SPEAKER'S CORNER

[Stanley]

This was always the topic anyone could use if they wanted to sound off about something. Worth keeping the option open I think

[Stanley]

I'm watching the debate on the benefit cuts. No, I don't have an answer or a clear opinion, it's all far too complicated. I reflect on how we got into this mess and remember how, over the years, benefits have been used as a political tool and become more and more complicated. Add to this the collapse in provision of social housing and the escalation of rents fuelled in part by housing benefits and then load on top of that the present debt crisis and we have a perfect storm. The only thing I am certain of is that the poorest and least able to resist will be the hardest hit. I can't help thinking the unthinkable, that our system has got too complicated to control and what we are looking at is the collapse of the capitalist/market system in its present form. We can't run the world without it but it is, at the moment, unfit for purpose. Could it be that at the root, inefficiency and incompetence coupled with the pursuit of personal advantage by the capital holders has been the main driver over the years?

[Stanley]

I have a peculiar little Sony radio in the kitchen which is incredibly difficult to tune in to a station. In consequence it gets left on Radio 4 all the time, no hardship because it is my favourite listening. We are so lucky to have the BBC and doubly so with Radio 4, the only thing that comes anywhere near it is the World Service. I remember how delighted I was when I first went to the US to find that the public broadcasting channel 13 carried a feed from the World Service from 10pm through the night to I think it was 7 am in the morning. So, each Sunday morning I get my weekly dose of religious news and views. I have never been particularly religious even though I was in the right places to be indoctrinated at Wycliff Sunday School and always a member of the choir. I am what Wilfred Garlick of St George's church Stockport used to call a "Four Wheeler", christening, marriage and eventually, funerals. Nevertheless, I do have views on spirituality and quite enjoy hearing the various topics discussed on Sunday morning. Some of you may remember that about 18 months ago I did some serious reading on the subject and learned a lot about the history and development of the various religions.
One of the main things I recognised was that there was a common thread through all the variations I looked at. No religion is free from those who believe that they are right, have closed their minds and oppose any change on the grounds of continuity and tradition. It really does amaze me that they are still arguing over subjects like women clergy and whether homosexuality is a permissible deviation or an abomination. Perhaps what they should really be discussing is the general subject of dogmatism and its place in any organisation.
One relatively new subject caught my attention this morning. The Catholic Church are running a seminar in Rome for bishops and other senior clergy on the subject of improving the church's handling of priests accused of paedophilia. As we have all learned in recent years, apart from the problem of the priests themselves, there has always been a section of the church which swept the matter under the table and in many cases allowed the offending clergy to carry on with their perversions. What has struck me all along has been the secretive behaviour of the church, not only on this but other matters as well. In many ways it still functions like a medieval feudal system with a rigid hierarchy and a requirement of total obedience. I think this worries me even more than its major shortcomings. It may be that the major religions of the West need to revise their models of governance, bring them forward a thousand years!
If they did this, who knows, many of the doctrinal problems buttressed by dogmatism might become soluble and the good parts of religion might once again get some purchase on improving modern life. Now that would be a result!

[Whyperion]

Even in religious orders where there are clear documented procedures ( bit like schools as well ) , to deal with the moral shortcomings ( and illegal activities dependent on legislative territory ) , it is very difficult for a peer or superior to desire to challenge the behaviour of a misdeamining individual. Thoughts of the punishment that might be given , particulary if it is from some jurisdiction not of the religious order may have something to do with it. Of course some orders have such a strong moral code that any breach has sanctions that western liberal governments might find distasteful. A difficult path to tread when the state and the religion are not aligned in the same moral codes.

[Stanley]

I recognise that problem Whippy but when it is something clear cut like abusing children the course should be clear.

[Nolic]

If anyone - priest , teacher or lay person who has a duty of care to children and fails to act to prevent or stop abuse by another is not only failing in that duty but is also content to let the abuse go unchecked then they should be charged with ariding and abetting a crime and have the full force of the criminal law to face. Nolic

[Stanley]

I was listening to Andy Burnham (shadow mister of health) on R4 this morning and thought what a concise and persuasive argument he put up for ditching the changes to the NHS. Like him, I fear that the 'reforms' coming on top of retrenchment will lead to more private treatment in NHS hospitals and a reduction in available services for the public. For all its faults the NHS is recognised as the cheapest delivery system for health in the world and the concept of 'free at the point of delivery' is universally admired. The changes are all driven by economics no matter how they are packaged and in any normal business situation would be addressed by internal improvement of the existing system not wholesale change. I have to wonder what the verdict will be in say ten years. Will we have a better service? If it isn't, it may be too late to get back to the system that has looked after us since 1945.

[Tardis]

Isn't Andy Burnham one of those who until recently delivered what we call the NHS?

All that PFI money (the reason Burnley is being downsized), the involvement of the private sector, the massive increases in salary (far greater than the private sector), the tick box culture, targets that had no relation to patient care, the lowest "outcomes" in Europe, the internal market, the regional NHS quangos, the 'here' or 'here' choices, mixed sex wards, clostridium dificile, S.A. infections, mid staffs (minister refused to resign), Trusts, gerrymandering.

[Stanley]

It's still free at the point of delivery and looking after a high percentage of patients with no problems. Wonderful concept and despite all the faults the most altruistic political decision ever.

[Tardis]

It isn't free, it never has been. One of the greatest 'untruths' ever told. Otherwise the NHS would be one huge 'Big Society' project full of volunteers.

That is why we have National Insurance.

The greatest social invention was the introduction of this tax that meant that everyone could afford to be seen by the doctor and there were no variations in the rate other than the ability to pay. I would point you at Insurance rates for various ages etc for both medical and illness cover as comparison.

1909 budget (?) that the 1948 ediface copied and is attached to.

I also want to add that had Mr Burnham been in power the manifesto pledge was to cut NHS spending by 12%

Doesn't mean that we shouldn't ask why we pay 1st world health prices for 3rd world outcomes.

[catgate]

The reason why we have got a third world service is because we have developed a third world attitude. The idea that we should get hand outs and free milk and biscuits is endemic. The idea seems to be that because the service is free it should be gratefully accepted by the recipient, irrespective of quality, because "others" are footing the bill.
I was in Bradford Royal for 7 weeks over the Christmas period of 1940. I remember the Nurses who were spotlessly turned out, and the Sisters, who were obviously "in charge", and equally spotlessly neat and starched. There was also the daily visit of the obergruppen Matron, who too was lacking in nothing in the way of "smart neat and tidiness". There was also the care and efficiency born out of this neat-and-tidyness.
Since those days I have had a number of reasons to attend hospitals twice as as an In-patient and several times as an out patient. The thing that stands out a mile to me is how the smart smiling helpful nurses etc. have slowly become older and fatter, and more sluggish and scruffily turned out, and how no one seems to be in charge and no one really cares. (It is often difficult to differentiate between out patient, visitors and staff. This is a wonderful demonstration of how they view their job and the pride they have in it.
This in turn reflects the attitude of those above them. If those above allow this, they automatically condone it and it becomes apparent to those below that they too do not care. In fact the malaise stems right from the top. The entire NHS has become a political plaything and a route for a lot of people right at the top to take to make lots of easy money whilst waiting for their OBEs.

[Stanley]

So you'll both be opting out and going private?

[Tardis]

So you'll both be opting out and going private?

I don't have a choice

But why shouldn't I be able to say that I do not believe that the NHS is delivering value for money?

If I received the same sort of engagement at any other establishment I would be able to complain, but because it is the NHS it seems to be some hallowed religious territory?

This 'industry' literally has your life in its hands, and all I'd like to know is that the odds of dying are more in line with other systems.

I have never said I disagree with the establishment of the NHS, I just wish that the service was run with some recognition for the patient and that the people who worked there treated me as a human being who has paid for it (it took 3 years to get that in Crewe), and like Catty says have some pride in their work. Because if those people don't want to work there, then maybe they should stand aside and let someone else fill those positions.

I fully agree with the political interference, but the only alternative is an annual statement saying how much you have paid in and what your National Insurance payments entitle you to. Then patients have the ability to 'fire' the doctors, which the current system does not allow.

[catgate]

So you'll both be opting out and going private?

I can't afford to. The money which I could have saved for my old age was taken from me by politicians buying favours for their old age. Though I must admit I "wasted" quite a lot in providing a comfortable, warm, easy life for my parents when they retired.
Some of the money that was taken from me also went to supporting a variety of shifty projects at home and abroad.

[Stanley]

Michel Fallon (deputy chairman Tory Party) yesterday: "Nobody knows more about the NHS that Andrew Lansley and David Cameron". Apart from the breath-taking arrogance of this statement, does he really believe this?

[Tardis]

Michel Fallon (deputy chairman Tory Party) yesterday: "Nobody knows more about the NHS that Andrew Lansley and David Cameron". Apart from the breath-taking arrogance of this statement, does he really believe this?

ask him, with your 'intrepid' hat on

[Bruff]

What we need for 'health policy' in this country is a peer-reviewed meta-analysis, or at the very least a systematic review, of the the research base that exists for, for example,comparative health outcomes, patient satisfaction, efficiency and effectiveness, and so on and so forth.

In the absence of this, it is to easy for folk to cherry pick the evidence base to support their particular point of view. So when people talk about our having third world outcomes for some health issues, what evidence base are they using for this? I know that current Health Ministers were some time ago - as I guess a justification for the proposed changes to the NHS through the Health Bill - noting research showing that cancer and heart attack outcomes here were the poorest of the richest nations. But this was only the case, on heart attacks, if you cherry-picked static data from a time-trend study, and actually, sometime this year and most likely in the next month or two, outcomes would outstrip most other countries for a level of expenditure far below the average. On cancer outcomes, the research looked at the period 1985 - 1999 and made no prediction of what is happening now and so this was similarly misleading. Roll all the 'outcome' research into a review and we would have a better picture.

This cherry-picking is more dispiriting than the usual method for justifying changes to the NHS in this country, that of anecdote. That is, the citing of isolated examples of bad experience as somehow symptomatic of a trend. That is no more valid than my noting my experience for both acute and long-term chronic conditions being nothing but exemplary (and which is true - neither myself nor anyone of my immediate kin has had anything other than exemplary treatment and care). Quite apart from, in isolation, the one cancelling the other, neither is empirical. It is of vital importance that we have empiricism as the provision of a service (any service) is not about those who shout the loudest one way or another.

''I fully agree with the political interference, but the only alternative is an annual statement saying how much you have paid in and what your National Insurance payments entitle you to. Then patients have the ability to 'fire' the doctors, which the current system does not allow.''

I'm not sure what is implied here. Is it that if you pay in say, £3K, you get 'x', and if it's say £1.5K, you get 'y' which is a bit less than 'x'; and of course if you've paid in nothing you get nothing? So that, if you know you'll only get 'y' and God forbid you're unlucky enough to fall ill with something that requires 'x' well that's just too bad? It'll come as no surprise to know I'm not too happy with that as well, seeing the person getting regime 'x' for their health plan due to the size of their wallet cuts to the heart of my basic humanity.

Richard Broughton

[Stanley]

Richard, there was a good example yesterday of the lack of empiricism and reliance on out of date statistics in an interview on R4 yesterday. I missed the name of the informant but he was saying that one of the main drivers for the present changes was 'evidence' that productivity was falling right across the NHS. Turned out that the source of this was a report in which it was stated that the researchers didn't recommend the study results as evidence of current trends because the data were out of date but this was ignored. They were right and a more recent study has shown that productivity was rising and compared well with other systems but the old report was still being quoted as 'evidence'. It's time I published 'Healthy or Hungry Thirties' again in which Dr Charles Webster, official historian of the NHS, proved that in the inter-war years statistics were cherry-picked as you describe to 'prove' that health care was improving when in fact there were many areas where it was actually deteriorating.
Did you watch Panorama last night on American poor. One of the segments was the people still queuing at a sports arena in Tennessee because they had heard that doctors and dentists were giving free consultations and treatment. A perfect illustration of what happens to health care when market forces are allowed full reign. "No wage, no money, no doctor!" as one man said. I have a friend whose uncle was diagnosed with cancer. He kept it to himself and committed suicide so as not to bankrupt his family. We don't have to make those choices in the UK. This is worth defending!

[Tardis]

I believe I have stated earlier that I think the NHS should be torn down. I suffer the current NHS because I am chronic rather than acute.

The fact that the new reforms places 'power' in the hands of those who have a vested interest, i.e. GPs, is quite wrong.

If it is the first stage along the lines of my health care being controlled by me then I welcome any changes that undermine the 'home comforts' of those who believe that the NHS is free.

I pay, if my benefits are defined then that should be spelt out, if they are unlimited, then again it should be spelt out; just like ordinary insurance policies, and allowing no political gerrymandering around the edges.

Until other statistics come along to demonstrate the activities of the NHS we have to rely upon those that are available, and at the moment I do not see a rush from anyone to replace them, or for that matter any other workable suggestions.

'Sunlight' will shed much open accountability on the matter. It was not the patient who was paid to ensure that they could read their own notes in Law.

Just to show I wish to save money. I have asked my consultant to go onto the 'online consultation' project because twice a year is just too expensive when I am only deterioating gradually, I have asked to sign up to the online system for my blood results, I only ever ask to see the nurse at the medical practice, and I do tend to rely quite heavily on the advice given to me by my Pharmacist. I have even attempted to 'give back' by signing up for a piece of medical research which will not directly benefit me.

The NHS will not change whilst people scream and shout and fail to engage in any worthwhile debates by drawing lines in the sand. Evolve or die

[Stanley]

A small young acquaintance of mine in intensive care. His mother, a US citizen, married an Englishman and her new baby was early and has a mild case of RSV virus (Respiratory syncytial virus). Guess what she thinks about the NHS! She commented that she will have no gripes about her taxes!

[Stanley]

Mail this morning that Monty is doing well and expected to make a quick recovery.

PS. If you hadn't spotted him he's next to the whale!

[Stanley]

More mail, Monty is recovered and should be going home today. His grandmother mailed me "The NHS Rocks!"
Before anyone says "All well and good, but this is only one isolated case" reflect that this applies to the horror stories as well.

[Stanley]

It's funny isn't it.... anyone who has followed me through present day economics will know that one of my constant themes has been that I don't understand why the western economies have to grow by about 3% each year to survive. Suddenly I hear economists asking the same question and suggesting that GDP as a barometer of a nations economic health is not working. For instance, the UK GDP is falling by about half a percentage point a year and the markets brand this as 'recession' and if it goes on long enough it becomes 'depression'. What it means of course is that at least 99.5% of the economy is functioning normally.
I have always suspected that gross output is a bad goal to chase, bigger is not automatically better. For years I have been asking about levels of efficiency and profit levels. It's no good raising a firm's turnover if the net profit falls. A 5% increase in efficiency would not show up in the GDP indices but would more than cancel out any loss due to the raw output figures falling. The same is true of unemployment figures and in case you haven't noticed I have been banging on about these as well. There is no point creating jobs which do not give adequate hours or a living wage. It is quite possible for the unemployment figure to fall and be accompanied by a fall in the total take-home wage. Good for the statistics but a retrograde step for the workers.
The reason I say it's funny is that I hear on the news that a growing number of economists are voicing the same doubts. I wish them well and recommend that they also look at efficiency and its affect on profit levels. In the long run that will be a far more effective way of generating profit which pays taxes and finances the debt reduction.

[Tizer]

Keep banging on about it Stanley because I'm with you all the way on `growth'. It's always wheeled out and deemed to be absolutely essential and `don't you dare say otherwise'.

[Tardis]

Growth in purely economic terms is supposed to balance inflation, but also allow the banking system to function inbetween.

The arbitruary figure selected by governments only seeks to reassure everyone that any wages will not be inflated away and they will still be able to afford goods from the shop. At 3% it will take quite a while for inflation to reduce money by a half.

In purely economic terms without growth you get stagnation, and with stagnation you do not get innovation to the same extent because whilst items might be invented there would be no captal around to actually invest in the product and bring it to market, which paradoxically also reduces innovation because an inventor gets no return for his effort.

The fact that the Bliar and Brown years conflated asset price inflation alongside growth is one of the issues in the Western economies today