Paying for the NHS

There is currently a proposal doing the rounds.  It seems to have the support of a majority of General Practioners (GPs) but has got the 'left' into a normal, for them, froth.

The proposal? 

If you fail to turn-up for an appointment with your GP, then you must pay a fee.  The amounts suggested seem modest at £5-10 but that is still too much for the 'bleating heart liberals and lefties'.

Think about it though, you only pay if you fail to turn-up for your appointment.  That is, the appointment that is taking up time that is therefore no longer available to others. 

Once again Labour finds itself on the wrong side of the argument.  The Labour/Welfare party is only about being stuck in a 1940s time-warp where they are chained to the 'no fees and free at point of delivery' ideal and cannot therefore think beyond that time.

Surely this isn't about any kind of 'thin edge of the privatisation of the NHS' thing!  This is about making sure that those the really need the services of a doctor, have a better chance of getting them.  This is about making those, that take for granted and abuse the NHS, pay for that abuse.  Wouldn't we expect to see less missed appointments?  That is the point of this proposal.  It isn't about raising money, it is about improving services. What kind of organisation never looks at ways to better the customer (patient) experience?  If the NHS doesn't move with the times, time will increasingly pass it by.

My suggestion is that NHS Trusts move to implement this change, on a local basis and those GPs that don't want to, don't have to.  That way, just like in a science experiment, we will have 'with and without' data and we can see the results.  I would go further and apply this process to hospital appointments as well as those with GPs.

I have no problem paying if I fail to turn-up for an appointment, do you? 

Oh, and please don't bleat about 'the poor' being unable to afford the fee.  The cure for that is not more welfare (sorry Labour!).  The answer is, don't miss your appointment!

Keogh's NHS

Sir Bruce Keogh published a report, this week, into hospital deaths within the 'envy of the world' - the NHS.

The report was commissioned by the UK Prime Minister and the Secretary of State for Health, following the publication of the Mid Staffordshire Public enquiry (see here.  http://bit.ly/1222EJK).  This earlier report followed what can only be described as inhuman treatment of patients at Mid-Staffordshire Hospitals.  At the time, the Strategic Health Authority was led by Sir David Nicholson - now head of NHS England and the minister in charge was Andy Burnham, the emoting Merseyside MP who is currently Ed Miliband's shadow Health secretary.

So what did this report find? 

Well, it looked at the 14 hospital trusts that had abnormally high mortality rates and its findings speak to a common problem across the NHS - that is, a provider-led service which is more concerned with it's own preservation and conditions than those of patients.    The report found 'trust boards and management teams struggling to understand and deal with the complex issues of high mortality, particularly relating to urgent and emergency care'.  Read that again!  These 'leaders' were 'struggling' to handle the very things that they were put in place to deal with.  These are senior medical 'professionals' not street sweepers or pint-pulling barmen.  And yes, it is 'brain surgery' in some cases but they are supposed to know how to deal with this!

All but two of the trusts had what are called 'never events'.  'Never events' are 'serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented'.   Especially concerning was that many of the trusts had multiple 'never events'.  I read this to mean that the subsequent deaths were largely avoidable, or to put it another way, these people died because of the NHS

The report is, generally speaking, kind to the medical staff but hidden within are comments about junior doctors and nurses access to senior clinical staff being less than optimal.  Also about poor coverage at weekends.  To me this is code for 'those highly compensated consultants choose when they work, it is 9-5 and they only do Monday through Friday'.   

There is talk of high rates of sickness absence and this having to be overcome by the use of agency nurses and locum doctors.  Absence from work in the whole public sector is high and seems to be considered as yet another 'perk of the job'!  So no real surprise there!

And what of the 'left' and it's Guardian and biased-BBC allies?  Well, they have been somewhat quiet about this.  They haven't called for any heads to roll - methinks that this because the only heads that should 'roll' are those of Burnham and Nicholson - and the greatest stick that the left-wing media  commonly use to beat the Tories with,- lack of funding and local issues (as in underfunded local communities or 'send more taxpayer money') is completely discredited. 

The report states:  Factors that might have been expected - and are frequently claimed - to impact on high mortality rates, such as access to funding and the poor health of the local population, were found not to be statistically-correlated with the poor results of these trusts.  The average for the 14 trusts is broadly the same as the England average in terms of funding and the socio-economic make-up of the populations they serve.

As you would expect, the Labour Party response is to accuse anyone that points out that this report is yet another damning indictment of their mis-handling of the NHS, of 'playing politics'.  This is the same Labour Party that previously 'played politics' by saying that the NHS was safe in their hands and that the Tories would privatize the NHS.  Readers of this blog will know of the many previous examples of hypocrisy of which Labour can be accused but this must rank among the highest ones.  Labour's boast, through 13 years of mis-government was that only they could ensure that the NHS was adequately funded.  They did this as, having found that a shovel wasn't big enough, they decided to employ a bull-dozer to push cash in the way of the NHS.  And to what end result?  People dying unnecessarily and in great pain and without  a shred of dignity by the caring, sharing NHS!

At the root of it, that's the problem with Labour.  Their solution to anything is to throw tax-payer money at it.  Whatever the problem - more spending.  Nothing cannot be cured with more government (as in tax-payer) money.  The Labour Party hold-up the NHS as their greatest achievement - people dying unnecessarily - some achievement!!

Here are some snippets arising from the report.

Terry Day, a 35 year-old had been diagnosed with a low grade brain tumour.  When he was admitted to Basildon and Thurrock Trust A&E 13 months later, staff failed to take the condition into account.  No neurological assessments were carried out and his airways were not checked.     When his tumour haemorrhaged, he went into cardiac and suffered brain damage.  He died 20 days before his planned wedding.

The CEO of Basildon hospital received a £72,000 pay-off as compensation for loss of office.  This came on top of the salary he received, of £150,000 in the period April to September 2012 and an additional, tax-free payment of £30,000.  Oh and he had a pension pot of $1.7Million - that should give an annual pension of more than £85,000 a year, for the rest of his life.   

Two operating theatres immediately shut down at North Cumbria University Hospital Trusts over hygiene concerns.

Trust                                                Number of Excess deaths                   CEO Pay
                                                        2005 to 2012

Basildon and Thurrock                    1,607                                                £150,000
Buckinghamshire                             538                                                   £155,000
Burton                                              700                                                   £135,000
East Lancashire                                655                                                   £150,000
George Eliot                                     986                                                   £140,000
Medway                                           711                                                    £150,000
North Lincolnshire                          954                                                    £140,000
North Cumbria                                672                                                    £185,000
Sherwood Forest                             819                                                    £155,000
Tameside                                         833                                                    £145,000
United Lincolnshire                      1,531                                                   £180,000
Colchester                                        724                                                   £??
Dudley Group                               1,235                                                   £175,000
Blackpool                                     1,368                                                   £170,000


Two figures missing from the above?  Those of Andy Burnham and David Nicholson (sans knighthood) doing the decent thing and departing the scene.

Something else missing?  The removal of the spending ring-fence for the NHS - Cameron and Osbourne take note - the NHS has to be about care not about how much is spent!

America and the C word

Don't worry your grace (@His_Grace) I haven't gone all Channel 4 on everyone, read on.

If we are to believe Edward Snowden, any thoughts we commit to all kinds of electronic communication are being monitored and then read by the NSA in America.  I guess that one of the goals of a blogger is to get their message out to the widest possible audience, so that everyone can bask in their sagacity (haha!) so maybe because this has that edgy use of the C word (trust me, don't worry) in the title and mentions the NSA and America, perhaps this post won't bomb!

So, the C word.  The word that President Obama and his advisers have banished from their vocabulary.  The word of course is coup as in a military  coup d'état  and the Obama administration is tying itself into all sorts of knots because it doesn't want to be seen to be supporting a military C word but thinks that the military C word in Egypt is a good thing because it rid America of a fractious government in the Middle East.  The administration doesn't want to use the C word because to do so, would call into question the continued giving of aid to Egypt.  Heavens, it might even mean that those F-14 fighters may need to have their delivery delayed!

It is to America's shame that Obama and his administration are conniving in the deposing of a democratically elected leader.  Having touted the benefits of 'democracy' for so long, they support the overthrow of the democratic result, simply because the answer given by the Egyptian people, was not to America's liking.

This reminds me so much of how Europe and the EU operates.   Referendums are conducted and when the people vote the 'wrong way',then the relevant government is told to go away and ask again until they get the 'right' answer!  Incidentally it is  also to the shame of the EU for their tacit support of the C word but Europe is pretty much irrelevant on the World's stage, these days, so let's not make too big a thing of it.

What is happening in Egypt is a coup - there I said it!  Pure and simple.  My view of the initial uprising in Egypt was that this too was a coup but the military needed to mask their actions with the cloak of 'democracy'.  Well that cloak has well and truly slipped!

Make no mistake.  I am no fan of Morsi or the Muslim Brotherhood.  By all accounts he and  they have demonstrated economic incompetence on a grand scale (but then not many governments would be safe if that was a criteria for overthrow) and perhaps more worryingly, their is strong evidence that they have promoted anti-Christian activities against the Coptic Church and other Christians.

However, he was democratically elected.  He has now been deposed and replaced by a military-appointed puppet, who is promising new elections, 'soon'.  What happens if these elections again produce the 'wrong' result?

The 'problem' with Egypt and so many of these new 'democracies' isn't so much about representative participation or however you define democracy, it is about a lack of capitalism.  People really don't care too much about votes - it comes down to basics - food on the table and  a roof over the head.  Socialism in all its forms doesn't deliver that.  Democracy doesn't deliver that.  Capitalism is the only system that will deliver that.  Democracy is a 'nice to have' that comes afterwards. 

That said, if you push democracy, and America and the West does, then you have to stand by the outcomes.  However odious the new government may be, they shouldn't be overthrown by the military.  Yes, I know that Adolph Hitler was democratically elected and yes , I still wouldn't advocate overthrowing his regime.

And so to Syria.  Not a bastion of democracy but somewhere else where America and Europe believe that their own special brand of interference will produce positive results.  How are they going to interfere  Well the talk now is providing arms to the 'right' insurgent/rebel groups.  Who was it said that madness is doing the same thing and expecting different results.  The absolute last thing that the Middle East needs right now, is more weapons (indeed this is something that they haven't needed for a very long time).  The West's track record of picking 'winners' is very poor (can you think of a right choice?  Libya wouldn't be a good answer!), so why would anyone think that suddenly these governments are going to get it right.

Maybe America and Europe should consider that perhaps the reasons that they are so loathed in much of the Middle East is precisely because of their hypocrisy (democracy but only if it gives the  right type of government) and their trying to make countries in their own image (picking winners).  Maybe it is time for America and Europe to back-off and let the Middle East sort themselves out.  Yes it will be bloody and many people will die but having done such a great job in Iraq and Afghanistan does the West have any kind of template that they can hold up to show the success of 'democracy'?

Is the new policy on Syria some kind of surrogate for the abject failure of Obama's policy on Iran.  All that 'positive engagement' and 'open hand' doesn't seem to have slowed down their nuclear arms development, one bit.  So, try to put a 'friendly' in charge in Syria and take away an Iranian ally?  If that is the strategic aim it presupposes that the Syrian disaster will produce something that will be to the West's liking.  I have the strongest possible doubts, that it will.

MPs Pay

The Independent Parliamentary Standards Authority, let by Sir Ian Kennedy, seems likely, if rumours are true, to recommend a £10,000 per year salary increase for UK MPs.

It is expected that IPSA will also propose that future increase be linked to average national income.  I take this to mean that an MPs salary would be a multiple of the national average salary.  The £10,000 increase takes an MP's salary to around £75,000 and this will seem to set this at three times the current national average.

First thoughts.

All of the MPs that were elected in 2010 and in the subsequent by-elections were elected knowing what was the salary on offer.  Theirs is essentially a fixed-term contract with compensation set for the period.  So any change should only take effect after the next general election.

I would go further than IPSA and firstly reduce pay for those MPs representing Scottish, Northern Ireland and Welsh constituencies.  There are local assemblies for these parts of the UK and these bodies carry-out functions that are decided locally, so why should these MPs get the same as English constituency MPs, who potentially have a heavier workload?

Next I would follow the IPSA suggestion but with a regional flavour.  I would look not at the national average pay, and give MPs a multiple of that but look at regional average pay and base the multiple on that.  There is no better way to get these MPs focused on lifting the pay of taxpayers, than giving them an incentive that their salary will go up, as well!
 
Finally, I would go further than IPSA.  I would give all MPs that represent constituencies outside of Greater London, a flat fee for expenses.  Those within Greater London (as defined by the Mayor of London boundaries), would get less.  How much of a flat fee?  I am probably the wrong person to ask, as for me, I would split it into two.  Say £15,000 to cover London living costs and £30,000 to cover a constituency office.  Also throw in a flat fee for transport based on the distance from Westminster to their constituency, at the HMRC tax-free rate - currently around £0.42 per mile, and they would get this two times a week.

Of course, the expenses that they get for their Westminster living, must be taxable as a benefit in kind.  That is how such expenses would be considered by HMRC for any other taxpayer/employee.

I will send this to David Cameron and some of the others but don't expect them to actually do anything - turkeys voting for Christmas and all that - but they must, at some point, look at the essentially corrupt system that passes for how we are governed and bring about true reform.  Otherwise, at some point, people will do as gets done in other countries - they will invade the 'Westminster bubble' and bring down the whole rotten edifice - maybe physically or maybe by electing a one-term party whose sole goal is total reform!  Remember Sir James Goldsmith's pledge to get his people elected to give the people a referendum on EU membership and then resign?  The British are famously stoic but when finally roused, they don't stop until they get what they want.

  

Unequal Britain

For those of the 'left' persuasion, you may want cease reading.  Strictly speaking this isn't about the rich getting richer and the poor getting poorer.  Nor is it entirely about those people who work for a living being better of than those on welfare.  I will leave such class war clap-trap to the Labour Party, or Welfare Party as it is more properly called.  This is the party, who this week revealed their real leader.  Many suspected that the unions controlled the party and this was confirmed when the shenanigans carried out by the odious Tom Watson MP and Labour's paymasters, (and these are the same ones that elected  Red Ed Miliband over his brother, David, as party 'leader') in Scotland were revealed.  The real leader of the Labour/Welfare party is Len McCluskey, the leader of the mostly public sector Unite union.

But I digress.

The inequality of which I speak is that between the public and private sector.  Average hourly wages in the public sector are more than 24% higher than those in the private sector.  Simply put, this is scandalous!  Even its apologists admit that the best that they can reduce the discrepancy to, is just over 8%, when they eliminate factors such as public sector workers having more education and experience than their private sector counterparts.

Those reading this who live outside of London really need to think about those numbers.  Average wages in London are around 50% higher in the private sector and around 25% higher in the public sector, than the UK average. 

So what this means is that in those other regions of England and Wales, the public sector crowds out the private sector.  That is, the public sector pays better than the private sector.  The data (all from 2011) shows that outside of London the average hourly wages for the public sector is around £17/hour.  In London it climbs to over £22/hour, presumably due to the so called 'London Weighting' allowance.   In all regions outside of London, all, these averages far exceed the local private sector average wage.  In Wales and the North East, the average private sector hourly wage is around £13/hour.  So the public sector is offering wages that are 30% higher than the private sector.  Think about that and ask yourself why would anyone want to work in the private sector and much more importantly, why should a servant - because that is what the public sector are supposed to be - servants of the people - earn more than the person that pays his/her wage??

And of course we then move to the subject of pensions.  You will recall all of those demonstrations shown on TV, particularly by the biased BBC - the same BBC that uses license/TV Tax money to such great effect for it's own and recently ex-employees - where people were complaining about their public sector pensions being decimated and how unfair it all was, etc..   A great study by the independent Institute of Fiscal Studies, found that even after these reforms come into play

"Public sector workers will continue to accrue pensions that are dramatically more generous than those accrued, on average, by private sector employees, few of whom have access to a defined benefit pension."

 Which brings us back to the 'cuts' that the Labour/Welfare Party and it's union masters, (I was going to say paymasters but we now see that the union grip on Labour/Welfare is more than just money-centred), always rant on about - though recently in a confused and conflicted way - we will oppose 'cuts' but we will keep them if we regain power (or the latter gets changed depending on who is speaking!)

In all the talk about cuts and how the public sector is being 'killed off' and how these workers are suffering etc., consider this.  These public sector workers have achieved pay increases above the so-called 'freeze' that was imposed by the incoming Conservative 'led' coalition government.  Employment in the public sector fell by 6.4% between April 2010 and April 2012 and yet the public pay bill rose by 2%, which translates to a 9% increase, per head, over two years. 

I must be lying, I can (almost) hear you cry.  What about all those statements from the government saying we 'are all in this together' and the 'public sector must share in the pain'?  Surely they can't have been lies?  Especially when you hear confirmation from Labour/Welfare and the unions on how 'ordinary public servants are suffering at the hands of a heartless, typically Tory regime', etc..

Well it seems that yes, they are all lying - kind of.  There was a freeze but as fans of Yes, Minister will know, the Sir Humphrey's can always get around such trivialities.  It seems that a lot of public servants in  Whitehall and the NHS, etc., continued to receive 'annual increments' simply because, by staying employed they are 'building up experience'.  So they didn't get a salary increase but their pay went up!

Unequal Britain isn't about the so called rich and the so called poor.  It is about the continuing differences between those that work in the public sector and those that they supposedly work for.   Between a protected and cosseted minority and those that pay for them.  And the tragedy?  There doesn't seem to be any political party that actually represents the poor schmuck who pays for this.  Taxation, in all its various and iniquitous forms, continues to be far too high in the UK and no political party is advocating slashing taxes and getting big government off of the backs of the working people.  Not one!  None are saying that the 'master' should be paid more than the servant.

Democracy 21st Century style! 

Still, I suppose it could be worse.  I am not a fan of the Muslim Brotherhood but in Egypt,  Morsi was democratically elected.  Wonder what his greater crime was?  The one that tipped the army?  Maybe threatening some of their perks? 

Enjoy the weekend and thanks for reading!