Not Mid Morning Matters

JD in the Morning, off air…

Tag: nhs

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50 and not out!

It’s a landmark in life being fifty, so we are told or sold. I have just hit that day of fifty circles around the sun and I’m not quite sure it really means anything though I don’t go for the “it’s only a number”.

I grew up, probably much like you, watching the “grown ups” celebrate being fifty with parties, “having a bit of a do” seeming to mark what appeared to be an achievement. To get to the big “5 O” was an achievement. Wars, the reality of a much less easy life a generation or two ago and the physical nature of work, real labour all took their toll. To get to fifty was something to really celebrate, a milestone in spite of everything before. To be well and fifty was something to celebrate. Now, being fifty means what? I haven’t done a days manual labour in my life. I have worked hard and I have worked long hours. Until last year spent over 15 years holding down at least two jobs, often with just 4 hours sleep between them. I have built a number of businesses in my time and I have been self-employed for over 20 years but that’s either been wearing a suit or a floral shirt, surviving on my wits and sheer tenacity but I have been sitting on my arse doing it.

So what is being fifty? I probably have more days behind me than in front of me but that does not mean the days ahead will be any the less productive or adventurous. Being fifty is not about getting a red sports car, a gold chain round me neck and a young, blonde “popsie” on my arm. I had my mid-life crisis over five years ago with catastrophic consequences. I will live with that arrogance, self-indulgence and stupidity for the rest of my life. It did give me one incredible lesson. There is NOTHING more powerful on this earth than the truth. Truth beats Love, which is fickle little sod in all its forms. The Truth can’t be beaten or contained. If you are stupid enough or arrogant enough to think you can beat the truth then it will beat you, without mercy and when you least except it. So my mid-life “crisis’’ wasn’t all bad.

Back to being fifty. The increasing medicalisation of old age means I could go on for decades popping pills and having bits replaced as and when. By doing this I will add to the real cause of the painful, financial reality facing the future of the NHS; the National HEALTH Service not cure service. The NHS not a church, doctors are not gods and the NHS doesn’t need politicians to save it. The NHS needs us to look after us, and for us take responsibility for our health. If I take care of me then most of my years to come could be healthy and productive. One of the realities of those who are self-employed or freelance is they don’t get as sick as those who are employed. If I can talk I can work and if I can talk I will always work. It’s my responsibility to make sure the arse I sit to do it on doesn’t get bigger.

There is a another reason that celebrating being 50 is a bit off. This time last year my eldest daughter was preparing to go traveling, to have an adventure before coming back and, I have no doubt, forging a brilliant career when she came home. But that was not to be. Polly, my eldest bright, cleaver, funny, beautiful, player of daughter was killed in her car early in the morning on 31st October 2015. She had celebrated her 22 birthday on 17th October at my sisters home, where she was living and working while she saving up to go travelling. October is month that will never be, can never be the same again starting with me, ending with Polly.

As I pass 50 not out, I will look after myself better, I will do my best by those who deserve it, I will be there for my children and I will look up at the sun more than I look down at the ground. I urge you to do the same too.

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Experts; aren’t we all?

What makes Doctors think they are special, “so very special” that they don’t have to work 7 days a week like many of us? Actually, in reality, Doctors do already work 7 days a week on rota but they currently get more money for weekends than what’s being offered in their new, soon to be imposed contract. How you side in this Junior Doctor’s dispute, be it the emotive BMA “patient safety” or the Government “manifesto commitment to a 7 day NHS” against the constant “crisis” backdrop the NHS is always in, the whole thing is all about money.

Back to the initial question. What makes Doctors think they are special? Is it the commitment to be a doctor that starts in their early teens when they select their GCSE’s? Is it the vision, commitment and passion to select and get the right A Levels and grades to match? It could be the 4/5 years at Medical School followed by a decade or more of training, exams, more training and more exams? Maybe it is the constant changing of jobs and hospitals to gain vital experience, which could also mean travelling 100’s of miles a day, including at weekends? Perhaps it’s the failed relationships and missed family moments as being a doctor is all-consuming? Hard to know really what makes a Doctor special but in a world of Google and Social Media, where we can diagnose ourselves without having to do any of the above, what’s the point of all that effort and commitment? Doctors aren’t special. We don’t need experts.

During the now widely discredited Referendum Campaign (discredited on both sides in a report by the Electoral Reform Society published this last week) one of the most revealing moments was when Leave campaigner Michael Gove (remember him) said “I think people in this country have had enough of experts”. Experts had been telling us what might happen if we chose to Leave or Remain in the EU. It is fair to say that following the result to leave on 24th June all of the doom predicted by those experts has not happened, so far. In fact, after the initial shock, the UK economy has returned to pretty much where it was when the (then) Prime Minister David Cameron (remember him) called The In/Out Referendum in February this year. It’s been a very long 7 months.

Is Michael Gove right in his assertion that we don’t need experts? Is our existential age a time of instant information and connectivity to anything, everything and everyone making us all instant experts? We can now have hundreds of “friends”, we crave “likes” and most of us have more “followers” than Jesus could manage when he was “alive”. Does this means we don’t need real experts, doctors, elected politicians, public servants, journalists, newspapers, radio, TV because we can all get what we want when we want it, all at a click or swipe or scroll? The internet has democratized information and for those who wisely choose to go beyond one single source of information or a single “trusted” news site we can be better informed. You can check and cross reference anything.

Yet there is a problem with all this. If we don’t like what we see, read or hear we can trash it, troll it, attack it and get our “friends” and “followers” to pile in too. We don’t need experts. Your opinion is not mine. Your politics is not mine. Your race is not mine. Attack. We live in the moment were we can easily be extreme and many relish this. We are entitled to do so. We are entitled. Nobody is worth more money than me. Nobody. Social Media is allows us to be everything including judge, jury and expert.

Starting with newspapers many centuries ago, for almost the last hundred years radio followed by TV was all we had. This so-called traditional media is now changing fast to adapt to the social media world and rightly too. As this old media tries to marry with the new maybe the new needs to respect the old a little bit more than it currently does. Our rush toward Social Media is not taking account of the long path it took to get to this point. It took hundreds of years from the first printing press to create the first mass-produced published book. Facebook is just 12 and half years old. Would you just trust a 12-year-old with your life, business and future? We need to respect what was and how it came to be more than we currently doing or we risk losing the bath water, baby and the bath.

This is the case with junior Doctors too. We need to respect what happened in the past. This past and path gave us the Consultant Medics and Surgeons we rely on today and will have to rely on even more with the coming strikes. Both sides in the Junior Doctors dispute would do well to remember this and would do better to talk less and listen more. Doctors know better than most the power of listening. It saves lives. Taking a “history” is vital to diagnose and treat anyone. We need to respect our past, our experiences and do a little less existential scrolling, clicking, swiping and living. Doctors are special and we do need experts.

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‘I think y’know’

The current Labour leadership contest has thrown up many interesting moments not least the man who only just made it to be nominated is, according to those ever reliable polls, leading the field. Those who nominated him weren’t expecting that, only doing so to widen the leadership debate. Now many in Labour are crying foul because Jeremy Corbyn is doing just that. Watching and listening to the Labour leadership debate is both refreshing and 600,000 people getting involved can’t be a bad thing, even if some are making mischief.

Whatever your flavour or colour of politics any government needs a strong opposition. Democracy needs opposition or it doesn’t work and some very bad things start to happen. Look at Syria as a very painful, worrying case in point. The point of opposition is to oppose and give credible, thought out alternatives. As those alternatives are debated it makes the government up its game and we get better governance and a choice, a real and actual choice. We may even get something to believe in too.

What the last election proved was the ‘centre ground’ is not what many want, as to have a centre you need to have two points to know where it actually is. We didn’t have those two real opposing points. As a result other parties flourished although they are now not fairly represented in our first past the post system. Can it be fair that 4 million voted for UKIP and they got one MP and 1.5 million voted for the SNP and they got 56 MPs?

Whoever gets the Labour leadership we all need them to be an effective opposition, to hold the government to account. We need Labour to come up with ideas and policies that inspire, to raise the debate and our interest in politics for all our sakes. But there is a bigger issue.

Our political class, both locally and nationally, seem to lack any real ideas and vision. There are some obvious examples of those who do but the majority don’t, hence the disinterest and our contempt in our leaders and elected representatives. The evidence? Simple. When you hear them speak you will hear two key ‘tells’; ‘I think’ and ‘y’know’, as in ‘i think the NHS needs reform’ or worse ‘y’know, I think the NHS is the best in the world’. If our politicians need to think then they can do it in their offices or one of their many homes. When they talk to us through interviews or through parliamentary debate I want them to know.

I want our politicians to have arrived at some certainty, a clear vision and conviction and not to be still thinking about whatever it is they are talking about. And, y’know, ‘y’know’ is just lazy and shows a lack of clarity too. I don’t know, I’m waiting for you to inform me so I can make my own mind up, so I can decide who or what is best to make the big stuff happen. That is why I have elected you, to do this for me so I can live my life knowing that you know, that you are doing the thinking about it and then when know you tell me. I want to know our elected representatives are certain in their purpose, having informed me at the election their thought out intentions.

Currently our elected representatives keep putting it all back on us, maybe we so we can’t hold them to account for it. That is not part of the deal in a liberal democracy. The rise of the consultation is the weak answer to a lack of certain vision. It’s crept in from weak management and leadership in business. It’s the ‘I don’t know despite being elected/paid the big bucks/being somehow put in charge, so I will put it back to you, and then when it goes wrong it’s your fault not mine’ mentality of our decade.

Leaders lead, they tell us their already thought out vision and then do it, with our democratic support. Leaders don’t expect us to know ‘y’know’ because if we did know then we wouldn’t need them.

In the next few months we can only hope that when the silly season is over, the summer holidays are done and the political pondering is complete we have an effective government and an effective, vibrant opposition. This might get us all involved in the process more as we may have leaders who thoughts lead to conclusions, policies and actions.

You never know, y’know.

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Doctor, Doctor give me the news 24/7

This week the Government made it clear that it wants a 7 day a week health service because it will give us the patients access to healthcare, at its best, 7 days a week. Why? We are more likely to die at the weekend, which ‘statistics’ say will happen, because there aren’t enough doctors on the wards. Apparently the worst day to be admitted to hospital is Sunday. Imagine ending up in hospital on the ‘day of rest’ and finding a notice on the door saying closed until 8am Monday morning.

The stupidity of thinking that a doctor, any doctor, can cure you on his or her own is beyond belief so the idea of stuffing hospitals with Consultants together with ‘junior doctors’ who include Registrars and F2’s and F1’s is potty. Consultant Medics or Surgeons are not gods, although some believe they are. They are part of a team and the head of that team. The collective experience and wisdom of that team is the key to your successful treatment. If the Consultant is there along with their full team every day then this will impact on the following. Training, development and the numbers of doctors actually available every day of the week. This will impact on patient care. So the answer is we need more doctors, 10,000 of them.

It takes at least 10 years to become a Consultant in the NHS. You can’t fast track being a surgeon or a medic. If you think you can then you or your loved ones can get treated by that fast tracked doctor. I will always go for the one who has a breadth of experience.

My ex-wife is a Consultant Surgeon, a published, peer-reviewed author and award-winning in her chosen specialty. She is, frankly, amazing but achieving all this has consumed her. It is only our two children that she has time for outside of medicine. Nothing else. It has taken her 15 years to get there and she has sacrificed much to do so. So have her colleagues. She already works weekends, every 6th weekend on call, day and night. I know what this means because I look after our children when she is on call. It does involve a ward round Saturday and Sunday, then staying in the hospital or going back to the hospital at ANY time day or night to do what she has trained for and has the extensive experience to do. Her colleagues also do this for the other five weekends. Her hospital is just like every other hospital in the UK at the weekend. It is full of highly qualified doctors.

To have a full 7 day NHS you also need theatre nurses, lab assistants, receptionists, porters, clinical support staff, administration staff, managers, district nurses, mental health services, public health departments at councils and more ALL to work 7 days a week. You will also buses, park and rides, trains, shops, schools, all to be properly 24/7 so Monday is no different from Sunday. If we all don’t recognise that Sunday is not Monday, why have it? If you really want health care to be 24/7 then we and it all has to be the same 24/7. Simply this means more doctors and more bus drivers too.

If 24/7 healthcare were as simple as just making Consultants work a full Saturday and Sunday they would already be doing it. And they already are.

I have one last question that government has yet to successfully answered. This may well be the starting point to all of this call for 24/7 healthcare. If you are prepared to sit in an Accident and Emergency department for 4 hours or more, just how bad is your accident or emergency?

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May 14, 2015

Polls apart

For the last six weeks I have honoured the BBC’s request of me to step aside from the daily ‘phone in show I love and present the afternoon show, which was great fun and I really, truly enjoyed. It reminded me that radio and broadcasting is to inform, educate and entertain and I thank the BBC for this.

I also took this chance to positively step away from all the news I could. I avoided reading the newspapers, blogs, magazines, linked articles, opinion pieces or listening to podcasts. I just listened to the local news when I was on air and other news when it came to me, rather than me actively looking for it. I haven’t watched a news programme in over 6 weeks apart from the election night coverage. In the last few days, minded I am going back to my topical news based radio show on Monday 18th May, I thought I should get ‘up to speed’ on things and start to cram. I need not have bothered. Hardly anything has really happened nationally or locally apart from a change of government that the media failed to see coming.

I have learnt a great deal this year about many things. Firstly, the real kindness of people in contrast to how foul and depraved others can be for no real reason other blind stupidity, misplaced loyalty or actual mental health issues that could happen to any one of us at any time. Secondly, there is a real contrast between reporting and actual journalism in our papers and in on our broadcast media. There is plenty of the former but very little of the later. Thirdly, the news really doesn’t change that much at all. You might like to think it does but, in reality, nothing much happens other than the constant reporting on reports.

Here is a prime example of this. According to one study by a leading University on how the general election was covered by the main broadcasters, over a third of the coverage was based on reporting the polls. Broadcasters reported how close the polls were and what would happen if the polls were the actual result. There were lots of talking heads about red lines, coalitions, compromises and so on. The press followed this too. Nobody asked the question ‘what if the polls are wrong?’. In contrast the NHS got less than 2.5% of TV news coverage and according to other polls the NHS was a key issue in the election. Were those polls wrong too? In the current post-mortem of the election with the Left is complaining the Right got biased coverage and vice versa, we should all be complaining that our news was dominated by polls and surveys but very little actual journalism.

Any journalist should ask questions, get answers and then question those answers, regardless of what he or she might actually think. Thinking is not knowing and when you hear or read the phrase ‘I think’ it should be a warning to us all. Reporters are not journalists and journalists should not be reporters. To report and not to question is not news. To have an agenda and report it is not news. If you want this then buy your daily newspaper of choice just to confirm you were right all along.

Here’s a thing to try. Buy a newspaper you don’t usually take and see how you feel once you’ve read it. Listen to and watch other sources of news. Find local bloggers writing about where you live. Go beyond the lazy reporting and ask questions of those who just rehash press releases or report what they have been given without asking a single question about it.

The biggest lesson I have learnt over the last six weeks is to question everything and believe me I will, starting now.

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April 19, 2015

The lack of NHS Mental Health Care is madness

In the last few months I have met someone, fallen in love, moved home, got engaged, been forced to ‘go public’ by one of my main employers about my relationship to protect their values while totally compromising mine, lost a job I loved to my bones, again found myself in the papers for something I said that I didn’t actually mean, been the victim of some pretty shoddy journalism and, to cap it all, I been the subject of death threats.

I am now getting some counseling and support for all this. Having suffered Depression before I recognized the signs of what was beginning to creep over me again. I am paying for this support myself because I can and I don’t want to burden the NHS. There are many who can’t access or won’t get the help and support they may need because Mental Health Care in the UK is appalling.

Imagine that someone threatened to kill you, to actually kill you. In my case the individual wrote to my partners place of work and threatened to run me over, then called to say that it would happen, then wrote again and included the newspaper articles I never wanted to be in with my face burnt out implying this is what would happen to me. The police were called. They came to our home in the evening and took a statement. My partner then took the two police officers to her office and gave them what had been sent threatening me, complete with their name and address. I was left at home shocked and I had never been more scared in my life for my children, for those I love and for me too.

Later that night the police went to the individual’s home and made an arrest, finding further evidence of their intent. Within 24 hours the individual was sectioned under the Mental Health Act. A few days later another threatening phone call was made from the secure unit the individual was being held in.

Please read that last paragraph again.

For anyone to threaten another’s life and really mean it is extreme. The threats to me were not the threats or thoughts of a sound mind. It implies that they are under some form of mental distress and it’s likely they have needed some help for some time. The individual who threatened me was failed by their family, friends, society and, most worryingly of all, Mental Health Care in the NHS. How can any individual get to the point that they send threats to kill anyone and they not be protected or be offered support from their mental state?

The answer is simple. For far to long Mental Health has been the very poor relation in the NHS and it now needs serious money. Mental Health is not sexy, it’s not glamorous, there’s no money in it, it’s full of stigma and, because its not easy to ‘cure’ or diagnose, it is very easy to ignore. A broken limb or a little girl with cancer are some of the things the NHS are brilliant at. Good luck to you if you have a Mental Health problem. The reality is that one in four of us who WILL suffer with some form of Mental Health problem in our lives. We are told to ‘pull ourselves together’ get a ‘stiff upper lip’ or we just ignore it, until it all gets too much and then we do something ‘nuts’ like threatening to kill someone. Only in a crisis does the NHS help those with Mental Health problems.

My hope is that the individual who threatened to kill me is now getting all the help, support and treatment they need and have probably needed for some time. Mental Health and those who need real help must be given the support and treatment they deserve. We all need to be be more aware and do more to make this happen for those we know and love should they be in distress. You wouldn’t leave a fractured arm to fester, so why leave anyone with a fractured mind to break and potentially do something that may harm themselves or others?

Mental Health needs the real investment and respect it deserves. Nobody should ever get to the point that they threaten to kill anyone. I hope that you never suffer any form of Mental Health issue or problems with your mind because if you do the NHS is not the body fit enough to help you.

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January 6, 2015

The NHS is not safe in anyone’s hands.

The NHS is in crisis. It’s probably been in crisis since it was founded in July 1948. It will be in crisis no matter how much money you throw at it or who runs it. It doesn’t matter which political party comes up with yet more policy or politics on the NHS or who changes it or who blames the other for what they did. Politics has put the NHS in crisis. They are all at fault. They are all to blame. To blame each other is naive and utterly insulting to us, the voter.

The most naive part of the NHS was the founder himself. Bevan’s devastating mistake was not to have the foresight to factor in the likelihood that medical advances and an ever progressive medical profession would render a health service free at the point of need impossible to deliver. If you marry medical advances and science to an NHS promised in our low taxation economy, as pledged by our two principal political parties, the NHS as promised is, frankly, little more than a big fat lie. It just can’t be done and all political parties should come clean and tell us the hard truth. Neither Labour or the Conservatives will give the NHS the £8bn it has asked for.

Let’s deal with the basic principle of the NHS being free at the point of need. This is a worthy aspiration and it is achievable, if it’s not confused with free at the point of want. ‘Need’ really means this: if you are fat and want a gastric band because you want to be thin then you pay for it. You can be treated for any mental health issues that make you eat excessively so you stop eating so much. But it is for you get off your arse, reduce your food intake and exercise. It’s not the state’s job to make you thin, that is down to you.

An NHS free at the point of need is about the heart attack, the broken leg, a stroke or Ebola. It is not for want as in ‘I want a nicer nose as my nose is to big’. But what about the heart attack due to smoking and drinking or poor diet or lack of exercise? That is why *in a world where the NHS is free at genuine ‘need’* you must pay more tax to fund your *own* failings in you not looking after you. You either pay more tax under they current system or you don’t get anything free at the point of *immediate* need, let alone at the point of want.

What of the future of the NHS? As it is now it can’t survive? There isn’t the money or the resource to deal with an ageing population who can be kept alive thanks to costly medical science and its continued advances. It is medical science that defies nature and keeps us going long after nature should have taken us.

So here is my prescription for an NHS worthy of all.

1. All political parties need to stop blaming each other for the NHS in crisis. They have all caused it and they have failed us by not being honest in what is needed. In simple terms, you and I need to pay more tax for the NHS to work. We need to pay for a GP appointment, much like those who can pay for the dentist and optician now. The same exemptions would be applicable. If we don’t turn up to the appointment we must to be fined £10 before we can see a doctor again. Personal responsibility starts with all of us treating the NHS with respect and responsibility.

2. We need be more responsible for our own health and not expect the NHS to pay for what we knowingly do to harm our health. If you want to smoke, drink to excess, go rock climbing, skiing, caving, ride a horse, surf and so on then you need to take out some insurance to protect you if you come to some harm. Don’t expect us all to pay for your choices.

3. It is a bit late for many of us but our children need to be educated about health and wellbeing at school, as part of physical education. They need to be taught how to exercise throughout life, what to eat, first-aid and life-saving, how the body functions and how to take care of it. In a generation, through education, we may have a healthier society than we have now. *If we achieved that,* they *might even* be fortunate to pay less for an NHS free at the point of need.

4. The current NHS needs to be split into the following basic groups. Acute Care, Chronic Care, Social Care and Elder Care. You will fall into one or more of these categories and will be treated accordingly.

5. Pharmacies need to be empowered to deal with sniffles and basic ailments with the power to prescribe and, if needed, refer accordingly.

6. GP’s need to be open 7 days a week, 9am to 7pm. Outside these times you wait or if it really is an emergency you go to A and E. This is THE last port of call on the NHS not the first stop in our ‘I want it sorted now’ society of today.

7. 111 must be scrapped. Like NHS Direct before it, it is a fundamentally flawed idea, thought up by a bunch of Whitehall wonks who didn’t think it through. If you’re ill you need to speak to someone medically trained, not a call handler.

8. Most importantly, we all need to be educated to take responsibility for our own health. It’s not the government’s job to make you better, it’s your responsibility to do everything you can to keep you well in the first place. If you take risks or make choices that impact on your health then you must be responsible for the consequences, regardless of income or social standing. Being rich or being poor is no excuse for poor health.

Being fit and well is all of our individual responsibility. Paying tax for those who are genuinely unable to be fit and well in our society, so they can be cared for properly, is the mark of a civilised society. Tax is the price of civilisation. We all have a responsibility to do all we should to look after ourselves in the first place so the NHS is only used when we really need it.

Finally, as this is an election year, perhaps our politicians can be honest about the NHS, its cost, its failures and its future rather than blaming each other for their collective failings since its inception back in 1948. That would be start to saving the NHS for all of us.

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Video | October 22, 2014

It’s gonna cost you being ill

In the last few weeks, doing my day job, I have talked with those who are living with dementia and cancer. They have told me about how these dreadful diseases have touched their lives. I have also heard how dementia and cancer has changed their lives and how their lives have never been the same since they found out they have these two potentially devastating illnesses in their lives.

A generation ago you couldn’t even say the word cancer on hospital ward, let alone at home. Nobody talked about it and if you actually, eventually got ‘the diagnosis’ that was pretty much it. Get your affairs in order if you can, the clock is ticking and you can’t wind it up any more. A generation on and cancer is not the killer it once was. Some cancers are still not treatable and are fatal but most are livable, most are treatable. Today you can have a life and do something while you live with cancer. Linda Bellingham proved this beautifully, with great style and great humour too.

Dementia today is where cancer was a generation ago. We are still in denial over it, there are very few treatments for it and there is currently no cure for it. Cancer and our success in tackling it means that dementia has now been exposed for the illness it is. It’s not inevitable it will get you as you get older but, like cancer, you have a one in three chance of ‘the diagnosis’ and those odds are not good enough for you and me.

The principle problem with dementia and all its various types is getting the actual diagnosis. We know there are no treatments or cure and because of this we don’t want to face having to be assessed to see if we have it. As it stands the medical profession is currently not equipped or skilled enough to recognise the signs of dementia, treat it or cure it, much in the same way they were with cancer 30 years ago.

So giving GP’s £55 to diagnose dementia is ridiculous and it’s abhorrent. GP’s shouldn’t be paid a fee to do something that they should already be doing. If it’s a training need for GPs then train them but paying per diagnosis of dementia is just wrong. What next? £10 per cold and a £5 for ‘it’s a virus’?

The reality is that doctors already earn good money and they have to commit to a profession that takes their all. That is the deal. I used to be married to one and I am in awe of all she has done and still has to do every single day. All doctors constantly learn and train. It’s what they do. Adding dementia to their continued professional development should not be a problem. Dementia is fast becoming the health issue of our time and every doctor would benefit from this specific focus in their training.

The other issue we all have to face is that healthcare costs far more than we are all paying at the moment. Like or not every drug used costs millions to develop, prescribe and that has to be paid for. Every doctor, nurse, care assistant has to be trained, developed and rewarded and that has to be paid for. Every bit of the NHS has to be paid for. And the NHS needs to be managed and that has to be paid for too. 113 billion pounds is not enough to run the NHS you and I want. We are just going to have to more for it to use it.

The NHS is not free. It was never set up as ‘free’ and now, with health challenges like dementia, unknowns like Ebola, further advances in cancer care and its treatment we, you and me, are going to have to pay for it. Maybe we will not be paying for ourselves but for others, our loved ones to be treated and cared for. One thing is certain we are not paying enough today.

Here is THE question. Would you pay what you could to save your partner, your child, your parent? I would. I would give all I could. It’s about time we all faced up to that reality.

Another reality is that the NHS is not a political football to be kicked between the political parties claiming they can make it better. They have both made a mess of it, through under investment, PFI, miss management and perpetual reorganisation starting back with Enoch Powell in 1962 and every government of every colour since. They one thing politicians have not be fundamentally honest with us about the NHS is its cost. A NHS set up in 1947 is not equipped for 500,000 people living over the age of 90 and all the medical advances to today. Our healthcare success is the NHS financial failure.

If you and me want the NHS, to save the NHS, use the NHS you and me are going to have to pay for the NHS, if we can. Dementia proves it and the political parties need to stop prancing about saying they can do better and be honest about our healthcare.

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October 19, 2013

You are going to have pay more tax.

In the west, Bath and North East Somerset have revealed that they are looking to cut spending on early years provision by £2.3 million over the next two years. Bristol City Council is now facing further budget cuts of £90 million on top of what they have already have cut. Central Government will also have to cut more public services and welfare if the country is ever likely to pay back the debt. All rather bleak isn’t it?

Does it have to be like this? Could you pay more?

There are a number of painful realities we all need to face here. If you or the country borrow money then you have to pay it back. The only way to do that is by using the money you earn to do it. If you don’t earn enough you either prioritize your income so you pay what you’ve borrowed back or you have to earn more money to do it. The reality is hard and, for many, very difficult but there is no other way, other than to extend the length of time you pay the debt back. This will always cost you more money.

There are those who think public services are a right and public money grows on trees. There answer is to tax the wealthy more to pay for it. The trotting out of ‘tax the bankers bonuses more’ is a very popular solution offered to the public spending shortfall. That, like the idea of the Big Society, is utter tosh.

If you want an NHS that does what you want and when you want it you have to pay for it. If you want trains with seat you can sit on, at times you want to go then you have to pay for it. If you want local services, real and proper care for your elderly relatives or loved ones, decent schools or the rubbish collected on time then you have to pay for it. And there are only two ways. Either you pay more tax, buy it yourself or you give more to charity. We all have to pay more or give more. It’s worth remembering that less than 100 years ago charity provided health care, education, social mobility and social care before central government decided it could do it better.

HMRC have released some figures that don’t sit well with the silly cries of bankers paying more tax on their bonuses or with the premise of the big society filling in the gap. Out of almost 30 million people now working just 703,000 people will earn at least £100,000 or more this year through wages, bonuses, self-employed income, dividends, rents and interest. Of those, 320,000 will make at least £150,000 and 287,000 of these will pay the 45p top rate. This IS loads more than the 236,000 that paid the 50p tax rate in 2010-11.

This may surprise you too. Just 18,000 people will earn over £1m, which is up on the 13,000 in the previous two years and it was 10,000 in 2010.

But this is the killer number to the argument that rich need to pay more income tax than you. The 6,000 people on £2m or more will pay more in income tax (£13.2bn) than you and the 12.5m other taxpayers who earn under £20,000 a year. They are coughing up less with cumulative £11.5bn.

Simply, the top 1 per cent of UK earners have 13.7 per cent of all income but they pay a record 29.8 per cent of all income tax. In 2004-05, the top 1 per cent paid 21.4 per cent of all income tax. So who is taxed more and paying more? It is certainly not the 2 million more who will pay no tax at all in the next year compare to last year.

One last thing; these top earners are most likely to buy the services they need and are paying tax to the government for those who can’t. So should these top pay more tax? Your answer to that is most likely to be yes, but then you should pay more tax too if you want the things that are being cut. Or maybe we should hand it all over to charities to provide as it use to be.

One last thing. £35 billion in tax goes uncollected every year.

Painful, isn’t it.

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