hunt’s ‘imposition’



Lawyers in the senior courts regularly use Hansard in a technique known as ‘statutory interpretation’ to act as clues about the intention of legislation.

For example, one could argue that the same parliament could not have intended to legislate for human rights and intended to ignore whistleblowing protection for junior doctors in training in 1999.

The judge in the High Court said clearly that he did not intend to assess on the merits of the Secretary of State for Health’s policy, and nor do I.

But arguably there is a clear mismatch between his conclusion in the official judgment here that “he is not exercising compulsory powers”

SECOND GROUND

 

misled

 

and the consistent Hansard official reporting of the opinions of the Secretary of State over a period of months (this was from April):-

Hansard

If it is the case that parliamentary statements cannot be taken seriously, then what?

It has been argued that this is the ‘hurley burley’ of politics, but in fact this is the judiciary potentially making the legislature and executive look like an outright joke. This is ‘not a good look’ for the higher courts.

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A crucial issue is that if there was NOT going to be an imposition why didn’t the Secretary of State make this clear in subsequent statements to parliament?

Why was the BMA JDC left with the impression of imposition?

 

It can be easily argued that the whole case rests on this fundamental potential deception, and needs to be scrutinised from a jurisprudence perspective with utmost care.

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