Cameron's Rhetoric on NHS Reforms Tells Us Nothing

The five pledges Cameron is proposing today with regards to reforming the NHS are simply the rhetoric that he patronised the country with in his election campaign.

Not endangering universal coverage means nothing where there are clear signs of postcode lottery with a range of services, including IVF in today's news. With consortia at a 100,000 person level, not every one will contain a hospital, nor will all midwifery services be available. Therefore what Cameron is saying is nonsense, he cannot increase existing services on 80% of the current PCT budget therefore the gaps already in existence will stay, and new ones will form.

The same applies to improving efficient and timely care, with limited budgets, which are currently below EU average in any case, and rising costs, the timeliness of care will obviously be effected. When thrown into the mix the debate of 'concentrating hospital services', one must recognise this means closing other hospitals and services.

Cameron says there will be no sell-off, but it is prudent to observe he does not echo Clegg's announcements on potential problems with competition introductions. Therefore he is still intending to commission services to private contractors, which amounts to the same thing.

As well as this, such reform will create an opaque layer of bureacracy which will mean reviewing performance will be virtually impossible with commercial sensitivity, something we already see with Council service contracts.

The only solace in Cameron's rhetoric is he will maintain that services will be free at the point of delivery. But even this silver lining has a cloud, one can still receive retrospective invoices.

I have little faith in the report published next week, and remain as ever cynical.
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Are We Still in Coalition?!

The much anticipated speech by Cameron today highlighted he has very little intention of reforming the NHS bill. In addition to this we have significant failures to upkeep the Green Deal with nuclear energy funding and targets under scrutiny and a significant reduction in Lib Dem attention to House of Lords reform. If it weren't for the paternity leave proposals, I would be questioning the Lib Dem role in the coalition at all.

The NHS has never been so good

In spite of Cameron's speech demanding that the NHS is in dire need of reform, patient and public experience has never been higher.

He labours on about the cost, stating the NHS will need £130billion in 2015 to continue this way. What he is, in fact, saying is that Conservatives do not want to pick up the bill for the universal right to the public health service. He is unwilling to fund the NHS which has the best satisfaction records seen in decades.

Of course, Cameron and Lansley argue that current recovery, survival and treatment rates are lower than average in Europe. But Cameron has also stated that Britain funds less than the average EU country.If you pay less, you expect less. Cutting GP Consortia budgets will not exactly assist this.

In addition to creating an opaque layer of bureaucracy in GP Consortia that 94% of NHS Managers believe is irrelevant, Cameron wishes to cut all funding for defecits. "Need your broken leg fixed? Oh we can't this year as we'd be over budget".

And this is without addressing the significant conflicts of interest and private firms monopolising public services.

So, I am seeing very little in put from Lib Dems in spite of Clegg's dramatic attempt gesture in an attempt to retain a sense of leadership, it seems highly unlikely any of the 'pause' will have had the slightest effect. And while peers may fillibuster, their effort may indeed be wasted.

Nuclear Agenda

One of the biggest successes the Lib Dems had in the coalition agreement was to stop government funding of nuclear power, instead paving the way for serious sustainable green energy. Or so we thought.

It now seems that the Tories can circumvent this too, in order to keep their business buddies sweet, and provide loans to part subsidise.

With Green Agenda spokesman Chris Huhne caught up in a rift of marital and speeding proportions, this seems to be allowed to be happening with no Lib Dem objections at all.

Too focused on constitutional reform?

The Evening Standard reports, somewhat delightedly, that Clegg is taking a step back from House of Lords reform, and instead senior Tories, no doubt being mollified by their lack of ministerial responsibility, will take charge.

As just noted, the Tories are very cunning in the nuance of language, and were they to assault proposed reforms in the same way as they have the Green Agenda, we will be lucky to see the 80/20 proposal from Clegg enacted in this parliament.

While I appreciate Clegg could be seen to 'toxify' the debate, I am suspicious enough about Conservative motivation, especially as they have said they are anti the concept of elected Lords.

We cannot call our country a (liberal) democracy all the time we have 'cushtie' peerages for MPs and who ever is popular on TV (Sir Alan). This body represents a third of the country's executive and the 'old boys club' simply has to stop. Now.

On a Positive Note

Proposals on paternity leave being extended to 8 months will be a major step forward in gender equality and in tackling hegemonic matrimony head on. But with the tidal wave of loopholes the Tories are finding, it does feel like a patronising pat on the head from our coalition partners.

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NHS Proposals are Conflicts of Issues at Every Level

NHS reforms are tipping the press headline scales again, as more and more proposals and rejections are outlined.

In this morning's i paper, Health Secretary Lansley is referred to as saying that he understood the conflicts of interest with GP Consortia and Doctors from hospital both commissioning and providing.

What he, and the press, seem to have missed is that GP Consortia will always be in a conflict of interest as currently PCTs commission GP surgeries, so it is irrelevant if hospital docs also breach this interest.

The proposals to reform the NHS would go much further if they addressed the glass ceiling and projected seniority between doctors and health professionals. Current proposals continue to put doctors on a pedestal allegedly befitting to their status, but not in a world where there are a range of health workers, from nurses to physios, who are equally trained and capable but on a quarter of the salary.

The proposed 'pause' also fails to address the 30-40% of PCT workers whose expertise and employment has already been lost in mass redundancies, not least of all through clustering.

However, I doubt Jeremy Hunt MP could alter the progression in any way.

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What are We Missing While the Coalition Allegedly Argues?

Media diversion tactics a-hoy.

The Liberal Democrats complain vigourously about misrepresentation of their coalition part in the press. Scathing attacks across all papers are damaging electoral prospects nationwide,while the Conservatives are portrayed as paragons of virtue by the right wing press.

RUmours started at the beginning of the month with Downing Street apparently being "discontent" with Lib Dem Press Strategies.

Then (good ol') Vince launched a vitriolic attack on Cameron's extremist inciting speech.

So called "cabinet tensions" play into delighted media who talk of coalition splits, bust-ups and dilemmmas.

Strategies

All in all, it's a very clever strategy for both parties.

They can be seen to disagree without offending their core votes too much.

This has never been clearer than today's rise to internships (see my post on this.

Clegg proclaims traditional Lib Dem Views of social liberalism, supporting social mobility, challenging social divide and still promoting the aspirational status of the middle classes. Ticks most left wing voters', free market or not, boxes.

Cameron announces his attitude is "relaxed" towards internships, maintaining conservative values of maintaining traditional values of networking, retaining class separation and hierachial institution. Ticking those bozes of entropic tradionalism and right wing establishmentarianism.

The fundemental differences between the parties is demonstrated, no one gets offended and no one gets (too) attacked.

Much better than when Andy Coulson was in charge.

Diversion Tactics

So while Parliament is in recess, we are presented with an image of a coalition in turmoil, each party straining to maintain their individuality to their voters in time for the local elections, and, indeed, for the electoral reform referendum.

But what are we missing?

Well, while parliament is in recess, we are sidelined into a debate about the strength and potential longevity of the coalition.

This neatly diverts us from anything Milliband (reserved to paragraphs 5 and 6 in most news articles now anyway) may have to say. Reducing any effect Labour may hope to have on parliamentary process, and, indeed, on the council elections.

It also, quietly, distracts us from the ongoing NHS saga.

The discourse over the future of the NHS has escalated to such a point the government has been forced to "take a pause". However, such a pause can be ignored, and legislation slowly progressed, when the press is occupied with far more pressing, and news worthy stories such as Kate Middleton's knickers and the coalition chances over the next four years.

Such insidious behaviour could have come from a Yes Minister sketch, where by bad news is hidden behind bigger headlines.

As the joke goes, the best day to announce a tax increase is on the anniversary of Princess Diana's death.

Convinient distraction is one thing, but diversion tactics that remove a democratic process in one of the country's institutions is quite another.

Week Commencing 170111 - The Joys of Politics

Sometimes, a week in British Politics is a long time. This week must have seemed very long for a lot of people in public office.

But what a week!

January 17th

Monday morning we had Cameron on BBC Radio 4's Today Programme being grilled quite delightfully by John Humphries.

First thing that leapt out at me as I drove to work was the numerous times Cameron lost his cool. We are not talking about a junior minister here, or even a back bencher, so to hear Cameron raising his voice and arguing vociferously was quite shocking. This man is in charge of the country, he should be better controlled.

Listen to it here.

Getting defensive and frustrated over questioning on reforming the NHS gives the impression that (a) he was not sufficiently briefed on the issues at hand - again, this is the Prime Minister we are talking about, and (b) the issues are not as clear cut as the tory-led government would like us to believe.

Being challenged over potential postcode lotteries, to which Cameron responds evasively, there are striking differences now, is political ignomminy. And that is just the tip of the iceburg in concerns about NHS reform, explored by The Guardian's Politics Live.

Now, of course, John Humphries wouldnt let the opportunity of the PM on the radio go to waste and queries him over Bankers, to which Cameron is equally evasive, fuel prices, ditto and Coulson, tapping on that little crack in the damn that is about to explode.

Embracing Equal Childcare Leave

In the same day, Clegg announced a spectacular policy change to maternity and paternity, which will have had feminists and lesser confrontational "equalists" celebrating.

Proposals to provide paternity leave for longer periods will (hopefully) continue to sand away at entrenched ideological roles of parents and gender stereotypes.

It's a victory for society in Britain as a whole, and to continue chipping away at structural misconceptions that, as Clegg identifies, are little more than Edwardian and "have no place in 21st Century Britain".

To filibuster or not to filibuster

Fillibustering: an informal term for blocking or delaying parliamentary processes.

The Lords are determined to make the agony of the AV Referendum (Electoral Reform Bill) last as long as possible to delay campaigning for and against.

This also commenced Monday!

EDIT: I'm struggling with tonsilitis this week and not up to blogging more today. Back later-when I can't sleep!

A few views on Frig's Day 2010

Hell Boys

I have run one or two diatribes on the "hell boys" so far so I need not impress my opinion on the illogical systems of criminal culpability and social care in this country any more. I will, however, say that no man is without merit, and if I had any faith in our British Psychology, Rehabilitiation or Young Offenders Institutes, I may be more forth coming about their ages.

But, in the true political prevaricating way, can I just say that Ed Balls on Radio 4 made an excellent point about the case being used for political gain by the Conservatives. The sound bite "broken Britain" is more Blairite than Hazel Blears.

The Pirates of Distraction Technique
Somewhere in the reports of bungled rescue attempts and removal of ring fenced budgeting, reporters seem to have forgotton the plight of Mr and Mrs Chandeler. It is almost as an afterthought in this article they add;

[The couple] "had been separated and beaten by the pirates and [Mr Chandler] expected to be killed within "three or four days".

I'm sure the local papers in Tunbridge Wells are clamouring for justice, but has the world got so big that we are blind to people suffering harm unless it is a mass disaster or a political tool? I hazard a cynical guess that were Cameron to take up their cause, it would be the main thrust of the BBC et al. However, "Chandler" does not make for a good soundbite, and he would only target the same story presented, blaming Labour spending cuts for the resulting harm the couple are suffering and may suffer still.

Perceived Terror Threat

This comes a little late in the day, would you say? Nearly four weeks after the event? The event that was farcical at best. The biggest fall out has been that the Dutch will be even more scrutinised in customs, and more personal freedoms will be erased with inept profiling based on stereotypes and masqueraded as UK Border Agency Security.

Brown's Debut at The Iraq Enquiry

Sir John Chilcott may have "said the committee was still concerned about the risk of the hearings being politicised in the run-up to the election. and we all knew it was inevitable.

I fail to understand why anyone would want to enter a ballot for tickets to see Blair dissemble arguments when we had that for 8 years with him as a Prime Minister.

And on the Iraq Enquiry, do they not have Lawyers and Judges because the cost of creating a logo eradicated their budget perhaps?

Munchausens Mother Jailed

While the facts of this case are terrible, it perhaps raises mroe concerns about our National Health System than I had initially perceived. With the advent of medical technology, one has to wonder how a child went through 8 years of medical examinations, in a high profile case, and was still diagnosed with conditions which require medical evidence. While I appreciate she put sugar in his urine samples to make him diabetic, I am not sure how anyone can fabricate cerebral palsy and cystic fibrosis without a level of incompetence in the diagnostacians involved.

It also raises an interesting point about coping with Disability.

"Andrew Macfarlane, prosecuting, told the court that Hayden-Johnson's... medical treatment meant that the child was socially stigmatised."

This in turn makes me think about how society responds to disability. We currently live in a society that pities disability and yet stigmatises those who suffer from it. People with disabilities are constantly pandered to in the worst possible way, with no responsibility, few friends and exclusion from society, yet renounced with charity and gifts. But I will leave this for another post I think.

Where exactly is the choice in the NHS?

Listening to a discussion on BBC Radio Four this morning between the Labour and Conservative Health Secretaries, I have to note that there appears to be a huge misconception by the government about people's desires for health public services.

Recent prebudget report announcements indicate severe cuts to NHS funding.

The discussion this morning, as ever with a mediocre chairmanship by James Naughtie, surrounded the concepts of choices within the NHS. Blunkett discussed how he considered that choice in the NHS was now a perceived fundamental right of the people.

Is it?

The last time I checked, living in Ashford, in the centre of Kent, I am required to go to Canterbury to get my teeth looks at in an emergency, if I break something I have to go to Ashford to have it operated on, if I need dialysis I have to go to Folkestone, I only have the options of Ashford, Tunbridge Wells and Greater London boroughs for a full A&E service and if I were to be diagnosed with a terminal cancer it is dependent on what part of the body it is in as to what hospital I would need to attend. Having a baby would also be difficult, not to mention locating a GP surgery is actually allowing NHS patients.

As far as I understand, the majority of people require the NHS to be nearby in situations of necessity. If someone breaks a limb, they reasonably expect to be able to access an A&E department where all their needs can be catered for. When a friend of mine broke their leg in Canterbury three years ago, they were rather surprised to be informed that although KCH could take x-rays, they would need to be sent to Ashford to get it reset and then back to Canterbury to have the cast put on.

I am failing to see the choice that we apparently have by right.

I would rather see services in every major town that catered for the majority of health needs such as dialysis, scans, operations, maternity wards and cancer treatments than the current system of pick and choose when you might need medical attention in order to receive the best treatment.

The only choice that I have encountered within the NHS has been when I've required a more detailed scan such as an MRI. I had the choice of Margate, Ashford or Maidstone. However the choice was really based on how soon I could be seen. And, of course, if I could actually get to the location where the scan was available.

A two hour drive to Margate may get me seen six weeks earlier but unless I have the petrol money or someone willing to give me a lift, I am far more likely be seen in 14 weeks in my local town.

Or perhaps, the choice is in fact on how much you pay for the services.

When seeking dental treatment due to an addiction to toffees, I was informed that the only dental surgery accepting NHS patients would not allow instalment payments and all costs had to be paid for before they were down. My only other choice was to go private for the treatment, so I had a choice of locating £400 for NHS treatment or £1700 for private treatment.

Actually, I think here, my choice within whether or not I ate the toffees!

Joking aside, we need a National Health Service with a Bentham approach. Not an 80% administrative force surrounding key performance indicators and quality frameworks that nobody needs or cares about when they are in dire need of medical treatment and informed that they allegedly have "the choice" as to where this treatment is delivered.

NICE (sarcasm)

Is quite tragic that we live in a country that justifies the cost effectiveness over quality of service.

The leading example today, of course, the medication that could prolong the life of liver cancer patients has been rejected by the NICE committee on the grounds that it is not cost-effective.

I refer to the BBC in my link because it provides a nice bite sized chunk of the arguments being bandied around. If you want to know more about the arguments you can attempt to read the papers, but the premise is much the same. Nexavar is simply too expensive.

The figures provided by the NICE executive on the Today programme on BBC Radio Four do you indicate a rather ludicrously high level of spending. It medication prolongs the life of the liver patient three year, we can assume that it will cost a minimum of £36,000 to supply the drug alone. When taking into account that we will also have to supply pain medication, potentially further radiotherapy, benefits and a care service. when the person finally succumbs to the disease, there is a chance of the necessary procedure to supply funeral costs, court costs to resolve will disputes and at the same time the government is not earning any tax revenue from this person.

This is ultimately the "business case" that I would imagine the NICE committee discussed at length before deciding that spending hundreds of thousands of pounds on TV one person alive three year when they could dispose of the responsibility Far swifter by refusing to supply the medication.

Sadly, people suffering from terminal liver cancer are not the only ones to the subject of this standard of quantifiable cost versus benefit the public services in this country run on. These one of the lateral effects are they "target culture" taken from the private sector that fails to address the purpose and in need of the public sector.

Other services subject to this ludicrous decision on social care include the Crown Prosecution Service, where they will not prosecute unless there is a 99% chance of conviction otherwise it would be a waste of money. After all, public safety is not a target of the CPS.

Another example would be sheltered accommodation, as mentioned in my previous post. Councils will remove Resident wardens who provide companionship, support, maintenance and help prevent emergency situations for over 2000 people in one borough and replace the 13 permanent resident wardens with one travelling warden to cover and nearly 800 mi.² area.

We need a return in this country to public services being for the public

Not simply to cut corners so that ministers can be paid more, pen pushers can be given bonuses or on local levels rubbish recycling collections can be reduced.

Stay at Home and Stop Moaning

Home Births as Safe as Hospitals

Am I the only one to read this as hospitals have descended so far you may as well have your baby at home?!

While a study in the Netherlands may reveal interesting information about their birthing services, the abhorrent system in the UK cannot be compared, nor any conclusions drawn from this.

Interesting comparison statistics identify the issues with the UK's maternity units, and from this I would conclude it is safer to give birth in a public toilet as your child would have the same chance of survival.

While this will encourage people to take weight off the nhs, I have to question why this comes as such news worthy information. Women ha vent been going into hospital to give birth for thousands of years. Therefore it is fair to assume unless a woman has a severe problem with her child, eg breech, record of gestational diabetes etc then she should be able to give birth as confidently at home as in a hospital.