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The “disastrous” performance of this Tory-led government was not accidental. It was entirely deliberate.



PMNHS

One conversation I once had with Jos Bell (twitter here), an incredibly productive campaigner and chair for the independent Socialist Health Association London division, had much more of a profound impact than I thought at the time.

I simply remarked that the Conservative-led government had been ‘disastrous’.

Jos disagreed. She pointed out that the term of office had gone extremely successfully for the few who’ve made shedloads of money through private equity and hedge funds.

A massive assumption we’re all prone to make, some more than others, is that the political class largely represent us and our interests.

The number of ‘lost votes’ is the reminder to all of us of how disconnected parliamentary politics have become with our needs and concerns.

There are, of course, some truly outstanding MPs, however.

Another realisation for many, almost a right of passage, is the “lightbulb moment” that some leading ‘independent’ health and care think tanks have not been offering useful reliable impartial advice after all.

The performance of some on the issue of competition, a shoo-horn for neoliberal markets, against the wishes of many professionals, is a testament to them.

Dodgy advice was used to prop up the business case for the Health and Social Care Act (2012), and it is going to take a long time to unwind from this.

I know of the misery that the ‘welfare reforms’ have had on the morbidity and mortality of disabled citizens. This does not prevent ATOS from fulfilling a lucrative contract, which was made under the last Government (Labour).

There are accusations and counter-accusations of the effects of injection of private capital, the private finance initiative, which many hope will be addressed properly by the incoming government next year. City financiers and law firms continue to benefit from this sustained policy which has reaped havoc on various ‘local economies’ of the NHS.

The sale of Royal Mail, and various other projects, into the private sector at an undervalue (it is alleged) clearly has not been to the best benefit of the taxpayer. But again many in the City, some alleged to be close to the current Government, have benefited personally (it is alleged).

Through the prism of me and my friends, this Conservative-led Government has been ‘disastrous’. But they’ve actually achieved a lot for themselves in the last few years in the tenuous argument of ‘austerity’.

The buzzword for George Osborne was ‘choice’, and you could hear a pin drop literally at George Osborne’s reassurance in his speech yesterday, “We’re all in it together”.

I simply can’t agree with political commentators who wish to pollute the discussion with their meme that ‘Labour do not wish like a party who wish to govern.”

Many grassroots activists in Labour are desperate to sort out the mess the country finds itself in.

They certainly detest the idea of a Tory-UKIP coalition.

The repeal of the Health and Social Care Act (2012) will be in the first Queen’s Speech of an incoming Labour government.

This Act of parliament turbo-boosted the aggressive pimping of NHS contracts into private sector providers. Correct – another set of beneficiaries from this government, led by the Conservatives but the lifeblood of which is currently provided by the Liberal Democrats.

In many ways, the next period of office is a ‘poisoned chalice’ once again, with debt in the last four years 4 x as much as the debt amassed by Labour in 13 years.

But, to repeat David Cameron, “we can’t go on like this”.

And the goalposts keep on moving.

An identifiable threat still remains having a means-tested social care service bolted onto the ‘universal’ health system, like a badly soldered “lemon car”.

A threat, less visible on the event horizon, is the corporatisation of general practice in the English jurisdiction.

I suspect that, despite the noise produced by UKIP and LibDems, the NHA Party will fail to make inroads in seats in the actual election. This will be of great sadness to me, despite the fact I wish all Labour candidates very well, as they are clearly campaigning on many relevant issues.

I feel that Labour will win the next general election. But I am terrified that, like the aftermath of 1997, it will be another missed opportunity for us.

 

 

@legalaware

The GMC needs to be a good citizen too



Weltkarte, Lupe, Europa, Krise, rot, Eurokrise, Suchen, Lösunge

The topic of how corporates act as ‘good citizens’ has been significant in recent years, for example the synthesis of work on strategy and society.

Broadly speaking, this work has identified a number of different concepts which are vital to corporate social responsibility.

The first is a ‘moral obligation’.

This must include honesty and integrity, and directly relates to domain 4 of the code of conduct “Good medical practice” for standards in trust and probity from the “General Medical Council” (GMC). Moral behaviour and legal regulation are dissociable. A legal ‘duty of candour’ or ‘wilful neglect’ are enforcement mechanisms for people telling the truth and protecting against deliberate malicious behaviour. But these are undeniable moral imperatives too. If the clinical regulator finds itself in dealing with a case in an unnecessarily protracted length of time which is disproportionate to reasonable standards, the clinical regulator should make an appropriate apology, ideally.

Sustainability is important if the clinical regulator is to be ‘in the long game’ rather than grabbing headlines for being seen to be tough on misfeasance from individuals. This means in reality that the clinical regulator should be sensitive to the environment and ecosystem in which it operates. If it is felt, for example, that politically and economically it is expedient to pursue ‘efficiency savings’, the regulator must have a sustainable plan to ensure that it is able to ensure that such savings do not impact on patient safety. The raison d’être of the GMC is supposed to be promote patient safety. A proportion of the Doctors will be unwell. The legal precedent is that conduct which is so bad cannot be condoned whatever the reason. However, it is also true that ‘but for’ alcoholism, for example, certain problems in misconduct and poor performance would not have occurred. An ill doctor is about as much use economically as somebody out of the service entirely, so it is an economic sustainable argument that the health of doctors should be an imperative for the NHS. A ‘patient group’ within the GMC would go a long way to demonstrate that the GMC is capable of playing its part within a wider ecosystem. I know of no other important entity which does not have one.

Thirdly, there should be a license-to-operate. This cannot be overstated. ‘Mid Staffs’ commanded much momentum in the media which was a problem for both the medical profession and its integrity, and yet there is still an enduring issue whether the GMC were able to regulate this as best they could under the confines of the English law and codes of practice. The GMC are also yet to report on the deaths of Doctors awaiting Fitness to Practise hearings, and the outcome of this will be essential for Doctors to ‘buy in’ literally into wishing to pay their subs.

Last of all is reputation. This goes beyond the popularity on a Twitter stream. At the moment, there is concern that neither the medical profession nor the public feel very satisfied about the performance of the GMC. There is uncertainty what the public perception of the GMC is; many feel that it is a general complaints agency, when it is, in part, to regulate the performance of individual Doctors. There’s no statutory definition of what ‘unacceptable misconduct is’, and hugely relevant to the reputation of the medical profession. This had been addressed in the English Law Commission’s proposals for regulation of clinical professionals, which are yet to see the light of day. Without this definition, the GMC can simply come down heavily on behaviour which it feels is embarrassing with impunity, whatever the potential other contribution of that doctor might be. It is quite unpredictable what the consistent set of standards where members of the public feel wronged might be for this; the GMC is very unwilling to be seen as a ‘light touch’ against members of the public who want tough sanctions.

There are so many aspects how the GMC could demonstrate its willingness to be a good citizen, which could help with the four points above. I feel as a person who has been through the whole cycle of having been regulated, who takes his credentials of being a NHS patient and being a student lawyer regulated by the Solicitors Regulation Authority rather seriously, there are constructive ways to move forward.

Firstly, I would like to see a ‘user group’ of Doctors who’ve been through the regulatory process, and who have had bad health, who might wish to volunteer on helping the GMC with improving its operational output. Secondly, I understand the temptation to throw ‘red meat’ at the readership of certain newspapers. But likewise, the GMC could make more effective use of local dispute resolution mechanisms, looking at what the Doctor, the Trust and the member(s) of the public would like as a compromise to problems. This could have the aim of having a Doctor where reasonable corrective action has taken place finding himself or herself being able to return to work. The current situation has evolved through history as being adversarial, and this can err towards catastrophising of problems rather than wishing to solve them. Likewise, there is a public perception that some issues are completely ‘shut down’ before any attempt to investigate it. Thirdly, the GMC must be aware, I feel, of the evolving culture and landscape of the medical profession across a number of jurisdictions. This means the GMC, patients and professionals could be, if they wanted to, united in their need to uphold the very highest standards of patient safety. Clinicians work in teams, and techniques such as the ‘root cause analysis’ have as an aim finding out where the performance of a team has produced an inadequate outcome. Furthermore, there is no point in one end of the system urging learning from mistakes and organisational learning with the other end of the system cracking down heavily on individuals, with the effect that some individuals never work again.

Like whole person care in policy, the clinical regulator should be concerned about all the needs of an individual, including health needs, public safety promotion, and the needs of the service as a whole. I have every confidence that the GMC can rise to the challenge. It’s not a question of light touch regulation, but the right touch regulation. 

And, as per medicine, sometimes prevention is better than cure.

 

 

 

Andy Burnham at the Fabian Society explaining a need for ‘whole person care’



Andy Burnham MP was invited to speak at an event called ‘Together’ on the subject of his Fabians pamphlet of the same name. This video was taken at the Labour Party Conference 2014.

Here he gives a vigorous defence of the proposed policy, not unique to this jurisdiction, on ‘whole person care’. In England, however, it will mean the formation of a National and Health Care Service. It therefore has profound policy implications.

Andy Burnham’s speech to the Labour conference on 24 September 2014



AB

 

Andy Burnham MP, Labour’s Shadow Secretary of State for Health, in a speech to Labour’s Annual Conference 2014 in Manchester, said:

 

 

Conference I’ve got a question for you.

Hands up how many of you would walk 300 miles to save the NHS?

Stand up if you actually have?

Leading from the front, speaking for millions – Conference, please show your appreciation for the Darlo mums and the People’s March for the NHS. We have arrived at a big moment.

The party that created the NHS in the last century today sets out a plan to secure it in this. A rescue plan for a shattered service.

But more than that. A vision for a 21st century NHS there when you need it, personal to you and your family, with time to care. A national health and care service based on people before profits.

Today we place that proud Labour plan at the centre of our election campaign.

And, thanks to Ed’s great speech, we have the money to back it up.

A plan worth voting for, proof that all parties are not the same, giving you a real choice over the future of your NHS.

Because it certainly didn’t happen last time.

Remember that solemn promise of “no top-down reorganisation”?

It was a bare-faced lie.

Days into office, the Tories set about dismantling your NHS.

And the plan that dared not speak its name before the last election is now plain for all to see: run it down, break it up, sell it off.

So today we serve notice on Cameron and Clegg: Thursday 7th May 2015 – your day of reckoning on the NHS.

A reckoning for trashing the public’s most prized asset without their permission.

And a reckoning for a ruinous reorganisation that has dragged it down and left it on the brink.

A winter crisis in A&E now a spring, summer and autumn crisis too.

Over three million people on NHS waiting lists.

Families waiting longer for cancer treatment to start – and the national cancer target missed for the very first time.

The NHS can’t take five more years of Cameron.

I could go on about the damage he’s done.

But let’s be honest – would that help people worried about where the NHS is heading and wanting real answers?

I know there will be families and carers out there watching us today wondering whether anyone really understands what their life is like.

Soldiering on from one day to the next, feeling invisible and taken for granted, ringing the surgery early in the morning but unable to get through, telling the same story to everyone who comes through the door.

You feel no one listens – and no wonder.

So that’s why I’m going to do something different today.

I want to speak directly to you.

And to the parents of children with disabilities, for whom life feels like one long battle and who fret endlessly about what would happen to your son and daughter if you weren’t around to fight.

To the millions of you who face the daily worry and stress of arranging mum or dad’s care whilst trying to hold down a job.

And, most of all, to those of you who might be watching this alone at home fearing what the future might hold.

My message is simple: Labour is with you; your worries are ours; we know things can be better than they are; we want an NHS that takes your worries away; and we can achieve it if we do something bold.

The time has come for this party to complete Nye Bevan’s vision and bring social care in to the NHS.

That allows us to rebuild our NHS around you and your family.

No longer ringing the council for this, the NHS for that.

But one service, one team, one person to call.

An NHS for the whole person, an NHS for carers, an NHS personal to you. At last, a National Health Service keeping you well, not a national sickness service picking up the pieces.

And an end, once and for all, to the scandal that is care of older and vulnerable people in England in 2014.

I ask you this: how much longer will we say that people who are so frail that they need help with getting up, washing and eating, and who suffer from loneliness and isolation, are only worth a slap-dash 15 minute visit?

How much longer will society send out the message to young people looking after someone else’s mum, dad, brother or sister that it is the lowest form of work, lower than the minimum wage because it doesn’t pay the travel time between the 15 minute visits?

How much longer will we see these shameful scenes from care homes on our TV screens of people being shouted at or abused and not say enough is enough?

And for how much longer, in this the century of the ageing society, will we allow a care system in England to be run as a race to the bottom, making profits off the backs of our most vulnerable?

If this party is about anything, then surely it is about ending that.

I want you to understand why I feel like this.

About ten years ago, I saw my own mum ground down and worn out by the battle to get decent care for my gran.

She was in a nursing home where corners were often cut and where it was hard to get GPs to visit. The decent people who worked there were let down by the anonymous owners who filled it with untrained, temporary staff.

My gran’s things often went missing and we had got used to that.

But I will never forget the day when we walked in to see her and her knuckle was red raw where her engagement ring had been ripped off.

Right there, right then – I made it my mission to end this scandal.

And the greatest sadness of all was that this so-called care cost my grandmother everything she and my granddad had worked for.

I know millions of families have been through the same or are going through it now.

People look to Labour to change these things and that is what we will do. You know the Tories will never do it. They put profits before people – always – it’s in their DNA.

Their answer is to let the market that has ripped through social care carry on ripping through the NHS.

Conference, we will do the precise opposite.

I am clearer about this than anything in my life – the market is not the answer to 21st century health and care.

People out there know a minimum wage, zero hours approach will never secure the care they want for their mum and dad.

So our ten year plan for the NHS is founded on people before profits.

We will free the NHS from Cameron’s market and, yes, repeal his toxic Health and Social Care Act.

We will ask hospitals to collaborate once again and reinstate the NHS as our preferred provider.

The public NHS, protected with Labour. Not for sale. Not now, not ever.

Cemented at the core of every community so that it can then begin the job of bringing social care in and lifting it up. Building a culture of respect for all people who care and ending the indignity of flying 15 minute visits.

Caring no longer a dead-end job but part of one workforce working to NHS standards.

But there is a reason why we give the public NHS such stability.

It is so that we can ask it to embrace radical change in the way it provides services to you and your family.

We will ask hospital trusts and other NHS bodies to evolve into NHS integrated care organisations, working from home to hospital coordinating all care – physical, mental and social.

Why? Because it makes no sense to cut simple support in people’s homes only to spend thousands keeping them in hospital.

We can’t afford it. It will break the NHS.

But, more, it’s not right for you.

The ever-increasing hospitalisation of older people is no answer to the ageing society.

Bringing social care in doesn’t add to the financial burden.

It is the key to unlocking the money. But it will mean change and you need to know what that means for you.

Just as Nye Bevan wrote to every household to introduce his new NHS, so I will write again in 2015 to explain what people can expect from our national health and care service.

And this is what I will say for any family caring for someone with long-term needs, one team around you.

No longer should frail or vulnerable people be shunted around the system, from ambulance to A&E to noisy ward. Instead, this team will come to you. Its goal will be to keep you in your own home, safe and well.

You and your carers will have one person to call to get help so no longer telling the same story over and over again.

You will have a care plan personal to you and your family.

If you and your carers get what you really need from the start, then it’s more likely to work. Building the NHS around you will need a new generation of NHS staff, as Ed said yesterday.

So we will recruit new teams of home care workers, physios, OTs, nurses, midwives with GPs at the centre.

And will we have mental health nurses and therapists at the heart of this team, no longer the poor relation on the fringes of the system but making parity a reality.

And to make sure this investment is not creamed off by others, we will look at how we can ensure private health providers contribute their fair share towards the cost of training.

But, with the best will in the world, the NHS won’t be able to do it all.

That is why I can announce today a big change in the way the NHS supports carers so they can keep going.

No longer invisible but at the very centre of this new service.

So today we announce new support for carers: protected funding for carer’s breaks; the right to ask for an annual health check; help with hospital car parking for carers; and we will go further.

We will give all families the right to care in their home, if they want it.

A national health and care service truly there from cradle to grave – from a new right to have a home-birth and a right to be in your own home at the end of your life, surrounded by the people you love, with your care provided on the NHS and no worry about its cost – starting with those who are terminally ill with the greatest care needs.

These are the things that matter and this is about an NHS there for you at the most important moments in life.

This is what people want and this is what becomes possible with our plan.

True whole person care – simply not possible in Cameron’s fragmented, privatised, demoralised service.

Make no mistake – this coming election is a battle for the soul of the NHS. The fight of our lives.

Now we must walk 300 miles for the NHS to every doorstep in the land. With hope. With pride. With passion. With a plan you can believe in. But, in the end, this is about more than us. This is about you.

Your children, your grandchildren, your great grandchildren.

It’s about whether an NHS will still be there for them in their hour of need as it has been for you.

Don’t regret it when it’s gone. Join the fight for it now.

So I make this appeal to you.

Help the party that founded the NHS give it a new beginning.

Help us make it the service we all want it to be.

An NHS that puts people before profit.

An NHS that cares for the carers.

An NHS there for your mum and dad.

An NHS with time to care.

An NHS for all of you.AB

The story of me



I’ll be giving a talk on Thursday 25th September 2014 on my personal experiences of alcoholism and interacting with the GMC, at a meeting called “Regulation, Respect and Health Practitioners” in London.

This is a draft of the text of my talk.

** Please check against delivery. **

alcoholism

Thank you for inviting me to speak for about 15 minutes on my viewpoint of the creation of a healthier regulatory process to benefit doctors and patients.

My speaking here comes at a time when there is a genuine drive for care and compassion in national policy in healthcare.

I believe that there should be a mutual respect between junior and senior clinicians, and the clinical regulator. In fact, I think this respect should be cherished and nurtured.

Last month, I had a hearing arranged by the Medical Professionals Tribunal Service (“MPTS”) to hear my application for restoration to the GMC register. This was just weeks after my 40th birthday.

I was asked by one of the panelists there what I had learnt most from my time off the register.

It is, of course, a necessary requirement that all Doctors on the GMC register have kept their skills up to date. This is so that Doctors can fulfill their obligations of performance, skills and knowledge. One of the benefits of having had at least five years out is that I’ve read the doctors’ code of conduct, “Good medical practice”, very many times. But I gave an answer which I don’t regret now for a moment.

I said, “Most of all, I finally know what is like to be a patient.”

I was erased in July 2006. At the time, it was uncertain what my ultimate diagnosis was, but a number of psychiatrists were in no doubt that I was suffering from an alcohol dependence syndrome. After I erased, I then spent heavily drinking alcohol a year in a pub. I used to go to local pubs at opening time, and leave at closing time. They say that unemployment is a big risk factor for mental illness.

Not being regulated at all by the medical profession was a big part of losing what I had perceived to be my identity. There was absolutely no structure or goal to my life. My life hit rock bottom. But, as an alcoholic, you soon realise that, however low you have gone, you can always go even further.

I had been first referred to the GMC a few years earlier. At the beginning of the process, no-one ever told me how long the regulatory process would last. This uncertainty about the future was a huge part, I feel, in my subsequent precipitous decline in mental health. I was erased ultimately for deficiencies in conduct and performance, and poor health, in 2006.

Whilst I was not punished for being ill, it was clear that the professional regulator could in no way condone my undisputed shortfalls in conduct and performance. The question about whether the clinical regulator views health to be intimately linked to professional conduct and performance is an important one. I do.  This matter is also relevant to ‘revalidation’. I feel a junior must not ignore his own personal ill health first selfishly, above the needs of patients.  He needs to get help as soon as possible. With the benefit of hindsight, I so wish I had sought help sooner.

When I was erased, I felt I became “public enemy number one”. However, they say that self-pity is a huge risk factor for drinking relapse. It was at one level a private shame . My father, who later passed away in 2010, was deeply humiliated by the whole experience, even though he had caused none of it. My father had been a GP for about 25 years. Therefore he adored the GMC. He felt GMC was “God”. But God moves in mysterious ways? As a loving father, he stuck by me throughout. As did my mother, with whom I still live.

The whole thing was, however, also a very public shame.  You can still find reams and reams of it adorning Google. The avalanche of news reports about this, while creating a moral panic, virtually invariably never mentioned my severe alcohol illness. But that, as such, doesn’t matter to me any more even though I am keen on one aspect. I am still keen to remind myself of the distress I caused while I was powerless over alcohol. That’s why I have never asked for any of it to be deleted off Google in this jurisdiction.

I’ve never had a salaried job for the last eight years following erasure. In the only two job interviews I had for legal posts I was asked about my Google footprint of the GMC case.

On a day at the beginning of June 2007, I was ‘blue lighted’ into the Royal Free. I had had an epileptic seizure, but the crash team lost my airway. They tried to intubate me, but I then had a cardiac arrest, from which I was successfully resuscitated. I literally owe my life to the NHS.  I was kept alive for six weeks, while completely unconscious in a coma. When I woke up, I could not walk or talk. I became newly physically disabled. But the neurorehabilitation team at the National Hospital for Neurology and Neurosurgery, where I was in fact a junior doctor, then taught me how to walk and talk again. I remember how the occupational therapist taught me how to shop in a supermarket. I learnt, from scratch, how to perform basic tasks, such as making a cup of tea.

I always had loved medicine. I got the second highest First in neuroscience in my undergraduate course in Cambridge. I got my PhD in 2001 in identifying an innovative way of diagnosing behavioural variant frontotemporal dementia. I later passed my diploma of the membership of the Royal College of Physicians. I have published three books for junior physicians negotiating each of the three components of this demanding examination for core medical training.

My late father, however, emphasised to me that that coma, in many respects, saved my life. I agree with him now. It heralded the start of my period of abstinence from alcohol. I have now been in recovery from alcohol continuously for seven years. I take one day at a time.  I am content now.

Since my coma, I have obtained my Bachelor of Law, Master of Law and my Master of Business Administration, and completed my pre-solicitor training. I adore the law as well, and I am fully signed up to the legal doctrine of proportionality, where the law must balance competing interests where they exist. I became regulated in 2011 by the Solicitors Regulation Authority after an extensive due diligence process.

Last month, my application for restoration onto the GMC Medical Register was approved.

This is not, however, by any means the ‘endpoint’ to my new life. I am not only keen to learn lessons for myself from the experience, but I am now also keen to help others. This is why I regularly attend, voluntarily, the ‘suspended Doctors group’ for “The Practitioner Health Programme”. I am under a psychiatrist, whom, without being hyperbolic, I feel saved my life.

I look back on the psychiatry reports of me when I was ill during 2004-2006 with utter disbelief. I was hugely in denial – had no insight into all how I at all junctures minimised the catastrophic effects of my active drinking. The “paradox” for dealing with a drink problem is that you cannot ‘do it’ on your own, and yet you must get help for the problem and realise your powerlessness over it.  For me, it’s very simple – I can’t ever have a casual drink ever again. One alcoholic drink is one too many, and yet one drink is never enough. It ruined my life.

For me, the critical key to success is having a close circle of people in a social network, including an after care group in my local hospital, would be able to spot and intervene early in problem behaviour. For the first time in 2007, after my coma, I fully engaged with my General Practitioner. I had numerous ‘false starts’ in dealing with my alcoholism between 2004 and 2007.

I personally found the pressure of being investigated and dealing with my illness, during this period, unbearable. A part of me wishes, in retrospect, that I had been “better managed” in terms of performance at the time. Witness statements report me as looking ‘alcoholic’ and ‘dishevelled’ while on the wards, when my performance was clearly poor. A part of me wishes I had been “made to go to occupational health”, when these problems first surfaced.

But a part of me strongly resists my transference of blame onto other parties. As I admitted to my restoration panel, I made plenty of mistakes of my own: for example, I never engaged properly with my own G.P. until my coma.

I was most obviously, prior to my coma, a clear threat to patient safety. And it states clearly in s.1 (1A) Medical Act 1983, the GMC must promote patient safety. So I strongly believe the original sanction was the correct one.

But now, next month, as a different person, I’ll be presenting my research, based on an online survey, on the funding of dementia care. This will be at the prestigious Alzheimer’s Europe conference in Glasgow. This January, I published a popular book entitled, “Living well with dementia”. I feel that, with my truncated medical training thus far, and my postgraduate degrees in law, medical research and business management, I can be an asset to the public health and health policy arm of the medical profession.

For me, my return to the GMC register, after completion of the identity check, will be a huge privilege.

Sadly, it can be rather too easy for colleagues to gang up on individuals and ringfence problems, rather than solving the problems at root to make the health and care services better. I am sure that many juniors feel: “there for the grace of God go I”.

One cannot away from the enormity of the problem of unwell Doctors in the NHS, however. I felt totally abandoned during the regulatory process and could have done with more support at a time when I especially needed it? In conclusion, the public including staff would like to have pride in the medical profession and its regulator. I too would like to see this goal come to fruition one day.

Death might not be inevitable in Ed Miliband’s “leader speech”, but taxes might be?



cigarettes

 

Tobacco use is expected to kill around 5.4 million people worldwide a year.

It is undeniable that the state of the NHS is directly linked to the overall state of the economy. Austerity has posed a challenge to patient safety, though the official line is that “efficiency savings” have not impacted on safety in England. Nonetheless, it is a fact that unsafe levels of staffing have often been at the root of shortfalls in clinical safety.

The “Keogh review” could not have been a clearer example of this.

The public tend to be most concerned about the NHS if there is an identifiable event, such as Mid Staffs, or breaches of the four hour wait.

It is no big secret that Labour intend to make the NHS THE big issue of the general election campaign of 2015. This is despite the Conservatives’ electoral strategy Lynton Crosby not wishing to discuss the NHS.

But like a Marlboro cigarette, the issue of the link between Lynton Crosby, Philip Morris International Inc. (“Philip Morris”) and smoking policy has been a slow burn in the last year or so.

Labour has always wished to paint the picture that the Conservatives do not come with “clean hands” to the discussion of smoking and health.

There has always been the question: are the public aware of the financial problems facing the NHS? And, despite an universal consensus for low taxes, would they wish something to be done in the specific case of the NHS?

A new dawn for NHS campaigners was the relief that the media, who once a upon a time had been respected, were conflating “unsustainable” and “unaffordable” in their discussions of NHS funding. The NHS is, as they will tell you, should be comprehensive, universal, and free at the point of need. It is hard to know precisely where this confusion had arisen from. I remember vividly complaining about this on this SHA blog in October 2013.

In yesterday’s speech, the Shadow Chancellor Ed Balls made the direct link between income from taxes for the Government and the NHS.

“‘Next year, after just five years of David Cameron – with waiting times rising, fewer nurses and a crisis in A&E – we will have to save the NHS from the Tories once again,’ he said. ‘And we will do what it takes.’”.

Also in October 2013, the Local Government Association published a pamphlet entitled, “Changing behaviours in public health – to nudge or to shove?”.

And there is more than a cigarette paper between the two main political parties here on this ssue.

The current government has made exploring the potential of behavioural change a priority. In fact, the coalition agreement itself made direct reference to the issue, stating that the government would be “harnessing the insights from behavioural economics and social psychology”.

But likewise it has also clear that tools available to government include more draconian approaches as shown by the fact that consultations were carried out on plain packaging for cigarettes (a shove) and minimum pricing for alcohol (a smack). However, neither policy has subsequently been introduced.

I, over a year ago, wrote on this blog on the topic of changing behaviour in relation to smoking.

Ed Miliband has been banging on his “cost of living crisis”  drum for some time. And, in fairness to him, it is an issue which resonates with the general public. For socialists, such as Owen Jones, the issue does particularly resonate as an example of how privatised companies with vested interests have protected their profits at the expense of their customers. They are able to do this due to markets, which have not failed from the perspective of the shareholder, but which have clearly failed from the perspective of the end user.

And a noteworthy consideration here is that such providers have been able to rely on robust demand, for example the need to drink water or to make a phone call. Likewise, certain luxury brands have not seen their profit margins dented by the global economic recession.

Indeed, on May 12 2009, it was reported that tobacco use would continue, possibly grow, during recession, according to experts at the time.

Death and taxes may be inevitable according to the famous Benjamin Franklin quote. But Lord Stewart Wood, advisor and friend to Ed Miliband, is known also to be petrified that Labour once again becomes known as THE “tax and spend” party. Whilst Labour might have been flirting with sexier and covert ways of working things to their advantage, such as “predistribution”, an epiphany lightbulb moment came when Labour realised it could get away with taxing entities rather than people, provided that it did not offend the neoliberal virtues of competition and enterprise.

In an economic downturn, products seen as giving comfort in the midst of stress tend to sell very well. In the U.S. and abroad, tobacco is no exception. That’s why taxing a commodity which does not become popular, and which could damage your health, is such an attractive political policy.

“It’s not well understood, but as people lose jobs, the unemployed and others affected by tough economic times may rely on ‘affordable pleasures,'” Eriksen has said.

“The irony is that the more deprived someone is, people will rely on simple pleasures that are unfortunately deadly pleasures.”

Just under a year ago, in October 2013, Ben Page as Chief Executive of Ipsos MORI  presented a talk: “Public opinion: What price the NHS?”.

79% of the general public were reported as opining that the NHS should be protected from cuts (as opposed to other areas such as policing, benefits or schools).

88% of people agreed that the NHS “would face a severe funding problem in the future”.

Lack of resources and investment in the NHS is way above (42%) is way above other factors which could be posited to be “the biggest threat” to the NHS (including, for example, not enough doctors or nurses, or too much management).

Fast forward to now, and in a September 2014 report from “The Health Foundation”, entitled “More than money: closing the NHS quality gap”, the authors Richard Taunt, Alecia Lockwood and Natalie Berry considered that the NHS faces a significant financial challenge is well known and much discussed. This ‘financial gap’ has been projected to reach £30bn by 2021. This is due to the disparity between the pressures on the NHS and the projected resources available to it.

In the leader’s speech later today, Ed Miliband is ex[ected to put the nation’s health at the centre of a 10-year plan for Britain’s future on Tuesday, front loading the NHS with funding from a novel windfall tax on the profits of UK tobacco companies and the proceeds of a mansion tax on homes worth more than £2m.

A windfall tax normally has its critics because it’s considered to be a very short term measure that risks really damaging the relationship between government and big businesses.

But here is a windfall tax somewhat like no others – as the demand for cigarettes, despite the threat from e-cigarettes, is largely sustainable, and Labour if it is at any war with business is as at war with big businesses abusing markets.

In his final Labour party conference speech before next year’s general election, Miliband will tell sceptical voters he can bring the country back together and offer six ambitious goals, including changes to the NHS, designed to overcome “the greatest challenges of our age and transform the ethics of how Britain is run” over the next decade.

A mansion tax could raise £1.7bn, and had originally been earmarked by the shadow chancellor, Ed Balls, to fund a 10p starting rate of income tax, but that is now due to be funded by abolishing the marriage tax rate.

The poorest twenty per cent of households in Britain spend an average of £1,286 per year on ‘sin taxes’, including betting taxes, vehicle excise duty, air passenger duty, ‘green taxes’ and duty on tobacco, alcohol and motor fuels. In addition, they also spend £1,165 on VAT.

“Sin taxes” have generally been unwelcome by proponents of the free market, such as the Institute of Economic Affairs (“IEA”). In October 2013, the IEA published a report entitled, “Aggressively Regressive: The ‘sin taxes’ that make the poor poorer”.

In this report, the IEA made their disgust for ‘sin taxes’ clear.

It is said that, despite significantly lower rates of alcohol consumption and car ownership, the poorest income group spends twice as much on sin taxes and VAT than the wealthiest income group as a proportion of their income.

It is possible for the Conservative Party to mount an argument that tax is the single biggest source of expenditure for those who live in poverty, and indeed indirect taxes are a major cause of Britain’s cost of living crisis.

The average smoker from the poorest fifth of households spends between 18 and 22 per cent of their disposable income on cigarettes. The tax on these cigarettes consumes 15 to 17 per cent of their income.

And tobacco remains one of the world’s most profitable industries. Current data suggests that smoking is still a huge part of the global  consumer landscape and that the habit is not going to die out anytime soon.

Philip Morris is currently the leading international tobacco company, with seven of the world’s top 15 international brands, including Marlboro, the number one cigarette brand worldwide. PMI’s products are sold in more than 180 markets.

In 2013, the company held an estimated 15.7% share of the total international cigarette market outside of the U.S., or 28.3% excluding the People’s Republic of China and the U.S.

On Sep 14th 2014, it was announced that the Board of Directors of Philip Morris on the NYSE/Euronext Paris PM), increased the company’s regular quarterly dividend by 6.4% to an annualized rate of $4.00 per share.

But cigarettes contain more than 4000 chemical compounds and at least 400 toxic substances.

Cardiovascular disease (disease of the heart or blood vessels) is the main cause of death due to smoking.

Smokers are more likely to get cancer than non-smokers. This is particularly true of lung cancer, throat cancer and mouth cancer, which rarely affect non-smokers. The link between smoking and lung cancer is clear. Ninety percent of lung cancer cases are due to smoking. If no-one smoked, lung cancer would be a rare diagnosis – only 0.5 per cent of people who’ve never touched a cigarette develop lung cancer.

Other types of cancer that are more common in smokers are bladder cancer, cancer of the oesophagus, cancer of the kidneys
cancer of the pancreas, and ervical cancer.

Chronic obstructive pulmonary disease is a collective term for a group of conditions that block airflow out of the lungs and make breathing more difficult.

So, in a weird way, smoking may come to be saviour of the NHS due to a perversion of market forces. It might be the latest brand of “left populism”, leaving Ed Miliband to want to have another puff. It is hard for the Conservatives to criticise without appearing to come down heavily on the side of tobacco companies such as Philip Morris, but Philip Morris are unlikely to forget this in a hurry if the Labour Party are responsible for denting their profits.

Public health was never a sexy campaigning issue for the Labour Party, despite the best efforts of some, with popular newspapers coming down heavily on the side of the consumer than the “interfering state”. But the whole concept of the ‘responsible state’ has become tarnished with neoliberal governments increasingly outsourcing state functions to companies embroiled in inefficient practices and allegations of fraud practices. A windfall tax on cigarettes, despite giving off an unattractive odour of Labour “going back to its taxing roots”, may be, however, just what the Doctor ordered at this particular time in the history of the service.

And, as all politicians know, you can’t please all of the people all of the time.

After today, Labour might be feeling like (a) whole (person) again.

Burnham announces plans to implement a National Health and Care Service over ten years



gp reception

The Constitution of WHO (1946) states that good health is a state of complete physical, social and mental well-being, and not merely the absence of disease or infirmity.

The Shadow of Secretary of State for Health, Andy Burnham MP, says that he has tried to produce an answer ‘which people can believe in, and which people can buy into’.

This is particularly timely, as it is well known that Labour intend to make the NHS a major general election issue next year.

The Conservatives and Liberal Democrats are now deeply unpopular over their management of the NHS, as evidenced, for example, by the campaigners who converged on Trafalgar Square recently on behalf of the “Darlo Mums”.

Over successive governments and most recently, the finances of social care have suffered massively.

Speaking at a fringe event for the Fabian Society in Manchester yesterday, Burnham felt that things are not satisfactory as the response to an ageing society has been through a medical model.

Burnham’s problem is that he is about to be bequeathed a fragmented illness service, not a national health service; and that the system is patient-focused on ill people not person-focused on people through health and illness. Burnham feels that focusing on people will enable a greater focus on friends and families too.

Burnham feels that the “ever-increasing hospitalisation” of an ill ageing population will not work, and that hospitals are becoming increasingly dysfunction all the year round due to a social care system which has been malnourished over successive governments.

“This failure piles pressure on the acute system”.

Burnham further adds that people “are battling in caring for people with complex needs”, and that “these silos are not ones which can afford any more”.

This policy is anticipated to bring in housing, education, and leisure strands in due course.

But the urgency for Burnham is to deal with people having to avoid recounting their personal stories repeatedly to different people; and that professionals are often making clinical decisions on the basis of incomplete information.

The intention is, ultimately, to bring together systems for physical health, mental health and care. Sir John Oldham had earlier in the fringe event observed that the general public can have a poor understanding of the word “social” in relation to ‘social care’.

Burnham intends to set out a ten year plan for a whole person care, fully accepting the findings of the Oldham Commission, and which “endorses” the findings of the Barker Commission from the King’s Fund.

Such a plan will be strongly attractive to those vociferous critics, such as Sir David Nicholson the immediate predecessor of Simon Stevens as the CEO of NHS England, that health policy has traditionally been adopted on the basis of the electoral cycle.

This system will be a “National Health and Care Service”, which will realign an activity-based tariff for episodes of illness to produce a single ‘year of care’ budget for each person covering his or her physical, mental or social meeds. This, Burnham feels, will support prevention and wellbeing.

At first the idea was to have a pooled integrated budget across health and care, but, in the subsequent question/answer session, Burnham made extremely clear that he was mindful of the need to move away from privatised fragmented care; and to move away from compulsory personal health budgets which had not been proven to work well.

Burnham, instead, signposted plans to be announced later this week that he would instead advocate a general ‘rights based approach’, where citizens could be given realistic expectations of the development of personal care plans according to their needs.

Burnham emphasised that he remained unconvinced that personal budgets were the sole instrument that could achieve this aim.

He is of course extremely mindful of the public’s overwhelming lack of appetite for the marketisation, outsourcing or privatisation of the NHS.

As an example of ‘market failure’, Burnham cites how councils in their wish to compete to keep council tax bills low end up failing on high quality care.

Interestingly, he also feels that this plan has the potential to be ‘radical’, allowing people can be supported to care, enabling full personalisation.

Such a system will involve a “care coordinator”. This has already been mooted publicly very recently by the Shadow Minister for Care, Liz Kendall MP, as a point of contact for the elderly to navigate themselves through the maze of information including care information.

Such a rôle, it is felt, might not be for general practitioners, but possibly for specialist nurses. The voluntary sector, such as Dementia(UK) which developed the innovative specialist “Admiral” nurses programme, might be well placed to act as these coordinators.

In the alternative, social care practitioners might be particularly well suited for a care coordination rôle for people with dementia, as they command expertise in decision-making and capacity. Social care practitioner leads in this context would help to overcome a barrier to cultural integration, furthermore; this is especially important given the often perceived hierarchies of the professions involved.

“Carers will no longer be peripheral to the system, but central to the development of a care plan.”

This plan would be established over a ten year period to integrate services around the individual, not through a sudden ‘top down reorganisation’.

A potent steer for this would come from the Health and Wellbeing Boards.

It is expected that the Labour Party will also use their party conference this year in Manchester to emphasise its intention to repeal the Health and Social Care Act (2012) in the first Queen’s Speech of an incoming government in 2015.

Jackie Ashley, Sir John Oldham, who chaired the Oldham Commission, and Kate Barker, who chaired the Barker Commission of the King’s Fund, panel members yesterday evening, all agreed that it was unlikely that politicians would openly wish to pledge to raise taxes for health and care. The way in which this had been politically debated in the 2010 UK general election, it is felt, had been unimpressive.

Nonetheless, the general sentiment was that the public would appreciate an open discussion of how sustainable funding for health and care systems could be  achieved.

Jackie Ashley, who writes for the Guardian, explained the difficulties in the news media approaching this topic, when headlines consistently remained fixated on crises in the NHS.

The general policy trend has been try to support people who wish to live and to be cared for at home independently.

However, Ashley alluded to the need to avoid a narrative that hospitals are necessarily bad and non-hospitals are necessarily good.

It is felt that when the NHS was originally set up it was not designed to be catering for people in their 90s with their multiple clinical care needs.

Nonetheless, Oldham urged the need for NHS England to move away from the needs of hospitals, and urged, as an example, a greater number of representatives from local authorities (currently involved in commissioning social care) on NHS England.

For a condition such as one of the dementias, citizens have the perception of their care needs being financially punished through the need to pay for care; this is, for example, in contrast to a condition such as one of the cancers, where the NHS appears willing to pay for expensive medications often.

Equity, equality, fairness and justice will therefore be key aims of this new National Health and Care Service.

“These are some silos which we desperately must get rid of”, exhorts Burnham passionately.

Finally, Burnham wishes this to be a plan for the National Health and Care Service fit for purpose for a 21st century, synchronising at last the wishes of the public, professionals and politicians.

@legalaware

The Scottish referendum was, predictably, a disaster for Westminster’s historic view of the NHS



Scotland

Scotland’s decision on its future, everyone knows, was as much a referendum on the past performance of the Westminster governments to date. In human resources, a guiding principle is that a candidate is likely to behave in future as he or she has down in the past, unless there are exceptional circumstances.

Andy Burnham MP was quoted himself many times as warning against the creeping privatisation of the National Health Service in England. While the ‘No’ campaign consistently explained the Westminster government had protected the NHS budget, it was widely known that the statistical authority has rebuked David Cameron for stating incorrectly that NHS spending has increased in recent years.

The ‘no’ campaign nonetheless did put up a valiant fight, with exceptional campaigners Clare Lally and Johanna Baxter, for example. These campaigners, against some formidable abuse, tried to explain why the leverage of being united with England was especially important for Scotland to withstand future economic pressures resiliently, and why it was in fact intensely patriotic to keep Scotland as part of the United Kingdom.

Whatever Andy Burnham promises as the Shadow Secretary of State for Health, it is a fact that the efficiency savings in the NHS and the private finance initiative loan repayments have put enormous pressure on the operations on the service. Managers, who all too often behave in a divorced way to frontline clinicians, do not appear easily accountable for poor staff shortages impacting on clinical patient safety.

The efficiency savings operate on the assumptions that nobody wants to pay any tax to fund the NHS properly, and that the economy is not growing. Labour, whilst rightly drawing attention to how the ‘cost of living crisis’ is damaging the wellbeing of people, cannot easily claim that people are so unwilling to fund the NHS properly. Nor can they easily dismiss that the GDP of the UK might now be improving.

The resulting democratic deficit which has happened in Scotland is therefore an extreme serious one. Whilst it is the perception that New Labour and the Conservatives, at least, have paid more attention to their friends in the City of London rather than their workforce, there has been a lack of trust between voters and the mainstream parties. Today, UNITE decided it would go on strike. Labour has not yet given a clear indication of what intends to do about the private finance initiative.

In a way, the decision for Scotland was in fact very simple. It was about making a firm decision on separating from England, rather than subjecting Scotland to another eighteen years festering with Devo Max prior to another vote. But of course, we all know it was far from simple. Whatever one’s views about Johanna Lamont or Alex Salmond, the answer of many voters is a response to David Cameron’s original question, “We can’t go on like this.” Gordon Brown’s uttered the famous words yesterday, “And proud that with the powers of the Parliament we can guarantee that the National Health Service will be in public hands, universal, free at the point of need, as long and as ever as the people of Scotland want it.”

But will the general public believe Westminster any more?

It is clear that the Westminster governments totally underestimated the passion and drive of the ‘Yes’ campaign. If Gandhi had been subject to rolling news, one wonders how the Indian independence would have turned out. But the gut feeling of many ‘Yes’ campaigners was a blatant abreaction to lies and misinformation by people who were supposed to be acting in their best interests.

Predictably, Big Business were all mobilised to depict the #iScotApocalypse #ProjectFear scenario. Unfortunately, it had Westminster’s fingerprints all over it. The Westminster delegates, including Danny Alexander, George Osborne and David Cameron, looked utterly unconvincing in raising a populist case. And the media as per usual totally screwed up the reality of the economic contribution to the rest of the UK, which is quite a formidable one albeit not as strong as London and the South East.

When Margaret Thatcher reached Downing Street in 1979, she said, “And I would just like to remember some words of St. Francis of Assisi which I think are really just particularly apt at the moment. ‘Where there is discord, may we bring harmony. Where there is error, may we bring truth. Where there is doubt, may we bring faith. And where there is despair, may we bring hope’ … and to all the British people—howsoever they voted—may I say this. Now that the Election is over, may we get together and strive to serve and strengthen the country of which we’re so proud to be a part.”

England currently is deeply divided, between rich and poor, between employed and unemployed, and, as a result of the ‘welfare reforms’, between able bodied and physically disabled. September 18th was a chance for Scotland to have a ‘clean break’.

The question is, however, will Scotland go Alex Salmond’s way?

It is a massive honour to be able to return to the GMC Medical Register. A dream come true.



Facundo looking sideways

Yesterday, I went for lunch with my friend and colleague, Prof Facundo Manes. Facundo kindly wrote a Foreword to my book ‘Living well with dementia”, an essay on the importance of personhood and interaction with the environment for persons living with dementia. We were just a stone’s throw from all those bars and pubs in Covent Garden I knew well in a former life.

I spent nine years at medical school, and very few as a junior doctor.

I’ve now been in recovery for just over seven years.

But in that time I do remember doing shifts starting at Friday morning and ending on Monday night. I remember the cardiac arrest bleep in Hammersmith at 4 am, and doing emergency catheters at 3 am in Norfolk.

I had an unusual background. I loved medical research at Cambridge. In fact, my discovery how to diagnose the behavioural variant of frontotemporal dementia is cited by the major international labs. It is in the current Oxford Textbook of Medicine.

Being ensnared by the General Medical Council in their investigation process devastated my father. He later died in 2010. I remember kissing him goodbye in the Intensive Care Ward of the Royal Free, the same ward which had kept me alive for six weeks in 2007.

I of course am completely overwhelmed by those events widely reported, especially in the one in 2004. The newspapers never report I was blind drunk. The media when they do not mention my alcohol dependence syndrome are missing out a key component of the jigsaw.

Until I die, I will never be safe with one alcoholic drink. I will go on a spiral of drinking, and that one event I am certain would either see me in a police cell or in A&E.

One event did change my life. I was blue lighted in, after a year of heavy drinking after I was erased by the GMC in 2006, having had a life-threatening epileptic fit. The crash team attempted emergency intubation, but I ended up having a cardiac arrest which was successfully resuscitated.

I do not wish to enter any blame games about what happened a decade ago. It turns out that the Trust which reported me as dishevelled and alcoholic, and having poor performance simultaneously, is in the Daily Mail this morning for a running a ‘chaotic’ A&E department.

It also turns out that another Trust in London which reported me as dishevelled and alcoholic, and having poor performance simultaneously, had its A&E department shut down this week.

I have written previously here about my experience as a sick doctor.

I was in denial and had no insight. Hindsight is a wonderful thing, but I needed sick leave and a period of absence and support. But I do not wish to blame anyway for those events I wish had never happened some time ago.

But the GMC referrals were absolutely correct. I had a proper medical plan put in place for me when I awoke from my coma. I followed religiously my own GP’s advice too.

I am now physically disabled, and have had no regular salaried job since 2005. But I am content. I live in a small flat with my mother in Primrose Hill. I regularly go out to cultural events. I maintain my interest in dementia, going to a fourth conference this year for Alzheimer’s Europe in October, where I have been chosen to give one of the research talks. It’s actually on an idea which David Nicholson inspired me over.

I’ve done four books on medicine, including one on living well with dementia. The Fitness to Practice panel in their judgment note my contribution there, which I am pleased about.

The Panel also crucially made the link in their judgment that my poor performance in conduct and competence coincided with my period of illness, the alcohol dependence syndrome, for which I am now under a psychiatrist.

I go to AA sometimes, and the weekly recovery support group at my local hospital. Being in contact with other people who are starting the same process of getting their life back continues to inspire me. I also attend the suspended doctors group for the Practitioner Health Programme, which helps me understand myself too.

I believe that there is no higher law than somebody’s health. I understand the pressures of why trainees preventing them from seeking help in the regulatory process.

But I do have an unusual perspective. First and foremost, I am a patient myself, and proud of it.

Secondly, I am regulated by the Solicitors Regulation Authority. I can become a trainee solicitor, if I want to be. I had a careful due diligence process in 2010, and I thank the legal profession for rehabilitating me.

Thirdly, I will now be regulated once again by the General Medical Council pending a successful identity check on October 7 2014. Having my application to be restored to the UK medical register is a massive honour for me. I caused a lot of hurt to others during my time with the medical profession last time, and this time I would like things to be different, and be of worth.

This, I hope, will mean a lot to my late father.

I am grateful to all the people at the Medical Practitioners Tribunal Service, and to the GMC prosecutor for presenting a fair case on behalf of the GMC who need to promote patient safety.

I am encouraged that the GMC’s new Chair, Prof Terence Stephenson, “gets” change for the better for the profession, and has an excellent track record as a clinical leader.

I genuinely feel it’s only a matter of time before the giant supertanker which is the medical profession changes its bearings to acknowledge that sick people in their profession exist. Dr Phil Hammond has done a superb article on this.

I love my law school, BPP Law School. They got me through this. I have become a non executive director of their Students Association now. There’s a lot of work to be done there, but I am lucky that there are two colleagues there of mine who are simply the best: Shahban Aziz and Shaun Dias.

I am now about to be regulated by two professions. I could not be happier.

Thanks for your support. I couldn’t have done it without you.

The Kailash Chand Factor



Dr  Kailash Chand (9) (1)

In terms of experience and knowledge about the NHS, this is no time for a novice.

Dr Kailash Chand OBE, to put it politely, is old enough to be Dr Dan Poulter’s elder and wiser uncle. Whereas Poulter gives the impression of being a hapless junior on a ward round who hasn’t had enough time to tabulate all the recent full blood counts, Chand behaves like a senior consultant who is also worried about whether the patient had a good night sleep.

The problem for the Labour Party is wondering what on earth they have ended up with. At first, Labour promised to abolish an internal market, only to re-introduce one in the form of the iconic ‘purchaser provider split’. Chand is more than aware of budget sheets being crippled by the private finance initiative loan repayments, even though this policy was introduced to improve the infrastructure of the service.

It is all a curious mystery how the Labour Party became so keen on harmonising procurement legislation with Europe. It could of course be coincidental that Tony Blair was President of the Council of Europe for July – December 2005, just before the Public Contracts Regulations popped out in 2006. It is equally unclear to what extent New Labour was keeping the bed warm for the private providers who wanted a slice of the “NHS nooky”.

Labour cannot be blamed for wishing to campaign on the NHS, but the NHS chimaera that exists today cannot be said to be divorced from the policies introduced by Labour in its period of government. The NHS, overall, has suffered, as Chand puts it himself, from ‘death by about thousand privatisations’.

I can never remember whether Kailash Chand has been a member of Labour for over 25 years, or has been a GP for over 25 years. But either way it doesn’t matter. Both facts are on the public record, so is Chand’s commitment to fighting the current Coalition government on policy which he claims vociferously is not in the best interest of patients.

I, of course, like the fact that he regularly contributes to the medical press, and has held various offices of responsibility; but I should like the Labour Party to make full use of his formidable intellect, preferably with the Labour Party in government from next year; and his enormous undoubted popularity with the driver of his democratic ambition, people who are fed up to the back teeth with his Government.

I don’t happen to agree with Dr Gordon Brown on some things, such as wishing to be so intensely relaxed about the City of London (I am of course vicariously attacking Brown when this was a remark made by Lord Mandelson).

But as regards Kailash Chand’s full potential – no doubt there will be lots of new talent next year in think tanks and so forth, but this is possibly no time for a novice. Chand needs to be at the heart of decision making.

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