HEALTHCARE - A PERSPECTIVE

There is an articles by Roger Steer entitled Alternative European Healthcare Perspective published this month. For anyone interested in the future of the NHS and Healthcare generally it is, in my view, a must-read. It certanly gives one a view of what is going on in France as well as the UK. 

He brings together a number of texts, all providing very useful insight into the problems of Healthcare and the contributory factors directly affecting the nation's health. I found the references to the Health Foundations conclusions of particular interest:

Findings include

Money and resources: people on the lowest incomes (the bottom 40% of the income distribution) are more than twice as likely to say they have poor health than people on the highest incomes (the top 20%), and more than 5 times as likely to say they have bad or very bad health. Poverty in particular is associated with worse health, especially persistent poverty.

Employment: employment, or the lack of it, can have considerable influence on health and wellbeing. Poor health can limit people’s ability to have and sustain work. The nature of people’s work matters for health, but also impacts other factors that influence health, such as having sufficient income and forming social connections.

Housing: housing affordability matters for our health. Difficulty paying the rent or mortgage can cause stress, affecting our mental health, while spending a high proportion of our income on housing leaves less for other essentials that influence. health, such as food and social participation. People on the lowest incomes are hit particularly hard – 26% of households on the lowest incomes spent more than a third of their income on housing costs in 2019/20, compared with only 3% on the highest incomes. Ending the freeze on housing benefit and increasing support would help people who rent their homes to meet their housing costs. Alongside this financial support, there needs to be an increase in the proportion of social homes and new affordable homes for the future.

Transport: increasing physical activity and minimising time spent sitting down helps to maintain a healthy weight and reduces the risk of cardiovascular disease, type 2 diabetes, cancer and depression. The NHS recommends that adults should do at least 150 minutes of moderate activity, or 75minutes of vigorous activity, each week. Walking and cycling as part of one’s travel routine – whether for an entire journey or to access public transport – can help meet these targets. There will be little benefit, however, if this means of exercise merely displaces the time for physical activity, or if the activity is not prolonged or intense enough to affect health outcomes

Reading the above acrtually comes as no surprise and more or less fall into the category of "we hold these truths to be self evident". Comments relating to Wes Streeting and Rachel Reeves are a bit of a worry, but I urge you to read the piece for yoursleves: It is at:

Aug 2023FINAL.pdf(Review) - Adobe cloud storage

WHO'S GOT IT RIGHT?

In the United Kingdom there appears to be a general feeling of discombobulation. The advances and developments across the globe in industrial and economic growth, whilst initially seen as beneficial, have clearly caused havoc to the environment to such an extent that the survival of the planet is in doubt. Rapid deployment of new technology, and the restraint and phasing out of the old, is urgently required.  The social and economic difficulties being experienced throughout the world however, show little sign of allowing the programs, already discussed and approved at numerous environmental conferences, to take effect. Therein lies the confusion and perplexity of the current government as well as the current opposition.  The same can be said of a number of other countries.

 

Rising inflation and corporate greed do not assist in providing the immediate and necessary funding for a National Health Service, social care, housing, secure employment in education and public transport. None of this is helped by the current war in the Ukraine and other strife-torn parts of the world. All that coupled with a move towards isolation and misplaced nationalism away from global co-operation, is even more disconcerting.

 

The complete overhaul of the economic and industrial complex into remedial and pollution-free enterprise will take time and effort. The transition towards an electrical and solar powered world no longer reliant on contaminating fossil fuels is proving difficult, and in any event, the production of energy without polluting side-effects is probably impossible.

 

A lifetime of human habit is indeed difficult to change, particularly where the economics of desired and required change is concerned. An example of this problem is illustrated by the proposed extension of ULEZ (Ultra Low Emission Zone) in London, as well as the imposition of LTNs (Low Traffic Neighbourhoods) and cycle lanes. All of this to encourage the move away from vehicles reliant on fossil fuel. LTN’s and cycle lanes restricting the passage of vehicles has created congestion and slowed traffic to such a degree that engines remain running for longer in built up areas. How many citizens used to driving have actually abandoned their vehicles or have even been able to do so? The cost of switching to electric or other non-ordinary petrol driven vehicles, is outside the reach of many. Providing the financial assistance needed, from the state, to enable that to happen is prohibitive in the face of other national commitments. 

 

As a  consequence, the by-election held in the Uxbridge and South Ruislip constituency, gave voice to the local citizens’ discontent with the ULEZ extension. This result saved the seat for the Conservative Party, who shamefacedly used that discontent with the London Labour Mayor’s policy, to retain the seat, whilst shying away from environmental concerns, which they allegedly seek to deal with. How two -aced is that? On the other hand, the Labour leadership finds itself in difficulties over whether or not the mayor’s policy is in fact counterproductive to winning elections, all the while itself claiming to champion environmental issues. A dash of hypocrisy perhaps?

 

Clearly the politics of change and the necessity for change does not run smooth. However one approaches the problem there will be a cost, hence the requirement for economic growth called for by Labour and Conservative Parties with varying degrees of enthusiasm, each claiming their way is better that the other’s.  The trouble is no party is prepared to take the drastic affirmative action that the London Mayor is willing to take. What he is saying is, if you want to have your particular polluting vehicle, then pay a contribution toward the cost of cleaning up after you. It is essentially no different from picking up your dog’s poo in public spaces. People have become used to that, but £12.50 a day is another matter. £4,562.50 a year per car will raise a lot of revenue, and that’s not dog poo. The cheapest fully electric vehicle is in the region of £25000 plus, which is about 5 and a half years of ULEZ charges. I suppose one could scrap one’s current vehicle and just put £12.50 a day in a savings account for the next 5 years and 6 months and buy an electric vehicle to be back on the road. That is of course if you can afford to put by £87.50 a week, and you’d be helping to save the planet.

The United Nations secretary General, Antonio Guterres has announced the era of ‘global boiling’ has begun “This is just the beginning” he says. In fact, it is the continuation of what started some time ago. The impact is just becoming more apparent. His call for worldwide cooperation in dealing with what is manifestly a world crisis is perhaps a bit late, but nonetheless welcome. What effect he will have is questionable.

 

Whatever the economics, in Britain, it is difficult to ascertain just what any government can do to tackle climate change, invest in and stimulate the economy, while at the same time, getting the NHS on line with properly paid staff, social services, teachers and transport workers properly rewarded, able to do their work successfully, and secure affordable housing for those in need of accommodation. There will be a cost. The era of global billing has begun.

 

PS - Since writing this blog it has been pointed out to me that global warming and pollution are two separate matters, although they are part and parcel of the same problem.

A MIXED BAG OF THOUGHT

There are two articles in the Observer, one by Kenan Malik - It’s in Milan Kundera’s ambiguities and contradictions that we find his truths, which can be found at:

https://www.theguardian.com/commentisfree/2023/jul/16/in-celebrating-europes-glorious-diversity-milan-kundera-confounds-its-bigots

and the other by Will Hutton - Europe is surging rightwards. But, as Britain has shown, the populist tide will start to ebb which can be found at:

https://www.theguardian.com/commentisfree/2023/jul/16/europe-surging-rightwards-but-populist-tide-start-to-ebb?CMP=Share_AndroidApp_Other

which are well worth a read. One deals with the recently deceased author Milan Kundera’s writings and his views on the question of European identity, and the other deals with European identity from a political perspective

 

How the European continent will emerge from the current financial and climate crises, as well as the Ukrainian war, is dependent on how individual European states chose their representatives in government. Is it really a matter of how the individuals in each state finds or defines their identity as citizens of the state?

 

There is a view that as the individual European states become more closely aligned economically and politically, they will merge into a single state and citizens will lose their individual identity as Frenchman, Germans, Italians Greeks, Hungarians etc. It is being suggested that as a result of the European Union, people are losing their cultural heritage to the extent that they no longer understand what it means to be French, German, Italian etc. and that consequently there is a backlash being fermented by individuals who are dead set against any further deterioration of what they perceive as their patriotic identity, which includes their historical myths and specific cultural history. Hence there is an instinctive reaction by some to conserve and preserve that narrative. This fear of loss is what appears to be driving the movement towards a conservative right, intent on stopping any other form of movement. It is a matter of battening down the hatches and stopping any further leaks, or influx into the existing mix. It is an attempt to return to what was before the rot set in, all the while maintaining an economic link and remaining in the European Union. Quite a feat.  To do that one needs to employ whatever means it takes to stop and prevent dissent or wayward thinking of any kind. Once that is achieved and equilibrium restored one can move on.

 

As to the UK one sees that happening with legislation preventing protest and freedom of expression, as well as illegal draconian legislation in an attempt to stop all immigration. The list goes on. (The UK has unfortunately cut ties with the European Union , making isolation far more costly) Under the guise of acting in the public interest, Suella Braverman and Priti Patel have crafted legislation that would have prevented their parents from entering the United Kingdom.  So much for filial responsibility. But I digress.

 

The problem for them all is that the hatches no longer have their covers. They’ve been blown off ages ago and the current attempts at closure is the equivalent of using a sieve to stop the flow. The internet and all forms of media, social or otherwise, has opened access to all forms of ideas, new myths and cultural output from across the globe. The output from streaming media companies conclusively demonstrates the similarity of global output. United States crime series, such as CSI, Law and Order, NCIS, Criminal Minds etc. are being eclipsed by similar output from the United Kingdom, Denmark, Sweden, Germany, France, South Korea, Italy etc. Every country does cop shows, soap operas, sitcoms etc.. They depict human beings doing the same things all over the world, having lives and living in societies that have the same problems, seeking solutions in their own ways and in their own languages. Any number of Netflix, Prime, iPlayer, channel4 or My5 box sets are available to us all.  Every country has its own version of reality television as well, mostly in the same format but with their own particular national quirks. Most successful shows are shown in just about every country in translation voice over. It is no longer surprising to see Upstairs Downstairs, Downton Abbey, Unforgotten, Friends, Neighbours or The Big Bang Theory dubbed in Spanish, French, German, Dutch etc. Fortunately, the UK have taken to broadcasting Scandi noir and French policier in the original language with subtitles, as does Netflix and Prime. This does preserve the cultural aspects of the shows does it not? I digress again.

 

My point is, we all see and hear it all, so why is it so difficult for nations to get together. We all go through the same crap. Why is it so difficult to find global solutions? Why do we elect representatives that are so totally partisan that whenever they are interviewed their sole reaction is to slag off the other party.

 

There are problems which are now so exacerbated that any incoming administration will find it exceedingly difficult to resolve. The Labour leadership is currently floundering as to how, should they achieve a majority at the next election, they will go about getting the NHS back on track, how they will cope with social care, supplementary benefits and housing, getting educational institutions back on track, in effect getting public services fully functional and properly rewarded. There is also the question of the environment. Will we have a planet that is habitable?

 

So far, they keep coming up with words like ‘reform’ and negotiating and resolving pay claims with the various public service unions. There has been no mention whatsoever of what is actually meant by reform. Reform what and in what way? Resolve pay claims, how? There are financial commitments that need to be made and the gathering up of sufficient funds to back up the reforms and resolutions has itself to be resolved. They also keep going on about economic growth and investment in growth. How do you get growth having closed off the market for the last seven years? From where will the funds be gathered?

 

One wonders whether the current government has maxed out the nation’s credit card or whether there is still some credit left? If so, is there another card available with a similar credit limit? Or is it a matter of extending the current limit? Make no mistake, there can be no lowering of taxation in any area, and, if anything, will need to be increased. Any notion that ‘growth’ will automatically increase the state's income sufficiently to cope with the required expenditure is pie in the sky thinking. Any prospective government that holds out that promise is being dishonest. Running a country as if it were a business is not a solution. Governments are about people and the needs and resources of individuals vary to a very great extent. Income, corporation, and windfall taxes won’t cut it. Nor will value added tax. Return on investment is equally unfounded as a backstop. There is no guarantee, unless, I suppose, you’re a shareholder in a water utility company.

 

There is an article in The New Yorker July 17, 2023 issue by Louis Menand entitled The Rise and Fall of Neoliberalism. (Sub title: The free market used to be touted as the cure for all our problems; now it’s taken to be the cause of them). The opening paragraph reads:

"Neoliberalism” has been called a political swear word, and it gets blamed for pretty much every socioeconomic ill we have, from bank failures and income inequality to the gig economy and demagogic populism. Yet for forty years neoliberalism was the principal economic doctrine of the American government. Is that what has landed us in the mess we’re in?

 

In effect it can be translated as Thatcherism. Menand posits that Friedrich A. Hayek and Milton Friedman still exert their peculiar influence. The idea of an idealised market place, where everyone behaves in an exemplary ethical manner, where wealth is accumulated by the few and trickles down to some amenable workforce fully accepting their lot, is as fanciful as Adam Smith’s other concerned person, as depicted in his Theory of Moral Sentiments, let alone his inquiry into the nature and causes of the wealth of nations so influential to Milton and Hayek. The difficulty with their theory is that it takes no account of the reality of humanity, and any concept of the totality of human rights.

 

The market place is there to serve the interests of humanity not the other way round. Human beings have devised nations and their constitutions to be able to guarantee their rights and freedoms. That guarantee is extended to each and every individual citizen under the rule of law and duty of care. That is paramount. Democracy is about ensuring that the theory is applied equally to each and every human being. It is also about sharing the cost of maintaining the structures and institutions that provide for the health and safety of all. There is no guarantee the enterprise will be successful; however, that being the case, what you can guarantee is the increased need for the services of an NHS, social services generally, housing and a planet to protect. For the next UK government to get all that together over the coming five years before another general election, is going to take more than whatever ‘reforms’ are being contemplated. Funding is required. We will have to pay.

 

MORE SHAKESPEARE

Thanks to Ernie I was taken to this video on YouTube with a performed version of Levin's piece. Enjoy.

DO YOU KNOW YOUR SHAKESPEARE ?

As one is still in Stratford-upon-Avon, Shakespeare keeps popping up. Some years ago, journalist and writer Bernard Levin wrote a short paragraph on the notion of quoting Shakespeare. It is a corollary to Cole Porter’s Kiss me Kate and Brushing up Your Shakespeare:

So, in line with that, I post here Bernard Levin’s piece on Quoting Shakespeare:

 

"If you cannot understand my argument, and declare ``It's Greek to me'', you are quoting Shakespeare; if you claim to be more sinned against than sinning, you are quoting Shakespeare; if you recall your salad days, you are quoting Shakespeare; if you act more in sorrow than in anger; if your wish is father to the thought; if your lost property has vanished into thin air, you are quoting Shakespeare; if you have ever refused to budge an inch or suffered from green-eyed jealousy, if you have played fast and loose, if you have been tongue-tied, a tower of strength, hoodwinked or in a pickle, if you have knitted your brows, made a virtue of necessity, insisted on fair play, slept not one wink, stood on ceremony, danced attendance (on your lord and master), laughed yourself into stitches, had short shrift, cold comfort or too much of a good thing, if you have seen better days or lived in a fool's paradise -why, be that as it may, the more fool you , for it is a foregone conclusion that you are (as good luck would have it) quoting Shakespeare; if you think it is early days and clear out bag and baggage, if you think it is high time and that that is the long and short of it, if you believe that the game is up and that truth will out even if it involves your own flesh and blood, if you lie low till the crack of doom because you suspect foul play, if you have your teeth set on edge (at one fell swoop) without rhyme or reason, then - to give the devil his due - if the truth were known (for surely you have a tongue in your head) you are quoting Shakespeare; even if you bid me good riddance and send me packing, if you wish I was dead as a door-nail, if you think I am an eyesore, a laughing stock, the devil incarnate, a stony-hearted villain, bloody-minded or a blinking idiot, then - by Jove! O Lord! Tut tut! For goodness' sake! What the dickens! But me no buts! - it is all one to me, for you are quoting Shakespeare."

 

All the quotes come from the works of William Shakespeare. Some were coined by him and others just part and parcel of the English language in and around the time of Shakespeare, of which he made good use and popularised.

 

My question to you all is, can you identify the phrases and who spoke the line. To be fair, some phrases appear in more than one work. Also, there is one phrase that does not appear in any work by Shakespeare.

 

Whosoever can provide me with the most complete and correct list of the above phrases contained in Mr Levin’s paragraph, by the 2^nd August 2023, will win a bottle of Champagne. I will post all the answers on that date.

 

I should warn you that my decision on what is or is not a correct answer will be final. For the nonce adieu and more of this anon.

COMMENTS ON THE SUPREME COURT

There are two YouTube videos that I think are worth a view in relation  to the Supreme Court of the United States of America:

 

MANAGING THE NHS

I was listening this morning to an interview with Amanda Pritchard who is the Chief Executive of NHS England and has been since 1^st August 2021. She was asked for comment on a joint statement made by the three main health think tanks in the UK, the King’s Fund, the Nuffield Trust and The Health Foundation, which said that the health service suffered from “insufficient resources to do its job, fewer hospital beds than almost all similar countries, outdated equipment, dilapidated buildings and failing IT”.

Amanda Pritchard

She did not make any comment on the matter. She did not even address the question and began with an upbeat message about the 75^th anniversary of the NHS and what a great thing it is. She also started her comments with the word “look”, as if to give the appearance or semblance of an answer to the question, being all chummy and down to earth, but is in fact a classic bit of condescension moving away from the question as if to suggest ‘that doesn’t matter, this is what matters’. She behaved like a politician, all the while suggesting “I’m not a politician, wages and funding is down to the politicians, I’m only the Chief Executive”. When it was suggested that she could put pressure on the politicians to resolve some of the issues causing the current difficult and possibly damaging industrial action, she again shied away from an answer. 

 

In the event she came across as ms pollyanna, speaking joyfully of planning for more trained staff in the future and generally looking forward. It sounded all very positive but was, in my view, merely a classic ministerial projection of neverland. She made no mention of the outdated equipment and dilapidated buildings and other basics which make it impossible for the staff to do their job. I do wonder just what the new trainees do, if they don’t have the facilities to actually perform the tasks they have been trained to do?

 

Look, she was, I’m sorry to say, all management speak. What can you expect from someone with a degree in modern history who served as a librarian of the Oxford Union, and, I’m guessing, after graduation, joined the NHS Management Training Scheme in 1997? Indeed, she has worked for the NHS her entire career. She has been in the system for over 25 years. So, you would have thought she would have developed some solidarity with the medical staff; however, that is clearly not the case. She is management and they are the workers. Her career path has been in support of management and hence in support of government (be it Tony Blair, Boris Johnson, Sajid Javid etc..) as opposed to the staff. Consequently, she will not be critical of government and mildly extolling the staff towards compromise.

 

What she should be doing is taking up the report from the King’s Fund, Nuffield Trust and Health Foundation and battering the Minister and government to deal with the failing infrastructure. Hospitals need urgent repair and maintenance. Hospitals need functioning and up-to-date equipment. Hospitals need the latest technology. Hospitals need the best and most efficient IT. Hospitals need staff trained to deal with the latest and best kit available. To train staff in, and with, crap facilities and equipment is counterproductive as they will have to be trained all over again. What reduces waiting and mistakes is effective efficiency. What makes efficiency effective is knowledge and training with the right tools. With effective efficiency you get savings and with savings you get more productivity. To get productivity you need the best staff, and to get the best staff you need to pay them accordingly. Corporations have been going on about this for years (The BBC is an instance in point – they claim they must pay high wages to keep the best talent).

It is not a difficult formula. Ms Pritchard, with her management skills developed over the last 25 years, should be able to push for that goal. There may be difficulties along the way, but the promised objective is in sight, surely, it’s just a matter of going there. Once again there is a lesson from Lawrence of Arabia. Think of Acaba as the ultimate NHS: