NHS Reforms: Patient Choice or Doctor's Choice?

There is lots of Government spin about current NHS reforms being all about 'Patient Choice' ... but the reality couldn't be further from the truth ... as these reforms are all about 'Doctor's Choice' (or more specifically 'GP choice'), as NHS budgets are handed over to them to manage. 

As my previous blog pointed out, most GP's have already profited very well from previous 'reforms' (e.g. taking massive pay-rises for themselves whilst working far less hours), and have shown themselves to be more than happy to pocket any additional money too (e.g. spending it on building property portfolios).  

So now the plan is give them virtually all the NHS budget (£80bn) to spend ... under a mirage of 'Patient Choice' ... when in reality GP's will be making all the decisions themselves, and ensuring they maximise the amount of money paid to themselves, their consortia and business partners. Deals, bribes, partnerships and back-handers will all undoubtedly be uncovered, in addition to all the additional lucrative Government 'incentives' on offer (for helping the Government to achieve £20bn in 'efficiency savings').  

'GP's Choice' will become increasingly a choice between 'caring for patients' and 'caring for their own bank balance' ... something many honorable and trustworthy GP's have already expressed concern about.

The Coalition have countered this by saying 'Patient Choice' means patients can go to a different GP if they wish, but the reality is likely to be the complete opposite of this, with 'GP Choice' resulting in GP's being more likely not to take on patients with serious conditions, and more likely to restrict the healthcare provided to the most needy/unwell in our society too (e.g. for treatment of expensive chronic conditions).


The reforms being proposed are testing the honor/integrity of our GP's, with many unhappy about how they compromise their unique (and trusted) position ... of being able to provide healthcare in the best interests of their patients. At the same time, others are no doubt quietly look forward to further pay increases and taking advantage of many additional ways to boost their bank balances (e.g. 'buying-in' additional services - provided by themselves!) ... at the expense of patient care.


If "Patient Choice" is really behind this reform, at what point did patients 'Choose it'? ... as it was not part of any of the Coalitions' pre-election prospectuses!  


I'm afraid it's all smoke and mirrors and spin again I'm afraid ...

Update 29/01/2011: More healthcare groups are raising their concerns, including the Royal College of Surgeons, the Royal College of Physicians and the Royal College of Nursing. Many commentators, including the Nuffield Trust research body, are expressing their fear that patients will lose faith in their GPs if they believe they are denying them treatment on the grounds of cost. It also pointed out that the pay doctors receive, likely to include cash bonuses, will be “sensitive”!

Consumer confidence collapsing

The confidence of UK consumers in the economy and their finances has suffered its biggest monthly drop in 16 years.

Rising VAT was a key factor behind the "astonishing" confidence fall, the GfK NOP Social Research report said.  The UK faced a "very painful period", it added.  More government austerity measures and the surprise contraction in the economy meant talk of a double dip recession was "unavoidable", the study said.

According to the GfK NOP Social Research report the eight-point fall in a key measure of consumer confidence between December and January, to minus 29, was the biggest monthly drop since the end of 1994. Meanwhile, the index representing people's expectations of their financial situation over the next year slid to minus 12, down from plus 4 a year ago.

And the score for expectations for the economy over the next year was minus 30, compared with minus two a year ago. Earlier this week official figures showed that UK GDP shrank by 0.5% in the final three months of 2010 - with the Government blaming the poor weather for most of the fall.

And last week, the Office for National Statistics said that the rate of CPI inflation had risen by more than expected to 3.8%. Meanwhile at the beginning of this month - the standard rate of VAT increased from 17.5% to 20%.

"The VAT increase is the first of the government's austerity measures that has had a widespread impact on consumers, and it seems to have hit people's economic confidence hard, especially as the biggest drop was in consumers' appetite for major purchases," said GfK's managing director Nick Moon.

"With inflation on the up and the full force of the cuts yet to hit, these figures could be the beginning of a very painful period."

indeed ... but not for all ... e.g. take a look at my last post.

Boris Johnson pushes for tax cuts ... for the rich

Boris Johnson, the Tory Major of London, previously a fellow member of the elite Bullingdon Club alongside David Cameron, is no master of political spin and is well known for coming straight out with what he thinks.

In an interview with The Daily Telegraph, the Conservative Mayor of London urged the Chancellor, George Osborne (another past member of the Bullingdon Club), to set a course for low tax and stated we need “a clear direction of travel” that will include how taxes will be reduced over the course of this parliament ... but for who?

Yes you guessed it ... the rich!  ... as he's only arguing for a reduction in the 50% top rate of income tax,  suggesting it is harmful to London's economy (and therefore Britain’s)! David Cameron and George Osborne are obviously having to play a much more political game (particularly given their need to keep their coalition "partners" on board), and are careful to currently offer only vague assurances that they will lower tax.

David Cameron and Boris Johnson

Mr Johnson says he does not want his comments to be seen as “a criticism of my friends”, but he adds: “I need to speak up for London and its interests. I think we need to set out a pretty clear direction of travel, a pro-enterprise direction of travel. He said “I understand about 50p tax politically but there has got to be a sense of where we are going and where we want to be as a country.”

Mr Johnson hints that the Chancellor is planning tax reductions in the March Budget. He says: “I know this is something George knows and he wants to do. Labour have created a climate that is miserable and anti-wealth creation and was resentful … it takes a real effort of political will to dispel that. I hope very much that is what George will do and I will lay money he will. That is the way forward and I know he thinks this.”

Boris Johnson appears to definitely be 'in the know' (no surprise there), so maybe David Cameron and George Osborne are quietly behind him asking for such a tax cut, stressing it to be an 'absolute necessity for kick-starting economic growth' ... so they can gauge reaction ... and determine if they'll be able to get away with it!  Shock, horror, do these kind of things really happen ... absolutely, and all the time in politics ... if the reaction's not too bad then they'll know they can get away with it ... and if there's a violent reaction to it then they'll know they can't (just yet) ... and can conveniently distance themselves from Boris!  

It's worthy of note that Mr Johnson is also urging Mr Cameron to step in quickly to bolster trade union legislation too, to make it difficult for union leaders to call strikes, saying the Coalition needs to develop its “Norman Tebbit side”, a reference to Margaret Thatcher’s industrial enforcer in the past. Yet another interesting 'test' ... at a time of growing concern/unrest about this Government's motives (and actions) ... and at a time where other Government's around the world (1,2,3) are under pressure and being kicked out*!

NB It's interesting to see the political elite in Egypt are moving rapidly to cut off the internet and any mobile communications, to avoid a 'coup de text'!

It's official - Families are having to pay for bankers greed

Families will see their disposable income eaten away as they “pay the inevitable price” for the financial crisis, Mervyn King warned.

With wages failing to keep pace with rising inflation, workers’ take-home pay will end the year worth the same as in 2005 — the most prolonged fall in living standards for more than 80 years, he claimed.

Mr King issued the warning in a speech in Newcastle upon Tyne after official figures showed that gross domestic product fell by 0.5 per cent during the final three months last year, increasing fear that the country is poised to slip back into recession. 

Disposable household income has been hit by sharp increases in the cost of food, fuel and tax, coupled with restricted wage rises for most workers. Last year, take-home pay fell by about 12 per cent, official figures showed, and the trend is expected to continue in 2011 (nb a back drop for recovery - I don't think so)!

The governor warned that the Bank “neither can, nor should try to, prevent the squeeze in living standards”. He said that the economic figures were a reminder that the recovery will be “choppy”. However, he said the biggest threat facing the Bank’s Monetary Policy Committee, which sets interest rates, was rising inflation.

The Bank is expected to use interest rates to keep inflation below two per cent, but the governor said inflation could rise “to somewhere between four per cent and five per cent over the next few months”.

He claimed that rising inflation had been caused largely by increases in global oil and commodity prices, and tax rises such as the increase in VAT introduced at the beginning of the year, which the Bank was powerless to control (nb not true, as 'quantitative easing', or 'printing money', devalued the pound and increased import prices).

“In 2011, real wages are likely to be no higher than they were in 2005,” he said. “One has to go back to the 1920s to find a time when real wages fell over a period of six years.

“The squeeze on living standards is the inevitable price to pay for the financial crisis and subsequent rebalancing of the world and UK economies.” (nb this statement shows they've known all along who will pay for bankers' greed).

Mr King insisted that the Monetary Policy Committee could not have increased interest rates from their current record low level to tackle the rise in inflation. (nb they did not however have to embark upon quantitative easing, which pushed up inflation, and served to only benefit the banks)

“If the MPC had raised the Bank Rate significantly, inflation might well have started to fall back this year, but only because the recovery would have been slower, unemployment higher and average earnings rising even more slowly than now,” he said.

“The erosion of living standards would have been even greater. The idea that the MPC could have preserved living standards, by preventing the rise in inflation without also pushing down earnings growth further, is wishful thinking.”

He added: “Monetary policy cannot be based on wishful thinking. So, unpleasant though it is, the Monetary Policy Committee neither can, nor should try to, prevent the squeeze in living standards, half of which is coming in the form of higher prices and half in earnings rising at a rate lower than normal.” (nb see later on to understand their plan with respect to the latter).

“The Bank of England cannot prevent the squeeze on real take-home pay that so many families are now beginning to realise is the legacy of the banking crisis and the need to rebalance our economy.”

The comments represented one of the governor’s starkest warnings yet, and yet alongside his apparent sympathy lies a very different truth ... as instead of expressing apparent frustration at not being able to prevent the squeeze in take-home pay, the Governor was actually telling us he wants to make sure take-home pay continues to be squeezed (by keeping down pay)! He said "attempts to resist the implications for real take-home pay by pushing up wages would require a response" from the Bank's monetary policy committee (i.e. they'll raise interest rates), implying that the Bank plans to thwart attempts by wage-setters to keep up with the above-target price rises (i.e. stop above 2% pay settlements). This sinister threat was almost 'hidden' from view, under a veil of sympathy, from someone we cannot trust. 

Mr King's feigned sympathy for savers and highlighted the failure of lenders to pass on cuts in interest rates. “I sympathise completely with savers and those who behaved prudently now find themselves among the biggest losers from this crisis,” he said. “But a return to economic stability from our fragile condition will require careful and well-judged steps looking beyond the next few months.”

He chose not to mention the big winners in the crisis, i.e. the bankers! Yet his claim that the banking crisis was behind the ongoing squeeze on living standards also comes at a sensitive time as the banks, who indeed created this crisis, under the watchful eye of the Bank of England, announce multi-million pound bonuses for their executives and whose current speculation is continuing to push up commodity prices (and hence inflation)!

Oh they must see the people in the UK as bunch of 'mugs', or more specifically a group of ignorant and apathetic people!

Shock, Horror ... the economy is contracting

For all the shock/horror expressed by mainstream economists and pundits, such news comes as no surprise to the online blogger community (or most people in the street)! 

Mainstream economists were predicting GDP was going to RISE by between 0.2-0.6% (due in part to the poor weather in December), but the Office for National Statistics figures show that the economy actually CONTRACTED by 0.5% (and was at best flat, after stripping out the impact of the poor weather)!  Hence their complete shock at seeing the figures!

The economy is clearly 'heading south' and the fiscal tightening has hardly even begun (e.g. public sector cuts, VAT hike)! In fact many bloggers (including myself) have for some time been saying that the real economy has never actually recovered ... as all the measures introduced (e.g. bank bailouts, quantitative easing, near-zero interest rates), combined with excessive amounts of spin, served only to postpone the reality check ... and at great expense unfortunately too (e.g. the creation of a collossal public debt, the significant devaluation of the pound, rising commodity prices and imported inflation).

The Government saw the financial crisis as a green light to bring in swinging public sector cuts, and to introduce massive (and regressive) tax rises (e.g. VAT hike) for the vast majority of people (nb but not for the ultra-rich - who are quietly being given more opportunities to avoid tax altogether).  

The truth is, as in business, in the long run you cannot 'cut your way to success', and one needs to have a robust plan for creating sustainable growth and prosperity for all, by 'leading' in innovation and the adoption of best practice (a point emphasised from the outset in my book - "Lean World: The DNA of Success and the Path to Prosperity"). 'Leaders' have failed to do this in business, and political leaders have failed to do this in Government too ... and we're now suffering as a result (nb future generations will suffer too).

Sir Richard Lambert, outgoing Director General of the CBI, yesterday chose to attack the Coalition Government for its lack of vision, and a lack of a growth strategy to compliment its hardline plan to cut public expenditure.  Whilst this is true, I have to say there is a certain amount of hypocrisy in Sir Richard Lambert saying this (and particularly on leaving office) as whilst in post for 5 years he did very little (i.e. nothing) to help/support business adopt best practice and to put its own house in order, but he did a great deal to lobby Government on behalf of banks during the banking crisis, as the CBI proved itself to be the "Voice of Banks" rather than the "Voice of Business" - which the Government did not seem to realise at the time (NB the CBI is a predominantly a lobby group paid for by business in proportion to their size - and most of the largest UK companies are banks)! 

Smaller businesses are still not getting loans, despite the bailouts given to the banks, and 2 years on the government is still trying to press them hard to do this (and it appears they are failing).  Double dip - here we come - unless we see drastic change from our 'leaders' now ... and not just in the spin that's used!*

* NB The current 'leaders' have pressed home the need for drastic cuts for the last six months, which has not surprisingly raised concern about the security of people's jobs. The current spin (i.e. about the dip being mainly a result of 'the weather', and not the fundamentals in our economy) is IMHO a desperate attempt to stop consumer confidence falling even more ... and to stop the economy going into free-fall ... but will it work, and if it does, how long will it last?  Time is running out to do anything ... and all this does is buy a little more time (with even worse consequences further down the line if nothing is done)!

Are we really 'all in this together'?

Government announces tax free saving and inheritance plan for the ultra rich

The Government, with the use of a clever mix of smoke and mirrors and spin, is telling us it wants to sell off 15% of our national forest-land to private owners ... and says it is needs to do so to cut the deficit, but the real reason could not be further from the truth ... !

In reality this move is being done so the super-rich can profit from it, and at the same time have their tax bill reduced ... by expanding a unique tax free investment/savings loop-hole only available to them ... as investments in land are free from capital gains tax ... and are uniquely free from any inheritance tax too (which is why many ultra-rich landowners, bankers and football players have been quietly 'cashing in' and buy more land).

This carefully crafted move exposes the 'double standards' that currently exist and the real hypocrisy lying behind the 'We are all in this together' spin, as this move comes at the same time as ordinary hard-working people are being disproportionately forced to pay higher levels of tax as a result of the recent VAT hike!  

As I have said on this blog before, one of the most fair/just taxes we should be introducing as a country is a Land Value Tax, in order to replace unfair property taxes, to reduce VAT, to reduce tuition fees and to reduce the tax on jobs. The loophole on inheritance tax should also be closed too (so why have the Government, and indeed the last Government, failed to do such things ... well it's obvious really isn't it - i.e. just follow the money ... and look out for all the self-interest and greed).

Vince Cable (Business Secretary) understands the importance of introducing a Land Value Tax, as he held a summit on the subject in the House of Commons recently, so it's a disgrace that this Government, which he and the Liberal Democrats are a part of, are now actively pushing such immoral/unjust changes through ... especially after the immoral tripling of tuition fees and the scrapping of the EMA. Vince Cable must not care or he has become quickly corrupted - see my Homer Simpson post earlier. (NB Today his department also come under fire from the CBI, saying it needed to be 'less of a talking shop' and 'more of an action-oriented growth champion').

It's clear the Liberal Democrats are providing a convenient smoke-screen for the Conservatives, who are taking every opportunity to quietly reward their ultra-rich families/backers (e.g. landowners, bankers) ... and the quicker this smoke screen is removed the better!

It is worth noting that any potential benefit gained from selling off land is going to be short-lived, as any one-off revenue claimed will be quickly offset by large reductions in capital gains tax and inheritance tax bills for the ultra-rich (for generations to come). 

This proposal highlights how 'ignorance is not bliss', because it's young people, pensioners and hard-working taxpayers that are having to pay for these tax cuts to the super-rich, whilst also bailing out bankers (who are still paying themselves obscene bonuses)! 

Ignorance or Apathy - Homer Simpson's view ...

Who do you know that thinks like Homer Simpson?

If most people don't understand what Homer is saying in this caption then we need to educate ... On the other hand if most people think in the same way as Homer then the future (e.g. for families and future generations) is bleak ...  as those exploiting (and stealing the future of) hard working people will continue to do so (e.g. banksters, politicians, judiciary, lawyers) ... up to the point* where all the honest, honorable and hard-working people can no longer survive (e.g. afford to eat - which will be the point when they finally decide they care) ... and riots begin! ... 

* NB Those in Power, and abusing their Power, will try to stop just before this point, but their insatiable greed will make them carry on!

What's worse - Ignorance or Apathy?

As bankers pay themselves billions in bonuses for gambling, and everyone else suffers and pays the cost of bailing the banks out ... most people are living a life of ignorance or apathy ... with hardworking people/families losing their jobs and paying higher taxes, and with future generations being burdened with debt.

Meanwhile these legalised ponzi scheme fraudsters (banksters) are carrying on regardless and getting away with it ... they are lending very little to businesses but speculating a great deal on commodities (such as oil, precious metals, cotton and grain - pushing up raw material prices and thus inflation) and the collapse of economies (e.g. that have bailed them out, such as Ireland).

At the same time the medical profession (consultants and doctors) are busy ripping off the NHS, with consultants earning £100k's (e.g. taking £100k plus extra a year by charging £1000 for just 4 hours extra work) and with doctors quietly taking home 40% more pay (and for many much more than this) for doing less work (e.g. no out of hours cover) as a result of flawed GP contracts.  I raised these issues on BBC's Question Time at the time and they reluctantly admitted it ... nb people used to go into the medical profession with a passion for helping people, not to milk the system dry and use the proceeds to fund property portfolios ... the money they have taken out could have paid for MORE doctors/nurses and much better patient care ... but they clearly decided this was not in their own best interests and decided to take the money for themselves instead (nb as a result taxpayers now pay some of the most expensive doctor/consultant fees in Europe).

Can we expect the current wave of politicians to sort these things out properly ... Well I'm afraid the answer at the moment is 'no' as the truth is they do not have the interests of ordinary hard-working people at heart ... and their own self-interest/greed stops them from challenging others playing the same 'game' too ... so it's going to take far more than this I'm afraid.

Some argue that people get what they deserve ... and if they remain ignorant/apathetic they should not be surprised (or even complain) about being exploited (i.e. 'taken for a ride') by others ... but do you agree with this?  ... and what's worse in your view ... ignorance or apathy? (why not think about it, and avoid the obvious "I don't know and I don't care" answer!)