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Will there be a queue for Basketcase Britain?



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The LBC presenter didn’t know what to say.

The caller from Germany explained, ‘Germany thinks you’re a basket case’.  While not totally convincing about his sources, he then articulated an argument to do with how Britain’s perception of its own brilliance wound people up. Exceptionalism in the wrong place.

The next caller simply started, “I agree with the previous caller”.

The New York Times has written a series of articles about how Britain is in decline. We can of course debate on the details but Britain is experiencing a worse energy crisis than the rest of Europe, a 37 year low of the pound against the dollar, and gross levels of inequality.

The Queen’s death was a hit for those who believe in the Monarchy and those who don’t alike.. Some ardent republicans found themselves soul-searching how they had quite liked the Queen but were ambivalent to the Monarchy as an institution.

Indeed, many thousands of people are queiung on the South Bank in London  to see a box which may or may not contain the late Queen. The coffin is a symbol of a sense of national pride of times gone by. For me when the Queen died it was months after my mother had died. It felt like an end of an era, and the death of somebody whose values and character I found inspiring.

It may be that people waiting to pay their respects, either by legitimately queuing like David Beckham or queue-jumping, are truly emotionally invested whatever their means of showing it. People waiting for twelve hours or more in a queue may simply be there for ‘fear of missing out’, but likewise are there in a once-in-a-lifetime experience of something rather quite extraordinary.

An aside. People like David Beckham make me proud to feel British. An East End boy with extraordinary talent, who didn’t misuse his celebrity to get a VIP pass to see the coffin. Andy Burnham missed a trick here.

England decided in 2016 to propel itself into a period of society uncertainty and self-doubt through the EU referendum. The fact that the pound is tanking and that Sterling has increasingly become an unattractive currency to lend is symptomatic of the ‘shock’ liberal economics of Truss and Kwarteng.

There has been no realistic  hope of reversing a collapse in productivity lasting for several decades through tax cuts for the wealthy. “Trickle down economics” is well and truly a busted flush. There is, however, one possibility based on actual economics. Increasing GDP through decreasing our trade deficit is not a bad plan, and joining the single market could be a practical way of incentivising productivity.

Criticising the New York Times is literally shooting the messenger.

A focus on the Oxford comma looks a bit like outright denial, or at the very least being a tad ‘out of touch’.

The current Conservative Government is trying to justify the removal of the caps in bankers’ bonuses by saying it is restoring the competitiveness of the UK. It is not. It is simply lining the coffers of those who are in a position to donate the Tories.

It is a Brexit benefit only in as much as leaving the European Union has facilitated bankers bonuses and international tax evasion. This particular lurch into England being a ‘Singapore-on-Thames’ is simply going to incentivise riskier banking behaviour, thus precipitating another disastrous global financial crash.

Rather than contribute to a mountain of marmalade sandwiches on the floor, it would be better to donate to food banks. Britain has no reason to be proud that it has more food banks than branches of McDonalds. It is no longer possible to hide or spin these facts. Twelve years of Conservative Government has led to Britain being a divided basket case. Sewage being pumped into the sea, and privatised utilities up the spout. Ambulance waiting times dangerously long, and the police being grossly under-resourced to solve any crime.

And yet the cheerleaders of culture wars and identity wars bugger on regardless. Even criticising a mega racist being invited into a safe place could lead to that person being ‘cancelled’ – and OUTRAGE. The only people who have benefited from this perpetual gaslighting are those with books and TV to sell. They are improving their brand, paying off the mortgage. They are the true anti-patriots, who couldn’t care less if the UK has trouble applying for the G-200 in future.

With there being no functional democracy in the UK, so long as proportional representation is kept off the agenda, Britain looks like lurching from one fiasco to the next. Tory landowners get a boost from selling off Tory land to frackers. Frackers, notorious for inducing tremors and earthquake-prone land and producing an energy supply which is totally non-sustainable in real terms, do not of course care.

Brexit meant we came out of the Treaty of Dublin. You know, the one where we had reciprocal arrangements to deal with those people crossing the English Channel by dinghy from France. One audience member to a Tory leadership hustings suggested “returning these boats back to Kenya” – but in the real world, the Tories are drawing ever closer to full withdrawal from the European Court of Human Rights, so they can dispose of meddlesome red tape on human rights, and get flights done (to Rwanda).

The left wing want this country to succeed. There’s nothing left to sell. There’s nothing left to de-regulate. But they are intensely patriotic too, but not the extent they need to shag flags.

It probably wouldn’t be a good idea for the Tories to hold another referendum on the Monarchy in 2025, despite this being a known issue. But then again the Tory Party are as united on the Monarchy as they are on capital punishment.

There is, however, a lot to do. Things really can’t get much worse.

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Influencing politics has become like watering an artificial pot plant



I laughed out loud when I read a tweet by someone who reported she had been watering a pot plant. The difference was that the pot plant was artificial, with ‘life like’ leaves. She thought that she was going to make a difference.

This sort of thing can easily happen, of course. The more I came to reflect on this tweet the more I felt the disconnect between action and outcome. I then felt that it was an excellent allegory for voting in our current political system here in the US.

Truss and Sunak are playing to their loyal membership base. I am not the intended audience, so I cannot be offended if I find their values on degrees and money earning potential, WASPI or unpaid carers perplexing.

I was most politically active when both my parents were alive in 2009, under a Labour government. My mum died at the end of July 2022. This has become my yardstick of whether I feel that life has improved much. There used to be a measure, for example, that you would want to leave the country or world in a better place than when you had found it. I felt this sharp reality when I was watching an item on the new TV channel about ‘levelling up’.

That TV channel, like the Tories and its recent political journey, is thought-provoking certainly. I too believe that one can be allowed to disagree, without being disagreeable. The discussions frequently can revert to certain topics. Take for example: why do the Police advertise their rainbow flags? The discussion is never about why funding for the Police has drastically been reduced, such that community policing is under-resourced, and a small minority of crimes such as theft or burglary reach prosecution. Or, take another example. Why shouldn’t you get angry about a statue about someone you haven’t heard of has been pulled down in a location you haven’t heard of? Of course, this cultural vandalism would be objectionable, until you realise that, also under a series of consecutive Tory governments, local libraries have been shut down.

In an elegantly executed leadership debate with Liz Truss on that TV channel, one member of the TV audience suggested sending ‘illegal immgrants to Kenya’, missing totally the point that the number of dinghie crossings had massively gone up due to UK’s pulling out of the Treaty of Dublin through Brexit. This is another problem caused by Brexit, caused by a Conservative government, which has whipped up idiotic views out of nowhere. It is not difficult to realise that the UK needs co-operation with other countries to have any standing in the world. And it is not difficult to understand that Brexit has damaged that, and that any political party should face up to that.

One can assume that one of the critical functions of any government is to run public services safely. Whatever your own belief about public services adding to the ‘productivity’ of this country, we can all agree that delays in ambulances for medical emergencies is unsafe and is unacceptable. A bad dancer will always blame the floor, but the media attention to this issue is at least as deserving as whether we should have unisex toilets.

Back to the ‘levelling up’ TV report package. The one from Cornwall. I remember when David Cameron with immense pride talked in the 2015 Conservative Party conference announced how the whole of Cornwall had gone Tory. So much for the deceit of levelling up. If you talk to most people even in the Red Wall, they will confirm a decline in public services, ranging from NHS, to social care, to libraries, which coincides with the period of austerity and decline from the Conservatives in the last decade.

And another event happened in 2016 which has led to an enduring process. Whatever you feel about Labour’s participation ever in the Brexit process, it is hard to work out why it has never allowed a discussion of participation in the single market. If Keir Starmer is indeed worried about ‘partnerships’ and ‘productivity’, like he now claims to be, it is of concern why he should wish to exclude a large market on his doorstep, unless he has other markets in mind.

If Brexit is the solution from the Tories, what problem did it fix? The most parsimonious belief is an internal dispute within the Conservative Party. It is obvious if you ‘replay’ the speeches of David Cameron that he wished to settle this dispute in the same direction as the Scottish referendum. He lost – and the fact that he didn’t know how to cope with it explains why he simply walked away. The Conservatives have never explained why their exit plan was never articulated. One can assume, perhaps, that the plan all along was to make the UK a successful ‘Singapore on Thames’. Labour could have decided instead to demonstrate solidarity with Scotland on important issues. It didn’t. So it should not be surprised if Scotland seeks solidarity with the European Union instead.

It could have been up to Labour to advance a sense of solidarity with the Scottish, except that the leadership of Scottish Labour was not that friendly to a left wing Labour. The Scottish SNP have always been more popular and more left wing than the Westminster Labour. Nicola Sturgeon is a much more charismatic politician than Keir Starmer, whether you agree with either of them or not. The most relevant, point, however is that it is in the Conservatives’ interest for the SNP to be more popular than Labour in Scotland. Every time that the SNP is popular, a bit of the probability that Labour will win an outright majority drops just a little bit more. Brexit was of course a gamechanger for the Scots. It may be the Conservatives ultimately lose the UK Union because it gifted Scotland to the SNP on purpose.

Therefore Brexit was another solution to a problem which caused more problems. It’s as if the Conservatives not only did not ‘fix the roof while the sun was shining’. It’s as if the Conservatives actively set fire to the roof while the sun was shining.

About a decade ago, in an evening course MBA, I studied economics and markets. I learned that if you privatise a state-owned monopoly, if you don’t break it up, you get a privatised monopoly. One can blame it all on the Ukraine War as an externality, but the catastrophic outcome with the privatised utilities from Thatcherite economics was entirely predictable. It was so predictable that Ed Miliband actively campaigned on it in 2014 prior to the 2015 general election, discussing ‘predators’ and ‘producers’. And he lost. The tragedy is that national ownership of basic resources is not a terribly controversial policy. More controversial is a ‘regional’ water company being owned by Malaysian private equity.

So it might be that the artificial pot plant is not actually innocuous after all, but is a “triffid”, or something which you would buy off a little shop of horrors. Can Labour now make the UK a better place with such an open goal? Time will tell.

The Tories can’t be allowed to hold the UK to ransom any more



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By playing fast and loose with the Northern Ireland protocol, and even wishing to overrule the international rule of law previously, it is clear that the current Government has no intention of being respected – or even liked – in the world. Even though Boris Johnson may feel a temporary grandiose delusion, pretty much in keeping with a narcissistic persona, of British exceptionalism when talking about his contribution to the conflict between Ukraine and Russia, it is patently clear that if the conflict escalates to involve the European Union more including neighbouring countries things will change more. That is, Britain will ‘feel’ its identity as being a geopolitical loner. It already has had a taste of being a loner with the perception from France, and much of the world, that Britain is now a laughing stock. British people, especially Scottish and Welsh citizens, need to prioritise not being tarred with the same brush. British conflict with France means that Britain will remain unsuccessful in ‘securing its borders’. Immigration policy is fitting for Priti Patel’s Britain: having an immigration issue getting more out of control, and yet having a lack of freedom of people inwards to keep key industries going, whether that be lorry drivers, fruit pickers, or people to wipe your grandma’s arse in the care home.

The problem with the populist media, and the stereotype of the Red Wall, is that they collectively are dragging the rest of us down. The stereotype is that they’re at home watching Ricky Gervais, fist pumping attacks on ‘women’s with penises’, but all along they’re simply sticking two fingers up at the people who stole their jobs. Fine, this is a stereotype. But why has their war so far been on lawyers, NHS, GPs, the BBC, Starmer, people who care about equality, University academics, and so on. It is all nonsense. This all points to an arrogant Executive, loving their freedom of speech but suppressing the feelings and views of others, a deeply nasty autocratic authoritarian state. The fish rots from the head down and Starmer’s difficulty is that he has no interesting offering on the European Union, no clear strategy on improving the NHS and social care, no overall idea about how to win on inflation despite screaming rather sanctimoniously about his Windfall tax. Labour currently is a deplorable collection of has beens, some of whom are nasty, unpleasant, and so on, but they are needed. Britain needs to get out of one party rule. One Nation Toryism has turned into a tinpot dictatorship, where it feels impossible to get rid of Boris Johnson despite the fact he is unbelievably crap. Whether it be P&O Ferries, or the fact that the British automobile industry has imploded, the phobia to discuss how badly |Brexit has gone is now really rancid. It is stopping getting in the way of the country. The people who are holding the country to ransom are not the Unions who want to protect transport from being so automated that disabled people don’t have a chance. The people holding the country to ransom are the Tories.

Sunak probably has a skimpy idea of behavioural macroeconomics despite having had a well paid job in the City and access to lots of other money. But be in no doubt that his recent helicopter drug is an ideological addiction which will see inflation, coupled with Brexit, go through the roof. It does matter that Nadine Dorries does not have a clue, because her ignorance is totally dangerous to the rest of the UK’s (ironically) culture. The destruction of the BBC, enabled by its senior membership, has already begun. Look at CBeebies or BBC4. Not everyone has access or means to universal broadband. Yes, remember the nasty git who wanted to introduce a green economy, improved social care and NHS, rail nationalism to stop unconscionable fair increases, break up of the energy companies (a known issue since about 2014 and successfully ignored by David Cameron in the 2015 election to ‘get Brexit done’ and a load of other crap), national broadband, and so on? Yes, that evil Jeremy Corbyn. Thanks to the power house of intellectuals at the Guardian (I am joking), partly, and despite socialism going from strength to strength in Wales and to a lesser extent in Scotland, we now have permanent Tory rule in England. The Lib Dems, under Jo Swinson, have shown how toxic they can be. Back to the internet. Not everyone can watch Netflix, or the Disney Channel, so these kids definitely will be sorry to see the back of Hacker T Dog. Be in no doubt the Tories are holding the UK to ransom. Sure, you can blame it all you like on the COVID-19 pandemic. Or you could explain it through naked opportunism from a bunch of corrupt crooks with no moral compass.

It is undeniable that the Tories have unleashed a series of political fiascos that could accelerate the breakup of the United Kingdom. That’s ok with me, because it will remind these people that ‘take back control’ and tub thumping about national sovereignty can go in one direction. Talking of one direction, even musicians are feeling the pain of Brexit. But why the news blackout in talking about how dire Brexit is, costing about £400 million per week? Surely it’s time to call time on those who personally profited out of Brexit but who have happily seen the UK implode. Boris Johnson with his culture of corruption has to go. Even if the Guardian are complicit in keeping this lot in power, something radical has to be done to get rid of this lot. The Tories can’t be allowed to hold the UK to ransom any more.

End of the Partygate?



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The Sue Gray report didn’t change much, much to the disgust of the Labour luvvies in the media who think they can rule on who the PM should be.  Of course people are sick of ‘Partygate’, but they were even sicker of an offer to: carry out the denationalisation of British Rail, fund the NHS and social care to a higher level, scrap tuition fees, build one million new homes over five years, abolish zero hour contracts, a National Education Service, breaking up the big six energy companies, more investment in mental health, and promotion of the green economy.

All the right-wing tropes have re-emerged with galliant chutzpah, and emboldened with two new Freeview channels the facilities for promoting an ideological cesspit has never been easier. Whether or not Boris Johnson knew he was lying has been one of semantics for his lawyers (it’s funny how Johnson suddenly wants to instruct ‘leftie lawyers isn’t it?)  But the cabal of Beth Rigby, Robert Peston, Pippa Crear, James O’Brien and Jonathan Freedland now bore me senseless with their sanctimonious dissection of one issue, Partygate, when they have been patently sleeping at the wheel prior to the Starmer golden era of Labour.

It’s very difficult for somebody like me, who had voted Labour all his life, to support the Labour Party given how much it tried and succeeded to assassinate politically its leader despite winning two leadership elections twice. It cannot also be ignored how toxic the perception that Labour wanted to reverse the referendum had become, with the carrot of a second referendum. It soon became a stick whereby Brexit supporters couldn’t support a Knight of the Realm, wealthy, lawyer wanting to look neutral. The right wing can do the politics of envy, as best as the next man or woman.

Of course it was optimistic and foolish in equal measure for the establishment automatically to support ‘Remain’ especially with Alan Johnson and Sir Stuart Rose leading the charge of the very light brigade for ‘Remain’. There was no serious attempt to dissect the Northern Ireland Protocol from Starmer. Labour rightly wanted to stamp out all racism, but we have heard little about their progress on this year, and heard even less about the infamous Forde Report.

So instead of talking about social care reform, reform of the energy markets and so on, we’re in a never ending cycle of discussing whether the rainbow symbol and Ukrainian flags are overused, whether transsexual athletes should compete in international tournaments, whether risqué comedians and academic should be cancelled, whether icons as great as Churchill or Oswald Mosley should necessarily be ‘cancelled’ and so forth. In a weird utopia, there’d be 57 channels devoted to various varieties of Dorries TV, discussing the same thing: how Starmer ate a pasty. Result: a hung parliament, with Scotland voting SNP.

Andrew Rawnsley famously wrote a piece called ‘End of the Party’, and in a way I want it to be the end of the Partygate. I am sick that they lied and others died, of course I am. But there’s a debate to be had about whether all the quantitative easing in previous Tory governments has helped with the ‘cost of living’, as well as maximising shareholder dividend for all the privatised industries. But Tory voters aren’t thick. Please hold my non-alcoholic beer.

Starmer doesn’t do it for me. A London cabbie told me that, despite being a lifelong socialist, we should now rally behind Starmer, who’s so forgiving that he has expelled socialists from the Labour Party. But in the same breath that London cabbie told me we must root out benefit scroungers.

It never fails me how Tory England is, nor Boris Johnson’s interminable ability to ‘get away with it’.

@dr_shibley

You may knock GB News but it helped me understand the election results immediately



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I had been a lifelong Labour voter since 1992. When I ‘came out’ in support of Jeremy Corbyn as the democratically elected leader of the Labour Party, twice in fact, I was much derided on social media. I was attacked for supporting someone who was alleged to be ‘anti-semitic’, and the whole thing became totally unpleasant with much time-wasting leadership bids from Owen Smith and Angela Eagle.

There’s currently much for all of us to be concerned about – to name a few, the ‘cost of living’ crisis including sky high energy bills, inflation creeping up to 10%, record waits on the NHS waiting list, the possible independence of Scotland and Northern Ireland, crises abroad such as Afghanistan or the Ukraine. I would not consider the numerous fixed penalty fines from Johnson (or Starmer, if they happen) an issue to be one which occupies my mind much (so called “Partygate”), or his dreadful gaffes including the CBI Peppa Pig speech.

You may knock GB News, and to be honest I’m not that interested in the “culture wars”. But watching the channel, with some favourite shows, for a few months has exposed me to an open discussion of many issues which I simply did not hear on the BBC. Likewise, just because I am a regular GB News viewer, that does not make me ‘far right’. To imply that is to imply GB News viewers are all far right. It’s as insulting as saying Brexiteers are lacking intelligence, an easy insult to make in the heat of the moment.

The discussions on GB News tend to be respectful and informed. Clearly, some of the panels are a bit Mail/Sun/Express for me, but I choose to watch these individuals. Some arguments are bit off-the-wall and to my knowledge incorrect, but you get that everywhere. But the election results from England came as no surprise to me. Keir Starmer will not become Prime Minister, and I am certain that the Labour Party in due course will replace him.

The exclusion of Jeremy Corbyn is an admission that we live in a Presidential system, and that there should have been processes and procedures in place to root out all antisemitism in the Labour Party. But that is clearly not the only problem in the Labour Party – others include its funding crisis, the lack of publication of the Forde Report, allegations of Islamophobia, and so on. The attacks on Corbyn simply look like a hate campaign, a highly personal one, and disenfranchises all the people who supported him for the last few years. Last Thursday, the ‘get out the vote’ door knocker who came to my flat was clearly a young person recruited during the Corbyn era, who did not really want to be there.

Having read Paul Embery’s book ‘Despised’, which I strongly recommend by the way, it struck me that I fall into the demographic which did not really understand Brexit, living in North London, a Europhile and University-educated. The book is very elegantly argued, and it has helped me understand what has gone badly wrong from the ‘left’. For example, we have pumped a huge amount of an effort into an university class saddled with colossal debt with few opportunities to build a future sometimes. It happens that, from my personal experience, that the people on the left who have succeeded have come from privileged backgrounds.

Seeing gains in the North East for other parties, and basically the performance of Labour flatlining, made me think that Dehenna Davidson MP’s opponent in a TV debate really didn’t understand why Labour was so unattractive to the voters, almost to the point of lacking all insight. It was totally exasperating, almost to the point that that Labour MP looked dangerously out of touch.

The next general election could come sooner than you think. Starmer offered no alternative thinking in the pandemic, nor on Brexit. OK, he has put all his eggs in the windfall tax basket, but it seems that Starmer cannot put forward a political argument and take people with him. Optics matter. The spectacle of Sadiq Khan euphoric in Barnet in London as a ‘game changer’ was utterly ridiculous, and possibly itself alienated voters. The issue is that Labour did not do well in the rest of the country, and the Conservatives and LibDems even managed to make some gains.

The fact that Labour can’t even discuss Brexit or immigration is staggering. The lack of opposition on Brexit is extremely worrying given the potential effects this is having economically and geo-politically, and even Brexiteers, I assume, don’t want a total cover-up. At a time when freedom of speech is so cherished, why is that the problems regarding Brexit aren’t discussed in a mature manner.

Rather surprisingly, I was called a ‘fat gammon’ this week on Twitter, despite the fact that I troll Tweeps with my profile which says, ‘Woke’. Watching GB News as entertainment has helped me to understand other people’s views, even though I may not necessarily agree with them. There are, for example, reasons why some people felt they did not benefit from membership of the European Union. I suspect some Tory MPs know that Johnson is more in touch with his voters than they are, whatever your personal views about these voters. The election results from England last night therefore made perfect sense to me, even if the BBC pundits seemed extremely surprised.

As it happens, I too feel despised by the Labour Party, and the discussions on GB News have in fact opened my eyes. There’s a lot there I disagree with, rest assured, but I am mature enough to make up my own mind.

 

@dr_shibley

 

The delirium OSCE. We need to talk about this.



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When I sat finals in clinical medicine in Cambridge in 2001, student doctors would be given ‘short cases’ and a ‘long case’. It was all a bit of a carnival in short cases, where you’d be taken to various patients and you might be given a few minutes with them.

For example, in the ‘old days’, you might be taken to a patient wearing a wig, and the discussion might be causes of hair loss. Or even, you might be taken to a patient with a glass eye with a successfully resected choroidal melanoma, and the discussion might be on melanoma.

There is no wish from me to be nostalgic about this. This was a very hit or mess method of assessment, and suited those people who treated clinical medicine exams like a game show. Exactly twenty years later I find myself writing a station for an ‘objective structured clinical examination’ – the OSCE – where student doctors are given a finite amount of time to take a history or to do a focused clinical examination, and examiners mark off certain competences against checklists to provide a rating overall.

Once qualified, student doctors after a period of pre-registration will become registered by the General Medical Council. This means that they are considered ‘fit to practise’, and their primary duty is to the patient and to observe patient safety. For a qualifying examination, you would therefore expect the candidate, a student doctor hoping to qualify in clinical medicine, to interact with a ‘real patient’ or a ‘simulated patient’ or even mannequin.

The key word here is ‘patient’ not ‘carer’.

When I first embarked on an academic journey into dementia, which led to my first book on dementia published in 2014 entitled ‘Living well with dementia’, it was very much the case that the narrative was individuals with newly diagnosed dementia were individuals in their own right. They had autonomy, independence and are deserving of dignity. It was argued that the stigma and prejudice surrounding people with dementia came from persistent media distortions representing people with dementia as devoid of credible speech and other behaviours.

But it is clear that carers are relevant to patients in all sorts of contexts – such as improving health and wellbeing, shared decision making and integrated care and support planning.

Delirium might be a presenting syndrome in someone who later goes on develop a full-blown cognitive impairment of some sort. In many cases, delirium is said to ‘unmask’ the dementia, comparable to how a urinary tract infection might reveal underlying vulnerabilities in an older person with frailty.

The issue here is that a person with delirium might have no idea who he or she is, might be talking gibberish, might fall asleep mid-sentence, or might not know where he or she is. Therefore, taking a traditional history off him or her might be very challenging, to say the very least. We should like student doctors to feel confident in identifying accurately a patient with delirium. With time, we should expect doctors to be able to complete successfully a quick 4AT on someone with delirium.

Delirium is worth diagnosing because what it isn’t in all cases is totally reversible with no sequelae. With, for example, recurrent delirium episodes, somebody might become more cognitive impaired, lose indeependence, become deteriorated in functional activities of daily living, and might even die earlier than expected. Carers often say to me in person that they have a really awful time communicating with doctors in the NHS. Carers in reality are friends or close family, often, and the bad communication is not intention.

Carers end up being quite important in health and social care services, including unpaid family carers. These family carers are often with a ringside seat to observe an acute change in consciousness and cognition or behaviour over hours or days. They invariably end up being care partners during somebody’s hospital admission which tends to be emotionally demanding for all, including healthcare professionals. They are clearly important at the point of discharge, especially if somebody loses abilities temporarily including physical deconditioning.

I find myself coming full circle studying a Masters in medical education at Nottingham. In designing an OSCE for delirium, I find myself drawing on experience as a family carer, and my situated learning of delirium in that context. As it happens, I am also a physician by training.

I am drawn to the immense distress the delirium episode provides for me as a carer, the loved one (the patient) and the clinician.

If I am to write an effective OSCE for delirium it is therefore to emphasise its position as a medical emergency. This is because delirium is often the ‘canary in the mineshaft’, i.e. the warning for something more sinister like severe constipation or an infection of some sort.

It is therefore a test of the art of diagnosis.

But it is also a test of someone’s communication skills and especially empathy. Distress requires attention. Delirium, or the “acute confusional state”, therefore does merit some practical examination of clinical skills. It is virtually never likely to come up as an examinable case for the membership of the Royal College of Physicians, but conceivably could be a 10-minute GP-consultation “CSA” case in the corresponding clinical examination for the Royal College of General Practitioners.

What is striking to me is the lack of published peer-reviewed literature on the examination of communication skills of doctors with carers, or the ability to take an informant or collateral history prior to undergraduate qualification.

We know that that the official curriculum is over-burdened, and hard to put in practise, but delirium is inherently distressing as well as clearly a patient safety matter.

We might be able to do better.

 

@dr_shibley

 

 

Claire Fox hit the nail on the head. It doesn’t add up at all.



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The narrative from the media is: Cressida Dick bad, the rest of the world good.

I’m not surprised Baroness Claire Fox’s head was hurting after hearing two opinions on GB News, about the resignation of Dame Cressida Dick.

I am likely due to the ‘footballification’ of politics likely to indulge in a bit of conspiracy theory that Dame Cressida Dick is best mates with Boris Johnson, both having been to the same Oxford college (perhaps, I haven’t checked the factoid).

But if the referendum has taught us anything at all, it is dangerous to do ‘binaries’. And the world is full of them: vax or no vax, net zero or no net zero, Brexit or no Brexit, lockdown or no lockdown, and so on. Life could just be a series of referenda.

Dame Cressida Dick is the top of her profession, regardless of her gender or sexuality. And uniquely so, regardless of her politics.

It would therefore be unlikely that Cressida Dick is a misogynist, and so on.

For all the talk of the Met Police being institutionally racist and sexist, why would they need so much training in these domains? Why go to so much effort with rainbow armbands or “taking the knee”?

To reuse a binary, the Met Police is either misogynist and racist – or it’s not.

But I personally am fed up of the abuse of marketing about diversity.

For all the talk of the disability employment gap, the NHS is ineffective in employing people who are disabled at the bottom or the top or in between in the NHS.

I attended a teaching day yesterday, and there was no discussion of the value that disabled doctors could bring to the NHS. The teaching session went straight in with ‘reasonable adjustments’ under law.

Somebody I had never known before tweeted me to say he had been encouraged to seek a non-medical job, despite being a very intelligent doctor, on account of ‘you can’t cure autism’.

I am not especially surprised at this sentiment from others. For ages, I have been wanging on about how adults who suddenly find themselves disabled need a phased return under reasonable adjustments of the Equality Act 2010. That is their right.

In effect, nothing happens. The NHS does not even have a workforce plan for disabled doctors. It instead has a glossy ‘People Plan’ which is no more useful than Grazia magazine.

Not for the first time I find myself in agreement with Claire Fox.

And I am no contrarian!

 

 

@dr_shibley

Starmer and out?



I don’t have any skin in the game.

I voted Labour all my life – between 1992 and 2019. I’ve never voted Tory.

A small confession. I’ve never met Sir Keir Starmer. I have seen him sitting in the audience as he was supporting the then newly crowned leader of Labour, Ed Miliband.

Ed Miliband is somebody I could happily have as Prime Minister.  I remember David Cameron’s Twitter jibe, now infamous:

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That was of course he set in motion a chain of events that led to the referendum, causing Britain to exit out of the European Union. It is widely thought that Nigel Farage can be thanked for precipitating this. He of course is not especially happy how Brexit has gone now. And who can blame him, with fishermen losing business, pig culls, huge loss trade, marked shortages in certain sectors of the economy, to name but a few. Luckily for the current Conservative government there are voters who are desperate for Brexit to work, like they are for the Tories to reverse years of Tory austerity under the guise of ‘levelling up’.

I understand Rachel Reeves’ optimism about a possible Labour victory. I also have experienced this illusion of ‘one last heave’ – where one final push will guarantee a Labour government.

But having followed this for years, I don’t think we’re there yet.

There are a number of reasons.

If “Captain Hindsight” can only be offering ‘constructive criticism’ while continuously to carp irritatingly like a back seat driver, “General Sit on the Fence” hardly inspires confidence with his endless streams of boosterism and lies.

A rosette on a Starmer cannot explain the lack of input into policy on Brexit, coronavirus or even the reorganisation of NHS and social care. Starmer and the whole shadow cabinet are lost in action. Nowhere to be seen.

They indeed, like Hilary Benn was so obsessive about, seem to be more focused on winning power than turning heads with policy. The brut force of Michael Foot intellectually, or indeed Enoch Powell, offered something quite unpalatable politically – though in defense of Foot, he never wore a donkey jacket and much of his 1983 offering has now been assimilated into current policy.

I want a Labour government, more than a Johnson one.

I don’t think people are keeping diaries about what they think of their civil liberties, the vaccination programme, or the battle of the dinghies.

But the step before the public vote for a Labour government is them endorsing a new Tory Party under someone like Liz Truss. I thought nobody would ever vote for Boris Johnson, but it turned out the media loved him, and that people had ‘factored in’ all his misfeasance.

Starmer would prefer to keep his mouth shut on environmental issues, or human rights, or policing, or housing.

But this policy of muscular silence is going nowhere. Nobody knows what he or Labour stands for, much that they find this current Government sleazy and a bit dodgy.  It could be argued that Starmer has bus loaded in a lot of ‘serious people’ but I can’t name many of them apart from Yvette Cooper or Rachel Reeves who were instrumental in making my life hell for much of the 2010s for feeling guilty for being disabled.

The arithmetic is pointing to a solid SNP victory in Scotland, and it’s very hit or miss who will be the dominant party in England and Wales. Possibly Wales might save Starmer’s bacon, so to speak.

Dame Maureen and Dame Margaret are totally irrelevant to me.

Whilst the poll lead is welcome for Labour, I don’t think it is at all meaningful. John Rentoul, for all his brilliance, is badly wrong – or maybe it’s merely wishful thinking.

 

@dr_shibley

Whisper it softly. Keir Starmer is especially crap at politics.



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Donnez-moi a break.

At a time when Labour has voted in a new General Secretary in David Evans, the news is of sacking staff, threatening compulsory redundancies, losing revenue, and a full frontal attack on members. Evans was hardly voted in with a supermajority. Sadly, the vote was not advisory, even if it was at the level of 59/41, almost exactly the 60-40 split estimated.

To revisit an era, things can only can get better.

It’s on days like this that Dame Margaret Beckett had wished that she’d stayed in her caravan.

Labour has had a disastrous start to its latest conference.

The best that the political commentators could say to Keir Starmer’s handling of the launch of the Labour conference was that ‘it is good for Labour to be seen fighting the Unions’.

I suspect it would be good for Labour to be seen fighting the Sun newspaper, but, at the latest count, the Sun newspaper is out in force too.

At the launch of the Labour conference in Brighton, the day normally begins with something motivational for the membership. Not this time.

This time, we are told that, for the Labour leadership, the proposals are to raise the threshold of mp nominations, get rid of the “registered supporters”, and a commitment to review rules inc how to restore vote for unions’ political levy payers.

As far as the membership is concerned, Starmer has spent the last two years brown nosing the Johnson government, having given up even on the slightest of ‘constructive criticism’. Nobody can see the point of what is possibly the worst Labour opposition in my lifetime certainly.

Emma Radacanu, having won the US Open, has just said goodbye to her coach. Starmer, on the brink of the worst Labour disaster in history, even with the media this time supporting him to the hilt, is about to make all the offenders Knights of the realm or CBEs in his mission to promote failing upwards.

Starmer had a golden opportunity at the start of conference to make his mark over the energy crisis, inflation hike, driver shortage exacerbated by Brexit, dumping the triple lock, UC cut, NI hike, or public sector pay freeze.

As far as the over-spotted Red Wall voter is concerned, Labour is fronted by a Remainer who hated Jeremy Corbyn so much he was more than happy to be in his Cabinet. This particular Remainer, as it happens, can’t wait to get his teeth into the necks of anyone vaguely socialist in the Labour Party.

Let’s face it – not even an interview between Wes Streeting and Gloria Di Piero on GB News can stop the rot now.

The Conservative, Unionist and UKIP Party don’t especially to seem have any ideological direction to their roadmap, apart from an addiction to authoritarianism and the “market” which has consistently failed in the NHS, gas, education, and, you name it. All it cares about is media management of the latest crisis. Even Liz Truss MP is tipped for the top now.

Labour should be a hot bed of democratic socialism. It is instead a hotbed of undemocratic croneyism. A relatively popular contribution could be Labour’s proposed Fair Pay Agreements would give working people a pay rise and boost our economy. Labour would bring together representatives from workers and employers to agree minimum pay and conditions in their industry. A radical look at workers vs employees, and a revision of workers’ rights in a gig economy, to revise the Employment Rights Act (1998), would be a good contribution.

Instead, whilst the Labour rulebook states that conference should have a formal vote (show of hands) on the NEC report. Dame Margaret Beckett is not one for following rules to hold the vote. There’s no need to rig a vote any more. Just don’t hold it.

Of course, the HGV and tanker driver crisis is nothing to do with Brexit, and all to do with those pesky unions in Swansea at the DVLA, or refusal to do medical checks from lazy GPs. This is a weird dystopian Universe where Starmer has been taken hostage by a weird sect in the Labour Party determined to make Labour look out of touch and irrelevant.

@dr_shibley

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