Sunday 23 June 2019

Is it still necessary to feed NHS doctors a Private diet of Gold?

Aneurin Bevan   Pic. Wikipedia
The NHS was set up largely from a solely private health service, and needed to recruit many private doctors and did so. The NHS still encourages private medicine and private  Some private services used by the NHS today such as contract cleaners and groundsmen may not worry us, but others should. Greed is great incentive, especially when a system feeds you "easy money".

Aneurin Bevan set up the NHS in 1948 after demands for reform and contributions from other politicians. It was to be a single tier system, providing adequate health care for all, and free at the point of delivery.

When the NHS was set up doctors were allowed and encouraged to see patients privately as well as being given generous NHS salaries. This was to get them all on side and persuade them they would not lose out financially.

The “stuff their mouths with gold” strategy as it was known is, I believe, now destroying parts of the NHS as there is a perverse incentive to encourage private practice, theoretically leaving private practitioners free to engineer longer waiting lists to encourage business and also to use the NHS to "fish for patients" eg. by advising them that they may only get timely treatment if they pay extra for it. 
 When I was a young doctor in the 1980s Consultants who worked privately were paid 1/11 th less than full time consultants, often abandoning their private work for the 2 years before they retired to get a full final salary pension, many then continuing  private work in retirement.

Nowadays newer staff contracts give private senior doctors working in the NHS a full NHS salary and no deductions for working privately.

 I lost my own career some years ago for objecting to my private colleagues using NHS time and facilities for free to treat private patients at Prince Philip Hospital, Llanelli, all approved by the management. I thought it was appalling, especially when my own urgent patients were discharged home before getting their operations, to make way for those paying privately who mostly had waited a very short time and had less serious conditions.

 Ironically their private treatment was then subsidised further by the NHS management who provided the consultants with free use of hospital facilities and equipment for their private patients. I suspect the private patients did not get this discount and paid the market price for their operations, further packing the wallets of my colleagues. Of course not all doctors work privately but in some branches of medicine such as Orthopaedics, Ophthalmology, General Surgery and Anaesthetics, participation in the private sector is very common. 

I fear sometimes that little has changed since I was forced out of my job following my whistle blowing and I wonder about the supposed core promise of the NHS “free at the point of delivery”. I think that is much more important  than the "stuff their mouths with gold" principle, necessary to bribe the medical profession in 1948 but really? Do we still need to bribe very well paid public sector workers ?

A while back a friend asked me to “take a look” at her elderly dad who had had a knee replacement some years before and now was in terrible pain. I did not have his medical records but could see that the knee replacement he had was not functioning properly at all. I advised him to seek help from the local orthopaedic department who did the operation, but he has been continually “fobbed off” and nothing was done to actually solve the problem of his malfunctioning and painful knee joint.

Recently he turned to the private sector in desperation. He saw a new consultant surgeon, who he tells me, looked at his knee and medical records and declared that the “wrong type” of knee replacement was put in originally and he needed this worn out joint removed and a complete new artificial joint put in . It would cost him £20,000.

I don’t have £20,000” said the man. “Well, you can borrow it”, said the surgeon. The gentleman indicated the pile of notes he had put on the table for the consultation, £180.

 “I had to borrow all of that to see you today.” he said The surgeon took £40 off the pile and handed it back to him. A small discount, but no resolution to his problems of pain and mobility.

The NHS has failed this man by not treating him for his serious and life changing problem . For him there was no “delivery” of the proper treatment the NHS should be giving him and as he can’t afford private surgery. His only options currently are to put up with his pain and discomfort for good or go back yet again to the hospital doctors who have so far failed to offer him curative treatment. in the hope they will eventually offer him the operation he needs on the NHS.

Now that is surely not what Aneurin Bevan had in mind?  The NHS is a mature and much loved organisation. Its time to change the diet of private practitioners from public funding support to healthy independence. Surely all private practice can be housed in private hospitals and clinics and doctors paid by the NHS only for NHS sessions actually worked? 

Dr Siân Caiach. 

Wednesday 5 June 2019

Strategies For Welsh Independence. How Do We Get There?

It is difficult to follow the path when our Nation's Party and its supposedly Pro Independence stance seem to regularly U turn and lose sight of the destination,

No Clear Strategy

Political strategies for Welsh Independence have varied over time. Our country was conquered by its neighbour, England, in medieval times and although it has kept a fair amount of its culture and identity, no recent clear strategy for getting back national freedom has emerged other than trying to follow the Scottish example, yet to be fulfilled.

Muddied Waters & the Dreaded ‘I’ Word

The choice on Leaving the EU has muddied the water. How should Independence supporting Nationalists play the UK/ EU Referendum? What , if any was the plan?
Plaid Cymru had dropped the policy of independence in 1999, ostensibly to boost its numbers to the new National Assembly. Dafydd Wigley, the party leader had simply announced that the party was not for independence and the party had never been so. Whether this had any influence on the vote for Plaid is unclear but they did have their best Assembly result ever to date on that first election.
Over the years independence had crept back, but was pretty aspirational, without a clear pathway or deadlines Plaid Cymru supported Remain, ostensibly for the Grant monies administered by the EU for Wales which following Brexit they did not trust the UK to continue paying. and were concerned about any impacts on business. . Fair points, but nothing likely to explain abandoning Independence. Other welsh nationalists could see the possibilities of Brexit opening up a road to Independence.
In Scotland, former SNP depute Leader, Jim Sillars has eloquently set out the reason for his “out and out” policy.
In surely a regressive policy move against independence, the “I” word has again disappeared from Plaid’s literature in the leaflets for the European Elections. Presumably in a move to capture the Labour Remain vote. The narrative is just the nice generous EU with whom we will be far better off. No mention of the real issues of Wales, which is not primarily the money “from Europe” but the more pressing economic, structural, environmental and health service problems which threaten us all. These more due to the chronic problems of governmental neglect,  maladministration and the horrific waste of public money we see so often.

Leaving the EU Itself Is Not a New Idea

The original Treaty of Rome 1957, was signed in Perpetuity, but events have since forced the EU to allow countries to Leave.
First was Algeria after the declaration of Independence of the former French Algeria. Greenland became independent in 1979 after winning an independence referendum but as their only sizeable industry was fisheries they were severely economically disadvantaged by membership of the Common Fisheries policy. After winning a referendum to exit the EU in 1985 they were allowed to leave. As these areas were – in theory – territories of member countries (when the EU was formed) that had gained independence, a blind eye could be turned to the treaty of Rome as the legal issues were blurred.
In 2004 the EU expanded and the accession countries demanded a change in the constitution to allow whole states to leave. Obviously a treaty in perpetuity is a big ask, as there could come a time for any members when leaving was desirable.

Article 50

This was drawn up at the request of those new members by UK Peer Lord Kerr of Kinlochlard. It was difficult to get the original EU members to agree to it and Article 50 was incorporated into EU law only after the clause was inserted into the Treaty of Lisbon, which came into force in 2009.
Since then Saint Barthelemy, a French Caribbean Island which seceded by poplar vote from the community of Guadeloupe and France, has also left the EU in 2012. greatly improving its tourism economy
However Greenland and St Barts have accepted the position of becoming “Overseas Countries and Territories” of the EU. This means they have a far looser situation, a soft Brexit type position. They have the Euro, follow basic EU regulations, have EU citizenship and even have limited access to development grants, but also have a have strong degree of National Autonomy. They are not in the single market so do not have freedom of movement of workers, but do accept the EU workers rights and other directives.

UK - The First Big Fish To Try And Escape?

As the only countries who have left the EU so far, have been those who succeeded from existing member states,the UK is the first “complete” state to try to get out of the EU. The precedent is set for stateless nations and autonomous territories of larger states who democratically decided to claim their independence,.but not for big fish.
Suddenly the EU pulls out all the stops to keep the UK. Of course it’s the money. With the UK and Germany as the main countries bankrolling the whole of EU subsidies for Farming, development grants etc., many of the smaller countries and weaker economies are seriously concerned at the loss of a huge portion of their “aid money” on which they rely. Little problem getting out of the EU if you are Greenland or St. Barts and have practically no impact on the economy of the EU. But richer nations No Way! Of course it has to be hard and preferably blocked for as long as possible while the UK £millions are still donated to the EU coffers.

Frankfurt's Financial District
Are We Too Valuable To Lose?
And unfortunately even Scotland and Wales are probably too valuable to the EU to let go of easily. The loss of 10.000 former French citizens in St, Barts were not worth arguing over, but the EU seems less keen to encourage Independence in richer, populous provinces such as Cataluña.,
The evidence of that in 2014 during the Scottish Referendum were the huge efforts made by EU leaders to tell the Scottish people that leaving the UK meant economic disaster, a hard border with England, catastrophic loss of trade and a decade to get back in. The current policy in Scotland is now to demand a second referendum on the EU decision and whether they get it or not, go for Indyref2, preferably in 2020 .
This will honour the landmark historic Declaration of Arbroath., the emphatic last statement of the Flower of Scotland. and a timely reminder that there was a time when large English armies were driven by force from the soil of Scotland, not by force of numbers but by superior strategy and unwavering determination to be free, as the Declaration of Arbroath makes clear.

What About Wales?

Plaid's MEP Jill Evans at SNP National Conference 2017

Are Plaid just copying Scotland, waiting for step one, to win a majority in the Senedd? Then they persuade a UK Government to hold a referendum and then we fight for it and win it – probably in the face of a great deal of opposition from all of the powerful interests who benefit so much from the status quo? 
If Scotland win Independence would the rump UK to be nice to Wales? If they don’t win, its a great excuse to refuse even starting the Indy ref. process in Wales. The UK is unlikely to play the game. There may be lots of sweets for Scotland’s Ugly Little Sister (as Blair’s Cabinet allegedly called us) to persuade her to stay, as the last colony. It may work. If economic comfort is the first priority, we may never be free to build our own future .
But what are we doing now to keep the desire for Independence alive and the people of Wales properly educated about the advantages of leaving the UK? Independence of any country is always likely to lead to transient economic problems and various realignments and new alliances. If it is Plaid's view that the EU cannot be exited because of this possibility, are Plaid Cymru confirming that Dafydd Wigley was in fact correct in 1999? and despite the pro Independence Credentials voiced by Adam Price in his campaign for Plaid's Leadership, his actions are equally suspect. 
Personally, as a radical nationalist, I’ve never thought that staying in the EU will advance Independence for Wales. I was a leaver – like most Welsh voters.

But I do accept that for many welsh people, a promise of more certain economic security in the near future currently trumps a longer term project for Independence, even in Plaid Cymru.

The advantage the Scots have is that they won their national freedom in the past, and are only a part of the UK due to a king of Scotland inheriting the English throne. They have more confidence and other advantages such as a separate legal code.Our history does not make us lesser people, we can still chose our own course and not accept the status quo.If we are second rate it is because we allow ourselves to be treated as such . 

I believe personally that every day we fail to promote our own Welsh Independence we shall lose more of our people, more of our culture, and more of our National Heritage. Its a choice that should not be made by Welsh Politicians secretly and quietly in small rooms as now, but publicly and openly.discussed by all. What are we so afraid of ?

The question is “If not now, when?”. Supporting Remain for short term political gain may have a heavy price, if abandoning Independence long term is the practical result.

 Siân Caiach

Historical note: The Declaration of Arbroath - a letter to the Pope
Back in 1320, the king of England  asked the pope to find out his chances of persuading the nobles of Scotland to submit to English Rule. the Scottish King had been excommunicated from the church for some years and there was both a campaign from Scotland to have Robert reinstated as well  as the English argument that he was not a legitimate king . The written reply, in Latin is long and rambling and contains some historical total nonsense. It is signed or had a seal attached by a representative of every noble house in Scotland.  Many of the Flower had been lost, but some are still alive and listed there and their leader, Robert 1st was also present in Arbroath to see it witnessed. After seeing the letter, The Pope advised Edward III  not to have a go at invading Scotland
Robert was no saint and had almost destroyed the Independence cause by getting himself excommunicated after accidentally murdering another claimant to the throne, John Cymyn, in a Church in Dumfries. He invited him in for a cosy chat in a sacred sanctuary. but lost his temper and stabbed him.
After this he had to be crowned in haste, before the Pope, found out and his mate the Bishop of Glasgow got him to Scone and crowned soon as possible before he was excommunicated in Avignon, his wife, daughter and some of his family were captured, the women imprisoned and the men executed, and he spent a lot of time as a fugitive, hiding from the English until the final victory  in the mud of  Bannnockburn  in 1314.

The T Shirts usually quote the stirring patriotism:
"As long as but a hundred of us remain alive, never will we on any conditions be brought under English rule. It is in truth not for glory, nor riches, nor honours, that we are fighting, but for freedom - for that alone, which no honest man gives up but with life itself"
but the document is important politically for the assertion of the rights of all men ,and the first open rejection of the divine right of anointed kings: 
Immediately before the usual T shirt quote is this description of the king: 
 To him, as to the man by whom salvation has been wrought unto our people, we are bound both by law and by his merits that our freedom may be still maintained, and by him, come what may, we mean to stand. Yet if he should give up what he has begun, and agree to make us or our kingdom subject to the King of England or the English, we should exert ourselves at once to drive him out as our enemy and a subverter of his own rights and ours, and make some other man who was well able to defend us, our King;