Is the Government 'listening' ? ... to an almost unanimous vote of no-confidence !

The Government have said they need to 'pause' and 'listen' ... to the people and the professionals involved in the NHS .... and the RCN have made their voice heard very clearly today ... delivering an almost unanimous vote of no-confidence in the Health Secretary Andrew Lansley and his management of NHS reforms!  

... and rather than address the RCN conference today, Andrew Lansley elected to meet a small group of nurses from around the UK instead - a decision that caused anger amongst delegates at the conference.

Peter Carter, the general secretary of the RCN, added: 'I hope the health secretary goes away and thinks about what we have said to him. If there aren't changes there will be a hardening of opposition.'

Ed Miliband warned that the plans would put hospitals at risk and lead to staff losing the power to do what they believed was best for patients. He also dismissed the Government's 'listening exercise' as no more than a 'PR stunt', adding that 'they appear to believe that people don't like this bill because the Government hasn't properly explained it ... but the opposite is true ... the more people understand and hear about these proposals the less they like them!' 

'It's not a problem of public relations - it's a problem of principle' and added 'The answer to a bad bill is not to slow it down, but to junk it'.

No to GP commissioning ... to ensure good decisions and to avoid conflicts of interest

MP's are heaping yet more pressure on the government now by suggesting GPs should not be allowed to take control of the budget all by themselves - take a look at this article in the Telegraph for instance.

The House of Commons' health committee said they should be joined by a range of staff including nurses and hospital doctors to decide how funds are spent.

The move would improve accountability and decision-making, with the MPs stating that the sole focus on family doctors involved in GP consortia is wrong.

Instead, they said the GP consortia should be re-named NHS commissioning authorities and be overseen by a board with representatives from other specialities.

"The expertise of other professionals was essential to ensure the best decisions were taken and to avoid conflicts of interest".

The MP's in the Health Committee are pointing out the obvious ... e.g. the need "to avoid conflicts of interest" ... Public health vs GP profits (from rationing healthcare).

NB their suggestion will not solve this problem entirely ... as a GP's decision to refer a person for treatment is taken in their head ... so most of the time people won't know whether their GP has rationed their care or not! Hence GP's should not be allowed to profit from decisions they make in any other way! NB if you think all GP's are honorable and trustworthy, just remember how they took the taxpayer to the cleaners the last time they re-negotiated their contracts (whilst dumping out of hours cover) ... which was unfortunately down to the incompetence of the last Government too!*

Let's see if the current Government, who said yesterday that they are 'pausing to listen', actually 'listen' ... or whether they're just trying to avoid a total massacre in the forthcoming local elections (before pressing on regardless).

* NB I raised this issue on Question Time at the time these changes were being pushed through, and a fellow blogger made the following point about a GP's recent comments on Question Time too. 

"In a recent BBC Question Time programme a GP from the area from which the programme was being broadcast stated that he was aware of a conspiracy amongst certain GP's to loot the NHS budget for their own financial interest, which, in his view would be detrimental to patient care".

Another honest and trustworthy GP "spilling the beans" and the public ignore this at their peril - as ignorance blinds ... but apathy kills!

Pausing to 'listen' ... or 'avoiding a massacre' (in the forthcoming elections)?

At last - the BBC is finally starting to raise the fundamental issues raised by current NHS reforms ... e.g. rewarding GP's for rationing healthcare (a clear conflict of interest - i.e. profiteering from patients and from not referring patients properly), as well all the other fundamental issues raised by every medical professional body (e.g. British Medical Association, Royal College of Surgeons, Royal College of Nursing etc etc).

And its worth remembering that the BMA only 'backed' 'GP commissioning' due to private lobbying/voting from 'greedy' GP's. Everyone else is against these reforms, including the vast majority of honest, trustworthy and honorable GP's (take a look at this post  and this one for instance). 

To push through these reforms the Government are trying to bribe the 'greedy' GP's to take part, by offering them lucrative personal rewards (e.g. fees, bonuses and shares in commissioning groups, as well as lucrative deals in which they can profiteer from rationising healthcare and referring work to themselves). They have also been quietly trying to force those GP's against the reforms into commissioning (which they are still trying to resist), but the Government are now saying they'll let another 'GP consortium' profiteer from doing it instead!

The Government will still try to press ahead with these controversial reforms, which will be to the detriment of everyone's health and well-being, and which will eventually destroy the NHS. 

These reforms were not asked for, or voted for, by anyone (and were in no party manifesto) ... the introduction of the NHS was a key moment in UK history, and its effective destruction will be equally as dramatic ... we must not lest this happen ... and IMHO the BBC have a duty of care to continue to raise these issues too ... to ensure the public voice is heard!

In the meantime everyone can sign the petition to the Government ... as well as the petition being sent directly to their MP.

IMHO the Government are not 'delaying' to take time to 'listen' ... but to make sure they don't suffer a complete massacre in the forthcoming elections in May! Believing these people will listen is like believing Gaddafi will ensure a ceasefire ... and voters need to make sure their voice is heard in these elections ... as only by ensuring the coalition are crushed in these elections will they actually listen to anyone ... and stop the destruction of the NHS, as well as the removal of patient trust in their doctor to act in their best interests!

Bloggers are attacking the reforms from every direction, let's see if the Government listen ... I thought this post from a new blogger, Dr John Taylor, summed things up well by asking one simple question:

"The question is: Do I want my GP to look at me as a patient, with a focus on curing my ailments, or as a business person focused on reducing costs and maximising income? For me it's simple, I prefer my GP to remain a GP".

to which I added ... 

"a fantastic post and I fully agree - this one simple question sums up the problem with these reforms perfectly ... and it highlights how/why the government have been trying to bribe GP's to back the reforms ... as he can't do it without them and he needs their help to ration NHS care at source (i.e. before being referred any treatment) - hence they were prepared to offer GP's part of the profits/savings (e.g. as fees, bonuses, shares in commissioning companies, referral work to themselves instead of hospitals)"!

Let's see how people vote in the elections too, and let's see if they start to listen then!

Removing corrupt monetary and economic systems

Extracts from an excellent article by James Roberston, which uncovers the corrosive effects of current (immoral) monetary systems and some of the 21st century (ethical) alternatives available ...     

"More and more we are starting to see the corrosive effects of current monetary systems. They are being increasingly blamed for: 

• Systematically transferring wealth from poor people and countries to rich ones,
• The money-must-grow imperative that compels people to make money in socially and environmentally damaging ways,
• The diversion of economic effort and enterprise towards making money from money and from the rising values of existing assets, instead of from providing valuable goods and services,
• Systematic bias in favour of people, organisations and nations who should be managing the system efficiently and fairly on behalf of all,
• Eroding the credibility of political democracy, and
• Fuelling opposition to globalisation in its present form, thereby threatening world peace and security.  

Such insights all point to the fact that the workings of the money system now need to be changed ...

The starting point is to note that at the national level a government's principal operational functions include i) control of how the money supply is created and managed, ii) control of how public revenue is raised by taxing and charging and borrowing, and iii) control of how that public revenue is spent.  

Given the above, in a democratic society one might expect that all the money created as additions to the national money supply backed by the state would be created by an agency of the state, that it would be spent into circulation on public purposes, and that it would be created debt-free.  

What actually happens, however, is quite different. In the UK, for example, less than 5% of today's national money supply is created debt-free by the Bank of England and the Royal Mint as banknotes and coins - over 95% is created by commercial banks writing it electronically into their customers' bank accounts out of thin air as profit-making loans.  

It has been estimated that UK commercial banks make over £20 billion a year in interest from creating this electronic bank-account money, whereas the issue of banknotes and coins brings in public revenue of less than £3bn a year.  It has also been estimated that additional public revenue of about £45bn a year would result from a reform that i) prohibited commercial banks from creating bank account money, as they are prohibited from creating banknotes and coin, and ii) gave the Bank of England the task of creating it and passing it as debt-free public revenue to the government to spend into circulation.  

The following are further arguments for a reform along these lines. 

(1) The official-currency money supply is a public resource. The value of creating it should be a source of public revenue. To allow it to be captured as private profit is both economically damaging and unfair to particular sections of society. 

(2) Creating money as interest-bearing debt is systematically inflationary.  A debt-based money supply means that more money than has been created is always needed to pay back the debt involved in its creation - not only the "principal" (the sum borrowed) but also the interest payments on it while it is outstanding.  That is why the main objective of monetary policy now has to be a target level of inflation - within a bracket of, say, 2% - 3% a year. 

(3) Creating money as debt is pro-cyclical.  It tends to amplify the volatility of the business cycle instead of damping it, because banks want to lend more and bank customers want to borrow more when the economy is booming, and less when it is depressed. It thus contradicts the anticyclical aim of monetary policy. 

(4) If the great majority of new money entering circulation is channelled into the investment and spending priorities of commercial banks and their customers, it creates economic distortion in favour of speculative investment in the value of existing assets, and against productive investment to produce new goods and services.  For example it encourages speculative investment in land - one reason for the spectacular rise in house prices compared with other prices and wages and salaries in many countries in recent years.  

(5) One inevitable feature of an economy in which money is almost entirely created as debt is greater total indebtedness - higher levels of debt for citizens, companies and government which causes; i) Social damage and injustice as it artificially widens the gap between poor and  rich.  It increases the flows of money from poor to rich, since the poor have greater need to borrow money and the rich are better placed to lend it; and ii) Environmental damage and destruction.  When the money needed for all transactions has to include a sum to pay the interest arising from the way it was created, organisations and individuals are compelled to convert natural resources into money more rapidly than they might otherwise need to.  

(6) Allowing commercial banks the privilege of creating, free out of thin air, the main resource they need as input to their business gives them a subsidy enjoyed by virtually no other industry.  It protects the big, established commercial banks from competition from smaller, more enterprising, efficient and customer-friendly potential new entrants to their various lines of business, including the country's main system for making and receiving payments.  This reduces the economic efficiency both of the wider financial services industry and of the economy as a whole.  

(7) How money is now created and what the effects of that are, should not remain veiled in mystery. Widespread failure to understand how the monetary and financial system now works is a serious impediment to its improvement.

Fractional Reserve Banking - 'Creating money out of thin air'

The Bank of England can currently only influence how much new money the commercial banks create, by regulating interest rates, thus the price of borrowing, thus bank customers' demand for loans, and thus the amount of new money the banks create.  It is time now for the obvious next step - to make the Bank clearly responsible on behalf of the state for actually creating the required amounts of state-backed electronic bank-account money, just as state agencies create new banknotes and coins. 

As far as public revenue is concerned, existing taxes are also becoming less viable.  For example: 

• National economies in a competitive global economy have to reduce taxes on incomes, profits and capital to attract investment capital and highly qualified people - both being increasingly mobile. 

• Ageing societies will be unable to support growing numbers of "economically inactive" people by taxing the work and enterprise of fewer people of working age.  

• Internet trading is making it more difficult for governments to collect customs duties, value added tax and other taxes and levies on sales, and easier for companies and rich individuals to shift earnings and profits to low-tax regimes and tax havens.

• Tax avoidance by big corporations and rich individuals is reaching crisis proportions. Estimates are that tax havens cost £255bn annually to governments worldwide, and hold assets of $11.5 trillion ($11,500bn), causing serious distortion of economic priorities and supporting criminal money laundering.

Shifting a large part of the tax burden on to the value of land and other common resources which cannot be moved abroad will probably be national governments' most effective response to these problems. 


As well as becoming less viable, existing patterns of taxation are now positively perverse: 

• By heavily taxing employment and rewards for work and enterprise and lightly taxing the use of common resources, they systematically encourage inefficiency in all kinds of resource use - under-use and under-development of human resources, and over-use of natural resources (including energy and the environment's capacity to absorb pollution, including carbon emissions); and  

• By taxing the value added by most people's positive contributions to society (VAT), and failing to tax value subtracted by those who make most profit from common resources, they systematically skew the overall burden of tax in favour of a rich minority. 

These facts argue, on both economic and ethical grounds, for a "tax shift" on to the use of, or profits from, the value of common resources.   

Common resources are resources whose value is due to nature and to the activities and demands of society as a whole, and not to the efforts or skill of individual people or organisations.   The site value of land is the most obvious example. The value of a particular land-site, excluding the value of what has been built on it, is almost wholly due to the activities and plans of society around it.  For example, in the UK when the route of the London Underground Jubilee Line was published, properties along the route jumped in value.  Access to them was going to be much improved. A public policy decision and subsequent investment of public money, gave owners of those properties a £13bn windfall financial gain.  They had done nothing for it; they had paid nothing for it; they had been given a very large free lunch. By contrast, the UK Treasury raised £22.5bn for UK taxpayers in 2000 by auctioning twenty-year licences to use the radio spectrum for the third generation of mobile phones.  The governments of other European countries also raised significant sums that way. 

Local government in the UK, including the Greater London Authority, has been exploring whether rail and road transport developments could be financed out of the increases in property values which they generate.  In 2004, the  Vice Chair of Transport for London summarised some of the arguments for land value taxation:  

"With income from LVT … the government could provide new public transport infrastructure; abolish economically damaging property taxes such as council tax, business rates and stamp duty; raise personal allowances so that millions of lower-paid workers pay no income tax at all; and reduce VAT rates to help consumers and businesses. The tax would improve earned incomes; cut the cost of tax collection; provide affordable homes; reduce urban sprawl; avoid property-led business booms and slumps; and minimise the need for constant changes in interest rates to control land prices"

Pressures for a shift to environmental taxation have recently risen along with awareness of global warming and other threats too - including world shortages of energy, food and drinkable water, and worsening pollution of the oceans. 

In addition to land-sites, the electro-magnetic spectrum, the national money supply, and the environment's capacity to absorb pollution and wastes, important common resources include: the value of unextracted energy; limited space available for road traffic, airport landing slots, etc; and water for extraction, for fishing and for waterborne transport. The annual value of these and other common resources is very great, and rises along with the world's economic growth.  

The overall structure of public spending programmes needs more searching scrutiny by politicians, the media and the public than it now gets.  Two examples illustrate this. First, $1.5 to $2 trillion a year is estimated to be spent worldwide on perverse subsidies which encourage economically, socially and environmentally damaging activities (Myers, 1998).  These include the subsidies from rich-country governments to their farming and agricultural sectors, which - combined with tariffs against imported food - devastate those sectors in poorer countries and expose the hypocrisy of rich-country support for free trade.  But there are many other examples of perverse subsidies. Sustained national and international determination is needed to reduce them year by year.  

Second, support for a basic income (or Citizen’s Income) continues to grow, especially in Europe but elsewhere too. It would be paid to all citizens as of right, out of public revenue. It would include state pensions and child allowances, it would replace many other existing social benefits, and it would eliminate almost all tax allowances, tax reliefs and tax credits.  It would recognise that, in a society of responsible citizens, some of the public revenue arising from the value of common resources should be shared directly among them.  Politicians and government officials now channel huge sums in contracts and subsidies to private-sector business and finance, as well as to governmental organisations, to provide citizens with public services.  Much of that public money could be given directly to citizens to spend for themselves in a market economy made more responsive to their needs by the other reforms proposed.  It would especially help poor people who would not benefit from reductions in income tax but would have pay the new environmental taxes. 

The state should carry out its three main operational monetary and financial responsibilities in ways that will distribute the value of common resources among all citizens and reduce or even abolish taxes on earnings and profits from providing useful goods and services.  This will create a new framework of prices which reward the market economy for delivering outcomes which combine economic efficiency with social justice and environmental care.  The state will then be able to let the market economy operate more freely, with less intervention, than now.  

Business people and everyone else too, as citizens, will experience greater freedom at the personal level. A Citizen's Income will allow them, if they wish to do so, to reduce the amount of money they must earn by working as employees.  Then, with more time and energy to supply themselves and their families with some of the goods and services they now have to buy, they will be able to further reduce their need to spend money if they want to. As consumers, employees and savers they will be in a stronger position to influence - and choose between - the people they have to deal with in those capacities.  

Overall, attention will shift to creating well-being for people and the Earth; to enabling people to develop their capability, rather than reinforcing their dependency; and to conserving the Earth, rather than transforming its resources as rapidly as possible into money. The fairer sharing of the value of common resources will help to decentralise power and wealth - both by giving a fairer deal to people in their own places and by requiring rich and powerful people and corporations and nations to bear their full share of the environmental and social costs of centralisation. The new framework of monetary and financial incentives will automatically harness self-interest to common interest within and between nations. 

Together such reforms offer the prospect of  the democratic state performing its monetary and financial functions more purposefully and effectively, thereby being able to allow the market economy to operate more freely.  They will also make it financially easier for people to reduce their present degree of dependence on goods and services and jobs provided by big corporations and the state, and for both people and organisations to act in ways that conserve, not squander, natural resources ..."

-----

Robertson's excellent article goes on to look at this on an international level too (and I would recommend reading it in its entirety). Expanding upon this we clearly need to look at the barriers to such reforms ... including the vested interests and misuse of Power by the small minority in Power and quietly wielding Power (i.e. 'the Invisible Hand'). 

The current 'economic system' is designed to ensure the small minority in power 'profiteer' heavily from it, whilst adding no value themselves and at the expense of everyone else (i.e. Poweromics) ... and they will wield all of their power to resist any changes to this. 

For instance Governments (including the UK) are in the 'hands' of these people, either through infiltration (i.e. they are also part of this small 'elite' group), conspiracy (nb the current Conservative party gets the majority of its funding from this group), or by way of threat (e.g. due to indebtedness and/or by threats by this small group to move their accumulated wealth/ support elsewhere).

However Ignorance and Apathy are also to blame ... as those misusing Power will continue to do so for their own self-interest and gain ... until more and more people realise what's going on and start to demand change! ... and it is at this point people will start to see how the media, political and judicial systems are also designed to support this small minority too!

BBC - Duty of Care ... and a Dereliction of Duty

To date the BBC has singularly (and deliberately) failed to address the fundamental issues raised by current NHS reforms ... e.g. rewarding GP's for rationing healthcare (a clear conflict of interest), as well all the other fundamental issues raised by every medical professional body (e.g. British Medical Association, Royal College of Surgeons, Royal College of Nursing etc etc)

In my humble opinion this is not only a dereliction of duty, but also points towards a deliberate conspiracy between the BBC and the Government, which is allowing the Government to press ahead with controversial and detrimental NHS reforms which affect everyone's health and well-being, and destroy the NHS. For instance, ask yourself why the Government are trying hard to bribe the greedy GP's to take part (with lucrative personal rewards for implementing it) ... and why all the true, honest, trustworthy and honorable GP's are so against it.

Current NHS reform were not asked for, or voted for, by anyone ... yet are being pushed through rapidly by this Government regardless of all the concerns raised by professional bodies and the general public. The introduction of the NHS was a key moment in UK history, and its destruction is equally as dramatic. Yet the BBC are failing to cover this issue in any real way (despite the public repeatedly asking them to). Nick Robinson is conveniently (for the Government) and deliberately not addressing it, preferring to focus all his attention on Libya instead, and the BBC's health correspondent, Fergus Walsh, is not addressing the issue either (despite his stated aim of wanting to look into the future and into the ethical issues associated with healthcare in particular).

Here is what I have posted on his blog when discussing the sharing/adoption of good practice (nb my post, the first post in response to his blog, was referred to their moderators rather than posted, despite the fact it broke no house rules ... and was then left that way!) 

Hospital managers also have a responsibility to adopt world class leadership and management practices ... but unfortunately such practices are almost completely opposite to what most managers currently understand/practice! However in leading hospitals the adoption of 21st century practices is quietly (and successfully) transforming patient outcomes, radically improving patient care and reducing unnecessary stress for both patients and staff. The problem is this type of 'management' is radically different to 'traditional management' ... and needs far less 'management' ... which perhaps goes some way to explaining why some managers are rather slow to spot it and adopt it! (i.e. it's a mixture of ignorance, apathy and self interest on the part of leaders and managers). Why don't you have a look into this area as well?

PS Why are you not also blogging about the ethics of profits v patient care (e.g. rewarding GP's for rationing healthcare)? IMHO if this blog is worth anything at all it should really be tackling this. Or is this an 'agreed no go-area' for the BBC! I note Nick Robinson is also completely avoiding this area and is happy to allow the Government to quietly destroy the NHS too ... through reforms no-one voted for and every professional body is against ... yet no-one is being listened to ... ethics, democracy, an independent BBC? I think not.

... and here is what I subsequently posted (post 11), which the BBC did reluctantly post!

Post 1 was referred for no good reason and has still not been reviewed/published! 

IMHO the BBC health blog is failing in its duty of care by not tackling the fundamental (and once in a lifetime) ethical issues/crisis which the NHS is facing at the moment (e.g. allowing GP's to profit from rationing healthcare - i.e. conflicts of interest), and Nick Robinson isn't either (preferring to focus only on Libya), despite the fundamental concerns raised by every professional medical body. Incompetence, dereliction of duty, conspiracy ... could be any or all of them.

The BBC appear not to want to upset their paymasters ... and this is not the licence fee payer - but the Government who decide how much (if anything) the licence fee payer has to pay! Independent ... I think not! They are just as bad as the politicians ... i.e. looking after themselves with no responsibility/duty of care.

I think these posts say it all really ... i.e. don't expect the BBC to feel they have a duty of care to the public (who they are supposed to serve - as we pay their salary), as they know the group who actually decide their fate is the Government  ... who agree the level of BBC licence fee and force people to pay ... but then most learned people in the blogosphere realise this already (nb the ex-director general of the BBC, Greg Dyke, Jeremy Paxman and Peter Sissons etc have all previously voiced their concern about this in the past).