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Somebody once advised me in my 20s that destiny is when luck meets preparation.
When I was younger, I used to think that you could prepare yourself out of any situation. But wisdom and events proved me wrong. I soon discovered that what you did yesterday though can affect today, and what can affect today can affect tomorrow. The only thing you can predict pretty comfortably, apart from death and taxes, is change. When I was younger, I used to think I could live forever. All this changed when I woke up newly physically disabled, after a six week coma on a life support machine on the Royal Free Hampstead. The National Health Service saved my life. Indeed, the on call Doctor who led the crash team the day of my admission, when I had a cardiac arrest and epileptic seizure was in fact a senior house officer with me at a different NHS trust in London.
This feeling of solidarity has never left me. I do also happen to believe that anything can happen to anybody at any time. I studied change academically in my MBA in the usual context of change management and change leadership. It’s how I came to know of Helen Bevan’s work. I’ve thought a lot about that and the highly influential Sirkin paper. But I don’t think I honestly ‘got‘ change until this year. In 2007, I was forced to change, giving up alcohol for life. I realised that if I were to have another drink ever I would never press the off switch; I would either end up in a police cell or A&E, and die. This is no time for hyperbole. It was this forced change, knowing that I had an intolerance of alcohol as serious as a serious anaphylactic shock on eating peanuts, that heralded my life in recovery. I later came to describe this to both the legal regulator and the medical regulator as the powerful driver of my abstinence and recovery, rather than a ‘fear based recovery‘ from either professional regulator.
But I feel in retrospect my interpretation of this change, as due totally to an externality, is incorrect. As I used to attend my weekly ‘after care’ sessions with other people newly in abstinence from alcohol or other toxins, or from gambling, or sex, I discovered that the only person who can overcome the addiction is THAT person; and yet it is impossible to read about this path of recovery from a book, i.e. you can’t do it on your own. So ‘command and control’ is not the answer after all. Becoming physically disabled, and a forced change of career and professional discipline, and a personal life which had become obsessed by alcohol, meant I had no other choice. I had to ‘unclutch’ myself gear-wise from the gear that I was in, and move into a different gear. But I did find my new life, living with mum, and just getting on with my academic and practitioner legal and business management training intensely rewarding.
In 2014, I attended a day in a hotel close to where I live, in Swiss Cottage. One of the speakers was Prof Terence Stephenson. After his speech, I went up to thank him. I found his talk very moving. He was later to become the Chair of the General Medical Council (GMC). I was later to become regulated once again by the GMC. Two lines of his has kept going through my mind repeatedly since then. The subject of the day was how sick doctors might get salvation despite the necessary professional regulation process. Stephenson claimed: “If you’re not happy about things, I strongly urge you to be part of the change. You being part of the change will be much more effective than hectoring on the sidelines.” This was not meant as any threat. And as I came to think more and more about this I came to think of how much distress my behaviour had caused from my illness, how I wish I had got help sooner, and how looking for someone to something to blame was no longer a useful use of my energies. I am now physically disabled. I get on with pursuing a passion of mine, which is promoting living better with dementia. But if there are any people who are worthy of retribution I later decided then their karma might see them implode with time. Not my problem anyway.
I now try to encourage others where possible if they feel that they have hit rock bottom; I strongly believe that it’s never too late for an addict to break out of the nasty cycle. If you think life is bad, it unbelievably could be much worse. I think businesses like persons get comfortable with their own existence and their own culture, but need to adapt if their environment needs it. I think no-one would wish to encourage actively social care on its knees such that NHS patients cannot be discharged to care, if necessary, in a timely fashion. I don’t think anyone designing the health and care systems would like them to be so far apart deliberately, with such bad communication between patients, persons and professionals. Above all, I feel any change has to be authentic, and driven by people who really desperately want that change. I think change is like producing a work of cuisine; you can follow the recipe religiously in the right order, but you can recognise whether the end result has had any passion put behind it. For me, I don’t need to ‘work hard’ at my recovery, any more. I haven’t hit the ‘pink cloud‘ of nirvana, but I am not complacent either. Change was about getting from A to B such that I didn’t miss A, I was in a better place, and I didn’t notice the journey. If I had super-analysed the change which was required to see my recovery hit the seven year mark this year, I doubt I would have achieved it.
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.
Please note: This blogpost has been edited since the first publication, due to a factual inaccuracy of mine this morning where I stated the Tavistock Clinic was private.
It is not private. I do sincerely apologise for this mixup. It was an entirely accident error of mine.
I have also changed the word ‘aggressive treatments’ to ‘thorough interventions’ on the advice of two different people.
I am further posting Kate’s very helpful comment below the end of this article.
I am extremely grateful to Kate for her comment.
I have previously written openly about my personal experiences as a sick doctor and beyond (please see here). Thank you if you were one of the 2000 or views of that blogpost on that particular day.
In 2008, the Department of Health under the previous government funded a two year pilot to commission and provide a specialist, confidential, service, the Practitioner Health Programme (PHP).
The service was free to all doctors and dentists in London with:
- mental health or addiction concern (at any level of severity); and,
- physical health concern (where that concern was potentially impacting on the practitioner’ performance).
The PHP complemented existing NHS GP, occupational health and specialist services. It demonstrated the need for the service (over 500 patients have now been treated, many with complex problems) and how savings could be achieved through swift, safe return to work.
The 2009 Boorman review of the health of the NHS workforce reported that:
- the direct costs of ill-health in NHS staff are in the region of £1.7 billion p.a.;
- the agency staff bill for the NHS is around £1.45 billion p.a. (spending closely related to sickness absence and staff turnover); and 2,500 ill-health retirements (some possibly preventable) each year cost the NHS £150m p.a.
The Chief Executive of the General Medical Council, Niall Dickson, commenting on the PHP said:
“We know of the stress and anguish experienced by doctors who become sick and how this can affect their work. There is not enough good support at local level and the PHP programme has shown what can be done.”
It is now pretty widely felt that prevention and early intervention could save the NHS millions of pounds, and employers can achieve huge savings by supporting doctors and ensuring they remain fit to practise, whilst maintaining or improving quality. The potential savings for employers far outweigh the likely cost of establishing a nationwide service (estimated at around £6 million). There is therefore a real economic case, as well as averting tragedies in human lives training in the NHS.
If you’re a sick Doctor, ‘Good medical practice’, the GMC’s code of conduct, is triggered under domain 2 for quality and safety by the following clause.
In my own particular case, it is recorded in two detailed witness statements that I tried to discuss in detail the alcohol problem that was concerning me with two Consultant Physicians in London.
In neither case was I offered a programme of alcohol management. I confided in them personal details.
It is a real pity that I did take up an offer by a Consultant who recommended the Tavistock Clinic, as I erroneously thought it was private not public. Notwithstanding that, no offer of sick leave was made, but that is my fault for not having let the discussion get that far.
But I really don’t wish to play any ‘blame game’ – for example I failed in not being under a General Practitioner at the time, as I was at that stage absolutely petrified that that GP would have reported me to the GMC subjecting me to years of investigation. I had years of investigation anyway, but without the critical help I needed.
Being under a General Practitioner for a medical professional is a requirement of their Code of Conduct according to rule thirty.
I think many aspects of my dire situation reflects a fundamental misunderstanding of the medical profession thinking that if a sick Doctor is ‘aware’ of his problem he has full insight into the distress the problem is causing to friends, family and beyond.
I feel that, had my problem been aggressively dealt with earlier, the subsequent failures in my alcohol management would not have occurred (three years later).
My erasure for me was perceived by me as the ultimate personal failure for having been through a public hearing, treated still in the media as a “show trial”, and a personal failure for not having got clinically better. On a note of wider contrition, however, I have no objection to the issues I was found proven to this day, and I think the GMC ultimately made the correct sanction.
Media reports, despite public humiliation, distressing not just for me but my late father at the time, make no reference to my underlying medical problems. I was sectioned in May 2006 due to alcoholism. It’s as if the establishment wishes purposefully to airbrush doctors being sick.
I was distraught on my erasure, for having no solution to my mental health problems in sight. The regulatory process exacerbated my misery, with psychiatrists not being able to rule out at anxiety and depressive component while I was heavily drinking.
I know I was ‘aware’ of my problem with empty drunk bottles of red wine, but it doesn’t mean that I had the motivation to take time off work then to do something about it.
Likewise, the GMC code (see clause twenty eight above) assumes that the sick Doctor has full insight.
In my case, it had a very unpleasant end.
Not just this, days before my 33rd birthday,
but this six week coma and two month neurorehabilitation (the full discharge diagnosis from a place where I used to be a junior clinical physician once with no health problems.)
I think it is incredibly hard for anyone to understand outside of the system how you get raped of your dignity and integrity by the regulator when you fail to improve from mental illness. And often this mental illness is exacerbated by the regulatory process, as 86 deaths of Doctors awaiting Fitness to Practice during the same period of my investigation might appear to testify.
As I never had a performance assessment or clinical supervisor during my regulatory process, despite four different consultants concluding I had a severe alcohol problem at least between August 2004 and spring 2005, I feel I was put into managed decline long before the final hearing in July 2006.
I think personally the system for sick doctors undergoing the regulatory process from the General Medical Council could be much better, but that might be just be an unfortunate personal experience: ‘there’s nothing to see here’.
But a good first management step for me would be to roll out the Practitioner Health Programme to a jurisdiction wider than London. Lives truly depend on it, and the general public deserve better from seniors in the medical profession. This, for me, is absolutely necessary to maintain trust in the medical profession, domain 4 of the current GMC Code of Conduct. The GMC need to make the dealings open in this regard, fundamentally.
As far as the Consultants who contributed to my 2006 erasure were concerned, I have been out of sight and out of mind. In fact, I haven’t spoken to them for a decade and needless to say they have not wished to contact me.
I may be newly physically disabled following 2007.
I don’t personally wish the GMC any ill will. I believe in rehabilitation being a regulated student member of the law profession now – but do they?
I am back now.
Kate’s really helpful comment:
The Med Net service IS FREE and confidential.
When medical trainees encounter difficulties, college tutors, clinical tutors, programme directors and educational supervisors are encouraged to signpost them to Med Net. It was very positive that the consultant, who was not your educational supervisor, took sufficient pastoral interest in your welfare to give you the Med Net contact details. Ultimately, it is down to junior doctors to contact the service. Had you sought an appointment with your trusts OH team, they’d have given you the same contact details. It would have still been down to you to make contact. (< Indeed. Thanks , noted )
Alcohol-related disorders are outside the Mental Health Act, so it is impossible to compel people to undergo “treatment”. “Treatment” is an unfortunate term, as there is little that therapists can do until an individual wants help or becomes so incapacitated that they cease using. Even then, the notion of “treatment” as something that is done “to” people is inappropriate. This is one of the reasons why addictive disorders are outwith the MHA. Compulsion doesn’t work. “Aggressive treatment” is a particularly unhelpful concept more appropriate for the treatment of leukaemia rather than substance misuse disorders. Intense cycles of chemo-irradiation may induce remission in oncology, but intense input achieves nothing in addiction.
Kate then said it was a pity that I did not take up the offer of that Consultant, which I absolutely agree with.
I understand why there have been so many deaths of Doctors waiting GMC FTP. That could easily have been me.
At least 96 doctors have died while facing a fitness-to-practise investigation from the General Medical Council since 2004, though it is not clear how many of these cases were suicide.
I can understand exactly how this has happened.
I had a prolonged GMC investigation between 2004 and 2006. At no point during this process was I told when then this mentally arduous process would come to an end.
I think now, seven years into recovery, that there by the grace of God go I.
The media have a remarkably level of detail of understanding from the perspective of the General Medical Council about forthcoming cases. It is impossible for the Doctor to get his side across in the media.
The GMC claim they don’t do show trials.
But my father was fully humiliated with the media storm.
My father was faced with a Doctor son who was in denial and lacked insight. My father is now dead, but I should like to say he probably died in complete humiliation of his son.
My experience is of a GMC which plays to people’s weaknesses in low self esteem and low confidence, a personality trait shared by many with addiction disorders.
Not one report in the mainstream media reported that I was severely alcoholic. And yet the GMC, prior to their erasure of me, erased me with five independent reports stating clearly that I had at least a severe alcohol problem; and that I needed help.
One of the referrals to the GMC was when I attended the A&E of a hospital with acute intoxication. In addition to the referral to the GMC by the Consultant in A&E, I was not offered any post-event support for alcoholism.
The GMC know how to present themselves in the media, but this is in contradistinction to the experience of those who have experienced the Fitness to Practise process first hand.
Dr Peter Wilmhurst writes in 2006 in a wide-ranging criticism of the GMC as follows:
In wishing to infer ‘bad character’, the General Medical Council must not go beyond its statutory duty of promoting public safety. Otherwise, there is simply mission creep and a torrent of smears into a hate campaign by the regulator or its company.
In 2005, one year before I was eventually due to see the GMC, I was suspended. This was due to an alcoholic bender in Northwick Park. I was crying all day in a pub because I could not cope with the investigation any more.
I had waved goodbye to my late father, and lied to him saying I was going shopping.
I didn’t. I ended up being sectioned by a psychiatric hospital in North London, and my father spent ages talking to the medical staff there.
I was then suspended. It was at that point, I wished to call it a day.
I phoned the Samaritans, and they talked me out of it.
I have never told anyone this story. I feel very strongly about what the General Medical Council did to me, even though it might have been merely a product of their inefficiency.
Nobody appears to wish to want to change the system. I’m pretty sure that there are juniors who wish to hold tight until they are Consultants.
What happened to me is that I had consultants in two Trusts in West and North London who said I was ‘late for work’, ‘smelling of alcohol’ and ‘dishevelled’.
None of this got reported in the main media.
I was erased. To this day, I still have no idea who retrospectively complained in graphic detail about my alcoholism did not offer me sick leave, or help with occupational health.
One of them even had the gall to write in his witness statement for the GMC that he gave me the phone number of a private clinic.
I find this particularly ironic as I was later done for incompetence, when that North London trust had allowed me to finish my medical job there, successfully running cardiac arrests there. I passed my Advanced Life Certificate there. I even have the certificate to prove it.
I feel disgusted by the way that the General Medical Council goes about its business.
Far too many one-sided media reports appear in the media containing detailed accounts, as yet unproven. There’s a sense of being hung before you even go to the gibbet.
I am now in my seventh year in recovery. I have done four books, and my Bachelor of Law, Master of Law and Master of Business Administration.
I even completed my pre-solicitor training, as I am regulated by the Solicitors Regulation Authority.
My late father died two months before the Solicitors Regulation Authority gave me permission to finish my legal training, after a meticulous consideration of various factors including details of my erasure.
I am now applying to be restored. And so everything gets racheted up again. The dogs will get unleashed.
And so far they’ve dragged me up to the City where I was struck off, without my late father, surrounded by the same bars and clubs and restaurants. I didn’t have a relapse. Care and compassion are simply two words which are not in the GMC’s dictionary.
I am even applying to go to a desk, non “facing job”. I am now following my erasure newly disabled, so I would not wish to do clinical medicine in any form.
I do not want to be in public health with the stigma of having been erased, for a period of life when I was very ill, and the undoubted discrimination that that would entail.
I had one year of sitting in a pub all day after I was eventually erased in 2006.
This was an extremely dangerous part of life. For my father, it was unbelievably distressing. Nonetheless, he came to visit me every day on the ITU when I was in a coma due to this a year later.
I so understand why there have been so many deaths of Doctors waiting GMC FTP. That could easily have been me.
But I am fighting fit now, and looking forward to my hearing very much.
One of the more nauseating aspects of #NHS14Expo were people asking me as usual why I hadn’t gone to #NHS14Expo.
It’s quite simple.
I wasn’t invited.
— shibley (@legalaware) March 4, 2014
I had a chat with Martin Rathfelder, the Director of the Socialist Health Association, about it. I’m currently on their Central Council.
Like one of my followers @RoyLilley, I have a vague interest in English health policy – as evidenced perhaps by my 300 blogposts on the matter this year?
“You would have loved it Shibley! You should’ve come!”
But then Martin suggested a number of routes by which I could legitimately come next year – one of them was joining a CCG, or becoming a NHS Foundation Trust governor.
I do have a cursory interest in postgraduate medicine, and have in fact written some books on it.
Martin also suggested I could capitalise on an interest in long term conditions.
As is well known, I survived a six week coma due to meningitis in 2007. That’s how I became physically disabled. I’ve been in recovery from alcohol ever since, and successfully regulated (and rehabilitated) by the Solicitors Regulation Authority who oversee lawyers.
Martin also suggested dementia as an inroad.
I have an interest in this too.
My paper in Brain in 1999 was the first to explain the symptoms of frontal dementia.
It has been quoted over 300 times by major labs.
It’s even in the current Oxford Textbook of Medicine in their chapter on dementia.
My pal Prof John Locke politely suggested that, as I had actually done a MBA, I was more than capable of marketing my own book.
In fact, in that MBA I also did come top of innovation in the year (though I did come top of both domestic and international marketing too).
Or is it because I am a total social recluse?
Tell that to my 11.7K followers on @legalaware, including David Nicholson, NHS England’s CEO.
Or is it that I didn’t do a pledge for #NHSChangeDay?
No – I did a pledge. It’s here.
I’ll think about Martin’s advice.
On a happier note, I’ve been given a desk to do my research questionnaire on perception of #G8Dementia at a one day conference in Scotland.
Glasgow of course was where I was born. I like their dementia policy too.
And they’ve given me a chance to talk about my evidence-based book on living well with dementia – it’s here, and my marketing opportunities are non-existent.
Of course, I wasn’t actively excluded.
And one final note.
My book on ‘Living well with dementia’ is here – go and buy it, I beg you! Pleeeeeezzzzzzzzzz
It was honour to speak to a group of suspended Doctors on the Practitioner Health Programme this morning about recovery
It was a real honour and privilege to be invited to give a talk to a group of medical Doctors who were currently suspended on the GMC Medical Register this morning (in confidence). I gave a talk for about thirty minutes, and took questions afterwards. I have enormous affection for the medical profession in fact, having obtained a First at Cambridge in 1996, and also produced a seminal paper in dementia published in a leading journal as part of my Ph.D. there. I have had nothing to do with the medical profession for several years now, apart from volunteering part-time for two medical charities in London which I no longer do.
I think patient safety is paramount, and Doctors with addiction problems often do not realise the effect the negative impact of their addiction on their performance. No regulatory authority can do ‘outreach’, otherwise it would be there forever, in the same way that Alcoholics Anonymous or Narcotics Anonymous do not actively go out looking for people with addiction problems. I personally have doubts about the notion of a ‘high functioning addict’, as the addict is virtually oblivious to all the distress and débris caused by their addiction; the impact on others is much worse than on the individual himself, who can lack insight and can be in denial. Insight is something that is best for others to judge.
However, I have now been in recovery for 72 months, with things having come to a head when I was admitted in August 2007 having had an epileptic seizure and asystolic cardiac arrest. Having woken up on the top floor of the Royal Free Hospital in pitch darkness, I had to cope with recovery from alcoholism (I have never been addicted to any other drugs), and newly-acquired physical disability. I in fact could neither walk nor talk. Nonetheless, I am happy as I live with my mum in Primrose Hill, have never had any regular salaried employment since my coma in the summer of 2007, received scholarships to do my MBA and legal training (otherwise my life would have become totally unsustainable financially apart from my disability living allowance which I use for my mobility and living). I am also very proud to have completed my Master of Law with a commendation in January 2011. My greatest achievement of all has been sustaining my recovery, and my talk went very well this morning.
The message I wished to impart that personal health and recovery is much more important than temporary abstinence, ‘getting the certificate’ and carrying on with your career if you have a genuine problem. People in any discipline will often not seek help for addiction, as they worry about their training record. Some will even not enlist with a G.P., in case the GP reports them to a regulatory authority. I discussed how I had a brilliant doctor-patient relationship with my own G.P. and how the support from the Solicitors Regulation Authority (who allowed me unconditionally to do the Legal Practice Course after an extensive due diligence) had been vital, but I also fielded questions on the potential impact of stigma of stigma in the regulatory process as a barrier-to-recovery.
I gave an extensive list of my own ‘support network’, which included my own G.P., psychiatrist, my mum, other family and friends, the Practitioner Health Programme, and ‘After Care’ at my local hospital.
The Practitioner Health Programme, supported by the General Medical Council, describes itself as follows:
The Practitioner Health Programme is a free, confidential service for doctors and dentists living in London who have mental or physical health concerns and/or addiction problems.
Any medical or dental practitioner can use the service, where they have
• A mental health or addiction concern (at any level of severity) and/or
• A physical health concern (where that concern may impact on the practitioner’s performance.)
I was asked which of these had helped me the most, which I thought was a very good question. I said that it was not necessarily the case that a bigger network was necessarily better, but it did need individuals to be open and truthful with you if things began to go wrong. It gave me a chance to outline the fundamental conundrum of recovery; it’s impossible to go into recovery on your own (for many this will mean going to A.A. or other meetings, and discussing recovery with close friends), but likewise the only person who can help you is yourself (no number of expensive ‘rehabs’ will on their own provide you with the ‘cure’.) This is of course a lifelong battle for me, and whilst I am very happy now as things have moved on for me, I hope I may at last help others who need help in a non-professional capacity.
Best wishes, Shibley
My talk [ edited ]
This is a brilliant plan for recovery by Ed Balls MP. Whilst drawing on aspects of management which were probably not familiar to John Maynard Keynes, the emphasis is most definitely on infrastructure investment to promote growth. A Keynesian argument might be that you do not need much money to identify a small disruptive change, but you might invest in implementing a minor change which dislodges incumbents in an international competitive market. Also, it is very clever that Ed Balls has combined this with a focus on the green economy, in accordance with the workload of Luciana Berger MP who works closely with Rachel Reeves MP in ensuring that the business case for a ‘green economy’ is made. Luciana has been arguing at fringe events why green ideas should not be a casualty in a drive towards austerity. This plan is indeed visionary, and would be exactly the sort of plan which would work for a flatlining economy. The only problem is that Ed Balls MP would not be able to implement such a plan until early May 2015 at the very earliest.
I am enclosing the full text of Balls’ speech as follows.
Full text of Ed Balls speech this morning to the #Lab12 conference
Conference, we meet here in Manchester, two years on from our leadership election, a contest held in the shadow of a General Election defeat.
And we all know what’s supposed to happen when political parties lose elections: acrimony and division, the party turning in on itself, out of touch with the views of the country.
Well Conference, two years on, in this generation, we have bucked that trend. I can’t remember our party ever being so united, so determined to win back the trust of the people.
And with our economy in recession, and the unfairness and incompetence of this Tory-led coalition now laid bare, let us show we are the people to rebuild Britain, strong and fair for the future.
And Conference, making the case for change, setting the agenda – on reform of our media, and banks, responsibility in our economy from top to bottom; showing the strength of purpose and moral conviction which won him the job and which will get him to Downing Street; Conference, let us pay tribute to my friend, our leader, Britain’s next Prime Minister, Ed Miliband.
Conference, I am proud to serve in Ed’s Shadow Cabinet – now with more than 40 per cent women, the first time that has ever happened in British politics.
And what a contrast to David Cameron’s Cabinet: where the men get the jobs, the women get the sack and only the chaps get the knighthoods.
Let me ask you this: what does it take to get sacked from David Cameron’s Cabinet?
Swear at a police officer and call him a ‘pleb’? And you’re defended to the hilt.
Get caught red-handed texting market sensitive information to News International? You get promoted.
Flat-line the economy and deliver the most unfair and shambolic Budget in living memory? And you stay in post – more than that, you’re allowed to do it part-time.
Do all those things and David Cameron will let you keep your job. But not if you’re a woman.
Conference, what kind of Prime Minister thinks it’s fair to sack a 54 year old woman from his Cabinet because she’s ‘too old’ – and then give the job to a 56 year old man instead?
Let me tell you: a Prime Minister who only appoints five women in the first place, sacks three of them, demotes the other two – and then attacks the Labour leadership for not being ‘butch’ enough.
Butch? Butch? Whatever did he mean? And if David Cameron is butch, where does that leave George Osborne?
Perhaps this is why George Osborne will never be sacked. A Prime Minister and a Chancellor destined to go down fighting together. And this time, let’s see them riding off into the sun-set. Butch Cameron and the flat-line kid.
And Conference, doesn’t it feel good to be back here in Manchester?
Or, should I say, to be back here in Labour Manchester: four Labour MPs, three world class universities, two world-beating football teams, one Labour Council. And not a single Tory Councillor in this whole city – not a single one.
Let us pledge today to keep it that way, and elect the brilliant Lucy Powell as Manchester’s first ever Labour woman MP.
And let me say too, I can think of no-one better to be Manchester’s first ever Police and Crime Commissioner than the wise and highly respected Tony Lloyd.
And Conference, at a time of such tragedy for policing in this city, our whole country remembers two brave officers who lost their lives doing their duty, and we pay tribute to all those public servants up and down the country – police officers, fire-fighters, our armed forces – who every day put their lives on the line to keep us safe.
And Conference, as we rightly praise the success of London 2012, let’s not forget it was Manchester’s hosting of the 2002 Commonwealth Games which showed the way, proving that Britain was ready to stage the biggest international sporting events.
So Conference, we salute Graham Stringer and Sir Richard Leese as we salute all those people who brought the Olympics to London, and made them such a success – Tony Blair and Prince William, Ken Livingstone and Gordon Brown, Lord Coe and Boris Johnson, too many others to mention.
But let us remember that none of them would have been able to play their part if not for the one person who made it all possible. Conference, please join me in thanking Dame Tessa Jowell.
Conference, it was Tessa’s officials who told her it would be a disaster to bid for the 2012 Games. It would cost too much, the stadiums would never be ready, London’s transport wouldn’t cope, the security would be a nightmare.
Tessa could have listened to all those concerns, but she didn’t. She persevered. We won the bid. And the rest is now part of our national history.
And Conference, this is the lesson we all should learn. With wise leadership and long-term vision and a strong partnership between government and citizens, business, trade unions and the voluntary sector, we can do great things, we can lead the rest of the world and we can rebuild Britain for the future.
But if you listen to the doubters, if you never take a risk, if you flinch when obstacles are in the way, you will never get anything done.
And if you spend your whole time fighting short-term political battles – Dave versus Boris, Boris versus George, George versus Vince – you will never rise to the long-term needs of the country. And in the end, you let people down and lose their trust.
And nowhere is that more obvious than in our economy today.
Thank goodness the Olympics has given us a short-term shot in the arm, that might just be enough to take us out of recession this quarter.
But that is no substitute for a long-term strategy. Not when families are struggling to make ends meet. Not when food and fuel prices are going up, but wages are frozen and tax credits cut.
Not when so many young people have been unable to find work or stay-on in education. Not when so many small businesses are struggling to raise finance so they can survive until the year-end.
Not when so many working people in the private sector and public sectors are worried about their jobs and their pensions – the human cost of this economic failure.
Remember what David Cameron, and George Osborne and Nick Clegg promised: that faster tax rises and deeper spending cuts would secure the recovery and make Britain a safe haven; that theirs was the only credible plan to deal with the national debt; and that we were all in this together.
Conference, the recovery secured? We’re just one of only two G20 countries in recession – the longest double-dip recession since the Second World War.
A credible plan to deal with our debts? Because we are in recession, the deficit is now not going down, it’s going up – up by 22 per cent so far this year. Rising borrowing not to invest in the jobs of the future but to pay for the mounting costs of this government’s economic failure.
Conference, there is nothing credible about a plan that leads to: a double-dip recession, thousands of businesses bust, a million young people out of work, billions wasted on a soaring benefits bill, and borrowing going up not down. That’s not credible, that is just plain wrong.
And as for ‘we’re all in this together’, we don’t hear that line anymore.
Not from a Chancellor who presented the most unfair and unpopular Budget in a generation. A Chancellor who tried to raise taxes on pasties, caravans, churches and charities, but who refuses to look seriously at proposals for a mansion tax.
A Chancellor who in six months’ time will raise taxes for pensioners on the very same day he cuts the top rate of tax for the very richest – a £3 billion tax cut, giving £40,000 a year to a millionaire.
Conference, what kind of government asks millions of pensioners to pay for a tax cut for millionaires?
What kind of government believes low-paid women will only work harder if you take away their tax credits and make them worse off, but millionaires will only work harder if you give them a tax cut to make them better off?
Conference, isn’t this the truth, we know what kind of government this is: failing on the economy, failing on the deficit, hitting the many to help a privileged few. Arrogant, complacent, out of touch.
Conference, it’s the same old Tory government. David Cameron, George Osborne, Nick Clegg. The same old Tories, every one of them.
But you know what the worst thing is? For two years they’ve told us all this pain will be worth it in the end, that it’ll be short-term pain for long-term gain.
But what we are now seeing is short-term pain already doing long-term damage.
Look at the facts: over 33,000 companies already gone bust since the General Election; investment plans cancelled – or diverted overseas; our economy weaker, capacity lost, more prone to inflationary pressures when the recovery finally comes; child poverty rising, and long-term youth unemployment becoming entrenched, damaging them for the rest of their lives.
And Conference, if we carry on like this – a divided coalition, muddling through, no vision, waiting for something to turn up – the danger is that two lost years becomes three and four and that we slip into a lost decade of slow growth, high unemployment and stagnation.
Lost investment, lost output, lost jobs, lost exports, lost tax revenues – a decade when we fail to make the investments and the reforms we need to make our economy stronger and fairer for the future.
And Conference, it doesn’t have to be this way.
While Britain has been stalled over the past two years, other countries have been forging ahead. Last year private investment in Germany rose by over seven per cent. One million extra students enrolled in university in America. China is building 80,000 miles of roads a year and is now planning 70 new airports.
And here in Britain? Private investment? Down over 2 per cent last year.
More students? No, over 50,000 fewer.
And not one of the road projects David Cameron announced last year even started in construction.
And when you look at this picture of stagnation and inaction in our economy, it’s no wonder the deficit is now rising.
We warned two years ago that drastic spending cuts and early tax rises – too far, too fast – risked choking off the recovery and making a difficult situation worse. We warned that you either learn the lessons of history or you repeat the mistakes of history.
Because this is the fundamental truth: if more people are on the dole, not paying taxes, you can’t get the deficit down. If businesses are going bust, not hiring new workers, you can’t get the deficit down. If the economy’s not growing, you can’t get the deficit down.
And that is why we must act now to kick-start the recovery, tackle the causes of rising borrowing and start to make our economy stronger for the future.
A year ago, we set out five actions the government should take – then and now – to boost growth:
Tax bankers’ bonuses and build 25,000 social homes for rent and guarantee a job for 100,000 young people.
Genuinely bring forward long-term investment in infrastructure.
Temporarily reverse the damaging VAT rise.
Give every small firm taking on extra workers a one year national insurance tax break.
And cut VAT to 5 per cent for a year on home improvements and repairs.
But Conference, since last year David Cameron’s government has done next to nothing.
Their economic plan is failing – and they don’t know what to do. Plan A, Plan B, Plan A plus – with this government, I just don’t see any plan at all.
Conference, one year on, the need to kick-start the economy is even more urgent.
So we must go further. With 119,000 construction jobs lost in two years and a 68 per cent fall in the number of affordable homes being built, we need bold and urgent action now.
So with Hilary Benn and Jack Dromey, this is what I propose. The Government is anticipating a windfall of up to £4bn from the sale of the 4G mobile phone spectrum.
In the good times, Labour used every penny of the £22bn from the sale of the 3G licenses to pay off national debt. But in difficult times, we urgently need to put something back into the economy.
So with this one-off windfall from the sale of the 4G spectrum, let’s cut through this Government’s dither and rhetoric and actually do something. Not more talk, but action right now.
Let’s use that money from the 4G sale and build over the next two years: 100,000 new homes – affordable homes to rent and to buy – creating hundreds of thousands of jobs and getting our construction industry moving again. Add to that a stamp duty holiday for first time buyers buying homes up to £250,000 and we can deliver real help for people aspiring to get on the property ladder.
Conference, a clear and costed plan to kick-start the economy and get people back to work. Building the homes that we need now and for the long-term. Building our way out of recession and re-building Britain for the future.
And we also need reform to boost long-term investment and skills – the only routes to rising living standards for working families.
Chuka is right to say we need a modern industrial policy to support long-term wealth creation, with strategic support for our advanced manufacturing and service industries.
And we need to work and campaign together to tackle tax avoidance, end bogus self-employment, prevent a race to the bottom through regional pay; and enforce the minimum wage, help parents balance work and family life and make sure our labour market is genuinely flexible and fair to working people, and let’s go further and promote the living wage.
And we know too our banking system needs cultural change and radical reform – reform which this Government is only interested in watering down.
That is why Ed Miliband and I are clear, we do need:
A full, open and independent public inquiry into the culture and practices of our banking system.
Radical reform to separate retail and investment banking.
Active support for mutuals and co-operatives.
A continued campaign for an international financial transactions tax.
And a proper British Investment Bank – fully backed by the Treasury.
And Conference, let me say this about the hundreds of thousands of working people, earning ordinary salaries, who work hard every day behind the counters of our high street banks.
They were as shocked and dismayed as everyone else at the gross irresponsibility and greed of a few millionaire bankers at the top who caused such damage and gave their industry a bad name. Working people who want tougher regulation, who want banks to work for the long-term interests of our economy, and who do not deserve to be pilloried for their hard work and service.
Conference, the financial crisis did expose deep-rooted problems in our economy.
After the global financial crash, it was always going to be difficult to get the deficit down. And even if we do get the economy growing again, even if we do reform our banking system for the future, we’re still going to face tough choices in the years ahead.
But the longer this Government staggers on with a failing economic plan, the worse it will get and the harder the job will be. Hard times will last longer than all of us hoped. And we cannot promise to put everything right straight away.
That is why, however difficult this may be, when we don’t know what we will inherit, we cannot make any commitments now that the next Labour government will be able to reverse particular tax rises or spending cuts. Because, unlike Nick Clegg, we will not make promises we cannot keep.
Of course we’ll make different choices – we’ll do things in a fairer and more balanced way and put jobs and growth first.
But Conference, as I said to the TUC, we must be upfront with the British people that under Labour there would have been cuts and that – on spending, pay and pensions – there will be difficult decisions in the future from which we will not flinch.
Before the next election – when we know the circumstances we will face – we will set out for our manifesto tough new fiscal rules to get our country’s current budget back to balance and national debt on a downward path.
Not a meaningless fiscal rule like George Osborne’s – a promise to balance the books in five years time, with that five year period moving forward every single year.
Conference, our fiscal rules will be monitored, independently, by the Office for Budget Responsibility, and we will take the action required to meet them. And when we sell off the Government’s shares in the banks every penny will go to repay the national debt. Conference, fiscal responsibility in the national interest.
And because we all know there can be no post-election spending spree, in our first year in government we will hold a zero-based spending review that will look at every pound spent by government: carefully looking at what the Government can and cannot afford, rooting out waste and boosting productivity, building on the work that Rachel Reeves and Jon Trickett are leading.
But we will do things differently to this Government. Not slashing budgets without a care in the world – damaging the economy, hitting women harder than men – but assessing every pound of taxpayer’s money including for its impact on growth and fairness.
Not opting for short-term cuts that look ‘easy’ but which end up costing more in the long-term – like deep cuts to youth services, to adult mental health services and to public health.
And not ducking the hard long-term issues we know we haven’t properly faced up to and which transcend parties and parliaments and where we badly need a cross-party consensus. So let us get a long-term plan to support the most vulnerable in our society – looked-after children and adults needing social care.
Because this is not just about policy, but about the kind of country we want to be and the way we do our politics.
Where we face important long-term challenges, we must seek a consensus that puts short-term politics aside and puts the national interest first, just as we did over a decade ago when we made the Bank of England independent.
And nowhere is such a consensus more essential than on our national infrastructure.
The lesson of the Olympics is that if we approach major long-term infrastructure projects by building a cross-party sense of national purpose then we can deliver.
And yet, it took 13 years from the opening of the Channel Tunnel to complete the High Speed Rail link to London. Crossrail was delayed for decades.
And why is this so often the case? Yes, our cumbersome planning system. Yes, legitimate concerns for the environment. Too often in the past, governments have assumed that vital public infrastructure can only be funded by public investment – and then baulked at the bill.
But, above all, successive governments – including our own – have ducked or delayed vital decisions on our national infrastructure, allowing short-term politics to come first.
And just look at this government: will Boris or Dave win on Heathrow? Will Conservative MPs block High Speed rail? Will George see off Zac on renewable energy?
What a ridiculous way to run the country. No wonder business is fast losing confidence in this government’s ability to make long-term decisions.
But Conference, it is not just a problem of this government or this parliament – and we have to be the party to break this cycle.
Because if we don’t, if we put off major decisions for another generation, it will be our children and grand-children who will face the consequences.
Let me give you some examples. We must decide how and when we are going to deliver super-fast broadband across the whole of the UK and avoid a two-tier Britain.
We must decide whether we need to replace our antiquated National Grid, or risk more power cuts in the future. We must decide as a country on a clear plan to invest in nuclear power, wind and tidal power and other renewables so we can lead the world in delivering clean, de-carbonised energy and green jobs.
We must decide how we are going to protect our country from rising sea levels and exceptional rainfall, including whether we need to replace or reinforce the Thames Barrier to prevent London from flooding.
And we must decide, alongside vital decisions on rail and airport capacity, how we are going to get more freight off the roads and onto the railways – it won’t help that our grand-children are all driving electric cars if they are still sat in gridlock on the M6 or the M25.
On all these issues, if we don’t start to plan now, what will we say in 30 years’ time when our children ask: ‘why didn’t you act when there was still time?’
That is why we need a comprehensive long-term plan to rebuild Britain’s infrastructure for the 21st century, and a cross-party consensus to deliver it.
And it is why, too, at a time when Government budgets are tight, we must think innovatively about how we can finance these vital projects over the coming decades, drawing on the private sector and long-term pension savings.
So Ed Miliband and I have asked Sir John Armitt, the chair of the Olympic Delivery Authority, to consider how long-term infrastructure decision-making, planning, delivery and finance can be radically improved.
And I can announce today that Sir John has agreed to lead this work and to draw up plans for a commission or process, independent of government, that can assess and make proposals on the long term infrastructure needs of our country over the coming decades and help build that consensus.
Not repeating the mistakes of the past, but learning from them. Building a consensus which crosses party lines, without chopping and changing one parliament to the next. A consensus to re-build Britain for the future.
And Conference, there is another lesson we must learn from our history.
Many people have said over recent weeks: ‘this has been Britain’s greatest ever summer’.
But let me remind you of an even greater summer still: the summer of 1945 – the end of six hard years of war – when our nation welcomed its heroes home from the battlefields of Europe, Asia and the Atlantic, and celebrated together the defeat of fascism.
Conference, our predecessors were elected that year to rebuild a country ravaged by conflict.
They faced even greater challenges than we face today: an economy enfeebled by war; a national debt double the size of ours today. And they made tough and unpopular decisions: to continue with rationing; to cut defence spending; and to introduce prescription charges.
But that Labour Cabinet also remained focussed on the long-term task ahead. And they learned from history and rejected the failed austerity of the 1930s.
And that meant they could put in place long-term reforms, enduring achievements, vital to our country’s future: the Beveridge report; new homes for heroes; the school leaving age raised; and, for the first time ever, a National Health Service free to all, based on need not ability to pay – over 60 years later, celebrated in our Olympics opening ceremony for all the world to see, still today the greatest health service in the world.
Conference, they were very different times. But it is our task to recapture the spirit and values and national purpose of that time.
Just think of the people in whose footsteps we now follow. Working men and women who, in the years before, had see a hardship many of us will never experience.
But their suffering did not teach them selfishness, it taught them solidarity. And they never settled for second best in the struggle for education for all, free health care and proper rights at work.
Conference, we owe it to them – but more than that, we owe it to our children and their children to come – to learn from that example, to make the tough decisions but not to sacrifice their futures.
Because when our grandchildren look back at us, what will they say? Will they say we cast a generation of young people on the scrapheap of unemployment?
Will they say we dismantled the NHS and made it harder to go to university?
Will they say we plunged Britain into a decade of economic stagnation while other countries raced ahead? Will they say we left Britain less prosperous, more unequal, more unfair?
Or will they say – even as we made tough and painful decisions – that ours was the generation that got a record number of young people into apprenticeships as well as university.
Ours was the generation that safeguarded the NHS, and started the rebuilding of our national infrastructure.
Ours was the generation that tackled our debts by growing and reforming our economy – and making sure the banking crisis that caused those debts could never happen again.
Ours was the generation that broke from the cycle of political short-termism and started to rebuild Britain anew in the long term national interest.
So let us go forward. Not flinching from tough decisions. Giving our young people hope. Rebuilding Britain for the future.
That is our challenge. That is our mission. Let us rise to it together.