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



The starting point is here.

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

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

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

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

stark choices

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

 

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

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

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

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

 

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

This has already been happening by the backdoor.

Nick Triggle writes for the BBC in 2012:

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

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

“Worrying news has emerged this week from the Midlands.

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

 

3. Relaxing performance targets;

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

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

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

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

 

4 Closing or reconfiguring services;

This has already surfaced to public discourse.

This for example comes from August 2016:

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

Also that month the Guardian carried further details:

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

The picture that emerges includes:

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

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

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

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

 

5. Extending co-payments or changes;

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

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

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

KONP comments:

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

 

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

The King’s Fund comments:

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

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

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

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

And it doesn’t stop there.

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

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

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

Caroline Molloy again, this time from 2013:

Taxation

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

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

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

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

Heavy lifting

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

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

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

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

 

Accidentally destroying the NHS with parliament’s permission?

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

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

Chris Hopson again:

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

The original Hobson choice is described as following:

Hobson's choice

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

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

@dr_shibley

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



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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

@dr_shibley

Some thoughts on Jeremy Hunt



Hunt

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



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

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

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

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

SECOND GROUND

 

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

Hansard

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

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

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

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

 

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

A new dawn has broken



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I’m 42 – and I’m a lifelong Labour voter.

And I’ve also never known a leadership election like this.

At his victory speech at the Labour election-night party, Royal Festival Hall, London, 2 May 1997, Tony Blair uttered the now famous words, “A new dawn has broken, has it not?”

However, the way in which this particular #LabourLeadership election was run was dreadful.

As Dr Éoin Clarke had tweeted,

I’ve known Liam Young, who supports Jeremy Corbyn, for a long time. His recent piece in the Independent details in full gory detail how, despite his best efforts otherwise, he ended up not voting. I can vouch for Liam’s commitment, having known him for years.

“I have been a member of the Labour for the last six years, and involved with the party for as long as I can remember. I remember heading to party conference in 2010 at the tender age of 15, and my grandparents often fondly remind me of the times they used to take me out canvassing in my pushchair – my grandfather was the leader of the local city council and mayor at one point. I had countless unrelated “aunties” who I grew up with, assimilated into my extended family by virtue of the Labour work they did with my relatives.

So this month, I was surprised when I didn’t receive my ballot in the normal timeframe for this leadership contest.”

The comments to this article make for desperate reading. Most authors, especially ones for The Guardian newspaper, never read the submitted comments, but I strongly suggest Liam has a look.

Here is a typical comment.

comment2

The whole Owen Smith campaign was a fiasco.

Buzzfeed charted the entire car crash of the anti-Corbyn camp brilliantly.

In fact, what happened from the time at which Hilary Benn threw his early morning temper tantrum was a full blown disaster.

Believe it or not, I had not intended to blog much about this #LabourLeadership election, though I’ve doing some sort of Labour political blog for about 7 years now.

Looking back on it now, the entire anti-Corbyn campaign imploded from the very beginning. The ‘challenger’ was implausible, the policies half-baked, the campaign sodden with gaffes, and, put simply, an insult to the wider Labour Party membership “electorate”.

I charted some of this mess in various blogposts including “Saving Owen Smith“, “The inevitability of death, taxes and Jeremy Corbyn’s re-election as leader of Labour“, and “Owen Smith MP must surely have been aware that the NHS is being rapidly privatised?“.

Some of my time had been taken up the desperate moves of the NEC to thwart people voting in the law courts, and that was before the #LabourPurge2 had gathered full momentum (pardon the pun).

The mainstream media were reluctant to cover the bare essence of the illiberality of the legal manoeuvring, astounding given the overwhelming ‘liberal’ press.

Such blogposts included “The Court of Appeal judgment was profoundly illiberal, and the issues need scrutiny notwithstanding“, “Nobody is above the law not even in the Labour NEC“, and “Tom Watson MP says he doesn’t believe in conspiracy theories, and nor do I“.

Ed Miliband MP, like other failed leadership contenders Liz Kendall MP, Lord Neil Kinnock and Gordon Brown (2010), stuck the boot in, possibly even adding to Jeremy Corbyn’s credibility, viz. “The overall incompetence of Ed Miliband’s opposition should still raise alarm bells“.

But there was no doubt at all, that if Owen Smith MP was the answer, the question was not even worth thinking about.

The Owen Smith MP candidate was the talk of the town – for all of the wrong reasons.

It never gained any credibility.

For example, I wrote on “Why has Owen Smith MP lost all momentum in his leadership campaign?“, “Owen Jones’ interview reveals Owen Smith MP is dangerous for the nation’s health“, “The Parliamentary Labour Party cannot cope with the decline and yet further decline of New Labour“, “Owen Smith’s campaign blowing up on lift-off is not a good look“, “Owen Smith is ‘reconstituted Labour’, but still a disastrous recipe“, and “Owen Smith MP is swimming in the deep end with armbands. We can’t go like this.”.

And it seems now that Angela Eagle MP’s leadership was merely now a ‘bad dream’.

This is where it all started:  e.g. ““Saving Labour” or “Crushing Corbyn” – that is the question?“, “Why the level of vitriol against Jeremy Corbyn?“, “Angela Eagle’s “Contrived Leadership” was overbranded and under authentic“, “The emphasis of Hilary Benn on “winning” ironically explains a lot Labour’s failure“, “For me, Angela Eagle is part of the problem for Labour’s electability, not the solution“, and “If Labour can’t unite behind a democratically elected leader, it doesn’t deserve to be in government“.

I feel hugely excited about this morning. I have had enough of trolls suddenly popping up on Twitter, and lying to me – I don’t have to waste hours trying to work out why they are shilling on behalf of a certain lobby any more.

I don’t have to think about reasons why Corbyn would be a ‘disaster for Britain’, or why Jeremy Corbyn ‘does not believe in winning’, or how Labour ‘has become the party of permanent protest’, or how Labour is now full of far left Trotskyist individuals allegedly, and so on.

Lies.

Lies.

Lies.

For me, it feels as if a noose has been finally removed from my neck. There’s about 10 or so Labour MPs I think their local constituencies should examine as to their suitability for parliamentary election. I don’t think any candidate should be renominated under duress if (s) he disagrees strongly with party policy. Democratic re-selection is very healthy for the party. As in all good teamwork, it’s a question of give and take. I don’t see a case for the parliamentary Labour Party having bullied their way into this all-consuming leadership election, detracting attention from the split and division within the Conservative Party, to call any shots. Most scandalous of all, the entire NHS is collapsing, grammar schools are on the way back, the foreign policy with Libya for example has been utterly discredited, and Owen Smith MP is obsessed about talking about he (not the House of Commons or Lords) ‘won the PIP debate’.

Too many people in the Labour parliamentary party love themselves, especially the ones who are now acting like spoilt brats having been to one of the big 4 accountancy firms.

I don’t mean him…

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Or Andy – who has been utterly brilliant throughout.

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The other bunch of loudmouth talentless Labour MPs, the “deplorables”, rather need to step up to the plate, contribute policy – or else get out of the party.

They should stop fanning their own egos in TV studios with vitriolic bile against Corbyn.

They need to do  some actual work in making Labour look like a serious political party. The membership are overwhelming sick of their narcissistic putrid selfish self-centred behaviour, rotten to the core.

Some journalists, especially at the Guardian, should stop preening their feathers, and stop spewing incessant negative junk in their low circulation papers.

Basically – anyone who is not up to the job of helping Jeremy Corbyn has overstayed his or her welcome -…

and should get out now.

And what have we learnt from all of this?

We now know that this man

paulmason

 

 

 

 

 

 

 

 

 

 

doesn’t want Seumas Milne’s job now, nor in the future, here or in any other parallel universe.

As was in the statement to the press on arriving at Hillsborough Castle for the Northern Ireland talks, 7 April 1998, Tony Blair said, “A day like today is not a day for, sort of, soundbites, really – we can leave those at home – but I feel the hand of history upon our shoulders, I really do.”

Wherever Labour goes from this point onwards, today is a very special day.

 

 

@dr_shibley

Democratic reselections and representation on the shadow cabinet are the only Labour way forward



Lab

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Whoever is ultimately responsible for the definite purge which is going on within Labour, it is clear that the purge has backfired on a number of levels. As Paul Mason identified, Bristol has now lost control of the council due to centrally-driven suspensions. Secondly, many longstanding campaigners for Labour who have given decades of their time have been ‘purged’ and lost the democratic right to vote. Thirdly, it has been a PR disaster of enormous proportions, of a centrally driven Labour NEC appearing to be incredibly vindictive against their own members, many of whom are not financially well off. Fourthly, its actual basis was very dubious, when it is known that the number of extremist ‘entryists’ are in fact very small, whereas the usual people (e.g. Old Holborn) have claimed it’s the best £3 they ever spent.

Whichever way you look at it, Labour is a joke. And it is telling of the state of Labour as it is that this is held as default as an abusive comment, rather than freedom of expression. When a mature Asian Labour voter told Owen Smith MP that he as a MP was wrong, Smith called it out as abuse. Channel 4 presented last night a documentary based on undercover filming, a textbook hatchet job on Labour, featuring a family relative of Alastair Campbell providing legal opinions. And the number of migogynist, antisemite and bullying events shown was nil.

BBC1’s Panorama fared better. Jon Pienaar did what he could to present an establishment view of ‘we’re stuck with Jeremy Corbyn with a landslide – but now what?’ Cumulatively, BBC1 and Channel 4 added to a long list including the Guardian notably of totally distorted mainstream media. The Guardian’s reporting does not even make the grade of toilet paper when printed out, though Suzanne Moore did a brilliant balanced piece on Momentum Kids only yesterday. BBC’s Panorama uncomfortably yo-yoed between Lisa Nandy MP and Peter Kyle MP, before referring to Owen Smith MP for an opinion.

By any reckoning, Owen Smith MP’s campaign was an unmitigated wholesome disaster. In a leadership bid which was in part supposed to have been precipitated by sexism and misogyny, Smith is reputed to have made a laddy joke about his 28″ inside leg measurement. The descriptions of his long term debt financing of infrastructure were so far fetched that ‘no economist disagreed with him’ (an achievement in itself) and, more’s the point, nobody in the mainstream media including the Financial Times, Mail or Times bothered to opine about it.

For all the criticisms of Corbyn and team, and there are many, the orchestrated hourly appearances of MPs in TV studios was vile. Episodes such as the staff of Seema Malhotra MP not leaving her office in a timely effect spun in such a way as to discredit a longstanding member of John McDonnell MP’s staff, were vile too. Alastair Campbell siding with Anna Soubry in her attack on John McDonnell, despite Campbell appearing to not make up his mind on which policies he actually disagreed with, was pretty ubiquitously reacted to on Twitter as vile; with many of the Twitterari commenting on how a Labour grandee got away with using the ‘twat’ so often on Twitter, when ordinary party members, maybe who had campaigned for the Green Party but who had now re-joined the Labour Party, had been ‘suspended’ according to the NEC’s ‘make it up as you go along’ rules for retweeting Caroline Lucas a few years ago, perhaps on taking back the railways into state control (now a Labour Party policy aspiration).

Ed Miliband MP himself in his resignation speech had asked for ‘people to disagree without disagreeable’ – and yet this is precisely what he and Neil Kinnock then did par excellence. They laid into the currently democratically leader of the Labour Party, Jeremy Corbyn MP, as if he had no mandate at all, completely ignoring the fact that they themselves had between them had lost more general elections than most of us have hot dinners.

Secondly, their remarkable achievement was completely to ignore the implications of the Brexit vote. There are some very basic level interpretations of how Brexit came about, including being ‘lied to’ (although lies are not a novel idea in election campaigns, if one remembers Nick Clegg’s ‘I’m sorry’ for example), the impact of immigration on local services, the notion of ‘taking back control’, and so forth. I voted as a Labour voter of 26 years for #Remain, being a ‘reluctant remainer’.

For me, a willingness to be part of the European Union goes way beyond the single market, but goes towards a feeling of genuine solidarity with our European neighbours in fighting on public policy issues, such as public health, data protection, employment rights, etc. But there are aspects of being in the EU which I do find difficult – such as the impact it has on state aid of public sector industries in stress, the way in which Greece had been forced down a path of austerity to the detriment of its citizens, the possibility of the EU-US free trade treaty which would have given a carte blanche to multinational takeover of parts of the NHS, the undercutting of wages happening during free movement of labour, and so on. So for me, it can’t be 10/10 for being in the EU. And Article 50 will probably have to be invoked sooner rather than later, if only because our European neighbours won’t want us to delay on this. It was not Jeremy Corbyn’s direct wish to have a referendum; he did not even stand on a manifesto pledge to have one.

Neil Coyle MP at the weekend was asked how he might win given the summer of discontent of Labour. Bear in mind, I went down one morning, with no expenses paid, to support his bid to become a MP in Bermondsey and Southwark. I was disgusted to hear that people like me who support Jeremy Corbyn are merely part of a ‘fan club’. He then had the gall to say he would be re-elected because of the ‘strong Labour brand’, given the monumental efforts he had made to rubbish the Labour brand, such as our leadership and teamwork, all summer. Good riddance.

I had never heard of Peter Kyle MP until he started TV studios slagging off Jeremy Corbyn MP – in other words, he had made absolutely no impact on me on the national stage in terms of policy.

Not everyone who disagrees with Jeremy Corbyn is though ‘disagreeable’. I differ with Karl Turner MP’s views on some things, but I feel he is fundamentally a very bright and pleasant man (having also briefly met him). I’ve met Tom Watson MP – I don’t think calling Momentum a ‘rabble’ as he allegedly did is crime of the century, and he probably was distressed at this summer’s events too. But I think strong arm tactics for the Labour PLP to ‘get their way’ are a mistake, Tom.

In a completely different category though are Margaret Hodge MP and Margaret Beckett MP who did not offer a coherent narrative on where Jeremy’s policies were ‘wrong’, why millions voted ‘Brexit’ and launched into highly personal attacks on Corbyn.

I don’t think people who disagree with Labour’s policies or dislike the leader intensely should be forced to be members of parliament for Labour. It should never be forgotten that the party is totally dependent on the grassroots activists who go round delivering leaflets, manning phone banks, door knocking, and so on. Momentum has never asked for deselections. I think, however, it would be very healthy for a democracy for our Labour CLPs to look at reselections. MPs who are unable to oppose tax evasion and aggressive tax avoidance, PFI, the lack of social housing, or the market failure of rail should not be ‘forced’ to MPs under duress, particularly this is in asynchrony with our membership’s views.

And John McDonnell MP is right, though he didn’t phrase it this way. Too many of our Labour MPs love themselves. There are a few who’ve done brilliant work such as Andy Burnham MP on Oregreave, or Debbie Abrahams MP on disability welfare, or Grahame Morris MP on local communities; and there is patently room for improvement in the operations of the top team.

We are where we are. Some of the 170 MPs who have previously had ‘no confidence’ in Jeremy Corbyn will want to campaign on behalf of saving their own seats, despite the mess they caused this summer. It is not far right to oppose that the NHS is now being destroyed at accelerated pace. It is not far right to oppose the savage cuts in social care. The only way forward I feel is for there to be   a ‘hybrid’ shadow cabinet, with members put forward by both the Party and membership.

Members of the Labour PLP over criticise the ‘delegate’ argument of the membership I feel. I think what is rotten to the core is the rotten spectacle of Labour MPs behaving like independents not representing their party’s membership. It is not true that all of the Labour Party membership, for example, supports Trident as a weapon of mass destruction.

Jeremy Corbyn is likely to be re-elected this week as the leader of the Labour Party.

 

As Corbyn says, “Things have to change – and they will.”

 

 

@dr_shibley

The Hopson Ultimatum



The Andrew Marr Show

So why did Chris Hopson do his outburst at the weekend?

This is the one where we warned about the parlour state of the NHS finances.

I personally don’t understand the obsession of NHS managers and politicians with the notions of “productivity” and “efficiency”, because I come from an area in medicine where adding “value” is more important. I think of productivity as a hang up of an widget counting ethos, so beloved of management accountants, in synchrony with a widget factory ethos of management of Frederick Taylor.

McKinsey originally suggested these ‘efficiency savings’ whereby the NHS could aim to contain its budgets, but we all know this is double speak for cuts.

Stephen Dorrell MP, former head of the influential Commons select committee, warned that it had never been done before, so we were in unchartered territory. The Labour Party, as it was then, were fully signed up to this draconian programme of austerity.

Especially when NHS Trusts are trying to balance the budgets, or cook the books, to account of the massive spend on agency staff and PFI corporate wongaesque loans, the idea of ‘efficiency’ has become toxic and frankly ludicrous.

Nonetheless, Chris Hopson CEO of NHS Providers continued with the myth this weekend:

“But NHS trust bosses are now ringing that bell – we face a stark choice of investing the resources required to keep up with demand or watching the NHS slowly deteriorate. Trusts will, of course, do all they can to deliver efficiency savings and productivity improvements. But they are now saying it is impossible to provide the right quality of service and meet performance targets on the funding available.”

These performance targets are only as good as the wisdom in their selection. I ‘get’ the fact that these targets do not include doctors’ morale or nurses’ wellbeing, but even on the more conventional targets such as delayed transfers of care, delayed discharges, or waiting times, Jeremy Hunt is missing by a country mile. And of course the whole ethos of simultaneously many people working their butt off under incredible pressure, while some CEOs are sitting pretty with inflated salaries despite catastrophic failure, is an enduring one of Hunt’s NHS culture. (And of course the relentless lack of statutory whistleblowing protection for junior doctors in training – see the Dr Chris Day case).

Hopson:

As the junior doctors’ dispute shows, it is also untenable to ask NHS staff to close the gap by simply working harder and harder.

“Faster, faster!”

All this reminded me of this tweet I had once made:

This is a reference to the Baumol “cost disease”.

In some sectors of the economy, however, such productivity gains are much harder to come by—if not impossible. Performing a Mozart quartet takes just as long in 2012 as it did in the late 18th century. Mr Baumol calls industries in which productivity growth is low or even non-existent “stagnant”.

In some sectors of the economy, however, such productivity gains are much harder to come by—if not impossible. Performing a Mozart quartet takes just as long in 2012 as it did in the late 18th century. Mr Baumol calls industries in which productivity growth is low or even non-existent “stagnant”.

The most parsimous explanation for the outburst of Hopson is the up and coming autumn spending review to be done by the new Brexit Chancellor.

Hopson remarks:

So what does give? A range of options are now open to political and NHS leaders. Additional funding is the most obvious, with the new government’s first autumn statement on 23 November providing an immediate opportunity.

Something has to give. This is particularly so since NHS funding increases are about to drop from 3.8% this year to 1.4% next year and 0.3% in 2018-19. As total NHS demand and cost rises inexorably, by at least 4% a year, this will mean even larger gaps after seven years of the deepest and longest financial squeeze in NHS history.

We know that demand has always outstripped ‘supply’ since the NHS’ conception, but the solution of tackling this demand by greater supplier competition in markets through the Health and Social Care Act (2012) was deeply flawed. It itself produced an opportunity cost of billions. There seems to be a lot of money for war but not for building hospitals, so it was entirely predictable that a lot of money got siphoned off into corporate restructuring management consultants and to paying off dismissal claims (and confidentiality agreements) for managers of PCTs, rather than frontline care. Nurses receiving yet another pay freeze “would not complain”.

That Doctors feel that they cannot cope with delivering safe care under the new contract should be a reason for their regulator to be concerned. As it is, anyway, the BMA recommended the ‘new contract’ which it had negotiated, and was left with the situation that a large number of junior doctors did not like the contract (for example for safety issues or gender pay gap issues, inter alia), and the attitude of whether to go on strike was “complicated”.

The media have generally portrayed junior doctors to be some mob of crypto-anarchists or Trotskyite agitators, and have regularly misrepresented the dispute as one simply of pay. The manifesto pledge from the Conservative Party was not actually to impose a contract on junior doctors or other staff, but to implement a 7 day NHS; but we know that in the absence of funding for a 7 day NHS with ancillary staff, and with corresponding funding in the rest of the system, it is impossible to deliver a 7 day NHS. The junior doctor contract correctly was seen as a way of putting 5 bags of sugar into 7 containers.

But the Hopson ultimatum is dire. Taken at face value, it appears to mandate the Chancellor into maintaining   NHS spending. Every time a Conservative minister ‘defends’ NHS spending, it is always said that the level of spending is what Simon Stevens, CEO of NHS England asked for.

Stevens remains inconveniently quiet on this. NHS spending is “ring-fenced” and social care is not, but the whole notion of ‘ring fencing’ has become dubious given the increased costs of everything and increased demand of the NHS. And the ‘elderly’ (horrible term) are not simply to blame for this bill, as many children and young people are benefitting from costly interventions.

SO while the NHS continues to trot out infograms and ‘calls to action’ like no tomorrow, sneaking in under the RADAR is that dreaded term ‘sustainability’.

Hopson says:

NHS trust leaders rightly argue that this piecemeal approach is unsustainable. It is not tenable to ask local leaders to deliver the impossible, make unpopular local decisions as quietly as possible and then carry the can when the decisions become public.”

And we’ve been here many times before. For example, The King’s Fund report, Deficits in the NHS 2016, published on the 11th July 2016 argued that due to increased level in demand of services the NHS is fast becoming ‘unsustainable’.

Unsustainable means chronic underfunding of the NHS.

Hopson produces a menu of other options

If, however, there are is to be no extra funding, the NHS must make some quick, clear choices on what gives, however unpalatable these choices may be. The logical areas to examine would be more draconian rationing of access to care; formally relaxing performance targets; shutting services; extending and increasing charges; cutting the number of priorities the NHS is trying to deliver; or more explicitly controlling the size of the NHS workforce. These are all approaches adopted by other public services such as prisons, local government and the police when faced with similar funding challenges over the past decade – though they would clearly provoke public unease and ministerial anxiety if applied to the NHS.

And the “logical areas to examine” would be a fast track to having a 2-tier health service. Get some astroturfers and the House of Lords Sustainability Committee, perhaps along with a cross-party parliamentary commission to boot, with a dash of the Socialist Health Association, to sign up to the meme ‘we can’t afford the NHS’, and then the machinery came come into action to produce a bargain basement NHS covering the very basics. The second tier consists of the private insurance market, where the profitable bit called ‘prevention’ is emphasised (see the rationale for the HMO Act 1973 in the US and President Nixon.)

The major problem with the “free at the point of use” meme, even used by Owen Smith and other Conservatives, is that it takes no account of the comprehensive nature of the NHS. If the railway network only comprised routes which were profitable, there’d be no train service to some remote part of Scotland; the equivalent is not bothering with people with ‘expensive’ rare diseases. When you get rid of the need for comprehensiveness or universality, you can ration to your heart’s content – starting off with cataract operations, but then building up to ‘NO’ for bariatric surgery.

Then you can twist the “taking responsibility for your own health” meme into a direct accusation of blame. In other words, “we don’t want to pay for treatments for these fat people as they ate too much” or “we don’t want to cure this lung cancer as they smoked too much.” This can all be dressed up under the gloss of ‘choice’ and ‘control’, and the ‘tough decisions’ CCGs have to make.

Hopson warns about the NHS finances, and Hunt ‘responds’ by maintaining NHS spend – all pretty twee and orchestrated, and everyone’s happy.

Well – they’re not. The nurses are taking out loans to be educated, the doctors are stuck with a contract they don’t want, certain failed NHS CEOs appear unsackable, social care is on its knees, and Hunt appears to have a job for life.

 

@dr_shibley

 

Saving Owen Smith



It’s all been an incredible mess.

Take for example Owen Smith MP talking about the EU referendum with David Dimbleby last thursday on the BBC’s flagship programme Question Time.

DD: You said you would like to see Labour going into the next election saying our party policy is to go back into the EU.

OS: Yes.

DD: You ignore the Brexit vote.

OS: Exactly.

DD: Exactly?

OS: Exactly. We need to find out what it is. The Brexit vote set a direction, if we like. We don’t know where we’re going.

DD: You know where you are going. You are going back in.

OS: Well, I hope we are. And I think we should be strong about that.

You could probably fill an entire blogpost with Owen Smith MP’s greatest gaffes. But this is no time for such hilarity.

The latest journey into the Trump school of campaigning involved Owen Smith MP ‘winning’ at something. Yes – winning at getting married.

@abiwilks

Cast your mind back to a long time ago – when Owen Smith MP tried to ‘counsel’ Jeremy Corbyn before launching his leadership bid. That bid was to prove it was all about winning.

Remember this?

winning

Embarrassingly, the man whom Owen Smith MP derides for “not winning” is, according to polls which have been known to be unreliable in the past, perhaps on the brink of winning by a landslide.

For me things got so testy I even wrote a non-abusive tweet complaining about Owen Jones MP!

@chunkymark often refers to ‘the man behind the curtain’. This is a reference to that classic scene in the Wizard of Oz, one of my favourite films.

Here, the man behind the curtain included our so-called friends at the Mirror.

Except the man behind the curtain was shouting above the real story, and was not that impressive after all. Cr68ZUgWIAAp36C

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

You name any policy area, and Owen Smith MP has made a mess of it. Owen Smith ended up trying to defend why he wanted to back increasing funding to the failed PREVENT policy, accused of causing further problems for UK muslims, in the Question Time debate last week.

 

This was reported in “The Canary” 

 

Audience member:

You say definitely Owen, you’re the one that endorsed the Prevent strategy…

Victoria Derbyshire Show, Owen Smith MP in the Labour leadership debate on 11 August:

…consider the issue of terrorism: I’d invest in our communities. The Prevent strategy, that is grossly undermined and under-resourced in this country, ought to be at the forefront of Labour’s policy, making sure we foster better community relations in Britain.

Owen Smith MP says he dislikes slogans, when he has often repeated the same slogans ad nauseam in the live TV debates. He accused voters in TV debates several times, “you’re wrong”, even flying completely in the face of all evidence. He has persistently denied that the orchestrated mass resignation of the majority of the Labour PLP was not contributing to the general poll ratings of Labour.

Unsurprisingly the members of the Socialist Health Association had backed Owen Smith. I have experience of that organisation which is the most pale, male, stale and useless Labour-affiliated entity currently in existence, having been of ABSOLUTELY NO USE in criticising policy, such as the outsourcing clause of the Act of 2012 or the private finance initiative. – or about as much use as a chocolate teapot or fireguard, being more generous.

Owen Smith MP’s campaign has been so shambolic it now looks as if, incredibly, it will be worse than Zac Goldsmith’s. And he resoundingly lost. The problem now for the PLP after September 23rd will be try to heal the rifts in the meantime, when this fiasco they have created has diverted news media attention away from Tories fighting like ferrets in a sack over the meaning of #Brexit, the introduction of an ill-thought out and highly divisive policy on grammar schools, and catastrophic financial performance of the NHS as a whole. Members of the parliamentary Labour MP now need to get a grip, or they deserve to be deselected. Had they actually done their job properly, and if Corbyn had lost 2020 monumentally if only because of the boundary changes, they could have easily blamed Corbyn. John O’Donnell MP has signalled that he and Jeremy would not be sticking around if Labour lost in 2020, but at the moment the parliamentary Labour Party have no moral integrity to call the shots. Perhaps some in the NEC will call this comment ‘abusive’, but in a healthy democracy, free speech should be welcomed. New members to Labour, say from the Green Party, should be welcomed, many feel, to build a strategic force to end Conservative rule. OK, the Labour PLP can put up their stooges for the shadow cabinet, but it should be remembered in this no-more-something-for-nothing world, if Labour MPs are not up to the job, they should be booted out. I strongly suspect, anyway, that Owen Smith MP having been pushed under the political bus by the Labour MP will be chucked out by the voters in Pontypridd in any case.

@dr_shibley

Why I feel very upset about the Junior Doctors’ strike



strike

 

I have spent much more time living with chronic long term conditions as a patient than I have spent as a Doctor on the UK medical register. I owe my life to the NHS, having been resuscitated from a cardiac and respiratory arrest on the same day and having been kept alive for a subsequent month in a coma both in a busy London teaching hospital.

My response to the notion of regular five day strikes is therefore mainly emotional, rather than cognitive, for which I apologise. As a member of the Royal College of Physicians of London, I’d like to thank NHS consultants who’ll be doing their best in exceptionally difficult times. They’ll have to do blood tests, write TTO discharge notes, do all the correct management for their complex inpatients as ever. That won’t be easy for them.

The NHS is not only in dire straits, but social care is. They act in one big system – therefore having social care in managed decline means that social care practitioners are hard pressed to enhance the wellbeing of users, but it also means that NHS patients cannot be discharged in a timely manner. Doctors are not the only ones who are demoralised. I have had personal conversations who are literally living in fear that something will go wrong on their watch. They view their shifts as a matter of survival. They know if something goes wrong the Nursing and Midwifery Council will not have any sympathy for the argument that nurses don’t even have time to go on a tea break, let alone implement the 6Cs to A* level.

Just as justice delayed is justice denied, and we know about the mental pain of grieving families from NHS scandals, treatment delayed can feel like treatment denied. I’ve never personally never bought this argument that ‘no harm is done’. Take for example, somebody writhing with colicky pain due to a ureteric stone (a stone in the tube from kidney from bladder)). Waiting and waiting for an appointment for a procedure to remove the stone, over months and months, is undeniably mental agony. But it is also physical agony – and what about those reams of reams of QUANGO guidelines about acute and chronic kidney injury?

Whatever the political posturing of the chief protagonists, such as the BMA, the GMC, the NMC, the RCN, the AMRCos, Hugh Pym or Roy Lilley, it’s clear that the cliché that there are no ‘winners’ is partly true. True up to the point that Jeremy Hunt can consider it a win that he can start the job he started, of imposing a contract against the will of some of the medical profession. A strike is now happening against some of the will of the junior doctors. We are all going for #Brexit, despite some of the will of many of us who wanted us to remain in the European Union. We’re all paying through the taxpayer route for the private finance initiative bequeathed to us from both New Labour and Conservative governments, akin to a corporate Wonga direct debit.

When you think about the NHS Outcomes, you realise that all the policies are immediately rendered null and void, and this should alarm most of us. We all have our own personal opinions about how we arrived at this mess. But for all the razzmatazz about NHS vanguards, new models of care, ‘rocking the boat’, we have the dire position that we cannot meet any of the NHS outcomes (for example on patient experience, avoidable admissions.) We don’t know how many people will die prematurely from the strikes, but we don’t know how much damage has been inflicted so far from paying off the PFI debt and paying for certain CEOs for a long period of time at the expense of running timely services either.

I have a particular personal pain, in that despite my moaning and groaning I think it’s a huge privilege and honour to be in a position to be a medical Doctor. I ‘get’ this thing about how one would be happier in New Zealand, but I feel I really have been through hell and back to get my professional registration. I was also given no support for my own substantial mental health problems from the NHS which prefers regulation to performance management. And yet, despite this, or perhaps even because of this, I feel a profound sadness of where we all are. And of course Jeremy Hunt can sleep well at night, one assumes?

 

 

@dr_shibley

 

 

We need to talk about Sadiq



This isn’t about me – nor about Jeremy Corbyn…

nor my followers, including

@paulmasonnews

paulmason

 

 

 

 

 

 

 

 

 

 

or @andyburnhammp

Andy

 

 

 

 

 

 

 

 

 

 

or @georgeeaton

george e

 

 

 

 

 

 

 

 

 

 

or @LabourEoin

Eoin

 

 

 

 

 

 

 

 

 

 

or @tom_watson

Tom

 

 

 

 

 

 

 

 

 

 

or @JohnmcdonnellMP

JohnMcD

 

 

 

 

 

 

 

 

 

 

or @georgegalloway

georgeg

 

 

 

 

 

 

 

 

 

 

or @Rachael_Swindon

RachaelSw

 

 

 

 

 

 

 

 

 

 

@chunkymark 

chunkymark

 

 

 

 

 

 

 

 

 

@iainjwatson 

IAIN

 

 

 

 

 

 

 

 

 

 

or even @sadiqkhan

saqiq

 

 

 

 

 

 

 

 

 

 

 

I happen to agree with Jeremy Corbyn’s policies. I was pretty appalled about the way the 172 Labour MPs disrespected democracy by trying to bully Corbyn into resigning outside of the rule book, and various antidemocratic moves were then subsequently tried – like keeping Corbyn off the ballot paper, then trying to stop 230,000 members from voting.

But we have to talk about my follower Sadiq.

I’ve been in the same room while Sadiq was giving a talk – and seen his manner and behaviour with people. He is very polite, and certainly not an ‘élitist’. I suppose he will wish to ‘side with’ the current Labour MPs who believe that Jeremy Corbyn will not win the 2020 election – but they can no more predict this than I can. I am though fairly confident that Jeremy Corbyn MP will win the current Labour leadership contest – and it is pretty unlikely that Sadiq’s comment will alter this outcome.

I’m not a Corbynista.

pinnedtweet

But the situation is clearly more nuanced than that.

There’ll be some traditional Labour voters who feel disenfranchised by the EU  – such as the undercutting of wages by multinational corporates, or local collieries being shut down due to application of EU ‘state aid’ rules.

I think Sadiq is pretty Fabian in outlook, though. I had to remind myself of Tony Blair’s aspirations for the Labour Party from a speech he gave to Progress last July. He believes that the socialist left wing errs when it does not project a positive vision about the future but is reactionary. Indeed the sole aim of the Labour government should not be to ‘fix’ the mistakes, but it happens that there are plenty of mistakes (e.g. tax loopholes, unconscionable profits in privatised utilities, market failure in social housing, rip off PFI deals crippling the NHS). It is of course essential Labour is vaguely attractive to all business, big and small, but I think Tony Blair fundamentally misses the point of how it’s also possible to have a vision about the future from Corbyn’s perspective, for example judicious use of investment in the North of England through an investment bank. Also, Blair’s caricature of socialists always being stuck in 1983 is clearly not true when aggressive tax avoidance and PFI are devices of today.

And the problems with Sadiq’s position politicially of doing ‘austerity lite’ is graphically represented by the closure of thousands of law centres in England on his watch as shadow minister for justice – not once did he pledge the timely return of these law centres, which like CABs were the lifeline of people like me who’d lost disability living allowance for no reason.

We were never a happy family in Labour. When I looked at this picture of me and Charlie Whelan, I thought of the time Nick Cohen was trapped in a pub with Charlie Whelan talking about the limitations of Alistair Darling during the global financial crash. As Nick knows, I defended Brown to the hilt, often irrationally, even when Brown claimed to be ‘saving the world’, during his 10p fiasco, when he was called Mr Bean by Sir Vince Cable, when he turned up late for the signing of a EU treaty, and so on. But Brown’s biggest mistake was probably the underregulation of the City – as the Americans pointed out, nobody forced the Brits to buy their dodgy securitised mortgage products.

In happier times maybe…? But remember how Brown tried desperately hard to get rid of Blair, and ultimately succeeded – then there was the fiasco of the election that never was.

Charlie Whelan

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I don’t feel in any way betrayed by Sadiq suddenly decided to endorse Owen Smith MP. I suppose Sadiq as Mayor of London feels also obligated to represent those members who robustly oppose #Brexit, such as corporate lawyers.

Everyone knows Jeremy Corbyn will win in this current leadership contest by a landslide – the question is whether the shadow cabinet is up to the job of writing coherent policy not in a cliquey club, and taking this policy to the doorstep. Owen Smith MP is worse than really dire as a contender.

Kinnock thought he’d win in 1987 and 1992, and look what happened to him. Blair won in 2005, despite a disastrous share of the vote – it is said that even he was so depressed by his own performance he turned the TV off for an hour of the election coverage.

We’ve been here before…

 

@dr_shibley

 

 

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