Malcolm Blair-Robinson's Blog, page 73

The NHS: In Crisis

Whoever investigates the NHS, the outcome is always the same. It is underfunded, understaffed and facing increasing demand. Backlogs and failures are now too numerous attract headlines. Yet as responses to emergencies reveal, it is world class in its skills, dedication and outcomes.

The money issue is solvable. It is a mathematical impossibility to run an infinite service on a finite budget. The solution is to allow the NHS to automatically receive more money the more patients its sees, by operating an insurance based service with the Government the only insurance provider. To do this you reduce income tax and introduce an NHS premium. Everybody pays, subject to normal exemption for low incomes and vulnerability.

The premium relates to income level so the rich pay more. Private insurers cannot be allowed to bid, because a requirement is that everybody is fully covered irrespective of their health or existing conditions and no surcharges are levied. One insurer covers both the sick and the healthy and so has an underwriting profile the same as the national statistics. More than one, and they start to exclude the sick and cover the healthy to boost profits and you end up with US style chaos.

Having organised and income stream, you then have to organise the service. There are about 27 quangos presently engaged in managing the health service and innumerable trusts and boards mixed up with running it. They must all be abolished. A Ministry of Health must be re-established with the minister’s head on the block and a razor sharp axe nearby. They are responsible for every aspect of the NHS, which is run directly by the ministry through Regional, District and Community managers. Doctors treat patients.

Next hospitals run 24/7 on three 8 hour shifts, with no excessive hours for staff and no waiting lists of any kind. You feel unwell, you see your GP today, the consultant tomorrow, you are operated on in the night and you are home for the weekend. It looks more expensive but the true saving across the economy is enormous. Vast armies of bureaucrats collating lists, statistics and car park charges, can retrain as health professionals, making a difference to the needy and and gaining fulfillment  in their lives.

Finally GP’s go back to their main function of diagnosis and co-ordination of their patient’s timely and effective care. They give up on pills which are left to pharmacists. We focus on the causes of illness and disease and find the cure. Drugs are not a cure, they just manage symptoms. That is important but it is a short term help, not a long term answer. For example to lead a life low on exercise and healthy eating and high on junk food, booze and TV, whilst protected from disaster by statins provided at public expense, is a fools game to be brought to an end.

Think about it. The more you do the better it gets.

 

May: Disappointment at Dinner

Reading between the lines of an opaque communique and especially seeing the expression on May’s face as she was driven away, it is clear that it was cordial and friendly but nothing was achieved by this well trailed dinner. Just as nothing  concrete was  achieved by her Florence speech. Maybe a cozier atmosphere but the reality is the same. From the very beginning the Brits have misjudged the mood of the EU and misread the Continental political mindset.

British political traditions are ideological and built on simple majority. But, post the traumas of the twentieth century, the countries of mainland Europe, both west and east, know the dangers of ideologies and the raw power that comes with majority. Their politics are now procedural and built on coalition. Moreover their aim is not to help Great Britain, which after all has chosen to rock the boat and leave. It is rather to steady the ship and preserve the Union. That view is shared widely across the whole EU, not just among the political class, but by business, the work force and the people.

So negotiations, which are often at cross purposes, remain stalled. It is now only a matter of time before the Government will realise that it is not going to get what it wants, whatever it is. That is when things really start to get ugly. Because then it becomes not a story about sunlit uplands but about losers. Multitudes of them. And, mark these word well, they will be angry.

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Kirkuk: Stop This Infighting

This blog has long lamented the inability of world coalitions to restore some kind of political consensus to underpin the fight against IS. Now that militarily IS is but a shadow of its former power and beaten back on every front, the worst possible thing would be for the victors to fight among themselves. Yet with the Iraqi army attacking the Kurds in and around Kirkuk, that is exactly what is happening.

The situation is not helped by the Trump administration’s visceral hostility to Iran, whilst fighting beside and depending upon, Iranian backed militias to achieve victory over IS. There are constant reports of chaotic processes in the White House, which may be true or fake. But the conflicting loyalties of America’s allies in the Mid East, whether those alliances are formally acknowledged or simply accepted as of necessity, have the potential to create a whole new chaos for the future, with no end in sight. This threat is very real. Everybody with a stake in these entangled Middle East conflicts needs to focus. Winning wars and losing the peace is a fool’s game and very costly in human misery. All of it the opposite of what Western civilisation stands for.

Hands Off Hammond: He Might Save The Tories

It would be very foolish for the redneck Brexiteers to force a reshuffle which dumps Hammond. First of all he is the leader of a dwindling band of competent ministers in the cabinet who can think rationally rather then ideologically. Second because business confidence, already fragile because of Brexit chaos, would plunge further. But most of all because reliable rumour has it that he is planning in his Budget to bring down the curtain on austerity, free up local authorities to borrow enabling them to build council houses big time, borrow to renew and develop infrastructure, reform taxation and reboot the economy, setting it back on a growth trajectory.

If he does all that it could transform the political dynamic for the Tories. If the rumour is false and we get more of the dreary same, with an abundance of rhetoric, a shortage of money and a paralysis of action, built on the shifting sands of ever changing forecasts, it matters not whether you dump him or not. The Tory party will be dead anyway.

NHS and Sexuality : When to Ask What

The report that NHS staff are to ask questions about a patient’s sexuality ‘to avoid discrimination’ suggests suggest a blunder somewhere.

First of all discrimination of all kinds is illegal and one would imagine entirely absent from the NHS. If it is not, asking intrusive and personal questions gratuitously will not help. Of course, if a patient is attending a sexual health clinic, it is an obvious part of information gathering to determine treatment and advice. But for an old lady having her corns fixed the inquiry has at the very least a smutty ring. And absolutely no relevance to the situation.

We are constantly reminded that the NHS is under pressure and short of staff. This is certainly the case. All the more reason to question this peculiar initiative and a very good reason to close it down.

Trump And Iran

What matters here is this. The agreement to stop Iran developing nuclear weapons took years to conclude, involved all the permanent members of the U.N. Security Council plus Germany and also the EU. All signed the treaty. The difference between civilised nations and rogue states is that the former sign agreements and stick to them and the latter tear them up when it suits them. We know Trump hates Iran. Yet America fights beside Iranian backed Shia militias against IS. There is no excuse to mess with this deal, as Trump calls it, because Iran is in compliance with every aspect of the issues covered by it. Moreover every single signatory is opposed to the American position, including Britain, France and Germany as well as the EU.

Trump cares not a jot. His ego far exceeds any other on the planet and if he wants, he will. The difficulty is that now nobody will rely on any agreement his administration seeks to make; least of all North Korea. The notion that they will stop their nuclear weapons development in exchange for a peace agreement in which America plays a part, is now off the table. This is a foolish act by a politically inexperienced incumbent in the White House, who plays to his conservative base before he considers the long term strategic interests of his country.

Of course he must be tough with enemies, but to be effective America must lead the world in reliability and trustworthiness.  After the TPP, the Climate Change Agreement and now this threat to the Iran deal, the signal is clear. You cannot trust America’s signature any more. But Trump does not care. He revels in it. He thinks it makes America Great Again. The sad truth is America just got a whole lot smaller.

It is one thing to be isolationist. It is another to be isolated. And yet another to be shunned.

Brexit Crisis Looms

There are two roads open to Brexit. One is the hard model favoured by the hard right of the Tory Party. It is driven by ideology and is willing to pay any price in terms of economic damage and loss of freedoms for what it sees as some Utopian national independence. In an interdependent world this is surely a fantasy, but in the Brexit drama it is an understandable way forward. It may be reckless or economically suicidal, but everybody knows what it is.

Next comes a sensible and practical Brexit. This disconnects GB from the political structures of the EU, but leaves the economic ties largely intact. Likewise the free movement of capital, goods and people carries on with perhaps minor modifications. In other words the lives of politicians change and grow narrower in connection with all things European, but the people and business carry on as usual. This is easy to understand and there is a majority for it both in the country and both Houses of parliament. There will be cost and compromise, but all within reason and within reach of the reasonable.

Unfortunately the disagreements in the Cabinet are so fundamental that there is no consensus on what is required or how to get it. This is the third road, as yet unmade. There is even confusion about the nature of the Brexit negotiations. They are, in the first stage, a complex unpicking of a tightly woven legal structure, where there are obligations which are contractually binding and which must be met and others from which withdrawal is feasible. But the government does not see it that way. Rather it sees a contest like a pub quiz. So it does not want ‘to reveal its hand’.

This means neither the government itself, the country at large, the EU, nor anybody anywhere can fix on what GB actually wants. This is where we are now. In the words of the EU’s lead negotiator, there is a ‘disturbing deadlock’. Maybe this is the crisis before the breakthrough. Or maybe the muddled thinking of our government has driven it into a thicket of its own false hopes.

But believe me, if that is where we are, we cannot hang about there for long. Because it is a thicket in which terrible national misfortune clings.

Trump State Visit: Off

According to reports on reputable media Trump will make a working visit to the UK in the New Year, which will be part of his proposed tour of European capitals. There will be no pomp or processions, nor staying at the Palace, no address to parliament.  It will be strictly business.

This is in line with protocol for previous presidents. If he makes it to a second term he may get his State Visit towards the end of that term. It is a way of saying thank you to our closest ally. Let us hope there is something to thank him for.

Hard Brexit? The Tory Iceberg Dead Ahead

From the beginning it went wrong. Cameron called a referendum and lost it. May came to power and failed to master her brief, arguing and dithering for months before triggering Article 50. When she did so she offered high rhetoric and even loftier aspiration in an initial situation which required fine detail and careful analysis of a legal position which offered little room for manoeuvre. This was because her Cabinet was hopelessly split between hard Brexiteers and Remainers. The negotiations opened and at once stalled. To give herself greater authority to deal with the Brexiteers, she called and election and lost her majority, reducing, not increasing, her authority.

There has followed a litany of mis-steps. Grenfell Tower, Florence falling pretty flat, Boris AWOL, the Conference disaster and various EU slap downs. So now she has thrown caution to the winds and told everybody to  prepare for a very hard Brexit. There is however a problem. There is no majority in the country or Parliament for that. So when it comes to a vote in the Commons the government will be defeated and her disastrous premiership will be over. As will the Tory grip on power. After a generation of faulty navigation it will finally meet its iceberg.

Unless something else happens. In today’s unstable politics anything can.