subtitle

...a blog by Richard Flowers
Showing posts with label Health. Show all posts
Showing posts with label Health. Show all posts

Friday, June 19, 2015

Day 5282: An Elephant's Queen's Speech

Thursday:


Bit of a flashback/catch-up today, but it does follow on from what I was saying yesterday about what the next Leader of the Liberal Democrats will need to do.

Back on the day of the first Tory Queen Speech in almost two decades, Auntie Caron asked Liberal Democrat Voice's readers to suggest their own bills for a Liberal Queen's Speech.


So, I came up with half a dozen ideas, pretty much off the top of my fluffy head. Auntie Caron was kind enough to include one of them (and several others were already covered by other cleverer fluffy toys)!

In coming up with these Bills in particular, I wanted to address ideas that would be clearly LIBERAL (and not ones that either Hard Labour or Conservatory Parties were likely to come up with) AND that would make genuine and TARGETED differences to people in need.

(And of course I've included one on voting reform because, not only is it now more vitally necessary than ever to have a Parliament that reflects the genuine spread of people's opinions – whether it's us, the Greens, even moderate socialists… even the Kippers(!); and to stop Conservatories and Hard Labour from all parasitizing votes off all of us – but if there's just ONE thing people remember about us – one thing that isn't the godawful mess we made of tuition fees, that is – then it's PR.)

There is a case to be made for a Government committing to what Sir Humphrey once described as "masterly inactivity": the Coalition made many changes, particularly to the NHS and to education, and doing nothing would allow those changes to "bed in" while giving nurses and teachers some respite from change for change's sake, and give Government the opportunity to observe and gather evidence for review.

And if we were still IN government, I'd certainly warm to that idea. Hard Labour's accusation of last year being a "zombie parliament" just because the Coalition was not intent on keeping up a blizzard of legislation never appealed.

However, having just fought the general election campaign on a platform of "no change, everything's fine" – and remind me, how exactly did that work out for us? – we are now NOT in government.

And a Queen's Speech is a political event, and that means making political statements: we have to jump up and say we would make things DIFFERENT.

Here then is my list in full:

UNITED KINGDOM PARLIAMENTS ACT
The Parliament installed as a result of the 2015 General Election so manifestly fails to represent the votes cast by the electorate that it is now of vital urgency that we replace our Nineteenth Century constitution with one fit for the Twenty-First Century. To this end, a Liberal Democrat government would empower a people’s constitutional convention – after the model that successfully developed the Scottish Parliament – to decide on a fair way of deciding who governs Britain.

HUMAN RIGHTS ACT
A Liberal Democrat government would celebrate the 800th anniversary of Magna Carta by reaffirming Great Britain’s commitment to the Human Rights and the European Court that were created under the guidance of Winston Churchill and the other leaders after the defeat of Nazism.

Measures will be introduced to increase Freedom of Information and to increase citizens' protection from abuse by government, including the abolition of the Regulation of Investigatory Powers Act, and a Digital Freedoms Bill to protect citizens from hacking and snooping.

CONTROLLED SUBSTANCES (DRUGS DECRIMINALISATION) ACT
A Liberal Democrat government will adopt a sensible, scientific evidence-based approach to control, monitoring, and treatment of drug use and misuse, based on the positive outcomes resulting from the changed approach in Portugal.

Funds currently wasted on the futile “war on drugs” can be transferred to more productive policing. The government will review legalizing the medical (and possibly recreational) use of cannabis.

UK PRISONS (ABOLITION OF SHORT SENTENCES) ACT
British prisons are extremely overcrowded in spite of falling crime and evidence shows that short sentences do nothing for rehabilitation and only introduce prisoners to hard drugs and more serious criminals. A Liberal Democrat government would therefore, with immediate effect, abolish all prison sentences of under one year in length to be replaced by programmes of reparative justice that have been shown to be more effective.


EMERGENCY AFFORDABLE HOUSING AND RENTS ACT
There is a critical shortage of housing in the United Kingdom which is damaging our economy by sucking capital into houses rather than investment and shutting people out of buying or renting homes near to where they want to work or where their families live.

A Liberal Democrat government would: immediately begin building more housing concentrating on new garden cities and renovating disused sites in cities, raising government borrowing but only where future rents can cover the interest; reverse Tory policies of Buy to Rent which have seen further reduction in the public housing stock and prevent further sales of public assets until the housing stock has been restored to sustainable levels; examine ways to outlaw the practices of holding large “land banks” rather than developing new housing, and keeping homes empty as “investments”; and bring in rent councils with the powers to reverse unfair rent rises or evictions.

CLEAN AIR / CAR ELECTRIFICATION ACT
The state of the air in our cities is among the worst in Europe and the only long-term solution is to replace the internal combustion engine with new, clean, green technologies.

A Liberal Democrat government would therefore begin research into the necessary changes in infrastructure to make this possible – e.g. greater generation of electricity; provision of charging points in homes and on street in addition to regular charging stations; changes to taxation.

Initial reporting to take place within one year with a view to – if evidence shows practical – trials before the end of the Parliament in two English cities (not London) and negotiating with the Scottish Government and other devolved authorities for similar joint programmes.

EDUCATION AND SOCIAL MOBILITY ACT
Under the Coalition, Liberal Democrats invested heavily of both our political capital and the little actual spending that we were able to wring out of the Tory Chancellor in targeting Education: both the pupil premium and the delivery of free school meals to early years pupils were targeted at redressing the balance and giving the best possible start in life to people who would otherwise be – by the age of six, even – left behind by their better-off peers.

To continue that investment, we would raise funds from better-off schools by removing the charitable status of fee-paying schools and spend that money to increase the number of years that free school meals are provided, and substantially to increase maintenance grants for university undergraduates, to allow them to use their time to study, rather than having to work part-time to feed themselves.

We would continue to maintain government spending on sciences. Additionally, as part of the BBC Charter renewal, we would seek to agree an increase in the licence fee in exchange for the BBC establishing apprenticeships in the arts and creative/productive industries.


I would also add a couple more to the list.

First, Mr Norman "Conquest" Lamb's
ASSISTED DYING BILL
Broadly speaking I do not, in fact, want people killing themselves, and I am deeply troubled that the largest cause of death among young men in the UK is now suicide, not to mention the way that this disproportionately strikes at the LGB and particularly T community. But as a Liberal it is not my place to deny choice to other people. It would be my hope that through a more mature consideration of the end of life, and openness about it – and a much greater openness to using medical cannabis and opium-based pain relief; and much greater care and much less stigma put into mental illnesses – we would see fewer people suffering but also actually fewer people choosing to end their lives.
and second,
ABOLITION OF VICTIMLESS CRIMES BILL
(an idea of Daddy Alex's, and a very good one, that would cover the decriminalizing of sex-working that Jade O’Neil in Auntie Caron's list proposes).

We put too much legislative effort into banning things we think are bad and then even more effort into criminalising people for doing things we have banned. We need to let go of this overwhelming desire to control others before ourselves. Among the first principles of Liberalism is the "Harm Principle" from "On Liberty" by John Stuart Mill and Harriet Taylor, and it is worth quoting here: "the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others."
I'd also like to incorporate Duncan Stott, Kelly-Marie Blundell, Maria Pretzler and Jon Ball's suggestions to Lib Dem Voice into my Emergency Housing Bill.

(Since I wrote these, and since the Queen's speech, Mr Norman has also made some substantive proposals on reducing prison numbers, while Conservatory Mayoral hopeful Mr Zac Goldfinger has called for an electric car revolution in London. So I'm clearly surfing the zeitgeist here!)


I think that between six and eight bills is enough to get the point across without becoming too much of a shopping list. But reviewing my suggestions I think that they are not very well BALANCED between the areas where I believe we should be targeting.


As a reminder: these are the FOUR areas where I said yesterday I think we need to be campaigning:

1. Personal freedoms and Civil liberties
2. Health, Social Care and Wellbeing
3. Opportunity and Education
4. The Economy

Three of my proposed bills, and both of my "extras", fall under "1"; whereas housing and clean air are both "Wellbeing" without substantially talking about either Health OR Social Care.

So there's clearly some work to be done.

Therefore (if I can keep this new spurt of writing going!), next time I'd like to talk some more about taking the fight to those people I named as our natural enemies, the Home Office; and then share some thoughts about a Liberal Economy and the longer term direction for the Party and the country.


PS:
Today is the memorial in Glasgow for Mr Charles, our much loved former leader.



Thoughts go with his family and friends.

Monday, November 24, 2014

Day 5076: When is 1% not 1%? When it’s 4%, apparently

Monday:


Today the NHS has suffered the indignity of a strike by thousands of nurses and midwives protesting that their pay has been frozen for years and all they are asking for is the 1% that was recommended by the independent review body and that the Government has reneged upon.

Except that’s not really true, is it.

The Government offered 1% to everyone who wasn’t already getting an automatic pay rise.

So if you’ve not had a rise in four years, it’s not the Government blocking the 1% on offer; it’s those people who want 5% rather than “just” 4%.

Nursing is a tough job. And a necessary one. Especially as we’re all getting older and more reliant than ever on the Health Service. And this year, we’ve been personally especially grateful to some good nurses, I can tell you. So who wouldn’t want to reward them well?

But it begins to look like their representation is, well, misrepresenting them.

Quite rightly, our nurses have the sympathy and support of the public, but they risk losing that if the public – many of whom have genuinely seen 0% increases, that’s a real terms (i.e. after inflation) decrease – discover that the NHS Unions insist on using such mendacious tactics as claiming that nurses have not had a pay rise when in fact nurses’ pay comes with a built-in increase every year.

More than a million NHS staff – except for doctors, dentists and some senior managers who are on a different scheme – are paid according to a system called Agenda for Change (you can tell it came in under Tony Blair, can’t you).

Under this arrangement, you are assigned to a “Band” based on your job and seniority level: nurses and midwives, for example, start from Band 5; sisters and senior radiographers are in Band 6; and so on. You then have “points” on the payscale and in the normal course of things you would expect to go up one point each year.

Here, from the Royal College of Nursing, are the current (agreed in 2013) pay bands.

So for a nurse in Band 5, you begin at point 16, which is a salary of £21,388 on the 2013 agreed rates.

Then in your second year you advance to point 17, and receive a salary of £22,016, an automatic increase of 2.9%.

In your third year this goes up to point 18 for £22,903, a 4.0% increase and so on up to your seventh year when you reach top of your Band. In fact it’s 4% increase all the way up to the top of the scale for Band 5 when a nurse can earn £27,901.

Similarly for Bands 6 and 7, the salary increase between different points varies from point to point but on average is 3.5% per year, to a top salary of £40,558.

(Bands 1-4, incidentally, who are assistants, secretaries and porters earning between £14,094 and £22,016, have average rises of 2.5%.)

The review body’s proposals, then, were to increase all of these pay points by 1%.

So the effect for a nurse going into their second year would be an increase from £21,388 (on the 2013 rates) to £22,436 (on the new 2014 rates) which is a pay rise of 4.0%. And pay increases of 5% for nurses in their second through seventh years.

The people who wouldn’t be getting an automatic pay rise are the people at the tops of the scales… to whom the Government is offering the 1% that they say they are striking for.

(So actually, the people affected by this are new NHS staff, coming in at the old starting rate rather than the new proposed one.)

There are 380,000 nurses in the NHS in the UK, earning at least £21,388 each or a total wage bill somewhere north of eight billion quid. That 1% increase will cost the NHS, will cost you because you pay for the NHS, at least eighty million pounds.

Or, in the emotive terms that people like to pitch this debate, 4000 nurses.

Not that nurses are paid brilliantly, but the £28,180 on offer (after 1% increase) to an ordinary ward nurse at the top of the Band 5 pay scale is above the median average national wage, and quite a lot more than quite a lot of people get, particularly people on sickness benefits who get hardest hit by NHS strike action, or people on minimum wage or zero hours contracts who lose money when they have to refuse work in order to turn up on time for their NHS appointments, and only get told when they get there that they’ll have to miss more work without compensation because their appointment’s been cancelled through NHS strike action.

Everyone is fed up with austerity. Everyone is tired of tightening belts. And it’s true that to get through the worst of the recession that they inherited, the Coalition did freeze all those pay rates that were over £21,000. The rates were kept the same for the first three years: 2010/11, 2011/12 and 2012/13.

Although rates were increased for those lower paid NHS workers, on Bands 1 to 4, but not the nurses who were already better off than that. And, of course, you would still get an increase by progressing up the rates each year.

But, something I’ve just noticed from the RCN website: all pay rates were increased by 1% for last year (2012/13).

So that “not had a pay rise in four years” just cannot be true.

A nurse starting in 2010 on £21,176 would expect to be earning £24,799 in 2014, an increase of 17% or an average increase of 4% a year. Better than inflation in every year except 2010 when Alistair Darling’s devaluation and George Osborne’s VAT rise both hit.

In real terms, then, nurses are barely any better off. But try telling that to people who really haven’t had a pay rise in four years.

It’s said that the NHS is what the British have instead of religion these days. It’s an article of faith that we must preserve it, as much as it’s a standard mantra that the NHS is in crisis. Labour in particular have made a fetish of “their” NHS – “don’t let the Tories ruin it”, they cry when all other rational reasons to vote Labour fail them; any attempt to empower local people to vary provision to suit their needs is greeted with cries of “post code lottery” and results in power being snatched back to the Secretary of State; at the last gasp, any reform at all is answered with the desperate war cry of “privatisation”.

But locked-in inflation-busting salary increases are another reason, along with Labour’s privatization through the PFI door, why the “best health service in the world” is going to go bust in spite of having ring-fenced, real terms cash increases no matter what the damage that does to other spending commitments.

The NHS has been made a sacred cow by at least five major Parties (and UKIP) including, sadly, my own. And as with most cows, the debate seems to come with a quantity of bull.

Friday, March 14, 2008

Day 2624: Healthy Debate

Saturday


So that was Liberal Democrat Spring Conference. This is the FIRST time that I have been there in the Spring – usually Daddy Richard is just too busy – but Liverpool '08 is a SPECIAL YEAR so we made a special effort.

The BIG controversy was SUPPOSED to be the debate on Health Policy. In the end, though, it was as dull as dishwater after washing some particularly dirty dishes. This is NOT to cast aspersions on any of the policy, or on the people who took part, but let's face it, the debate got a little SIDE-TRACKED by the amendments into a discussion about the pros and cons of giving local councils power to run local health trusts.

(To be honest, I thought that there were good points on both sides of that argument: We trust councils with schools and meals on wheels, why not doctors and hospitals? But then people would rather have a locally chosen health board, as one well-deployed bar chart ably demonstrated!)

But the real issue about health is that we have had to admit that we cannot pay for free care for the elderly. This has to be a disappointment, it was a GOOD policy, but we also have to be HONEST and say that Scotland has shown it to be much, much more expensive than we thought. Dr Evan urged us not to send Mr Norman Lamb naked into the fight… actually, and he was speaking as a doctor, he just urged us not to send Mr Norman naked…

Mr Norman himself came on at the end of the debate, with a pale blue shirt that almost matched his – in that light – pale blue hair. "Ooh! It is SUPER-LAMB!" said Daddy. Perhaps the YELLOW background could have been used for CSO to make him FLY! Or possibly just to add some DINOSAURS – that would have livened things up!

(Actually, Daddy Alex was telling everyone at conference how between speeches they should have played "Carry On Abroad" on the big conference screen: you know, the one where they arrive to find that the hotel is only half-built and then the big storm comes along… maybe it wasn't THAT funny…)

So anyway, instead of free care for all, we now have a universal care guarantee to make sure that even the least well-off can be sure of receiving treatment. It is a policy based on fairness, but also one that we can actually hope to deliver.

The policy also introduces the "Patients' Guarantee" (that you can opt to go private if the NHS fails to deliver) and individual care budgets so that patients with mental health problems can take control of their own regime of treatment, all aimed at taking control of money away from Whitehall and returning it to people.

That was a subject that Ms Julia Worth-Her-Weight-In-Goldsworthy talked about in her speech straight after. At the moment, Mr Frown's QUANGOs control more money than the whole of the NHS budget AND the Defence budget added together; more than ALL of the money controlled by accountable, elected councils. Typically, Mr Frown wants to control everything from his desk in Whitehall; while the Conservatories want to control everything from some privatised monopoly. Only WE Liberal Democrats are promising to CULL the QUANGOs and put people back in charge – starting with Health.

Mind you, I thought that the emergency motions – Mr Vince's on nationalising banks and protection for deposits that depositers believe in; Mr Ed's on the need for an inquiry into the whole Extraordinary Rendition business – were much more exciting! It is a shame that everyone had gone by that point.

Anyway, the REAL highlight was going along to the Gender Balance Blogger awards in my NEW RUCKSACK (courtesy of the VERY NICE Mr Brian's campaign to be Mayor of London), where we saw awards for loveliness in blogging go to the VERY lovely Ms Lynne Featherweight, and the VERY lovely Citizen Alix of Mortimer, and the VERY lovely Ms Jo Christie-Smith. HUGS all round.


Alix Blogger and the Goblet of Fire
Posted by Picasa


Oh, and Mr Clogg gave a speech too.

Wednesday, February 13, 2008

Day 2590: What's Up Doc?

Monday:


I guess that the trade union for doctors, the BMA (Bona Medical Appliances), were really JOLLY GLAD that the Archpillock of Canterbury decided to go so dramatically OFF PISTE, as all the loud coverage of HIM has enabled them to sneak out a quick backing down with very little press attention.

This is – I should hope – going to see some resolution to the long running DISPUTE about longer opening hours. It would make a whole lot more sense for people IN work to be able to visit their doctor without having to take time OFF work to do so. Because faced with the choice most people choose to skip the doctor rather than the office, unless they're REALLY ill. Which means a lot of preventative medicine goes undone.

I think that doctors actually recognise this and would like to come to an agreement – not that they do themselves any favours protesting "too much" that everything is lovely and 800% of patients love their opening hours. But both the BMA and the government are being pig-headed.

Basically, the Labour gave doctors squillions of pounds for doing stuff they were doing already, so now they are behaving truculently to try and get some FACE back.

Not that the doctors didn't DESERVE paying for doing all those little extras; you can't run the health service forever on the charity of doctors (despite what Mr Balloon might think).

Meanwhile the BMA respond with SCARY stories about this being the government attempting to privatise the health service.

Result: loggerheads. And the editor of the Lancet starts accusing the BMA of not representing doctors properly.


Being the Labour, the government decides to IMPOSE a centralised solution, and Health Secretary Postman Pat writes to GPs directly
http://news.bbc.co.uk/1/hi/health/7223245.stm

to give them their orders.

Of course, micro-managing EVERY GP's surgery in the country from No. 79 Whitehall is the sort of bonkers plan only a Labour Minister could come up with. And it's why you end up with these stupid head-butting contests where the centralised union and the centralised ministry end up eyeball to equally-ugly eyeball.

And it is the PATIENTS who get forgotten in the middle of all this – which is why it is so important to restore a sense of balance and put patients back in charge.

Friday, January 25, 2008

Day 2577: 'Ndividual Health Service

Tuesday:


Mr Clogg has announced exciting new Health policies for the Liberal Democrats.

The aim is to enable people to take charge of their own health needs, rather than having some remote minister dictate to them what they will get.

The Health Service is a BRILLIANT thing: looking after the poorly is truly a mark of being civilised. But too often the bureaucracy put in place by the Labour leaves doctors and nurses struggling to meet Whitehall's targets instead of the needs of their patients.

It is time to put a stop to that by putting people back in change.

Key proposals begin with a Patient's Contract, that will give you a GUARANTEED maximum waiting time, and if the NHS cannot meet that time, then you will be able to go private.

People with long-term needs will be able to take control of the money that gets spent on their care, freeing them from dependence on the state and letting them make the decisions about what treatments serve them best.

And there will be a "Care Guarantee" for the elderly, backed up with two BILLION pounds of funding, for a personal care payment based on need not means testing.

There has been some comment that this guarantee is not as generous as the "Free Care for the Elderly" policy that the Liberal Democrats in Scotland implemented while they were in coalition government.

The Labour's Ivan (t to have My Cake and eat it) Lewis said:

"…frankly this amounts to a retreat and U-turn by Mr Clogg on previous Liberal Democrat policy which said that elderly people would get free care regardless of income."

Nice admission that it WAS us who got that done in Scotland, by the way.

But we have got to bite the bullet on this one. Mr Clogg had the BOTTLE to admit that it would be impossible to afford such a scheme – indeed, it has proved far more expensive in Scotland than budgeted – and it would be DISHONEST to promise something that we could not really do.

Instead we have come up with a costed and affordable proposal to tackle the tragedy of old people having to sell their homes and spend their life savings on care.

That didn't stop Mr Ivan saying:

"…the guarantee is not worth the paper it is written on."

Although, the paper it's written on is STILL worth more than the Labour's offer of, er, doing nothing.


Going further, the Liberal Democrats propose to deal with the scandal of the Labour's QUANGOCRACY, where they pick all of their UNACCOUNTABLE chums to serve on the local Primary Case Trusts. We would replace these with locally elected Health Boards.

We know from our community campaigning that nothing motivates people like a threat to their local hospital or doctors' services. So this would give people the chance to get involved and solve problems DIRECTLY through the Ballot Box.

And we would let people decide to spend more (or less!) on their local health needs, by giving them the power to add an extra slice to the level of their local income tax.

Ultimately, controlling the MONEY is what give people real POWER over outcomes, and that's why Mr Clogg has "got down to brass tax" (you might say!)

Now, you KNOW that that is going to mean different solutions, and different OUTCOMES, in different areas. But it ALSO means that people are going to have the power to CHANGE things if they don't like it.

The CRISIS of the NHS at the moment is not that it hasn't got the money or the drugs or the skills or the people. It is that everything is controlled from the MUDDLE in the MIDDLE and if they find a solution that works in one place, they IMPOSE it on everywhere else. Without thinking whether everywhere else wants or needs it.

The National Health Service was founded sixty years ago based on a LIBERAL ideal – freeing people from the burden of sickness.

Now it needs another Liberal ideal – freeing people from the burden of CENTRALISM – to see our NHS continue to flourish for another sixty years!