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The only genuine protection for the NHS is meaningful reform

November 9, 2019 Leave a comment

red-herringFive weeks until the General Election and there’s so many red herrings around, you could be fooled into thinking our MPs are trying to sell us a smokery.

The biggest pool of them all surrounds the Labour-led debate over privatisation of the NHS – a topic which is a continual source of dishonesty for the Labour Party, the Conservatives – now the SNP too, and very much a political ball.

The issue was in many ways fuelled by the recent Channel 4 Dispatches Documentary about big pharma and the USA’s probable attempt at assault on the way that the NHS buys drugs as part of a post-Brexit Trade Deal with them.

However, what Labour’s push of ‘we are the only Party who believes in the NHS’ fails to so spectacularly address is the real level of the problems that exist within our National Health Service, how those problems became manifest and have to be addressed, and how fire hosing money at this Public Service might keep the wheels turning, but in the long term it will not save the NHS and in fact could be making all of  the problems significantly worse.

The principle of the NHS is a very good one. We should ALL continue to have access to free healthcare at the point of access. But we cannot continue onwards thinking that its existence can be assured in the future simply on the basis of how much We spend.

Privatisation in its most literal sense is – on the face of it – a very big part of the problem of cost attribution within the NHS today. So for Labour to even suggest that they can stop privatisation when it is already present, is either disingenuous on their part, or demonstrative of their ignorance of how the service actually works.

Many of the problems with cost have come about because of deals that the Blair and Brown Labour Governments constructed under the guise of PFI. Others have snowballed because of the cultural steer towards the use of private contractors or consultants to undertake backroom management functions and the excessive use of temporary staffing agencies that were never required before all good sense in employment laws and conditions was excessively overstepped and the door was opened to unbridled levels of profit making which has gone on for so long now that it is simply the way rather than individual choice.

Fixing this problem so that the NHS once again becomes sustainable isn’t easy. And with politicians who don’t even understand how it all works, real or meaningful reform is not  even currently on the agenda, let alone being a political choice.

The MPs that we have had, their Parties and the People who lead them have no incentive to really get to grips with what is really going on. Their lack of knowledge and understanding is self evident each and every time they are interviewed – which during an Election Campaign is pretty much every time that we turn the radio or TV on.

Until this changes, none of the problems that we as People within this Country face will be dealt with.

Yet we don’t even have the option of Political Parties or Candidates on 12th December who even have an idea of what is really going on.

 

image thanks to unknown

Don’t blame the Americans for doing what the Americans do. Worry about the people who have been appointed to negotiate with them – because it’s their ineptitude and self-interest that will cause us hurt

October 30, 2019 Leave a comment

So we are straight into the 2019 General Election Campaign and somebody in the Labour Policy Office watched the Channel 4 Dispatches Programme earlier this week on the Americans hoping to leverage open the pharmaceuticals market as part of a post-Brexit Trade Deal.

Should we be surprised that this is what US business interests want? No – of course not. This is exactly what they do.

All the concerns that the C4 Documentary flagged are real. But they are also replicated in the approach and mentality of big businesses across the world covering all forms of services and goods. It is inevitable that if the people going into negotiations with others have money as their god, they are not going to care about the fallout from any deal they make or the consequences for others, no matter what they are and no matter how many times removed.

What we should be more concerned about is the lack of understanding of big business, global markets and the impact of their actions on the economy on the part of our politicians, and just as importantly the people who they and the Civil Service may appoint in future to negotiate on our behalf.

We witnessed how high level negotiations go wrong – or rather how their direction goes to a location it shouldn’t – with the negotiations over Theresa May’s failed Brexit Withdrawal Agreement.

The process was carried out by people who were purposefully looking to frustrate the Brexit result. They were working with others whose main aim was to frustrate the Brexit result. It was all was overseen by a PM who ultimately wanted to frustrate the Brexit result. That’s why we still haven’t had Brexit.

Good negotiators usually get whatever they are aiming for or walk away.

But what they are aiming for will either be overt or hidden. It will never be both.

And that’s the biggest problem we now have as we look into a world of opportunity – once a meaningful Brexit has been delivered.

If negotiations between the UK and Countries such as the USA are always carried out on the basis of considering all consequences and knock on effects – as part of the process of negotiating deals which only work in our best interests – there will never be a problem – and in this specific case, pharmaceuticals are unlikely to ever be put on the table or involved.

But if negotiations take place on the basis of simple political expediency or just the benefits on the table for the negotiators involved, we will ALL be in a depth of trouble post-Brexit, like we have never been in before.

 

 

 

 

Government should be ensuring that people can afford to live on a basic income, not make cheap headlines from a non enforceable wage

October 1, 2019 Leave a comment

Our MPs are so busy getting drunk on their own power and glory, they really have lost sense of reality with the policies that they continue to propose.

The problem is that without looking at the detail more deeply – as the people we have trusted to run this Country really should – the soundbites that they keep pumping out in isolation sound all so very good.

In quick succession, we have had the Liberal Democrats. the Labour Party and now the Conservatives throwing out policies from their Conference platforms that have been designed as nothing more than cheap tricks to buy voters off.

Promising the earth and then failing to deliver has very little cost for the unscrupulous politicians involved.

But policies like simply cancelling Brexit, reducing the working week for everyone to 32 hours and raising the ideal hourly rate for the Living Wage has a real impact that will not deliver the beneficial experience that these politicians are suggesting they can control.

Pretending that Brexit and the vote that led to it can simply be cancelled as if it never happened would be beyond stupid and would have very serious consequences for everyone – no matter what fairytales those obsessed with Remaining in the EU would like us to be told.

But what we earn and how we earn it not only has an everyday effect on how we live our lives, it is also all about what we can afford.

Politicians on all sides are completely out of touch with what it actually costs us to live. The reality is that even on a 40-hour-week paid at £10.50 per hour in 5 years time, thats only £420 per week or £21,840 per annum. It’s not enough today for a single adult without children to be self sufficient, let alone tread water or basically survive.

The cost of living in this Country is stupidly out of control.

The way that we measure the health and success of our economy should not be wage rates and rises, GDP or statistics in any other form. But whether the poorest amongst us can look after and completely fend for themselves on the basic minimum wage without going into debt, claiming benefits or having to look to charities to someway get involved.

The way that a more enlightened government or MPs who actually know and have respect for what they are doing would achieve this is to actually use the power and responsibility that they have been given to make changes the the framework that business and finance operates within. Not to tinker on the edges by applying sticking plasters that will have already lost their ability to heal anything by the time that they come into use.

Too many businesses, financiers and property owners are taking too much value out of every product and every service that is provided in this Country, without putting like-for-like benefits back in.

The system is complex and complicated and few of us really understands how finance, markets and supply chains work. But the benefit is all going one way right now and continuing to take the most from the people who can least afford it. All so the people at the top of the chain can keep adding to a cash pile they have no genuine need to use, whilst looking at the ease with which they can work the system and concluding that they can take even more.

Politicians should not only know, but be acting proactively to address this. Not to eliminate the financiers, business people and economists like Labour might like to do so. But to introduce a considered set of ethics and regulation in every aspect of business in this Country, so that end users are only ever paying whats fair for the basic products and services that are essential to live and survive. But above all, is no more than what they can actually afford.

Until we have politicians prepared to take the steps necessary to address the real cause of the cost of living problem, the way that economics work means that the people who are now having to go into debt, look to the government or charities just to get by and stay alive will continue to see life as something that they simply cannot afford.

 

 

The Welfare covenant is broken and Universal Credit is not the answer when it already creates victims

October 12, 2018 Leave a comment

Basic Standard of Living Q

It is regrettably all too easy for some to overlook the realities of life for others when  everything is going well and there is no need to look to anyone else for help.

Sadly, this is not the case for many. At one time or another during our lifetimes, there is every chance that we will need a safety net in place for when plans don’t work out quite as we thought they might, and we find ourselves in need of money, food, clothing, transport, warmth and maybe even a home.

State provision of such a safety net within a civilised society is not only right. It is also necessary when government is convened, managed and operated with the greater good, benefits and consequences for all are firmly in mind.

However, our Welfare and Benefits system has and is being continually abused.

It is being misused by those seeking help. But it is also being mis-purposed by those who have been given the responsibility in Government for providing that help on behalf of us all.

The Welfare covenant between those helping and those seeking help has been broken. And for the benefits system to work beneficially again for all, there must now be a new way of thinking.

No form of Government provision can truly be beneficial to all if victims have been created of any kind.

Universal Credit has therefore proven itself flawed before it has even began operating fully.

With many struggling recipients identified already, we should all be asking questions about the many more who are yet to come and the consequences that will surely follow.

This doesn’t mean that the system we have had until now is good. That it is working. Or that we should just stay tied to the same old thing.

We shouldn’t, because the current DWP Benefits regime really isn’t working for anybody, and we are all in desperate need of a solution which really can be seen and experienced as a ‘win-win’.

Now before we get lost completely with how Politicians are getting Benefits and Welfare wrong, there must also be an acceptance on the part of us all of what it is fair to expect to receive, how we receive it, and under what circumstances that help will actually come from the State if we should ever find ourselves in the position where we genuinely need it.

As we look at what is really wrong with the system as it is, we must also understand and accept that if the Law allows certain types of behaviours to exist, it is inevitable that there will be people who will employ them.

It doesn’t make their behaviour right. Their actions are not inevitable. Everyone has free will and can choose how to behave, even when a rule covering that action or behaviour may appear to be absent.

If the system doesn’t accommodate for the misuse of Beneficiaries and those affected, it is the people who are responsible for its design and implementation who are equally responsible for identifying what is wrong, putting it right and ensuring that either good or bad, nobody who should be receiving help gets missed or is able to slip in between.

Why the benefits system isn’t working, isn’t simply about something structural, the technology used or the people who administer or receive Benefits of any kind.

Like most policy failures today, it is a combination of factors which are not being considered. Many of them overlooked for the cause of political expediency, or because their place and influences sit outside of the specific or central theme – in this case the Benefits regime.

The real cost of a Basic Standard of Living is not understood by Government

The greatest injustice visited upon the unemployed, is the Government and DWP assertion that in 2018, one person can live on a basic income of £73.10 per week.

They can’t.

And when the Government itself has set the Minimum Wage at £7.83 per hour, which at a 40 hour week would be the same as £313.20, who exactly do they think is going to step in and replace what for some will be the destitution-busting £240.10 per week which sits so ominously in between?

Yes, there are many other Benefits other than and beyond the scope of Jobseekers Allowance.

But Universal Credit is being sold as a method of simplification by rolling everything into one, when the true aim of saving money will not stop a similar way of allocating money to the very same things from then existing, just under the umbrella of being just one application.

Government must provide a Basic Standard of Living income to those who qualify and need it.

If it is too expensive to do so, those in Government would do well by beginning to ask themselves the question ‘why?’

Government has surrendered responsibility for setting the prices of goods and services essential to a Basic Standard of Living to the private sector

Sadly, little attention is paid to the elephant in the Benefits room. That being the escalating prices of goods and services which provide for everyone’s basic needs in life.

That’s food, clothing, accommodation, transport and utilities.

Not First Class or on the upper side of ‘Taste the Difference’.

Just the stuff that anyone would need to be kept fed, clothed, warm, able to get themselves to a job and home again, and knowing that at night they will have a roof over their head.

Control of all of these goods and services is now completely under the infuence of commercial interests which have money as their one and only god.

Free Marketeers and Neo-Liberals will tell you that the Markets will look after everything when they are completely free to do as they choose. They don’t, they won’t and they will continue to do everything to make profit from every opportunity, for as long as they are gifted with the freedom to choose by gutless Government. Government filled with Politicians who see ethical intervention in the Markets and Financial Sector as a problem because they believe that they have too much to lose by doing so.

No service which is essential to the public good should be placed in private hands or under the undue influence of any self-serving cause.

No food supply essential to basic, healthy survival should be subject to the whimsy of the Markets where multiple traders, agents and handlers are seeking to add one profit margin on top of another, just on one item supplied within any one producer-to-plate supply chain alone.

If the Government genuinely wants the Benefits system to work, it has to find an effective way of controlling these two essential areas of daily life so that once a system that does work has been identified and implemented, it is then not rendered useless by private interest, based on nothing but profit.

We are culturally conditioned to assume that all Benefits Claimants are in some way bad

Mud sticks, as anyone who spends any time on social media or reading the news will know.

But the phenomenon of people assuming the worst of others based on the first story they are told is nothing new. And when it comes to the unemployed, being work shy is basically the accepted view.

The truth is not as straightforward and anyone at any stage of their career can find themselves out of work and having to ‘sign on’ in order to get help.

The problem with the ‘accepted truth’, is that the system itself, both mechanically and culturally treats everyone who comes through the Jobcentre door as if they don’t want to work, cannot be trusted in any way and that they all fit into the same mould as each other.

This approach overlooks the fact that people find themselves knocking on the door of the Jobcentre and the administrative centres of the DWP for very different reasons.

Some are poorly educated. Others have grown up in conditions that reinforce a world view that this is all they are worth. But there are others too who have landed themselves with significant debt to gain degrees that have proven to be of no use. People suffering illness and mental health problems which restrict the work that they can do. And even highly experienced and very well-educated professionals who cannot provide anything like as simple an explanation for what life has put them through.

Sit in a Jobcentre for long enough and you will hear claimants complain about having to wait for the money they are entitled to. You will see others lose their rag because they have not conformed to the regulations that they are supposed to. You will also witness the presence of so many security guards, it clearly suggests that behaviour of this kind is not only possible, but actually the expected constantly and all of the time.

But not all Benefits Claimants are a burden. Many want to work. But they are branded as ‘no-hopers’, instead of gaining the help and support which reflects them individually.

It is little wonder that those outside of the expereince of having a ‘down period’ in their lives take what they have for granted. Then look on and see all these people as being worthless and occupants of society’s bin.

Taking this approach is little more than deliberately setting up Benefit Claimants to fail.

It is not the action of a Government which respects and fully fulfils its role as the representative body of a civilised society. Nor is it illustrative of a Civil Service which is fully considerate of its role.

We can hardly expect the general population to think differently when the system so demeans.

A significant element of Claimants consider themselves entitled to what they receive

Because the system has been so poorly thought through and has not evolved positively in a way that sees its role strategically and as a way to raise expectation from the ground level upwards, it encourages the belief that it can be used as a substitute for real life. For not taking part. For resenting the success of others and as such seeing Benefits as an entitlement or a worthy redistribution of wealth from others.

The Benefits system only works for those who surrender themselves completely to it, leaving no incentive to escape and provide us all with that so far mythical ‘win-win’

Because the Benefits system has been so poorly thought through and has not evolved positively in a way that sees its role strategically as a way to raise expectation from the ground level upwards, it encourages the belief that it can be used as a substitute for real life. For not taking part. For resenting the success of others and as such seeing Benefits as an entitlement or a worthy redistribution of wealth from others.

The Benefits system only works for those who surrender themselves completely to it. It  leaves no incentive for Beneficiaries to escape and benefit anyone but themselves.

With restrictions placed upon how many hours a Claimant can work without losing Benefits, and the process of reinstatement being long and arduous – even before Universal Credit begins, there is zero in terms of incentive for people to take on more hours and work towards self-sufficiency.

Because the 6 Benefits together are so very complicated for one person to qualify for already, the further any Claimant journeys into this portfolio of direct and indirect income streams the less and less likely they are then to leave.

We can only ask ourselves the question if we were to find ourselves in the very same position. When everything is taken care of already, what serious advantage is there to be gained by going out and working for a wage which might never come to anything near the total that becoming subservient to the system and therefore being a Benefits slave can achieve?

Again, we cannot blame people for responding this way when the system itself not only allows but facilitates behaviour of this kind.

Help should always be given to those that need it.

For those who currently choose to be beholden to the system, there must be a process of incentives which doesn’t leave them without all the basic essentials.

It must also encourage them and accept and appreciate that they have responsibility for themselves as well as the wider community. A community which is ready to help, but is itself entitled to see those who voluntarily choose a life on Benefits as a drain on resources that we desperately need focused to provide other Public Services and that they are as such disadvantaging others on little more than a whim.

As taxpayers, we are effectively subsidising the employers of low paid workers by providing the in work benefits which allow them to survive

I have already mentioned what it costs to live and the need for a basic standard of living above.

Yet the conversation and discussion needs to go even further than the power of commercial interests over the essential goods and services for life.

The debate and the action that follows also needs to recognise the role which our Government is playing in keeping wages low and propagating a system where profit margins for large companies are exploding, whilst the millions of people on low incomes are now being farmed for the debt they have to carry, just to survive.

The money that lower income workers receive is in many cases too much to allow them to be on additional Benefits, yet not enough to allow them to be self sufficient. It keeps them ‘functioning’ at the behest of others, somewhere within the ‘in between’.

If we could freeze the prices of goods and services right now, so that they no longer rise, and we could focus in on what it actually costs a normal person on their own to live, self sufficiently, to feed, clothe and take care of themselves, put something by, have a holiday, a realistic pension and have a life which reason would tell us would make a normal person happy, we can soon begin to see the disparity between where wages sit and where right now, in these ‘static’ circumstances they would need to be.

At £10.20 per hour in London and £8.75 per hour outside, without the help of Government with Housing Benefit and Tax Credits too, even the Living Wage Foundations advisory level for a basic income doesn’t come close to what self sufficiency – that’s what complete independence from Government support –  would actually require.

Such a reality where Government support for the growth of small business is concerned alone would probably make the whole thing more palatable.

But the real beneficiaries of this State-sponsored in-work poverty are the big Companies making significant levels of profit that would in reality only dip slightly if they were to pay wages to front-line staff which would allow those employees to function within the overpriced society which their Employers have helped to create.

That this situation has been allowed to exist is beyond questionable.

That successive Governments of all kinds have allowed a situation to exist where the Taxpayer is paying over the odds for products in services in their face value alone is simply wrong.

That customers are then paying again to subsidise the wages of the staff serving them would be funny, if its implications and the reality which surrounds it not so very serious indeed.

This whole process has only been possible because Government has either borrowed incredible amounts of money, or has cut other and arguably more essential Public Services in order to allow them to provide this massive giveaway. A free-for-all that has broken the Country financially and is one of the key reasons why unfettered immigration of low skilled workers from Europe has been possible. Itself an issue which is seen by many Remainers as key to the majority vote for the UK to leave the European Union and the one which they are still obsessively attempting to resolve.

There would be some sweet irony in this if this financial mismanagement had really been helping people and UK communities, rather than being overtly beneficial to commercial interests, private profit and yes, the EU all along.

But there hasn’t, and in terms of management of expectation, this and previous Governments would appear to have hamstrung any future Government which wants to take a stand and do the right thing.

Be that as it may. Doing the right thing, is the only way that all of this is going to end up working right for everyone involved.

The solution

Like almost everything that Government and Politics touches, the key to delivering change in the Benefits and Welfare system is thinking differently.

And it’s the thinking and ideas at the top of British Politics which needs to change first before it can change anywhere else.

The responsibility of Government

Before the Benefits problem can be fixed, the understanding of what the problem actually is, must be broadened to include the wide range of factors which feed and influence the issues which those claiming Benefits experience.

Right now, there is an obsession on the part of decision makers. One which leads them only to attempt to address the effects of any problem, rather than to tackle each and every one of the causes.

Until all of the causes of problems are addressed, the Benefits system will only ever work temporarily at best, until those factors which are outside of the scope of that consideration inevitably change and then exert their negative influence once again.

A Basic Standard of Living level or the real Living Wage will only be achieved and maintained when all contributing factors fall within the reasoned influence of non-idealistic Government that considers the consequences of policy making upon ALL.

Politicians simply do not understand the power they have to change things. They do not see the scope of their roles and they have no appreciation of the influence that they could really have if they were to put the interests of ALL the people who have elected them first, rather than themselves, their Political Parties and whatever ideas or interests sit around that self-serving mix.

It will not matter how simple or complicated existing of new systems like Universal Credit might be. If they fail to consider and be considered as part of the bigger picture, they will always fail – and our Politicians have both the ability and responsibility to ensure that this is no longer the case.

It is their choice to now decide and it is their choice which must come first.

The responsibility – and acceptance of Claimants and Beneficiaries

For any solution to gain traction, it is also vital that ‘being down in your luck’ is accepted as a normal part of life, rather than being a condition which renders any of us as being sub-standard to it – the position under which Benefit Claimants are often perceived.

Those claiming Benefits fall into two predominant groups. Those who are or should be  temporary claimants and are able and willing to work. And those who are longer-term or permanent claimants who are unable or unlikely to be able to consider working again because of disability, illness, or other genuine debilitating circumstances.

All of us as beneficiaries must accept that there is and never has been a magic money tree of any kind. That the support that is given can only be provided through the act of others contributing through taxation on earnings, whether they themselves earn little or some extraordinary figure that might blow our minds.

Whilst it may currently behave as if it is, and some Politicians continue to seek election on the basis of perpetuating this myth, Government and the Public Sector is not a separate and ‘benevolent’ entity which doles out cash to Welfare recipients on the basis of being kind.

Government exists to represent the best interests of ALL British people. Government is there to help us all to succeed in whatever way that might be possible for us as individuals. And on  behalf of us all, it is there to help and provide support to those of us who cannot do so, in such ways that we may never feel like an after thought or something that others have in some way been left behind.

Government is the formal community power which represents and is therefore ‘for all of us’.

Those of us receiving help should therefore be mindful that the help we receive comes from the people next door, up the street and across our Cities and Towns.

As recipients, we are not ‘entitled’ to anything. It is simply that looking after those in genuine need is the basis upon which our civilised society can be found.

 

 

 

 

 

Politicians must acknowledge the problems within the NHS before any serious steps can be taken to save it…

November 13, 2014 Leave a comment

David Cameron And Jeremy Hunt Visit A Hospital To Mark The 65th Anniversary Of The NHS

It is because we can all identify or agree with the principles of our healthcare system – to meet the needs of everyone; to be free at the point of delivery; and that it be based on clinical need and not the ability to pay, that it has become such a focus and play thing for successive Governments and the politicians within.

It is also why the NHS now finds itself at a point in its history where these very Principles may have now placed it at the most significant risk.

In time, the size of the milestone which was the creation of the NHS, may be fully appreciated for the very rare moment in time that it was when the political classes delivered a set of policies and principals which were genuinely created to be in the best interests of all.

Such moments are extremely rare. Governments such as those led by Churchill and Thatcher created and determined legacies which still affect us now and which their successors may only ever hope to emulate.

But the arrival of the NHS, much like the formalisation of working democracy through the creation of our Parliament following the Civil War, has the power to touch us all – even if we don’t or won’t openly acknowledge it.

Sadly however, once the principles upon which the NHS was formed were agreed and indeed became cornerstones of both our culture and society; what were soon to become the long-term political arguments over how their processes should operate soon began.

Today, the NHS might be best described as a series of industries within industries; of silos within silos; business unit lapping up against business unit; as an entire ecosystem where ideas, concepts and yes – even Jeremy Hunt’s ‘innovation’ [aka ‘commissioning] are actively competing against and ultimately all working against each other with the regrettable endgame firmly in sight, when some future Government will have no choice but to admit to no longer being able to afford it. Funny perhaps that it’s never this particular one…

Generations of the political masters of the NHS do themselves carry much of the blame for the crisis which the Organisation is in, with it having become the ongoing vogue to stake ideological claim to ensuring the future of the service.

Ideologies are all well and good, but it is such a cultural reliance upon specialists for every function outside of medical practice itself that has bloated backroom functions and created an ideal climate for non-clinical managers to lay claim to the most important responsibilities within what should have always remained a predominantly clinical-led world.

Add the performance-choking and burdensome elements of protectionism which have been fuelled by European red-tape and employment legislation; litigation culture and the motivation of many to look for almost any reason to create blame, and you can soon see why temporary staff, commissioning and the recruitment of managers who can surely only manage if they have a degree or an MBA has become the norm.

The pseudo-sciences do indeed have a lot to answer for not only within the NHS. Somebody somewhere will soon need to realise that blue sky and out-of-the-box thinking are reflections upon the ability and understanding of an individual to apply what they know. It is something which itself can rarely be taught, and the way in which qualification is prioritised above experience is really quite perverse in the age of equal opportunities. The text book technocracy which is now populating all tiers of middle and upper management threatens whole industries, and not least of all the NHS.

As discussed in a previous blog about Government, the NHS is not a business and should not in any way be treated like it is one.

One of the greatest ironies of Jeremy Hunt’s plans for making savings by cutting the hire of temporary staff, is the fact that many of them have and are being employed to manage and grow the processes of commissioning which he himself is stewarding – attracting daily rates for self employed ‘consultants’ which can easily reach £400-500 per day; plus expenses; plus the fees which the Recruiters and Agents who facilitate their ‘employment’ will be charging themselves.

Whilst sold to us as the way to streamline and make healthcare more affordable, commissioning is not only an extremely expensive process to manage, drawing funds, staff and resources away from areas where they are needed most. It is also a major step in the direction of privatisation.

Health service providers – government, NGO, not-for-profit and privately owned alike – are invited to bid to provide services, and all of them will be primarily thinking about the bottom line, and not the holistic level of care they will be giving the end user – i.e. you and me, as they do so.

The Government itself usually recognises a bottom line from fee generation as profit, whatever the legal status of the organisation behind it. The biggest question about the future of the NHS must therefore be how it can possibly be so that other organisations can now provide better services at lower cost whilst they are also making a profit, when the Government itself cannot deliver the same directly and without the need to pay an additional premium fee?

The NHS, like Local Government and many of our NGO’s is in serious trouble, not just because the Country is now effectively bankrupt and cannot actually afford to continue providing the services that it already does. But because it is also incapable of addressing the fundamental need for transformation and use innovation in its real sense to enact top-to-bottom change in working practices and the legislative areas that support them.

Politicians are not prepared to talk about the real issues that the NHS faces, even when they are themselves cognizant of them, because they fear the electoral implications of actually being seen to do so.

Meanwhile, the default approach to making savings is being employed yet again, and whilst savings can almost certainly be made, the decisions which lead to them should be based on the knowledge and experience which comes from the clinical end of the scalpel, and not from the money-counters and political theorists that populate the very fat end of the other.

image: blogs.spectator.co.uk

 

NHS and the predicted £30 Billion deficit: It’s time for change, but change is about much more than simply saving money

A NHS sign is seen in the grounds of St Thomas' Hospital in London

You can’t really help but admire the audacity of Sir David Nicholson, the outgoing head of the NHS, for his latest attempt to sidestep and cover the tracks of his questionable tenure by shining a light on what could become a £30 Billion deficit within the NHS.

His failure to fall on his sword over the Stafford Hospital outrage was beyond what many will agree as being in good taste and was compounded yet further by his indignant refusal to accept any form of responsibility, despite being the Executive Officer at the very top of the tree and arguably placed within the one position where there simply is nowhere to run or hide when it comes to carrying the can for mismanagement on what appears to have been an unprecedented scale.

The most regrettable facet of this latest twist is that the lack of respect which Nicholson holds with people now will surely deflect attention away from the cold reality of his message, which in a perhaps more capable set of hands would have not only been brought to public attention much sooner, but effectively acted upon too.

Many of us already realise and understand just how serious the problems throughout the NHS actually are. In local politics, where we closely scrutinize the real-world impact of ward and department closures; the centralisation of services, and the amalgamation of GP’s practices into so called ‘community hospitals’, there has been little doubt for us all of the real purpose of such changes for a considerable time.

Cost aside, the principles upon which the National Health Service were created and the application of universal care are still however very much valid even today.

But it is the continued compromise of those very principles at their heart which has led to the seemingly insurmountable financial and management problems that we face today.

These were principles that were intended to prioritise the care of the end-user; not the interests of managers, union leaders and politicians, who have all had something to gain at various points by moving those priorities elsewhere; often at everyone else’s cost.

Any commercially run business or ethical organisation is created and run to efficiently provide a particular product or service to its customers. It is not created or subsequently evolved to disable itself by prioritising the working conditions of its workforce and certainly not run for the benefit of harvesting statistics as part of some politically expedient mind warp which is simply designed to spread the message that things are running far better than they actually are.

Tragically, this is pretty much in a nutshell what the NHS represents today and evidence would suggest that people are dying needlessly as a result of it.

It’s not as if health professionals are oblivious to the realities of the situation either. Talking to a career nurse only a few weeks ago who freely admitted that she had been a lifelong socialist and Labour Voter, even I have to admit to my surprise when she clearly told me ‘Adam, I love the idea of socialism and what it stands for; but in my experience, it simply doesn’t work’.

Herein lies the greatest problem with the NHS; Its culture.

The culture within the NHS is the base issue which much be faced, understood and addressed if the Organisation as we have known it and the services that it provides are to be saved and our society is to be protected from the arrival of either tiered health provision across the board or UK-wide service which is only made available to those who can pay as they use.

Right now, we are all witnessing the preferred method of dealing – or I should say – avoiding reform throughout the NHS, NGO’s and the tiers of Government, which presents itself in the form of privatisation. Privatisation of any Government funded service has arguably become nothing more than avoidance of the need for reform at its worst because services are never the same when profit is the master. Furthermore, recreating public-run services once they are lost will be a whole lot harder than the reform which most Politicians already seem to see as impossible.

The only way we will keep and maintain the NHS as we have known and appreciated it in terms of what it offers the public will be the result of transformation and change which must begin with Government and work its way right the way through.

The NHS is strangled by the culture of workers’ rights, tiers of managers who barely understand what practical patient care is, Europe and the rise of the blame culture, where practitioners are increasingly forced to consider the bureaucratic pathways to treatment first, before addressing the urgencies and acuteness of clinical need. Ironically, such delays may of course be little hindrance to treatment for the people who will be looking for an opportunity to sue them either.

Government must act now to change and support the whole working culture of the NHS and put patient care back at the forefront of everything they do, rather than putting everyone else and the profit hungry ambulance chasers first.

It’s not an easy job by any means and most of us do appreciate that. But Governments get elected to take responsibility for big problems just like these; not so they can talk up the delivery of results when what they seem to be doing is looking for the easiest way out of problems they just aren’t responsible enough to face.

The patients of today and tomorrow don’t care about statistics or the money that providing treatment costs.

What they do care about is trusting that they can rely on getting medical help when they need it; where they need it and without worrying whether or not they qualify for it. Every day, the number of people who simply don’t have that trust are growing rapidly, and each new day is a sorrier one than the day before.

If Government keeps treating the problems in the NHS as if they all revolve around money, the cost of running the service will probably lead to its end.

It’s time for change throughout the NHS. But real change is about much more than simply saving money.

image thanks to http://www.channel4.com

Without Legalising Assisted Suicide & the Right to Die, it is an uncomfortable truth that in terms of our approach to ease of suffering, we are selfishly kinder to our animals than we are to other human beings

April 18, 2013 Leave a comment

The debate on Assisted Suicide

Without realising that we even do so, it is quite normal for us to look upon any situation or perhaps even the content of a conversation in terms of how its content could or does affect us personally at some level.

Fear permeates the decisions that people make at a very deep level indeed and whilst this can unwittingly prove to be a very self-destructive trait, it can also lead to what are arguably selfish acts in the extreme when considering the distant impact that these decisions have upon others.

Because most of us grow up conditioned to think this way, it is possible to become quite blasé about the way we talk about issues which may not seem to affect us directly, but nonetheless have the effect of pushing a deeply buried emotional ‘button’ which twangs our personalities just the same.

Death is of course one such issue and one that provokes all kinds of responses from people, probably because of the unknown issues which surround it and the very definite nature of its existence for us all as part of our human experience.

When I myself suffered the acute stages of a serious illness which nearly killed me and I was forced to look my own mortality in the face, I quickly became aware of just how self-focussed and personal the issues surrounding death can be for those who are close by who are not actually in the process of going through it themselves.

This experience perhaps gave me an invaluable insight on the whole issue when dealing with the terminal illness and decline of my own father, whom I like to think may have been at some advantage by having such nearby support.

Sadly, others do not receive that same level of understanding and selflessness that they need from us all in times that we may ourselves never personally have to experience, or at a time of their life when their perspective on mortality may be dramatically different from what it may be right now.

The deeply ingrained fear of death and our lack of control over it does mean that for many the issue of Assisted Suicide or Right to Die is actually a personal one, rather than a matter of ethics as many in the world would prefer that we were to actually believe.

Very few people are likely to covet death at any time; even those who commit suicide without any form of premeditated suggestion that they are readying themselves to do so. It is a matter of escape and release at a very personal level and it is unlikely that any other person will ever understand the complexity of issues, emotions and pain that such a person is experiencing at that time.

It is the same for those contemplating the need for Assisted Suicide or their Right to Die and we as a society now not only need to recognise this; we must put personal feelings and perceptions aside and provide help to those who need it, without any threat of recourse or stigma being attached to those who have provided or would willingly facilitate that help.

Our fear of Legalising Assisted Suicide and the taboo of the subject are borne from the concern that through illness or debilitation, we could find ourselves or loved-ones unable to communicate with or have influence with the outside world as we now know it, and that subsequently, the decision will be made to end our own or their life in that situation whether we like it or not.

Such perceptions have been helped very little by Health Authority Policies such as The Liverpool Pathway. But this should not prevent us from dealing with the subject as we now should and if anything is evidence enough that everything must now be done to get this difficult subject dealt with right.

Government and the Medical Profession could and should with Legislation put the necessary stop-guards in place which will provide assurance against abuses of a Right to Die, such as consultation with 3 independent Doctors and/or Psychologists who will quickly know if such a solution is best if they are genuinely allowed and are able to selflessly put the interests of the patient in question first without any other influences coming in to play.

There is no doubt that those suffering with horrific and terrifying conditions such as Locked-in Syndrome or those who have such low quality of life because of their physical conditions should have the right to end their lives with help if they so choose. We must all now be big enough to put our own fears aside and make it as easy as it can be for them to do so.

Without Legalising the Right to Die, it is an uncomfortable truth that in terms of our approach to ease of suffering, we are selfishly kinder to our animals than we are to other human beings.

image thanks to http://www.sunnewsnetwork.ca

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