A Letter to my MP: The Reply

 

Our ref: rw\fromzogA\100211

10 February 2011

Dr Alienfromzog

Alien Castle

England

Earth

Dear Dr Alienfromzog

Thank you for contacting me regarding the Health and Social Care Bill.

I am determined to ensure that the Government’s proposals should only enhance the services that are currently offered to patients, and not lead to the privatisation of the NHS. I believe the NHS should be there for everyone who requires it, funded from general taxation with services that respond to need, rather than ability to pay. I am pleased that we have been able to secure an increase in the NHS’ budget every year of this Parliament. I have welcomed the chance to visit medical centres and other health care service providers across the [________] constituency and feel that we should be very proud of the high standards of care that are currently available to .patients.

The proposals set out in the Health and Social Care Bill are an evolution of the plans which governments have introduced over the last twenty years. Foundation hospitals, and indeed allowing patients to choose where to be treated on the NHS, have been ideas in the NHS for the best part of a decade. The proposed changes are being developed by around six thousand GPs who have come forward to help modernise the existing system with the understanding that the savings made will be ploughed back into patient care and front-line services. The implementation of these changes is proposed to be carefully phased over the next five years and is expected to save £5 billion by reducing unnecessary administration in the NHS over this Parliament. These proposals have been developed from a number of those set out in both of the manifestos of the coalition members including the Liberal Democrat manifesto, which stated that local communities should be empowered to improve health services through elected Local Health Boards which would take over the role of Primary Care Trust Boards in commissioning care for local people and would work in co-operation with local councils.

Some of my constituents are concerned that as a direct result of these new proposals, the structure of the NHS will be fundamentally changed so that doctors and nurses act like accountants, considering the price of treatment over the needs of their patients. Frontline doctors and nurses should bring clinical leadership into NHS budgeting and must be given all the support they need to help them take decisions in the best interests of their patients. GPs are already responsible for taking decisions about NHS expenditure in terms of whether a patient needs a medicine or form of treatment but because they aren’t currently responsible for this expenditure, the Primary Care Trust has to ‘second-guess’ the decisions taken by all their GPs before deciding which services need to be offered. The proposals set out in the Health and Social Care Bill therefore allow GPs to influence the allocation of expenditure more accurately to where it is needed most. Ministers would continue to remain fully accountable to Parliament for the way in which NHS money is spent, but local services could be shaped to meet local needs through GP practices working together, rather than by designs imposed by a Primary Care Trust.

It can be very beneficial when patients are able to choose where they are treated, whether it’s in an NHS hospital or by one of the voluntary or private sector services. A number of my constituents have raised the concern that price competition in the NHS will lead to a ‘race to the bottom’ on quality in which private providers will cherry-pick the easiest cases and I am keen to ensure that this is not the case. The Government plans to establish a powerful new regulator to make certain that there is no set target for the amount of private sector involvement in the NHS and that the Government does not pay more for a private sector service than it would pay the NHS. Clear national standards of care will be set, so patients can be confident that wherever they are treated, the NHS care they receive will be of the same high standard. Consequently, choice and more competition should lead to benefits for patients who will choose from the highest quality so that competition will then be based on quality, not price.

The Health and Social Care Bill received its first reading in the House of Commons on the 3lst January. It was then granted a second reading and has been sent to a Public Bill Committee for further scrutiny in which MPs will examine the proposals at great length. It is important that these proposals are carefully considered over the coming months. You can follow the Bill’s progress at http://services.parliament.uk/bills/2010-11/healthandsocialcare.html

I have written to Andrew Lansley MP, Secretary of State for Health, urging him to consider the specific concerns that you and other constituents have raised and to explain how the Government will ensure that high standards of frontline care provision will continue to be maintained. I will contact you again on receipt of a response.

I hope that this information is helpful. Please do not hesitate to contact me if I can be of any further assistance on this, or indeed any other matter. If you would like to discuss this issue in more detail, I would be very pleased to meet with you at one of my upcoming surgeries, which are advertised on the website: [link provided].

Yours sincerely,

                                                     

 Lib De Mocrat MP

Liberal Democrat MP for the [________] Constituency

A Letter to my MP

Alien Castle

England

Earth

The Hon L de Mocrat MP
House of Commons
London
SW1A 0AA

5 February 2011

Dear Mr de Mocrat,

I am writing to you to express my serious concerns about the Health and Social Care Bill (2011), in the hope that I – along with many others who are similarly concerned - can prevail upon you to vote against it. I would also like the opportunity to discuss this with you further at one of your constituency surgeries.

I have been a doctor for five and a half years and as such have seen how the NHS works (and how it doesn’t). I am currently a surgical trainee, working at Bristol Royal Hospital for Children. In common with all trainees, I have previously worked in various specialties; including cardiothoracic, intensive care, colorectal surgery, vascular surgery and ENT.

In my view the Health and Social Care Bill presents a plan of reform that is unnecessary, unworkable, unwanted and ultimately counter-productive. Whilst I do not agree with some who view the bill as the ‘death of the NHS,’ it is – in my opinion – a dangerous step in that direction.

Unnecessary
The primary justification used by the government is that the NHS is expensive and delivers poorer outcomes than comparable countries.[1,2] This analysis can charitably be described as flawed or perhaps, more precisely, as very misleading. The NHS is surprisingly efficient, delivering comprehensive healthcare coverage for around £1700 per person. A recent report noted that the NHS is the most efficient healthcare system in the seven countries they looked at. (The seven countries were The Netherlands, Germany, The USA, New Zealand, Canada and Australia).[3] Most of the developed world uses insurance-based systems requiring another level of bureaucracy that the NHS does not have. Only a small part of NHS care is provided by for-profit providers. Taking these factors into consideration, it becomes less surprising that the NHS is more efficient than alternative systems and that so much of the NHS budget is spend directly on patient care. It is also worth noting that the widely-reported flat-productivity of the health service[4] is not necessarily correct. A more detailed analysis by the University of York shows that productivity is actually improving and that the ‘flattening’ was in part due to external influences such as the Working Time Directive and that some of the spending was on longer-term investment and hence the output from that spending will not be seen immediately[5]. Furthermore, healthcare productivity should always be interpreted with great care as crude productivity can always be improved at the cost of quality. A good example from the acute surgical ward that I worked on until recently was the decision to reduce the number of trained nurses on the morning shift from four to three. Simplistically this will look like a productivity gain as the same number of patients are being cared for, the same number of operations are being performed, and yet the unit now has lower costs. However, the nursing staff themselves will tell you that the quality of care has fallen and they are frustrated that they do not have the time to deliver the level of care they want to.

International comparisons of healthcare outcomes and conclusions about the healthcare systems must be approached with caution. Not least because there are several factors that impact on outcomes at least as much as healthcare itself, such as poverty, genetics and cultural factors like smoking and drinking. Furthermore, changes in healthcare systems and spending often take time to feed-through to changes in outcomes. Two noteworthy articles in the British Medical Journal challenge the government assertion that the UK is lagging behind our European neighbours: Analysis of cancer survival data shows that fundamental differences in the way that countries collect the data may significantly affect the interpretation, this combined with the fact that it is well documented that UK patients present later than in other parts of Europe may mean that the NHS is actually over-performing relative to other European healthcare systems[6]. Similarly John Appleby, from the independent Kings Fund wrote the following:

“The official ministerial briefing for the Health and Social Care Bill states that despite spending the same on healthcare, our rate of death from heart disease is double that in France. Although statistics from the Organisation for Economic Cooperation and Development (OECD) confirm that in 2006 the age standardised death rate for acute myocardial infarction was around 19/100,000 in France and 41/100,000 in the United Kingdom, comparing just one year-and with a country with the lowest death rate for myocardial infarction in Europe-reveals only part of the story.
Not only has the UK had the largest fall in death rates from myocardial infarction between 1980 and 2006 of any European country, if trends over the past 30 years continue, it will have a lower death rate than France as soon as 2012. These trends have been achieved with a slower rate of growth in healthcare spending in the UK compared with France and at lower levels of spending every year for the past half century”[7]

Despite the fact, that until very recently the UK has spent less on healthcare then comparable countries, the death rates from heart disease are falling faster than other countries and similarly the UK has the most rapid improvement in cancer survival of all European countries.

Untimely

At a time when the NHS is being asked to make unprecedented savings, it seems to me, ludicrous for £2-3Bn to be directed towards reform. Even supporters of these reform measures admit that the promised medium-to-long-term savings of these reforms are optimistic and that the reforms have with them significant dangers.[8] Inevitably, patient care will suffer as a consequence.

Unworkable
It is good politics to talk about given more power to clinicians – in the form of GPs - to decide on patient care. Whilst I work in hospital medicine and therefore do not have direct experience, I know that most of my GP colleagues are not enthusiastic. Doctors are trained in patient care, they are not trained in administration. It is misleading to think that the decision making will be made solely by GPs. They do not have the time or the training to commission services effectively. Many do not have the inclination. I am fully in favour of more clinician involvement in management, and particularly strategic planning. There are some GPs who are very keen to be involved in this. However, forcing this role on all GPs will simply mean that the consortia either employ those laid-off by the Primary Care Trusts or contract it out to the private sector. This will result in a multiplication of work for the hospital trusts who currently have contracts with a small number of local PCTs, who will now have to have contracts with multiple consortia.

Similarly, training is being squeezed. As a doctor in a training post, my basic salary is paid by the Severn Deanery, who are responsible for post-graduate training and appointed me. My hospital only pays a third of my salary. Already, training posts are being slashed. The hospital trusts still have to fill their rotas – to ensure patient care, therefore they have to directly appoint doctors to what are known as ‘trust-grade posts.’ The full costs of these doctors is paid by the hospital. Therefore, with less training posts, the trusts costs are increasing, whilst their income is static. This is one of the indirect methods in which hospitals budgets are being cut. It also means that in five to ten years-time there will not be enough consultants or qualified GPs. The lack of consultants will cause waiting lists to increase massively – and we have just spent a lot of money to bring them down. (It is much cheaper to keep them down than to decrease them). Insufficient access to General Practise results in an increased burden on A&E departments. The increased role of private providers is also concerning as they already cherry-pick services. This is problematic as hospitals inevitably have to cross-subsidise services in order to function and the private sector does not share the burden of the cost of training. One estimate of this is that training costs the NHS £5Bn per year.[9] With the increase in competition, especially from private providers who do not have the same responsibility for training, there is a very real risk of training being squeezed out. Training is expensive but obviously, absolutely vital to long-term planning.

Unwanted
Public satisfaction with the NHS is at an all-time high[10]. The NHS is much better than it was a decade ago. The more the public know about these reforms, the less they want them. Similarly, doctors, nurses, managers and professionals-allied-to-medicine are all against the reform[11]. It is unusual that all these different groups agree.

Counter-productive
There does seem to be an unshakable belief that competition and free-markets are the solution to all problems. We know that privatisation does not work when it comes to armed forces. Similarly I would argue that the market does not really belong in healthcare. The extreme example of this, of course is the American system with astronomical costs and around 20% of the population without healthcare. Similarly detailed analysis by the University of Bristol of the effect of competition in the 1990s with fund-holding GP’s showed that direct competition between hospitals resulted in a reduction in the quality of care. Using mortality after myocardial infarction (heart attacks) for their analysis they showed that death rates were increased by competition.[12] Whilst, it may be emotive, it is not inaccurate to say that competition in the NHS led to more deaths. This evidence of a reduction in quality along with the reasons to believe that costs will increase leads me to view these reforms with extreme foreboding. The previous government introduced some competition to the NHS system, however, this was specifically competition on quality and not cost. This fundamental difference is vitally important. Furthermore, so much of healthcare relies on cooperation between services. This is one area in which the NHS needs to improve. The fragmentation of, and competition between, providers risks making this much worse.



Conclusion
My great fear is that the great strengths of the NHS will be lost. Healthcare will get more expensive and less effective. I am not opposed to reform per-se. There is much that can be done to improve the NHS. There is also much that should be done. However this bill is not going to improve healthcare in the UK, it will only have the opposite effect.

Yours sincerely







Dr alienfromzog BSc(Hons) MBChB MRCS(Ed) DCH




References
1. “Already our health outcomes lag behind the best in Europe.” David Cameron The Times January 31th 2011
2. “Modernising the NHS is a necessity, not an option, in order to meet rising need in the future, we need to make changes now. We need to take steps to improve health outcomes, bringing them up to the standards of the best international healthcare systems.” Andrew Lansley, The Conservative Party Website
3. Commonwealth Foundation Report 2010
4. Office for National Statistics
5. University of York Centre for Health Economics
6. Beral V, Peto R. UK cancer survival statistics. BMJ (2010) 341:
7. Appleby, J. Does poor health justify NHS reform? BMJ (2011) 342:d566
8. Nuffield Trust
9. Liberating the NHS: developing the healthcare workforce. Department of Health (2010):
10. British Social Attitudes Survey
11.
GPs
Royal College of Nursing
Royal College of Surgeons
NHS Confederation
Chartered Society of Physiotherapy
12. Propper et al. Competition and Quality: Evidence from the NHS Internal Market 1991-1999 CMPO Working Paper Series No. 03/077 (2003)

More LibCon

Does the UK Media hate the NHS?

Tombstones

I had reason recently to talk of Alfred Nobel. Yep, him of the prizes. What's less well known about him is that he also invented dynamite. And more remarkable than that is the fact that two are linked.

Alfred Nobel had the (not unique, but unusual) chance to read his own obituary - a newspaper thought that he had died and published it. It named him "Le marchand de la mort" The merchant of death for his invention of dynamite. He went on the leave his great fortune as a legacy to establish the Nobel Prizes. He did this, for the very understandable reason that he wanted a better obituary.

Tombstone inscriptions fascinate me as how can you possibly sum up a life in so few words? But also because I think it may capture something very important.

In will come as no shock to any of you (I hope) that you're all gonna die someday. Given that fact, I would argue that a vitally important question is what do you want your life to count for? What do you want to do with your life?

I think that thinking about one's own epitaph is a helpful way to approach this question.

So, what do you want written on your tombstone?

I doubt anyone will beat the excellent Spike Milligan's choice "I told you I was ill..."

Paul Eddington's "He did very little harm" has always intrigued me.

So what would I choose? The honest answer is I'm not sure but here's a couple of possibilities:

"He found himself ridiculous"
"He was caring, thoughtful and just a little bonkers"

AFZ

Why I Hate Liberal Democrats at the moment

Ever since I began to form my own political thoughts, I have been a Labour supporter. Over most of my lifetime, I have found natural allies amongst LibDem supporters. We tended to believe in similar things and have similar values. We are the broad church that makes up the left in British politics.

Throughout the New-Labour years, many of my LibDem friends maintained a kind of moral superiority. Noting the Iraq war, the poor civil-liberties record, treatment of asylum seekers and the closeness of the government to big business as reasons why New Labour weren’t really a left-of-centre party. How they were the true-believers if you will, not willing to compromise principal in order to gain power.

I suspect I am not alone in tolerating this superiority complex in my LibDem friends because I knew they were right. I have however remained a Labour supporter because of many things that I believe in and because I knew that the Tories would be so much worse. Here are a few of the reasons; The minimum wage, the Human Rights Act, systematic use of tax and benefits to arrest (though, sadly not reverse) the widening inequality in our society, Kosova, massive investment in our NHS which has made a real and tangible difference…

So, after 13 years of accusing Labour of selling-out in order to get power, what has happened since May? Well, on the basis of ‘stopping Britain becoming Greece’ they have abandoned most of their pre-election policies in forming a coalition with the Tories.

It’s not the coalition per-se that I object to - although I do wonder how things would be if Cameron was leading a minority government - it’s the full-throated, unflinching, shameless defence of blatantly unfair policies.

It is clear that the Tories need to create a narrative that ignores the international banking crisis and blames all the country’s woes on Labour and the public sector, in order to carry out an ideologically-driven program of destruction of the public sector. That’s what post-Thatcher conservatism is all about, except that the LibDems are helping them to do it.

It is entirely true that Labour did not live up to all I hoped they would but I have never been ashamed of voting for them, because on balance I think it was the right choice and we on the left are appalling at celebrating our successes. However I am profoundly glad that I didn’t vote LibDem in May (I nearly did as a tactical vote): The smug, patronising, hypocrisy of Nick Clegg and his merry supporters is unbearable.

AFZ

P.S. I may actually lose it next time I hear someone compare our national economy to a house-hold budget.

Cameron and Clegg insist on doing so. They are either stupid or attempting to mislead.

Sorry...

My apologies to my avid readers (both of you) for not writing anything for a while. The reason for this is a mixture of general busy-ness and a tendency to be writing elsewhere.

As, my personal information says, this blog is very much about me, and my need to say somethings. I think this is the reason most blogs exist really. Having found other outlets, I haven't felt the need to write here so much.

If you're interested, I wrote this for Liberalconspiracy.org on medical care for asylum seekers and I am an occasional contributor to AngryMob, a Daily Mail watch website. You can catch all of my little articles here.

AFZ

Ok, so a little bit more...

A little bit of politics

Now, you know I'd never be one to blow my own trumpet, but someone called 'alienfromzog' currently has the top poster on the brilliant mydavidcameron.com website why not take a look?

AFZ

Ways to improve football.

Just after new-year a national radio station did a phone in on ‘how would you improve football?’ I have been thinking about this anyway for a little while and whilst I didn’t phone the show, it did provoke me to crystalise my thoughts a little. So, here is how I would improve football – if I had the power! (Wahahahahaha etc.)

1. Respect
The FA seem to be entirely weak on this. Entirely weak to the point of damaging the game. The many ill-informed comments of high-profile managers and the constant challenging and attempted influence on referees by players whilst on the field cause much dismay to those of us who love the game. I think the solution to this problem is actually very straight forward.
The FA needs to do two things – one is within its power the other would need to be an international move by FIFA. Firstly, managers who publically criticise officials need to be actually punished and not given what can only be described as ‘token-fines’ at best – and often nothing at all. If the punishment is real, managers will stop making the comments, especially as many are not ‘heat-of-the-moment’ but carefully crafted words. The other change – that has been suggested from many quarters – is to simply not allow any player other than the captain to talk to the referee during the game. Say anything to any official and it should be a yellow card. No debate, no question, just a yellow card. There is no doubt that the first few weeks after this law was brought in would be chaos. There would be a very large number of bookings and far too many red cards. And then everyone would get used to it and things would settle down, just like when the back-pass rule was brought in, nearly twenty years ago. This would change the culture of football subtly and yet profoundly. It would not be possible to back-chat referees. I do think that the standard of officiating needs to be improved but that is no excuse for the appalling behaviour displayed by many on the football field towards officials. If FIFA were really smart, they would remove the pointless rule that removing one’s shirt when celebrating a goal is an automatic yellow card. (Not that I have any idea why players do this)

2. Timings
The control of time in football and the amount of stoppage time is a cause for much debate in the game and often, in my view, is a cause of unnecessary argument. I am trying very hard here not to make too many comparisons with rugby union but this is one parallel I think is worth drawing.
In rugby union, the timing is controlled by the referee, but independently. Once the ref starts the game the clock runs down, unless he calls ‘time off.’ There is no such thing as stoppage time because the clock stops for stoppages – that is injuries, discussions with players etc. (not every time the ball goes dead). Once the time is up, the next time the ball goes dead – except for penalties or try conversions – is the end of the game. Simple and clear.
Football could easily adopt this policy. Referees would merely have to signal ‘time off’ for major injuries or substitutions. There would be no room for arguing that refs had allowed too much or too little because it would be unarguable. Once 45 minutes were up – and in professional games this would be publically displayed on the scoreboard - the half would end next time the ball went dead, except for freekicks, penalties and corners.
Simple.

3. The use of technology.
Eventually football needs to realise that as the world’s biggest and most significant sport, it is laughable that it is so far behind every other major sport in terms of technology. Which technologies are used and for what I think remains an open question – but that something needs to used is, in my view totally clear. Imagine Formula 1 still relying on stopwatches!
There is one piece technology I would like to see used and then we can look at the others and decide. There are many decisions in football that require judgement but whether the ball has crossed a line or not is entirely objective. I think the idea of goal-line cameras is flawed but a microchip in the ball that would indicate whether it has crossed, not only the goal-line but also the touchlines if brilliant in its simplicity. I understand that the technology is not yet perfected but I have no doubt that if FIFA said it wanted to use it in all top level games then it would be made ready in a very short space of time.
The linesman (my apologies; assistant referees) would still need to indicate who the ball game off for throw-ins and corners but they’d have no doubt that the line had been crossed. Probably the easiest way would be a ear-piece with a sound for the linesmen. Or maybe like ice hockey, a light that goes on when a goal is scored.
Once working, I could see the next step being the put microchips in the player’s shirts in order to aid off-side decisions – but that’s a potential future development, whereas I think a chip in the ball is long overdue.

4. Money
The money-related problems in football are many and numerous. In part it stems from a trend to concentrate the wealth with a small number of already wealthy clubs. That is what the various re-incarnations of the European Cup as the Champion’s League is all about.
It the long term this kind of thing will kill the game. The so-called G14 have a lot to answer for.
The solutions to this problem are many and complex but there is one very simple change that I think would be a very good start.
Up until the early 80’s all gate-receipts from matches were split between both teams. This still happens for FA cup games. Currently the home club keeps 100% of the income from the gate. Naturally that gives a massive income advantage to the big clubs. Simply reversing this stupid decision would do a lot to improve the income of the smaller clubs in each league.

The FA
So come on Football Association, save our beautiful game!

Angry Mob

An interesting article... ok, so I'm biased...!

Some more Pascal

I've been thinking about Blaise Pascal quite a bit recently. I don't really know enough about him but the little I do know has always made me a bit of a fan. Mostly, this is because he was a great all-rounder; physicist, mathematician, philosopher and theologian. I also know that he struggled his whole life with depression and doubt. It is said that when he died, they found sewn into the inside of his coat a little tag that said "remember Jesus died for you."

Pascal's Wager is probably his most famous philosophical pronoucement. It has been pointed out that it's a very poor argument for the existence of God. And it is. But that's not what it's really about. For those of you who don't know, Pascal's Wager it goes something like this;

If there is any doubt, the best course of action is to believe in God. If there is a God and you don't believe in him the downside is massive. If there isn't a God and you believe in him, there is very little downside. Essentially if you don't believe then your best-case scenario is the beliver's worst-case scenario.

Last year, the famous bus posters "There's Probably no God, now stop worrying and enjoy your life" caught the media attention. (Link here)

Pascal's wager is the answer to this. It's the answer to can't-be-bothered-agnostism as I like to call it. I'm not entirely sure how "There's probably no God" is meant to be comforting - a licence to unrestraint maybe but not comforting. There's no God so you are alone in a cold and hostile universe, you are just an animal like any other, you have no inherent worth, there is no justice, no hope and no purpose. Whilst the theist has to wrestle with why God allows suffering, the atheist has no right to expect anything else.

Where the argument "There's Probably no God" really falls down is that it's an attempt to find comfort by avoiding the idea that one is accountable to God. As C.S. Lewis said: If you look for truth, you may find comfort in the end; if you look for comfort you will not get either comfort or truth only soft soap and wishful thinking to begin, and in the end, despair.

AFZ

Pascal

We are only truly happy when daydreaming about future happiness.

Blaise Pascal

Never talk about politics or religion.... (Part 2: The great lie of pervailing wisdom)

Part one, written earlier, is my disclaimer and confession of my perspective. The following is my argument.

I think that there is no real doubt that David Cameron is an extremely capable politician. The rise of the Conservative party does seem somewhat unstoppable at the moment. I really hope this is not true. Not simply for party political reasons but because I honestly believe that Cameron would be extremely damaging to this country as Prime Minister.

The current Conservative strategy involves relatively little policy, encouraging and capitalising on the government's unpopularity and promoting the received wisdom that Labour cannot manage the economy.

The received wisdom that they intend to propagate is that a Labour government always equals economic mismanagement. This is quite simply brilliant political strategy, because if it works it will win not only the next general election but the one after as well. Massive cuts in the public service and almost any policy in the next 6 years can be excused by the statement "the economy was so bad when we came to power that we had no choice..." The genius of it is obvious. There's one small problem, though - it's not true. However I do fear it will be successful.

Let's try an imagination trip. I want you to imagine with me, what the country would be like if we'd had a Conservative government for the last 12 years.

The economy
Much has been said ad nauseum about the root causes of the current world economic situation but two things are indisputable. Firstly, it is a world economic crisis with origins in some absolutely crazy decisions made in American financial institutions. A large number of first world banks (including many British ones) are extremely culpable because they made what are now clearly foolish decisions. Now we find ourselves in a situation whereby in order to survive, as a nation we are borrowing massive amounts of money and the national debt is expanding amazingly. The figures involved are both scary and astounding.

So, what would have been different if we'd had a Conservative government?

Firstly the banks were under-regulated - that is clear to all, but it would have been worse under Prime Minister Major or Hague or Duncan-Smith or Howard. All through the last decade the Conservative party maintained their mantra that the government's over-regulation was strangling business. It's worth remembering which party first deregulated the city in the 80's.

The subject of the national debt is one of much concern and much misinformation. Clearly more debt is bad but as a proportional of GDP (National wealth) our current debt level is still the second lowest of the G8 economies. Secondly, the official opposition opposed vociferously the decision by then chancellor Gordon Brown to use the money generated from selling 3G licences to mobile phone companies to reduce the national debt by £30bn.

Part of the argument is that the government spent too much money over the last decade and thus stored up this huge debt problem. This argument sounds very compelling initially, one merely has to look at how much public expenditure has increased and how much debt we now have to come to this conclusion. However it is deeply flawed for two reasons. Firstly, much of the increase is expenditure was absolutely vital - more of that later. And secondly the idea that the public finances would be better with a Conservative government is somewhat laughable. The Conservative Party argued then that the money should have been given away in tax cuts. Now the macro-economic effects are difficult to see - and impossible to quantify completely but you would have to argue that the economy as a whole would be significantly better off for the public finances to be in a genuinely better shape if Ken Clarke had been Chancellor in 2001. So we would have the same public debt but without the much needed investment in the public sector over the last 10 years.

Public Sector Investment
Now, I speak as one of these feather-bedded public sector workers who enjoys a final-salary pension scheme on the backs of the poor private sector workers...

I can only speak for the NHS properly as that is my direct experience. There are several things I don't like about the health service and much of the political interference is frustrating but there is no doubt that the NHS is much better than it was 10 years ago. Much needed capital investment, sensible rather than ridiculous waiting lists. The huge ideological shift to actually spending money on our public services was and is hugely significant. Since 1979 we have been told that the private sector is always better than the public one. To anyone who thinks that please take a good look at the banks.

I think it worth noting, that whilst all of us intrinsically want to pay less tax and whilst there is no doubt that there are things the government spends money on that I'd prefer they didn't. I think it needs to be said how much of a bargain taxes really are. The NHS provides total healthcare. We have a massive road and railway network, despite all the controversy our schools are actually among the best in the world and our universities attract applicants from every continent. It seems to me that most in Britain have no idea how bad things are in the third world and how amazing it is to have all the things we have.

The NHS, education, Surestart programs are all things that will probably be slashed by an in-coming Conservative government. The very rich will be ok. The moderately well off will buy private healthcare and education, possibly noting that it's actually more expensive for them to do it this way, possibly not and the poor will be left behind.

The idea that the Government didn't fix the roof while the sun was shining is laughable when you look at how under-invested in much of our infrastructure was. The reason why there was such a large expansion in public sector expenditure was because it was so needed. Do we really want to go back to doctors working 120 hours a week and kids being taught in portacabins that leak?


The economic crisis is worldwide and whilst there is some blame for the government - there's a lot to go round - the idea that a Conservative government would have done better is somewhat doubtful, particularly when you look at the potential bank collapse that was only just avoided last year. In 30 years time when historians look back at 2008-9, regardless of everything else, the saving of the banks will be the most significant decision made. If the opposition is to be believed on what they said, then they wouldn't have stepped in to save the banks.

There is much this government has done that is somewhat disappointing to me, on the other hand their achievements have been seriously under-rated; The Human Rights Act, NHS spending (nursing salaries and doctor's pay both significantly increased), Education, the minimum wage, devolution, justice for miners afflicted with lung disease, Military intervention in the Balkans and Sierra Leone...

The received wisdom is wrong. A Conservative government now would be in a much worse state and if they win next year, will do what I believe is significant damage to our country if they win.

That is why I am posting because these thoughts, I expect debate, I expect disagreement but let's talk about it. I think it does really matter, the decisions taken in the next 5 years by our government will affect all of us and probably have effects lasting for more than a generation.

AFZ

End of Party Political Broadcast by the alien....

Never talk about politics or religion.... (Part 1: Disclaimer)

I've never liked that maxim. Politics is all about what's actually important to people in their daily lives and religion is all about what's actually important to people on a deeper level. Surely we should talk about the things that matter to us?

However, I have deliberately avoided any political statements on my blog thus far. Today is an exception, I am going to be very deliberately and unashamedly political. I cannot completely explain why I have avoided politics before but given that this blog is my thoughts, nothing more nothing less, I have decided that I am free to say what I actually think. Hopefully I can avoid polemic.

Firstly, I am unashamedly left wing in my politics. And there are some serious philosophical reasons for this. My political position is essentially Christian Socialist in the traditional sense. John Smith was known for holding this position and certainly it was an influence on both Tony Blair and Gordon Brown. How much of an influence is a matter of debate.

Unfortunately "socialist" is a word with many negative associations; partly this is because of the evils of communism and partly this is because of the prevailing wisdom of the last 20-30 years surrounding a genuine and inherently good belief in the twin values of personal freedom and personal responsibility. I would suggest that anyone who thinks that socialism is evil should read Martin Luther King Jnr on the subject of communism - written in the sixties when the full fear of the East was very real he makes no apology for communism but points out how foolish and wrong it is to ignore the great injustices that lead to the rise and appeal of communism.

Moreover that's not what Christian Socialism is about. Put simply, my Christian faith informs my politics for the simple reason that my God is deeply concerned about individual human lives and social justice. Even a quick reading of the Old and New Testaments would lead one to conclude that the poor and justice are God's core issues. From that basis, I approach all political issues trying to see the good. I think all issues are moral ones. It is this kind of thinking that led to the creation of the wellfare state and the national health service. Fundamentally to leave people poor and sick in the name of 'personal freedom' is not only wrong but blatantly paradoxical. I do not wish to party-politicise God. Simply my challenge to all believers is to approach politics from a Christian perspective and then listen to my arguments. To all non-believers my challenge is; listen to my arguments.

So that is where I am coming from, but it doesn't explain why I felt the need to write this political comment. The answer to that question is David Cameron.

Youthwork

It's been a few months since I did any actual youthwork but I can't help but think of myself as a youthworker. I do miss it, although I am not regretting my decision to take a break for a while.

On the Interweb I have been involved in a discussion about professionalism in youthwork and the relationship between being a professional and having a calling. The Etymology of 'professional' was mentioned:

Looking at the 'roots' of such things ... from the Merriam-Webster on-line dictionary, we find:
Main Entry: pro·fes·sion
Pronunciation: \prə-ˈfe-shən\
Function: noun
Etymology: Middle English professioun, from Anglo-French profession, from Late Latin & Latin; Late Latin profession-, professio, from Latin, public declaration, from profitēri
Date: 13th century
1: the act of taking the vows of a religious community
2: an act of openly declaring or publicly claiming a belief, faith, or opinion : protestation
3: an avowed religious faith
4 a: a calling requiring specialized knowledge and often long and intensive academic preparation b: a principal calling, vocation, or employment c: the whole body of persons engaged in a calling

This reminded me of my favourite definition of what it means to be a doctor from Thomas Sydenham in the 17th century:

It becomes every man who purposes to give himself to the care of others seriously to consider the four following things:
First that he must one day give an account to the supreme judge of all the lives entrusted to him.

Secondly, that all his skill and knowledge and energy, as they have been given by God, so they should be exercised for his glory and the good of mankind and not mere gain and ambition.

Thirdly, and not more beautifully than truly, let him reflect that he has undertaken the care of no mean creature, for in order that he may estimate the value, the greatness of the human race, the only begotten Son of God became himself a man and thus ignobled it with his divine dignity. And far more than this, died to redeem it.

And fourthly, that the doctor, being himself a mortal man, he should be diligent and tender in relieving his suffering patients in as much as he himself must one day be a like sufferer.

This got me thinking of whether one could draw parallels for a youthworker. This is what I came up with:

All of us who love the joy and the hard work of ministering to young people, let us reflect on the following:

Firstly a youthworker will one day give an account to the supreme judge for the influence he has had on all the young lives entrusted to him.

Secondly, whilst youthwork rarely brings financial rewards, let the youthworker remember that all his talent and energy are God-given and should be used for His glory.

Thirdly, a youthworker should remember always that God's own son died for every single young person. And if God thinks that someone is worth dying for, how dare I think otherwise. Most especially, let us remember that when faced with the young person who society deems unworthy of any care or attention.

And forthly, The Christian youthworker, being himself a forgiven-sinner, let him never forget that each of the young people need example and discipleship and not condemnation and judgementalism in order to grow to maturity in the same way that the youthworker needed it too.

Thoughts or comments?

AFZ

Mobile Phones

I recently managed to throw my mobile in the bath. Now I wouldn't recommend this behaviour but I am pleased to say my phone has had a miraculous recovery from this near-death experience.

Here's what you do if you ever manage to drop your phone in water:

1. Remove it immediately. (If you don't do this one the rest is a waste of time!)
2. Remove the battery. (Don't pause to turn it off)
3. Dismantle the phone as much as possible and put it in a warm place to dry
4. Leave if for at least 12 hours (some websites recommend up to 72...)
5. Only when you are convinced it's been dried completely turn it on again and see if it works.

The key is that water shorts the circuitry and if you can get the battery out before the water's managed to seep into the phone itself it will be fine as long as it's completely dry when you switch it back on.

Just thought this might help anyone out there who's as stupid as me...!

AFZ

Hannah Jones

The sad case of Hannah Jones (BBC Story) aptly demonstrates the contradictory nature of current English Law. For Hannah, the decision to drop legal proceedings is clearly the right decision and for her sake I am very glad that her wishes are to be respected. It does seem to me though that had her case come to court it would have been a perfect opportunity to correct the current state of the law on consent for medical treatment of minors.

For adults, the law is very clear. Any adult who has capacity (which means they have sufficient understanding of the issues to make their own decision) has an absolute right to refuse medical treatment regardless of the consequences to their health. The only exceptions to this are in cases where there are public health or public safety implications.

Necessarily the law is somewhat different for individuals under the age of
18. Parents (or those with parental responsibility) have the right and
responsibility to consent to or refuse medical treatment. If doctors feel
that parents are not acting in the best interests of the child then they
may appeal to the High Court for a child to be made a ward of court and
then have the court decide on appropriate treatment. By statute,
individuals aged 16 to 18 years can give consent for their own treatment.

In the case of Gillick v W Norfolk and Wisbech AHA the principal of what
was termed Gillick competence (now correctly referred to as Fraser competence) was established. This principal states that once a child has obtained sufficient maturity and understanding to appreciate the significance and implication of a decision they may consent to their own medical treatment. The problem comes with the refusal of medical treatment. Lord Donaldson in the cases Re R and Re W set the precedent that whilst a Fraser-competent child may consent to treatment, if they refuse treatment then this refusal may be overridden by the parents or if the parents refuse, then it may be overridden by the court. In Re R Donaldson used the analogy of three ‘key-holders’ to unlock treatment, the child, the parents and the court each holding a key. In the case Re W, Lord Donaldson wrote: "… I now prefer the analogy of the legal ‘flak jacket’, which protects from claims by the litigious whether [the doctor] acquires it from his patient who may be a minor over the age of sixteen, or a ‘Gillick Competent’ child under that age or from another person having parental responsibilities which include a right to consent to treatment of the minor. Anyone who gives him a flak jacket (i.e. consent) may take it back, but the doctor only needs one and so long as he continues to have one he has the legal right to proceed.” As a doctor, I find the phraseology of a ‘legal flak-jacket’ both worrying and offensive.

As the law stands, the hospital looking after Hannah were acting completely within the law and the court could have ordered that Hannah undergo a heart transplant. The implications of such a decision would clearly be massive for both her and her family, not to mention the practical problem of administering an anaesthetic to an unwilling 13 year old.

It seems to me that a child who is competent to consent to treatment must also be sufficiently competent to know that for her, a transplant is not what she wants even if that means her life is shortened. Whilst the doctors have and must have a duty to establish that a child is both competent and protected from coercion and abuse, the idea that a mature teenager who clearly understands the decision and does not want such a massive operation, can have her wishes overridden by her parents or the courts is somewhat troubling. If she were 18, no one would dispute her decision. I
believe that the law in this area is not only contradictory but also wrong.

For Hannah Jones, I am very pleased that her wishes will be respected and my prayers are with her and her family. However I think that the law does badly need changing and without the will of parliament to legislate is will require a case like this one to correct this dangerous contradiction.

I think Lord Donaldson was very unwise and plain wrong in his rulings

Not so much bad poetry and bad rhyme...

Lord, I want your will to do,
To serve you all my life through.
But I only seem to know,
Where I want to go.
O Lord please show me,
What my future ought to be.

Lord, I want your will to do,
To serve you all my life through.
My hopes and dreams are clear,
But God's voice I long to hear.
You I want to trust,
For you are kind and just.

Often the choices that I make
Are for my own sake.
Lord shape my will to be
In line with what you want for me.
In the years from now to my end,
I want you proud to call me friend.

Amen

Things I don't understand...

There are many many things in this world that I don't understand and here is an example;



Why?
I mean, why?
Just why?

AFZ

Rambling thoughts about company loyalty, the NHS, governments and politics...

Today's blog may well end up as a bit of a window on my mind. I suspect that is not a good idea and may disturb. You have been warned. Something that fascinates me is how trains of thought form and develop. It happened to me, just yesterday. On a bus.

So, sat on a bus yesterday morning, unsurprisingly various people were getting on it. I think that's normal. One of this morning's passengers got on without clearly showing her ticket (weekly bus pass or whatever) to the driver. Whether this was her fault or whether the driver wasn't paying full attention (long line of passengers) I'm not really sure, but he was quite diligent and got up from his seat and called the lady back to check her ticket and ensure she was entitled to ride said bus. Someone made a comment about the driver being very diligent. And that really got me thinking.

I have done various part-time jobs for various corporations and I have always tried to do my job properly but I've often found a general apathy about my employer as an entity. Not deliberately and not consciously but definitely real. Let me explain. When I worked for a major supermarket, I remember people who worked on the customer service desk being genuinely annoyed by customers who would try and get refunds that they felt weren't justified. They seemed to feel a certain anger on behalf of the company that someone was trying to take advantage of them. To me, that seemed entirely reasonable and morally right - in essence to make a spurious claim for a refund is theft. But I found that I didn't really care. I couldn't bring myself to care. The actual loss to the company was small and the small saving that you could make by deterring and preventing spurious refund claims would be so much smaller than the loss you would make by losing the good-will of customers with genuine claims. However, even so, I just can't bring myself to really care if the company was losing out in this way. Partly that's because it was only ever a part-time job and I think that changes one's perspective but also because the company was and is extremely profitable and simply making money doesn't really matter to me.

I do not think that making a profit is in any way immoral and companies have to make a profit in order to exist in the first place and the economy has to work in order for it to work. However it's just not inspiring to me.

These days, of course I work for the NHS. That changes how I feel quite strongly. I really does bother me if people take advantage of my current employer and 'play the system as it were.' On one level, I simply work for the government, the NHS is a state organisation but on another the NHS is entirely different and so much more.

I don't think there's any doubt that the NHS is a unique institution with a very special place in the public's mind. This isn't all good. The NHS is also a national joke in some ways - the health service is often jokingly referred to as doing things on the cheap. In the Western world we are increasingly cynical about our governments and I suspect this is where the cynicism about the NHS comes from. The fact the the only positive comments tend to be from politicians about what they have done or will do is probably the reason for this. That and the media obsession with pulling down the NHS. I wrote to a national newspaper recently, challenging them to publish only positive stories for a month. They didn't rise to the challenge. Given that over 95% of patients are happy with the care they receive and given how much the NHS does it would not be difficult but because the media don't do this there is a subtle but very real and pernicious bias in the reporting we see. Good news remains no news.

My final destination on this thought pathway was how spoilt we are in the western world to be able to be cynical about governments.

I am not for one second, suggesting that everything the government does is good. I am not for one moment proposing that governments are infallible or that we should be uncritical. What I am saying is that Cynicism is equally simple-minded and deluded as naive optimism.

A very famous and entertaining celebrity in the UK who is known to be out-spoken made the comment the other day that the UK is a third-world country. Now, I know he was saying this for effect but it still really annoyed me. It is so blind to the realities of our world. Britain is a country where there are laws and (in general) they are applied to all fairly. Britain has a massive infrastructure, roads, railways etc. Britain has free education, universal healthcare and a welfare safety-net that means no-one need starve. None of these things are a given; they don't exist in all countries and they have not always existing in this country. They came about by many processes but including governments making the right decisions - such as the introduction of the welfare state after the second world war. My grandmother was born before the NHS and before the welfare state. Governments serve us. How well they serve us is the key question but the cynicism that says they don't serve us at all is breathtakingly arrogant and denies the privileges we have that so much of humanity don't enjoy.

The end-point of such cynicism is the failure of democracy because then people stop bothering to vote and governments loose their accountability. Now, when it comes to democracy, I'm with Churchill Democracy is the worst form of government... ...except for every other form of government. People think that democracy works because people get what they want. This is not true. Our elected representatives serve us best by representing us not necessarily by doing what we want. The genius of democracy is that governments are accountable. It is accountability that makes democracy work. In a messy and complicated way, sure but ultimately work.

I guess for my poor readers, it is lucky that it was only a 10 minute bus ride - wow that was a lot of rambling...

AFZ

The problem of atheism...

Fundamentalist Atheism seems to be fashionable these days - or at least noisy.

It's interesting that in a philosophical sense I have met very few atheists. Well-thought-out philosophical atheist are rare in my experience. The vast majority of people in the western world are agnostic. And most agnosticism is not honest, open minded agnosticism but really I can't be bothered agnosticism.

Whilst I have met very few well-thought-out philosophical atheists, I have met many many functional atheists. Most people live, whether they believe in God or not live as though there is no God. And functional atheism is really the original sin in a slightly different form.

AFZ

It's a Wonderful Life

I've recently watched the classic film It's a Wonderful Life. I've been meaning to watch it for ages because I've heard so much about it but until yesterday I had never seen it.

For those of you fellow Philistines out there I won't ruin the plot (well not too much). It's an unapologetically sentimental film but I don't see that as a bad thing personally. The under-pinning philosophy of the film is actually really serious and incredibly real - that each of us has an impact on many many lives. Every time we interact with another human being, we potentially have an impact on that person.

All of us, I'm sure can remember dozens of key moments in our lives when we've been affected by another person - for good and for ill.

All people - certainly all adults - are responsible for there own actions (to a greater or lesser extend but that's for another time perhaps). All of us need to take responsibility for ourselves and what we do. However we cannot take responsibility for the consequences of our actions - not entirely - because it is impossible to know what the knock-on effects will be. That's in many ways the message of the film.

Some encounters we have with people are very minor - some very major but it's not always possible to tell the difference.

I think all, each of us can hope for - and indeed should aim for - is that in each and every situation we find ourselves, we seek to have a positive impact and not a negative one on the lives of the people around us. The English actor Paul Eddington wanted his epitaph to read "He did very little harm" and he made the very astute observation that this is not a small ambition and it is in fact difficult to do little harm. I do, however think we should aim higher. You never know how big an impact a small thing can have.

The kind people who carried me through the dark times, the teachers who challenged and inspired me, the true friends who have shared the highs and lows. All of these and countless more make me what I am. Do something positive for someone you meet and you never know how big the consequences may be.

A wonderful life may indeed be one that we wouldn't necessarily expect.

Opinion and fact

"Everyone is entitled to their own opinion, but not their own facts."

Sen. Daniel Patrick Moynihan

Wise words indeed - in my opinion that is.

Some more bad poetry....

My only defence is that someone out there asked for it!

This is a little piece I wrote six years ago when life was a bit tough. It has several themes, the main one is that I can honestly look back at the hardest times in my life - and some of them have been really rough - and not want to change any of them at all. This is an important perspective when facing up to current trials.

There are also some important sub-themes - particularly about facing up to the truth and not giving in to the temptation of denial: "...make true what is not, So that the lies that so appeal Were not the poisons that they are..."

Anyways, make of it what you will. Agree, disagree, post comments.

AFZ

Oh to have the power to change the way things are,
I'd reshape my life, make true what is not,
So that the lies that so appeal
Were not the poisons that they are;
That I could let my heart believe what it longs to,
To take away these hurts that cripple me.
If only I could change the world,
And make these painful truths untrue.

I remember the times that have been, and will be,
When I would change my life, to make easy
That which had broken me within,
Mental illness, cancer, failure,
All that I had to know, to walk through, I so longed
To take away these hurts that cripple me.
If only I could change the world,
And make these painful truths untrue.

So now I live with all these hurts I've had to know.
The now fading scars and new challenges.
And I see my God's hand at work,
That in me much work he has done.
I am coming to know that it is better not,
To take away these hurts that cripple me.
If only I could change the world,
And make these painful truths untrue.

Oh to have the power to change the way things are,
I'd live my life, with what is true; and not
Dwell on the lies that so appeal.
I'd trust that you are in control,
That you Lord do know what you are doing in not
Taking away these hurts that cripple me.
If only I could change the world,
I'd embrace these painful truths.

8.9.2002

"Should"

So, by popular demand - ok, so ONE person asked for it... here's some thoughts on the word 'should.'

Whenever we use the word 'should' we are making a moral or ethical statement.

Let us suppose that my friend Justin has cancer. Now he's a young man with a lot to live for. Now suppose that in my pocket, I have the cure for cancer, should I give it to him?

I don't think many of us will have any hesitation in giving an answer to this question (whether you know Justin or not). Of course I should. But why? Well, because the notion that to save life is good is embedded into our thinking. (It is for this reason that healthcare is primarily a moral pursuit and only secondarily a scientific one.)

It order for the word 'should' to have any meaning at all there has to be moral absolutes. That is things that are right and things that are wrong. . That does not mean necessarily that any one of us necessarily knows what's right or wrong in any or every particular situation but that such things do exist. A lot of people argue that morality is a matter of opinion or even about majority views. I have serious issues with this.

To take two extreme examples, the Nazis thought that exterminating the Jews and homosexuals and Gypsies and the mentally ill was right. Similarly, if you were to take a poll of the Maassi tribe in Kenya and Tanzania they would say that female circumcision (or female genital mutilation) is acceptable and a traditional ritual. In both cases I think they are clearly wrong. These are things that should not be done.

The philosophical arguement is one about atheism vs theism. The reason for this is that in order for there to be any such thing as more absolutes there must be an absolute bench-mark of morality which we call God. If God does not exist then there are no moral absolutes. Many people will argue that there aren't moral absolutes. If this is true then the word should is meaningless, there is no morality and we should (sic) do whatever makes us happy.

Matyrdom

It was the 40th anniversary of the assassination of Martin Luther King last Friday. I am a huge fan of Dr King, I think he was an amazing man for lots of reasons. If you read Dawkins' The God Delusion you will find a completely ridiculous argument that King's pacifism and dramatic impact on history particular in terms of race relations had nothing to do with his religion. Not only is this ridiculous but it takes about 10 seconds of examining the facts to discover that it is plainly wrong. King was a modern prophet, he was first and foremost a Christian minister. I would strongly encourage everyone to read or listen to his sermons - they are amazing. But none of that is the actual point of today's blog.

Today's blog is about my idle wondering.

I was wondering whether what we think of Dr Martin Luther King Jnr is affected by the fact that he was murdered. Do we think more of him because he was assassinated for what he stood for. And if we do, is this a good thing or not? For that matter, if we don't, should we?

Martin Luther King's murder was a personal tragedy for all who knew and loved him. In terms of the major cause that he is associated with - equal rights for black Americans - it may well have been a positive thing.

I think that anyone who is willing to lay down his life for his friends is worthy of respect and honour. But if he hadn't actually been murdered, would we still laud him as we do?

As I said, Idle wondering....

Power

Ultimately power extends out the barrel of a gun. Well, sort of.

In the UK, we live in a society that has a strong legal system that to a great extend protects every member of our society. People are not able to take away your home without due legal process even if you don't pay your mortgage. I could steal your car but you'd probably call the police. The police force would detain me and the courts could order me to be imprisoned. If I try to escape the prison guards will use force to detain me.

We often forget how privileged we are in a democracy. Despotic dictatorships often steal property and land from their citizens because they hold all the guns. In a society that has a respect for the law itself, all the people who hold the guns do what the courts and the properly appointed government tell them to do. But a Coup d'etat is simply what happens when the ones with the guns stop following those orders.

So Power extends from the barrel of a gun.

Except for one thing. It really, really doesn't. If you want to talk about real power, power to change people's hearts and minds and not simply force them to act our of fear, well then you need to talk to Gandhi or King or Romero.