Wednesday, December 19, 2012

Devil's Graffiti

One of my favourite authors is, no, my favourite author is, Adrian Plass. His ability to communicate deep truth, often through humour is, I think, unmatched. Some write-off his books as silly humour and miss the true depth (in my view). His ability to entertain is of course worthy in and of itself but most of the time it is a means-to-an-ends. To communicate something more profound about God's love. He is also a good and skilled theologian but perhaps not in the traditional sense. And for me that is the key to his authenticity. Theology is important as it's about the truth of God but it is not what disciples of Jesus are called to - we are called to be disciples. Theology that does not change how we live is worthless. Plass's writing expresses the reality of a relationship and not just dry academic study. What you might call practical theology. Ultimately for a true disciple, no other kind is worthy of any consideration. 

Plass wrote some years ago about The Devil's Graffiti, drawing on Jeremiah 31 where God declares that he will write His laws on our hearts. A little bit of theological work is probably needed here to understand what this means. Certainly I think it a mistake to see it legalistically. Good laws increase freedom and I believe what Jeremiah 31 is saying is that God would change cold hearts such that external laws become less and less important. Plass's observation was that sometimes before God can begin to write said laws he first has to scrub away to remove the Devil's Graffiti that's in the way.


The problem, assuming your heart is anything like mine, is that negative graffiti has built up over the years leaving very little space for anything else. The devil gets busy with his infernal aerosol can! Things people have said, failures that have destroyed confidence, traumatic experiences, profound, unforgettable embarrassments – all sorts of things.
Usually each one tells you a lie about yourself:
you will never succeed,
you are not lovable,
God has cast you aside because of that sin,
you’re boring,
happiness is impossible,
your life has no purpose.
The almost invariable untruthfulness of these scrawling should be sufficient indication of their ultimate authorship. The father of lies is anxious that our hearts be covered with a confused mass of misinformation, some of it etched so deeply it comes close to breaking our hearts.
 
I have written elsewhere, in a different context about the poisonousness of lies. I don't think you have to believe in the spiritual interpretation to see the truth of the observation. Most people carry with them deep scars and things that have been burned into them that aren't true. This is of course, most profound in people who suffered in childhood - particularly from abuse but it is also true that some of us accumulate it over the years through constant knock-backs or repeated messages from the world around us. These lies - for that is what they are - are often deeply poisonous, affecting relationships, confidence and hope.

My own personal graffiti - well there's probably a few bits - but the most important one said simply this; "You are unlovable." I can chart particular experiences that are probably the origin of these words but it doesn't really matter. These words, scarred into me, often made liars of good people - for it didn't matter how much people expressed their love, it just wasn't actually possible for people to love me. It's not that I doubted them, I doubted me.

I believe in a God of healing. These words are faded now - God has spent a long time scrubbing away to remove them. In fact they're not visible most of the time; it's only when the rain falls in a certain way that you can see them at all.

I have seen in the lives of many people the poison of such lies. I think recognising them for what they are is the first step to ridding ourselves of them, the first part of the healing the process.

AFZ

Sunday, December 09, 2012

Hippos...

Back in the day, when I was growing up, Crusaders produced yearly posters. These posters consisted of a bible verse with an illustrative image. The one I remember most vividly quoted 1 Samuel 16; "Man looks at the outward appearance but God looks at the heart." The image to accompany this verse was a hippopotamus. Presumably because this is an image of ugliness.

For reasons lost in the midst of time (and probably best left there) this became in family-lore "Man looks at the outward appearance but God looks at the hippo..." Now this silliness serves a purpose in that it makes the verse very memorable to me.

Then, when I (kinda) grew up I went to medical school and learnt anatomy. I learnt that there is a part of the brain (well, technically 2 of them) called the hippocampus. Now the hippocampus is part of the limbic system. It is somewhat questionable that the seat of the aphoristic human heart has any anatomical location but if it does, then it is the limbic system for this is the part of the brain responsible for emotions and instincts. So it turns out, worryingly that I was right all along, man does indeed look at the outward appearance and God looks at the hippo...(campus).

All of this extreme silliness is indeed going somewhere. Martin Luther King said that he dreamt of a world in which a child was judged not on the colour of their skin but on the content of their character. And whilst, in many aspects of life, racism itself is not tolerated, different kinds of superficiality still prevail. God however is much more concerned about what goes on in the heart (or limbic system if you prefer). In Matthew 23 Jesus expounds on this inside-out holiness. Get the heart right and the rest of life will follow.

AFZ

Thursday, August 30, 2012

Vocation and Calling

I have been thinking a lot about vocation and calling recently.

There is so much to say. But for now I want to concentrate on some words that really touched me a few years ago and the key truth that I think they express beautifully.

In 1928, in St Mary's Hospital in London, Alexander Flemming discovered Penicillin. It is difficult to overstate the significance of this or the effect it has had on the world in the past 84 years. This plaque sits just outside the laboratory where Flemming worked. When I visited the lab I noticed it and asked the guide about it. He told me this was put up in Flemming's lifetime and he approved of the wording.

Very few of us will have as dramatic effect on the world as Flemming did. But whatever we do, I believe if we do it for the glory of God and for the benefit of the people who's lives we touch then we are very much living out a vocation.

I also think that if you haven't found your calling yet, working in this way in the meantime means that whatever you actually do, it can be of immense value.

Just some thoughts.

AFZ

Monday, August 27, 2012

Is God... A Doctor?

It has been my great pleasure to spend the last two days at Greenbelt. One thing I particularly enjoyed was a series of short talks under the title "Is God...?" Speakers are strictly limited to 10 minutes to answer their specific question. (They will all be available on Greenbelt TV over the course of this year). I have to admit I was disappointed not to learn the answer to the vital question "Is God Scottish?" but I did learn answers to the following: Is God Time? (Quite philosophical but actually practical; no and yes) Is God Evangelical? (Emphatically No but actually...) Is God offended? (Importantly, no) Is God Jewish? (No.) Is God Anglican? (Well, no. But interestingly Sir Christopher Wren is apparently the founder of Anglicism). Perhaps inevitably this set me thinking as to what question I could attempt to answer in 10 minutes. Perhaps more inevitably I was struck by the question Is God a Doctor? So here goes:

Is God A Doctor?
In my life I have taken a large number of exams. One of the cardinal rules of exams is that you must answer the question asked and not a different one that you want to answer. However when speaking or writing it is often a useful device to answer a different question. So I want to start by asking Is God A Surgeon?

No.

It's easy to tell the difference between God and a surgeon - God has no illusions about being a surgeon.

In his excellent book on medical ethics, John Wyatt presents the analogy of the human person as a masterpiece made by God and the role of the doctor is to restore this masterpiece. For me surgery can be quite humbling. When we repair bowel or a blood vessel, it is the body's own healing processes that does most of the work. When we 'fix' what's wrong with the body, it is evident to me that my restoration work is rarely - if ever - up to the standard of the original. Surgical solutions are certainly very good but surgery is still a relatively crude instrument.

This kind of thinking does beg a question; If God's masterpiece is so wonderful why do we have disease and (particularly) congenital anomalies requiring surgical correction? For me, the answer lies in the answer to the question of why a good God allows suffering. I don't want to duck that question but I don't want to get stuck in it either - simply I want to acknowledge that we live in a fallen world. So God is not a surgeon.

But is God a doctor?

The word 'doctor' has a couple of meanings - the original is 'wise and learned one.' In that sense of course God is emphatically a doctor; omniscience does give him something of an unfair advantage.

More commonly we think of a doctor as a healer. In this sense I also believe that God is a doctor. I believe God is very much about healing. Healing in every sense; physically of course, but moreover and perhaps more importantly emotionally and also most significantly spiritually. And everyone who's a follower of Jesus has a role to play in that.

I have no doubt that God heals miraculously and that annoys me - because he doesn't do it very often. Moreover I think it vital that we do not despise or minimise the non-miraculous. Any healing is a manifestation of God's grace. It is my great privilege to be part of that. The healing miracles of Jesus show that healing is indeed something God values and it is making earth just a little more like heaven and in that sense fullfilling the command to be the Kingdom of God on earth.

But what about when God doesn't heal? There is, I believe a very dangerous heresy around healing - the 'name it, claim it' theology. Your healing is available to you, if you simply have enough faith. I think this kind of thinking very dangerous and often damaging to vulnerable people. In response to it - to the idea that if you do not experience healing, is is because you don't have enough faith - I say this: Paul. Anyone who's read the New Testament would struggle to conclude he lacked faith - anyone who can write "For me to live is Christ, to die is gain" is someone who has deep faith and understanding of his place in this world and the next. And yet God did not heal him of his thorn-in-the-flesh. Despite Paul's repeated prayers. There are two things to say about this. Firstly, God does not promise to always heal in this life - the fact that godly men and women have died over the past 2000 years suggests to me that more often than not God says "no" to those prayers. Secondly God is not only a doctor but also God. He has a bigger agenda about building his kingdom and glorifying his son.

So what about when we see God not healing - what about death? It is always very dangerous to talk to a doctor about death, because we don't like what we can't cure! We cannot cure death - but I do know a man who can! I can offer a pretty good cure for appendicitis but for death... It is important to note that whilst death is inescapably part of God's judgement on a fallen world - the wages of sin is death - it is also paradoxically part of God's grace. For the follower of Jesus, death is release from the suffering of this world and of course so much more - death is the perfect healing!

Jesus reveals himself to be the ultimate physician in that he provides the cure for death - in every sense. Jesus the self-sacrificing physician who chose not to heal himself so that you and I might be healed.

Is God a doctor? He's the very best.

AFZ

Monday, August 13, 2012

Glibness - a definition

I've had a strong dislike for glibness for a very long time. As with all communication the key is not what is said but what is heard. I think glibness is so dangerous because it is a lie wrapped in a truth.

"Smile, Jesus loves you" definitely contains much truth. Jesus loves you more than you can possible imagine and that truth is the source of much joy, but most often when someone says that what they are saying - or rather what is heard is very different.

Glibness is this: "Your pain makes me feel uncomfortable so please can you pretend to feel better so I don't have to be uncomfortable..."

AFZ

Saturday, June 09, 2012

Truth and lies...

I have in the past commented on my strong dislike of using factual statements to mask lies and deceive. Here is another example that is really winding me up at the moment;
"...this is the debate we ought to be having: how do we get resources from the back office on to the front line? How do we do it when right now only 11% of police officers are on the streets at any one time? That is the mess we have inherited; that is the mess we are going to clear up.”
David Cameron, Prime Minister’s Questions, 17 November 2010

“I think we all want more visible policing; it cannot be right that the system we inherited from Labour means that only 11% of police officers are ever seen on our streets at any one time. That is wrong and it must change.”
Nick Clegg, Prime Minister’s Questions, 10 November 2010

This 11% figure has been used quite a lot; it has come up again in the aftermath of last year's riots, with quotes like this: "Only one in ten police officers are on the streets fighting crime at any one time..." And this argument is used to suggest that the police force is very inefficient and can make savings without effecting community policing.

11% is quite impressive - that means 89% of police officers aren't available... Wow! And this is an official figure, it comes from Her Majesty's Chief Inspector of Constabulary.... You can read the Guardian's take on this report here.

The thing is though, that if one looks a bit closer at this figure, a somewhat different picture emerges.... Let's start by saying that as a nation we do want our police officers individually to have time off to sleep and eat and have a life and thus don't want them working 24 hours a day....

As you know I live in Alien Castle in England. Which lies in a small village. Now the local villagers are quite nice and don't cause much trouble but if we wanted to have a police station in the village that was staffed by one officer 24 hours a day, how many police officers would we need?

Three 8-hour shifts a day adds up to 1095 shifts a year. An individual officer working a 40 hour week would fill 260 of these shifts therefore we would need 4.2 officers. If we are going to allow them to have the normal amount of annual leave and allow for the potential of sick leave then just to staff one police station with one officer for this small village we would need 4.7 police officers.

So already we need 5 officers; so by definition only 20% of them are available at any one time (1 in 5!). Never mind the fact that real police officers do have to do a myriad of functions such as go to court from time to time and that many of the police's most effective roles such as CID are much less visible. This leads me to wonder if having 11% of serving officers actually available at any given moment is actually startlingly efficient?

AFZ


For the first time in 40 years, UK doctors are taking industrial action...

I am very torn by this. I didn't vote in the ballot - I couldn't decide what I thought. I certainly would never take strike action personally. In general I think the right to strike is a vital right in helping to redress the massive power imbalance between employers and employees. Of course, for vital services, like medicine, striking can never be an option.

In principal, I do think that taking some form of industrial action that did not harm patients could be justified. I am not convinced however, that such a thing is possible. On the other hand, the last time similar action was taken, apparently mortality went down - same number of staff on duty, only doing emergency work.

I am a paediatric surgeon in training and currently I am working in paediatric intensive care for a short secondment. Therefore this action will not effect me in any way - there's no way I could participate.

For most doctors this dispute is about honesty and fairness. And there is a lot of anger about this. It's also worth noting, that it's the same pension scheme for all NHS staff. So it's not just about high-earning doctors. Doctors only make up 10% of NHS staff, around a third are nurses and another ~15-20% are other professions aligned to medicine.

It is true that the NHS pension scheme is a very good scheme but I object to the term 'generous' for two reasons. Firstly, it is a contributory scheme and so - to a large extent - we pay for it ourselves. And secondly, it is part of the terms and conditions that everyone signed up for.

I've done a little bit of reading around this. As a back-of-the-envelope calculation, a lot of consultants will be on ~£100,000 / year. If they have 40 years of service to the NHS they would then be entitled to 50% of that as a pension (forty 80ths). A quick look on one of the many private pension sites tells me that such a pension would require a pot of ~£1.1m. I worked out that my pension contributions of around 8% on current pensionable pay for the years as a junior plus years as a consultant, roughly (without any interest or investment) comes to £500,000.

Notionally, the way the NHS pension scheme works is that the employer puts in a contribution of up to 11%. If you put these two contributions together over 40 years, then this pays for the pension. Over the past 30 years (or longer) the NHS pension has had a significant surplus. Governments of all flavours have decided, rather than investing the notional pension funds to keep the money in the exchequer and act as an underwriter to the fund. That is not necessarily unreasonable - for a nation-state. The excess returned to the exchequer is money the government would otherwise have to borrow. Currently the NHS pension fund is running at a £2Bn/year surplus.

In 2008, the NHS pension scheme was reformed significantly in such a way as to make it sustainable for the long term. Nothing has changed since then, the scheme is still sustainable in the long term. So this is simply a money-grab by the government.

The dishonesty and unfairness of it has angered many.

On the other hand, I daily thank God for the chance to do a job I love. And be paid well for. My income is very substantial and even if they do gut my pension I'll find other ways to save money.

It is worth noting that at my level (6-7 years experience - after 5 years at university) my basic pay is around £33k. I earn a lot more because of the out of hours work we do. I have to pay around £4000 / year in student loan repayments, £1000 / year in professional subscriptions so I can do my job and I have to pay for all my post graduate exams and most of the courses that I need to go on.

I am not pretending that I'm hard up. I'm really not. It's just that when you work a 90 hour week, you do tend to feel that you've earned the money you get. And that includes the pension scheme.

Having said that, I remain uncomfortable with the notion of taking action which runs a risk for patients. However, it is difficult to argue when people say the government has not given us any other option. They have completely and totally refused to negotiate. They have said, this is what is happening. No debate.

One final thought. When I read the various newspaper stories - all united in condemning doctors - I noted that in the comments sections, most of the comments were critical of the reporting and supporting doctors in taking action.


I remain torn. This is grossly unjust. There is no need for this change and the government is consistently lying about it (as they did about NHS reforms). On the other hand, I am a very well paid professional and the abuse and the indignity inflicted on the poor and particularly the disabled is a far greater injustice. So what is right? To stand up to this injustice or to accept that as well-off as I am, it is a minor indignity really? On the other hand, most NHS employees are not well paid doctors who will seriously suffer as a result of this assault on their pensions.

AFZ

Monday, May 07, 2012

snoitcelfer - 7 years on...

Recently I was preparing for a humongous, horrible and highly significant medical-interview. At stake, was my entire career - well future prospects anyway. One of the things one does in this situation is to review one's professional portfolio. In it I have a section - beyond all the publications and professional qualifications on Reflective Practice. 

This is there, because it is a requirement. Please don't misunderstand me, I think that reflecting on one's practice is vital, continuous and at the core of what we do. It's just that when someone gives me a piece of paper and tells me to "Reflect" I don't find it very helpful. Over my seven years of being a doctor there are a few interesting things I've put in there, often when things have not gone as well as we'd hoped. Learning how to deal with the unavoidable problems in medicine is - well - unavoidable... What really caught my eye though was something, again that was forced, which was a piece of reflective writing we had to do before qualifying.

My medical school - as do many - arranged for us to spend two weeks shadowing the doctor we would replace when we started work. This is a vital part of the process; learning where the blood bottles are kept, meeting the ward sister and learning how that particular job works. At the end of this time, we had to write something; this is what I wrote. 7 years on, I'm wondering what I would write now as a 'middle-grade' doctor.


Sunday, February 26, 2012

Thoughts from a railway platform.


Some days, you being gone doesn’t matter as much
On those days, there isn’t a strange hole in my world
On those days, I don’t think about you constantly
On those days, I can remember certain things:
I can remember that we were trapped;
I remember that life goes on
I remember that truth is always better than a lie
I remember there is so much hope for many futures.

Some days, you being gone doesn’t matter so much
On those days, my world makes as much sense as it ever did
On those days, I think about all the parts of life I love
On those days I can be so much more free;
I can be free to live
I am free to enjoy what I enjoy
I am free from the hurt and the sadness
I am free from the fears of what won’t be.

The trouble is, today isn’t one of those days
It’s one of the other kind of days.

AFZ

Thursday, October 20, 2011

Medicine, Money and what really matters...

From a blog I read regularly; abetternhs

I commend every word to you. This is how the medical profession should be and must be.

AFZ

Wednesday, October 05, 2011

Daily Fail

My dislike of the Daily Mail is well documented (especially here). I have an inherent intolerance of their complete dishonesty. There was, for me, a beautiful moment this week where they demonstrated for the world how they compose their ‘news’ stories.

Amanda Knox has become a media figure over the last four years. The terrible murder of her flatmate Meredith Kercher has almost been lost in the whole circus that has surrounded Knox’s conviction and subsequent exoneration. It seems clear that Rudy Guede committed this awful crime and the involvement of Knox and  Raffaele Sollecito was always less clear. In my view, Knox was convicted on a mixture of prejudicial rhetoric by the prosecutor and junk-science. As such, her successful appeal is a good thing but I can understand Meredith Kercher‘s family’s disappointment and sense of loss.

So, the appeal found Knox not guilty. They did find her guilty of a charge of slander. It seems that what happened was, the Daily Mail had a pre-written story, expecting her appeal of the murder charge to fail (or perhaps they had two?) and when they heard the word ‘guilty’ they immediately uploaded the pre-written guilty story to their website. Obviously it was rapidly taken down but thanks to the vigilance of various bloggers, the original is maintained for posterity.

It can be read in full here.

I would like to comment on a couple of aspects;

Firstly, the wonderful description of various key-player's reactions:
Amanda Knox looked stunned this evening after she dramatically lost her prison appeal against her murder conviction. ...
As Knox realized the enormity of what judge Hellman was saying she sank into her chair sobbing uncontrollably while her family and friends hugged each other in tears.
A few feet away Meredith's mother Arline, her sister Stephanie and brother Lyle, who had flown in especially for the verdict remained expressionless, staring straight ahead, glancing over just once at the distraught Knox family.
Prosecutors were delighted with the verdict.
And then the made-up quote:
"Justice has been done" - the prosecution
It is a wonderful window into the Daily Mail's methods. It demonstrates something many of us has been saying for years - Never, never, never believe what you read in the Daily Mail, where good reading always shows...

AFZ

Saturday, September 10, 2011

Land of Hope and Glory?

So I find myself, without really meaning to, watching the Last Night of the Proms...

This is fairly nostalgic in some ways, because it is a big childhood memory for me. But I found myself wondering if Britain has finally cracked the idea of patriotism without nationalism. Is is possible to be proud of who we are without some kind of superiority complex?

Watching this evening, one thing was particularly noticeable to me, amongst the many union flags being waved by an audience clearly having a very very good time were the flags of many nations. In about 5 seconds I spotted Arab nations, Scandinavian nations, as well as at least one German flag.

I have to admit a certain tingle down my spine at the sing-along of Land of Hope and Glory but then the music is a powerful anthem and when one listens to music, one is choosing to allow oneself to be emotionally manipulated by it. And maybe it doesn't run any deeper than that, but I wonder, we have so much to be thankful for as Britons, so many freedoms and benefits that much of the world does not have. These are things to be proud of, grateful for, never complacent of and willing to fight for.

Can we be proud of who we are and yet not consider ourselves better than others? Given our history - especially of empire building which was much more self-serving than benevolent (but strangely, not entirely) there are clearly massive issues. But in the past half-century we have changed as a nation and we don't see ourselves as Imperialists any more. Maybe that makes Rule Britannia and Land of Hope and Glory completely out of place and wrong.

But maybe, just maybe we can be proud of who we are and yet not nationalist-supremacists. If the flags are anything to go by, I think we can.

AFZ

Sunday, June 19, 2011

Father's Day

I wrote this some years ago and there is no way I could write it now.

So many more things I could and probably should say but not now. Let's celebrate fathers who probably don't realise how valuable what they do is; how important they are. And spare a thought for those who really need their dad but for whatever reason, their dad just can't be there for them.

AFZ


Saturday, June 04, 2011

Life, aims, achievements, purpose - some musings...

Back in 2004, I read Bill Clinton's autobiography. I would recommend it, it's a good read. Whilst, no autobiography will ever be an unbiased account, it certainly gives a different picture on certain events. Intriguingly, in addition to recalling events, Clinton offers some interesting insights as well. Primarily on the political process, but also on life in general. One observation that was that in all enterprises if you set your sights low, you may well achieve them, but what you achieve might not be worth celebrating. On the other hand, if you aim for perfection, you won't get there but even by coming up short, the place you get to may well be worthwhile.

When a young man, Clinton sat down and wrote a list of things he wanted to achieve in life. One of them was to write a good book. He finishes by observing that he'd managed to write a book and that it was for others to judge whether it was any good or not.

In 2004, in a place called Worcester, in the Western Cape region of South Africa, I sat down, looked out of the window at the beautiful mountains and wrote my list. Me being me, my list was much more a prayer than a wish list.

I've no idea where that piece of paper is now, I'm sure it is somewhere amongst my stuff. But I've never needed it, the priorities and desires are as clear to me as when I first put them into a coherent list. These are my desires and deepest prayers.

There is, of course, much to read into each of these, emotionally and spiritually about vocation and calling and about what is important in life.. I never felt the need to write down any explanations or comments - or indeed to think them through in a detailed way. I trust my heart and mind to know the truths and I trust God even more to know me and to know what I should be. One comment I would make, though; the order of the list is not remotely accidental.

I want:

1. To be a Good man
2. To be a Good husband
3. To be a Good father
4. To be a Good doctor

Amen

Sunday, May 01, 2011

Super-injunctions, a few thoughts...

So-called super-injunctions are big news at the moment and they are important. The issues raised are at the very heart of a free society; the tension between the right to free speech and the right to privacy.

So what is a super-injunction anyway?
In the past it was possible, under certain circumstances to get an injunction form a High-Court Judge to prevent (usually) a newspaper from publishing a story about you. The news of the existences of said injunction would then be reported (Mr Smith, the famous actor has taken out an injunction against the Daily News, preventing them from running a story about him...) this would in effect mean that the story would get out anyway. Super-injunctions have thus evolved to give extra restrictions - so that the names of people involved and specific details cannot be reported.

The Right to Privacy
Legal rights has a very interesting history. The Magna Carta was very much the beginning - the then radical concept that anyone who wasn't King had some basic rights. In the UK, since the Magna Carta we didn't do very much for over 750 years. Whilst the United States had a Bill of Rights, we in the UK had no codified rights.

The Human Rights Act (1998) changed that.* As a consequence, judges had a stricter understanding of 'privacy' as a reason for granting an injunction. Previously, a story generally had to be demonstrably libellous for an injunction to be granted. Because we do not have any statute law on privacy itself, it has evolved as case law only. Unless and until Parliament legislates it is only the legal precedent that forms the law.

As I understand it, the current situation is that an injunction will be granted if the claimant can demonstrate that the story invades their privacy and the respondent does not demonstrate an over-riding public interest in the story. The ideal that publishing a story is 'in the public interest' has a specific meaning. It is not the same as saying people are interested in it. For example, if the Secretary of State for Defence was having an affair with a foreign national, that would clearly have National Security implications and the public would have a right to know, despite the fact that it would invade the privacy of the people involved.

So, The Argument
  • Ian Hislop has been quite eloquent in arguing against Super-injunctions. Especially when arguing that in cases involving the sex-lives of footballers, it's difficult to argue that the public needs to know, but when it comes to more important issues, there is a great danger in gagging the media.
  • Similarly, the press is generally constantly complaining about any infringement of their Right to free speech - arguing that a free press is absolutely vital to a free society.
  
Free Press and Free Speech
There is no louder advocate for the free press than the press themselves. They seem to feel that the argument is so compelling, so self-evident that they rarely bother to articulate it; so I will.

The only guarantee of freedom in society is that those who make and control the laws are not above the law. That corruption, when it does occur, is brought to the light of day and ultimately anyone who holds power in a nation is accountable for how they use that power. This is true and the state-controlled media of oppressive regimens over the years and across the world bear-out this assertion.

But, I do not believe in freedom without responsibility. For me, it is that lack of responsibility that is at the heart of the problem. The media, for too long, has used that argument to excuse any excesses, any damage they cause, because they are really fighting for our freedom.

Furthermore, the principal that free-speech is not an absolute right is well established - this is why we have libel laws - however good or bad they may be. You cannot print demonstrably false and damaging information about people.

Privacy vs Free Speech
If you ever talk to anyone who knows about Human Rights law, the conflict of various rights is always the most challenging and most interesting area. There is clearly a clash of rights in this situation.  The Right to Privacy is a vital one. One may argue that anyone in the public eye who has an affair, deserves whatever they get and should forfeit that right. Quite apart from the fact that - as a wise man once said - it should only be he who is without sin who casts the first stone (and the press are unbelievably hypocritical about this) there are always innocent people involved. I do wonder how Coleen Rooney felt about the stories of Wayne's exploits with various women. I suspect she would have preferred it, if it wasn't all in the public eye. When children are involved, the judges have a stricter view of privacy and I suspect most people would agree with this.

I do not think that anyone in the public eye has given up their rights to a private life. Whilst, like most I have naturally less sympathy for people who have deliberately courted publicity compared with others who are simply thrust into the public eye.

I do think that free speech is really important, for all of us as individuals and for the media. Therefore judges should be very careful (as should legislators) whenever they seek to curtail free speech. However, I think This Story demonstrates how we all need protecting from 'free speech.' We all have a right not to have our lives invaded.

The Public Interest Argument
As I said above, the argument that a story is 'in the public interest' will normally override someone's right to privacy. I agree with this.

Given that the concept exists, some have sought to define the public interest as widely as possible. Paul Dacre is editor of the Daily Mail. He is also chair of the Press Complaints Commission Editors Code of Practice Committee. In 2008, speaking to the Society of Editors, he put forward the following argument:
  • A free society depends on a free press
  • A free press can only exist where you have a plurality of press organsiations
  • Therefore newspapers need to be commercially viable in order to continue to exist as a free press
  • In order to be commercially viable, newspapers need sensationalist stories
  • Thus, in order to protect all of our freedom, the press needs to be allowed to publish salacious stories
It is an impressively honest and open statement, if nothing else.

Conclusion
Ultimately, I have a lot of sympathy for super-injunctions although their extent concerns me. Mr Dacre's argument I think is obscene, especially when you look at the kind of thing the Daily Mail publishes. Essentially the argument boils down to The press should be the only arbiter of what we do and we can publish whatever we want because we need to in order to carry on existing and protecting everyone's freedom. The idea that someone he has the right to make such decisions, to sacrifice other people's privacy and quality of life to some supposed higher-good is absolutely horrific. There are many many indirect victims who are often totally innocent when the press has complete free-reign like this. (Max Mosley has described how his children were affected by the stories about him in the press which turned out to be significantly inaccurate.)

The newspapers - and many others to be fair - believe that (unelected) judges have no right to be making privacy law and in essence they are undermining the supremacy of Parliament to make this law. I have very little sympathy for this argument for two reasons. Firstly, judge-made law - or case law as it's known -  is well established in English Law. Where the Acts of Parliament do not quite specify what the law is, legal precedent guides judges and where no precedent exists, judges will look at established principals and then make a decision. These decisions may be over-turned by a higher court or revised by Act of Parliament and that is how our legal system works. Secondly, the solution is for Parliament to act. However I think it is politically almost impossible for anyone to bring forward a meaningful privacy law in Parliament because of the way the press will report it. Can you imagine the headlines? Given how the press jump on anyone who seeks to regulate them at all... So, the fact that privacy is only shaped by case law in the UK is hugely the media's own fault.

The Super-injunction that Trafigura Beheer BV were able to get against The Guardian concerns me greatly. I do not think this injunction should have been granted. However the majority seem to be about stories with no true public interest and I have no sympathy with the media complaining about it as they have only themselves to blame. If we had a responsible media, we wouldn't be in this situation.

Disclaimer: I speak with great confidence on some issues but not others. I am not a legal professional, just an interested amateur - if any real legal experts wish to correct me on details, please do. 

Alienfromzog

*Human Rights Act (1998) established in British law the European Convention on Human Rights. Most of what you read about the ECHR in the press is entirely inaccurate. Firstly the only connection between the ECHR and the European Union is that they both contain the word 'Europe.' Secondly this is a unique piece of legislation as it only applies to the government; it provides that the state may not infringe on your rights - for example they cannot imprison you without a fair trial or summarily execute you. It was formed by the Council of Europe in 1950 as a response to the horrors of Nazi Germany. Thirdly it is not Europeans imposing their laws on us - arguably it's the opposite as essentially it was Britain who drafted the convention in the first place. I think it is a great national shame that it took us nearly 50 years to sign up to it. 

The effect of the HRA(1998) in leading to privacy law is an interesting one - as I understand it the argument is that the courts as an organ of the state are compelled to act to protect a citizen's privacy even though it is not necessarily the state itself that is threatening it. I would be very interested to know from any real experts if this was an unintended consequence of the law or whether this effect was entirely predicted.

Monday, April 04, 2011

Writing to my MP again... I know, I really should get a life....!

Alien Castle
England
Earth

The Hon L de Mocrat MP
House of Commons
London
SW1A 0AA
 3 April 2011

Dear Mr de Mocrat,


Thank you for taking the time to write to me again. I also appreciate the inclusion of Lord Howe's response. However, I did not find your response or that of Lord Howe reassuring. If you forgive the analogy, if someone proposes to make holes in a perfectly serviceable boat, then the simultaneous offer of installing pumps to keep the water out will inevitably lead me to suggest that not making the holes is the more sensible option. And this is how I feel about the Health and Social Care Bill. Whilst some of the changes made to the bill are an improvement, fundamentally it is flawed and risks destroying the NHS.
I wish to raise some specific points from Lord‟s Howe‟s letter.
  • 1. Lord Howe states in his second paragraph that England‟s healthcare outcomes lag behind other countries.
As, I have said previously, this analysis is very simplistic and dangerously misleading. I would encourage you to read the British Medical Journal article I mentioned to you before (if you haven't already) by John Appleby of the Kings Fund. [Appleby, J. Does poor health justify NHS reform? BMJ (2011) 342:d566]. The article is freely available to all on the BMJ website. As Professor Appleby explains, point comparisons of healthcare outcomes do not tell anything like the whole story. To quote from the article;
“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”
Despite the fact that until recently the UK spent less on healthcare than comparable countries will have seen the fastest improving outcomes in both heart disease and cancer. I fully accept that healthcare outcome statistics are not straight-forward and it is very common for them to be misunderstood – often in the media. However surely, those responsible for healthcare should have a much better understanding of the data, otherwise it is impossible to formulate any kind of workable policy
  • 2. In that same paragraph, the minister describes falling productivity in the NHS (presumably, based on the Office for National Statistics data.)
These data demonstrate a fall based on a simple comparison of input of funds compared to output – measured in terms of  'activity.' The problem is that this is meaningless without some concept of quality of care. The report itself says:
“The measurement of quality needs further development to become comprehensive and relevant. We may be underestimating quality improvement.” 
The University of York's report on NHS productivity that I referred to before is a far more comprehensive study [University of York Centre for Health Economics] There is a need to always look to maximise productivity, although this is far from straight-forward to actually measure. Healthcare is not like a factory, outcomes must be very carefully defined.

It is very difficult for me to take seriously anything that Lord Howe says, after he begins his response with two statements that I know to be inaccurate. Why should I trust any of the reassurances that he gives?
  • 3. It concerns me greatly that the minister responsible for this cannot tell whether the bill opens up the NHS to EU competition law or not.
This is clearly of fundamental importance and whether it is an intended consequence or not, surely this should be known before the House votes on the bill.
  • 4. The use of competition to drive up standards is something that all three political parties broadly support.
However, there is nothing in this bill that prevents independent providers from 'cherry-picking'profitable services. Furthermore, according to the White Paper from 2010, there will be something around a 14% weighting towards private sector providers compared with NHS trusts due to the supposed financial advantages NHS organisations have. Whilst I am not necessarily against all competition per se (I would like to see hear more debate) as things stand, it is a system that will be significantly biased towards non-NHS providers. NHS trusts rely on cross-subsidising to cover the costs of services that cannot make a surplus and to cover the costs of training (estimated at around £5Bn/year for the NHS).
  • 5. The argument for increased efficiency is at best confused.
As I have described to you previously, major hospital trusts will have to go from having contracts with a small number of PCTs to having contracts with multiple GP consortia. This will inevitably multiply the work and administrative costs. In order to ensure quality for a multitude of suppliers and to commission more complex treatment whole new layers of bureaucracy are being created such as the Care Quality Commission, Lord Howe referred to. It remains to be seen whether these changes will actually save any money at all.
  • 6. The government claims that the number of GPs that have signed up to become 'pathfinders' demonstrates broad support for their plans.
This is plainly untrue. There are two more significant reasons why GPs have signed up. Firstly, they have a deep commitment to their professional responsibility and know that providing the best care for their patients necessitates being involved in shaping the plans. Involvement is not the same thing as enthusiasm. Furthermore, the way the DOH has structured things, any consortia formed before April this year will not be responsible for PCT debts. Any formed later will have to carry that burden.

I am not by nature cynical about any politician, however there is indeed significant dishonesty on the part of the government in response to questions about the NHS. On 8th February, in Prime Minsters Question Time, David Cameron was asked whether the NHS was safe in the Government's hands. Mr Cameron replied:

On the NHS, I can do no better than quote the shadow Secretary of State for Health. This is what he said about our plans:
 "No-one in the House of Commons knows more about the NHS than Andrew Lansley... Andrew Lansley spent six years in Opposition as shadow health secretary. No-one has visited more of the NHS. No-one has talked to more people who work in the NHS than Andrew Lansley... these plans are consistent, coherent and comprehensive. I would expect nothing less from Andrew Lansley."
That was said by Labour's shadow Health Secretary. I could not have put it better myself.[Hansard 9 Feb 2011 : Column 299]
This is what John Healey actually said (I think the missing words are quite important):
“This is a Conservative plan for the NHS. This is Andrew Lansley's plan. No-one in the House of Commons knows more about the NHS than Andrew Lansleyexcept perhaps Stephen Dorrell. But Andrew Lansley spent six years in Opposition as shadow health secretary. No-one has visited more of the NHS. No-one has talked to more people who work in the NHS than Andrew Lansley. 
The Health select committee concludes – in so many words – and as I believe, that these are the wrong reforms at the wrong time, “blunting the ability of the NHS to respond to the Nicholson challenge” to improve services to patients and make sound efficiencies on a scale the NHS has never achieved before.

But these plans are consistent, coherent and comprehensive. I would expect nothing less from Andrew Lansley.
[John Healey's Speach to the King's Fund only the words in bold were read out by the Prime Minister.]

One could describe the Prime Minister's response as in-keeping with theatre-poster writers who excel at quoting critics out of context. However, like the references to healthcare outcomes in other countries it is entirely misleading. I am not trying to make a party-political point here, simply to emphasise that the arguments in favour of this bill are a mixture of flawed logic and misleading information. I work in the NHS, I am aware of its weaknesses and issues. However, I also know of its great strengths which are hugely threatened by this bill.

I thank you again for inviting me to your constituency surgery; I will find one that I can attend, in order to discuss this with you further.

Yours sincerely







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

Saturday, April 02, 2011

As promised, my MP has written to me again in response to my letter...

Below is the follow-up letter I received from my MP. As promised he has forwarded the reply from the government after he wrote to Andrew Lansley to share the concerns of me and my fellow constituents who have written to him.

Voting Systems - why I don't like PR.

Now, Britain is in the grip of referendum-fever. The excitement over the potential change to the voting system is palpable. It is also non-existent. In a very British way there is a general sense of apathy. For the record, I think AV (The alternative vote) is a good system and I will be voting for it. Whilst, I will probably end up writing more at some point, for today I wanted to explain that I don't want Proportional Representation. That despite its advantages, I don't think it's a good system.

Firstly, I need to expand on my thoughts about democracy. The idea of democracy is that government exists for the people and by the people. (To coin a phrase). The principal of representation is of course at the heart of all this. For me, the genius of democracy is not that people get what they want per se. Mob-rule doesn't work very well, but that it holds leaders accountable to the electorate. It is in this context that I would evaluate any potential voting system.

In the UK, we have a relatively simple 'First past-the-post" system. The reasons for this are in-part historical but the idea is very straightforward. Each constituency has one MP. Of the candidates who stand, whoever gets the most votes wins. Whichever party has the most seats in parliament then forms the government. Either on their own if they have an 'overall majority' or in coalition is they don't have enough MPs on their own. It is also possible to form a minority government but that is a rarity in the UK. Given that most people vote for a party rather than an MP, this system favours bigger parties over smaller ones and favours parties with 'concentration' of support in particular areas. This distortion means that parties can have 100% of power with only about a third of public support, and that parties with as much as a fifth of popular support have much less representation in parliament.

So, one of the alternatives is Proportional Representation (PR). This is the simplest system in theory. Quite simply, the number of votes are counted nationally. And the proportion of MPs is then allocated to each party according to the proportion of votes.

Proponents always begin their argument by explaining how inherently fair such a system is.

My objections to PR are as follows:
  1. PR makes coalition government very statistically likely. This in itself is not necessarily a bad thing but does have implications. Especially when it's a coalition of lots of parties.
  2. In order to make a working majority such coalitions often have to include multiple small parties. These parties will seek concessions from bigger parties in return for their support. This often, in practise means that a party with 5% support has more power than one with 30% support. Extreme parties regularly hold the government to ransom in Israel. This for me undermines the fairness argument.
  3. PR makes the parties more powerful. Before each election, each party will produce a 'list' At the top of list will be the party leader, and then the rest of candidates are listed in order of priority. If a party wins enough votes for one seat, then only the leader becomes an MP -  if they win enough for 100, then the top 100 become MPs and everyone from 101 downwards misses out. In the real world, many of the most effective parliamentarians are ones prepared to dissent and stand up to their party leaderships, the relatively independent MPs are often best able to represent their constituents effectively. The party whips have an important role in delivering on a manifesto. However, I do not think that making the party machinery more powerful would be good for democracy. How many members would stand up to their leadership if it means being moved from the top 50 on their party's list to the maybe 250 where they have much less of a chance of being elected?
  4. PR breaks the link with the constituents and their MP. Arguably, the greatest strength of the current system is that each MP represents ~100,000 people. If you have an issue, you can write to or visit your MP to raise it. This constituent-MP relationship is one of the best things about representative democracy.
At some other point, I will probably talk about my thoughts on AV, STV and FPTP, but I think that's enough for now.There is no such thing as a perfect system, but I think AV is actually pretty good. FPTP has some strengths but also significant weaknesses.

One other very good reason to vote for AV is the no2AV advertising posters; if this is the best they can come up with then there can't be any good arguments!

Baby Poster
Soldier Poster

AFZ