There are stirrings of revolution going on. Here is an open letter to the BMA, printed in this week's British Medical Journal. The author is Clive Peedell(co chari of the NHSCA) along with 118 other signatories. It's basically telling the BMA to push or get off the can re the white paper. Here is the text of the letter.
Dear Hamish Meldrum, Laurence Buckman, and all members of the BMA General Practitioners Committee,
After the publication of the health white paper earlier this year, Hamish Meldrum wrote to the profession to explain that the BMA was going to ‘critically engage with the consultation process’ to defend the founding principles of the National Health Serice and the principles underpinning the BMA’s Look after our NHS campaign.
The consultation period is now over, and it is clear from the Department of Health’s response to the consultation that the BMA’s policy of ‘critical engagement’ has failed to persuade the government to alter its approach. The BMA responded with a damning press statement. ‘There is little evidence in this response that the government is genuinely prepared to engage with constructive criticism of its plans for the NHS. Most of the major concerns that doctors and many others have raised about the white paper seem, for the most part, to have been disregarded.’
In fact, Andrew Lansley’s plans are now even more market based. Within the new operational framework for the NHS in England, ‘price competition’ will be introduced, which fundamentally changes the NHS from a ‘quasi-market’ system of fixed prices (tariffs) to a more open market system. Hospitals will be allowed to charge rates lower than the national tariff, which sets prices for thousands of NHS procedures and covers roughly half of hospital income. According to Zack Cooper from the LSE, ‘Every shred of evidence suggest that price compettion in healthcare makes things worse, not better.’
The NHS Confederation shares this view. ‘ Economic theory predicts that price competition is likely to lead to declining quality where (as in healthcare) quality is harder to observe than price. Evidence from price competition in the 1990s internal market and in cost constrained markets in the US confirms this, with falling prices and reduced quality, particularly in harder to observe measures.’
Moreover, the BMA has stated that it has ‘concerns over the use of ‘best practice’ or deregulated tariffs in the NHS, because this system brings with it price competition, which can risk basing decisions on price rather than on clinical need.’
The white paper is still awaiting publication as the Health Bill, which will then need to be subjected to the legislative process before being enacted by parliament. We are therefore very concerned that the BMA and more specifically the BMA General Practitioners Committee is treating proposed policy (that is, a white paper) as if it is policy. For example, on 17th December 2010, the chairman of the General Practitioners Committee Laurence Buckman, stated in a letter to all GPs ‘Practices should now be working with other practices to make progress in setting up their embryonic consortia and electiong and appointing a transitional leadership.’
In addition, on the topic of general practice consortiums and commissioning, a recent BMA briefing paper stated, ‘The pace of change in developing commissioning must allow the vanguard to develop swiftly.’
The fact that market based policies have actually been strengthened by Mr Lansley goes against BMA policy from numerous BMA annual representative meetings and the stated principles of the BMA’s Look after our NHS campaign. The BMA should therefore withdraw its policy of ‘critical engagement’ with the government and engage more with its own membership. It is remarkable that despite ‘the most radical restructuring of the NHS since its inception, BMA Council recently voted against holding a special representative meeting of the BMA to allow its membership to debate the current proposals. This is in contrast with the BMA’s stance against the other most significant NHS white paper reforms, Working for Patients in 1989, when two special representative meetings were called.
Although the BMA hasn’t formally surveyed the profession about the white paper, surveys conducted by the King’s Fund and the RCGP have both highlighted the high level of concern among healthcare professionals, with fewer than one in four doctors believing that the proposed reforms will improve the quality of patient care provided by their organisation or practice.
We believe that the BMA has no mandate from the BMA membership to continue with the ‘critical engagement’ policy. Mr Lansley’s reform agenda has been widely criticised across the health policy and political spectrum as moving too fast, yet the current approach from the BMA could actually hasten the pace of reform because the association has effectively sent a message to the profession that the white paper is a done deal.
We have serious concerns that the proposed reforms will fundamentally undermine the founding principles of the NHS by creating a much more expensive and inequitable market based system. However, we also believe that the BMA could play a crucial role in saving the NHS from this fate, because according to the Health Service Journal, ‘From an influence point of view the BMA is critical because it could derail the coalition’s white paper reforms, which propose a clinically led system. If the BMA were to say no, then the whole initiative could grind to a halt.’
Thus the NHS really is in your hands. We understand the pressures you are under, but it is now time to mobilise the profession and stop these damaging reforms, which will not only destroy the NHS but also profoundly affect the social fabric of our nation.
This is a great opportunity for the BMA to achieve redemption for its opposition to the inception of the NHS in 1948. We urge you to take it and will support you 100% of the way.
Don't you just love that emotional blackmail at the end? Here's hoping it works.
Wednesday, 5 January 2011
Tuesday, 4 January 2011
Great Scot - Gerry Rafferty is Gone
This was not the post I wanted to begin 2011 with. Gerry Rafferty, Scot and song writer of the magnificently brooding Baker St, has died. Many things are memorable about this song, but it's the searing, sexy, sassy sax solo that is the soul of cool that makes it. Here's a reminder for younger people of what music sounded like when it wasn't a pile of merde.
Thursday, 30 December 2010
Good Deed for the Day - Preserve the Freedom of the Press
If you're looking for a good deed for the day, you could do worse than to log on to this petition and sign it. Rupert Murdoch already owns a huge swathe of the press - there is no reason to give him any more of it.
Tuesday, 28 December 2010
A Salutory Warning on the Dangers of Discount Flights from Airlines of a Hibernian Disposition
disclaimer: contains swearing of a Fr Ted nature..
Tuesday, 21 December 2010
Because We All Need One
The wonderful 'To Miss with Love' is no longer with us on the blogosphere and each year she used to post this video. I'm carrying on the tradition. And because we all need one. A Merry Christmas and a Happy New Year to you all..
Thursday, 9 December 2010
Good Men May Be Mistaken - More Thoughts on the End of Life Assistance Bill
In my previous post, I wondered who or what it is, that is creating the relentless push for euthanasia; if this is something that is directed or if it is a general zeitgeist that is prevalent at the moment. It isn't the first time that something like this has happened and in the early 1900's a similar discussion was taking place amongst the chattering classes and had enthusiastic support from left and right. Many people whom we now term as great were involved in it. I'm talking of eugenics and the campaign to introduce compulsory sterilisation for 'defectives' in the 1912 Mental Deficiency Bill.
The starting point for this debate was in the 1840's with Francis Galton, a cousin of Darwin. He studied the hereditary lines of 'great men' and concluded that unless something drastic was done, the breeding of degenerates was going to outstrip the breeding of more worthy people. From this, the seed of eugenics and sterilisation of the poor and the mentally ill was sown.
By 1905 this idea was reaching its peak. The main opponents to it were GK Chesterton and Josiah Wedgewood (another cousin of Darwin's) who did a filibuster of 150 speeches sustained by barley water and chocolate. (His modern descendent, Tony Benn, is also against euthanasia). But it's the people who were for it that make the interesting reading.Leonard Darwin, George Bernard Shaw, Winston Churchill, Beatrice and Sidney Webb, the Fabian Society, Arthur Balfour and none other than William Beveridge. There are more here. It also gained support from the Archbishops of Canterbury and York and Dean William Inge, Chesterton's bete noire. These people did the rounds of the Fabian Society, used their influence in church and government to promote it and gave professorships at universities to supporters.
Today it seems almost inconceivable that this happened. And to be fair to those who supported it, we have the benefit of hindsight. The horrors of the Nazis Aktion T4 programme had not been realised. But nevertheless the fact remains; for nearly 40 years, this idea was common currency amongst the brightest and best of our society. America, Sweden, France and Germany all enacted sterilisation laws. The UK escaped by the skin of its teeth. Good men may be mistaken. Great men may be mad.
Chesterton devoted an entire book to arguing against this bill. Amongst other things he said was this;
It is necessary to point out the essential fact which the eugenists seem to have forgotten all over again. We breed cows for milk; and not for a moral balance of particular virtues in the cow. We breed pigs for pork. . . . Therefore we cannot, and do not, criticise them in the way in which we criticise our fellow creatures when we call them feeble-minded; or when we betray our own feeble-mindedness by calling them Unfit. For the very word Unfit reveals the weakness of the whole of this pseudo-scientific position. We should say that a cow is fit to provide us with milk; or that a pig is unfit to provide us with pork. But nobody would call a cow fit without naturally adding what she was fit for. Nobody would call up the insanely isolated vision of the Unfit Pig in the abstract. But when we talk about human beings, we are bound to break off the sentence in the middle; we are bound to call them Unfit in the abstract. For we know how varied, how complex, and how controversial are the questions that arise about the functions for which they should be fitted.
In this argument, Chesterton puts his finger on the fallacy behind eugenics and what I believe is the fallacy underlying the assisted dying debate. The assumption underlying the legitimacy of those in favour of such things, is usefulness. A person has worth if they are industrious, make money, stand out, are independent and not a burden; they are useful. By contrast, if they do not have any of these attributes then they are not useful, therefore they have less worth. It is a seductive argument, because we need people to work and produce and pay taxes. And it is particularly appealing to people who work hard, make money and are independent. All their perception of their worth is tied up in being useful. And that is the glamour that is seducing the likes of Terry Pratchett, AC Grayling, Zoe Wanamaker and others to supporting this.They cannot bear the thought of being dependent on others or being limited by illness or disability. But the darker side of that view is how it affects their perception of others. If your worth is measured by these things, how do you then measure people that aren’t useful?
One of the things that has nagged me about this debate is this; the people who are promoting this bill are people of independent means with powerful friends. Whether or not euthanasia gets passed, they will go when they will and not a second before. If they want to take a poison, they have the friends to obtain it for them and to protect assisting relatives in any court battle afterwards. Which means in short that this bill isn’t about them. It’s about ‘helping’ other people. People that they don’t see very much of, that ‘aren’t the same’ as them, who aren’t very useful; at least not as useful as they are to society. And they do not seem to be aware of that value judgement. It underlies the feting of Susan Boyle and Stephen Hawking; they are celebrated, not simply because they are disabled, but because they are disabled people who are also useful. But the girl who lives near me with the same condition as Susan Boyle is not being feted or celebrated. Nor is anyone else with disability.
This post has wandered somewhat, but to get back to the point; what and who is driving this? I think that in part this is a fashion, a way of being avant garde. Sex is no longer taboo; death still is and the breaking of it holds a fascination. It’s also to do with the political climate. We are in a time of austerity and a growing elderly population. And the great unspoken debate going on underneath this is how they are all going to be provided for. These two forces are feeding off one another and creating a maelstrom into which the poor, the old and the disabled are being sucked into. As indeed they always have done. Those who speak of putting down animals in pain should reflect that we also put animals down when they are too old to work, too expensive to keep and when they have too high a medical bill. But what may save us is what saved us the last time; the experience of others. We have not yet enacted this legislation. Others have and we may benefit from their misfortune. In March this year, a petition with 100 000 signatures to allow those over 70 who consider their life 'complete' assistance to die, was presented to the Netherlands parliament. Let's hope for all our sakes that this doesn't succeed.
The starting point for this debate was in the 1840's with Francis Galton, a cousin of Darwin. He studied the hereditary lines of 'great men' and concluded that unless something drastic was done, the breeding of degenerates was going to outstrip the breeding of more worthy people. From this, the seed of eugenics and sterilisation of the poor and the mentally ill was sown.
By 1905 this idea was reaching its peak. The main opponents to it were GK Chesterton and Josiah Wedgewood (another cousin of Darwin's) who did a filibuster of 150 speeches sustained by barley water and chocolate. (His modern descendent, Tony Benn, is also against euthanasia). But it's the people who were for it that make the interesting reading.Leonard Darwin, George Bernard Shaw, Winston Churchill, Beatrice and Sidney Webb, the Fabian Society, Arthur Balfour and none other than William Beveridge. There are more here. It also gained support from the Archbishops of Canterbury and York and Dean William Inge, Chesterton's bete noire. These people did the rounds of the Fabian Society, used their influence in church and government to promote it and gave professorships at universities to supporters.
Today it seems almost inconceivable that this happened. And to be fair to those who supported it, we have the benefit of hindsight. The horrors of the Nazis Aktion T4 programme had not been realised. But nevertheless the fact remains; for nearly 40 years, this idea was common currency amongst the brightest and best of our society. America, Sweden, France and Germany all enacted sterilisation laws. The UK escaped by the skin of its teeth. Good men may be mistaken. Great men may be mad.
Chesterton devoted an entire book to arguing against this bill. Amongst other things he said was this;
It is necessary to point out the essential fact which the eugenists seem to have forgotten all over again. We breed cows for milk; and not for a moral balance of particular virtues in the cow. We breed pigs for pork. . . . Therefore we cannot, and do not, criticise them in the way in which we criticise our fellow creatures when we call them feeble-minded; or when we betray our own feeble-mindedness by calling them Unfit. For the very word Unfit reveals the weakness of the whole of this pseudo-scientific position. We should say that a cow is fit to provide us with milk; or that a pig is unfit to provide us with pork. But nobody would call a cow fit without naturally adding what she was fit for. Nobody would call up the insanely isolated vision of the Unfit Pig in the abstract. But when we talk about human beings, we are bound to break off the sentence in the middle; we are bound to call them Unfit in the abstract. For we know how varied, how complex, and how controversial are the questions that arise about the functions for which they should be fitted.
In this argument, Chesterton puts his finger on the fallacy behind eugenics and what I believe is the fallacy underlying the assisted dying debate. The assumption underlying the legitimacy of those in favour of such things, is usefulness. A person has worth if they are industrious, make money, stand out, are independent and not a burden; they are useful. By contrast, if they do not have any of these attributes then they are not useful, therefore they have less worth. It is a seductive argument, because we need people to work and produce and pay taxes. And it is particularly appealing to people who work hard, make money and are independent. All their perception of their worth is tied up in being useful. And that is the glamour that is seducing the likes of Terry Pratchett, AC Grayling, Zoe Wanamaker and others to supporting this.They cannot bear the thought of being dependent on others or being limited by illness or disability. But the darker side of that view is how it affects their perception of others. If your worth is measured by these things, how do you then measure people that aren’t useful?
One of the things that has nagged me about this debate is this; the people who are promoting this bill are people of independent means with powerful friends. Whether or not euthanasia gets passed, they will go when they will and not a second before. If they want to take a poison, they have the friends to obtain it for them and to protect assisting relatives in any court battle afterwards. Which means in short that this bill isn’t about them. It’s about ‘helping’ other people. People that they don’t see very much of, that ‘aren’t the same’ as them, who aren’t very useful; at least not as useful as they are to society. And they do not seem to be aware of that value judgement. It underlies the feting of Susan Boyle and Stephen Hawking; they are celebrated, not simply because they are disabled, but because they are disabled people who are also useful. But the girl who lives near me with the same condition as Susan Boyle is not being feted or celebrated. Nor is anyone else with disability.
This post has wandered somewhat, but to get back to the point; what and who is driving this? I think that in part this is a fashion, a way of being avant garde. Sex is no longer taboo; death still is and the breaking of it holds a fascination. It’s also to do with the political climate. We are in a time of austerity and a growing elderly population. And the great unspoken debate going on underneath this is how they are all going to be provided for. These two forces are feeding off one another and creating a maelstrom into which the poor, the old and the disabled are being sucked into. As indeed they always have done. Those who speak of putting down animals in pain should reflect that we also put animals down when they are too old to work, too expensive to keep and when they have too high a medical bill. But what may save us is what saved us the last time; the experience of others. We have not yet enacted this legislation. Others have and we may benefit from their misfortune. In March this year, a petition with 100 000 signatures to allow those over 70 who consider their life 'complete' assistance to die, was presented to the Netherlands parliament. Let's hope for all our sakes that this doesn't succeed.
Monday, 6 December 2010
Thoughts on the End of Life Assistance Bill
So the End of Life Assistance Bill gets rejected by 85 votes to 16. A day later Lord Falconer sets up a commission on the subject of assisted dying. A certain ethicist had a wee trip up to Scotland during the evidence hearing. This, to paraphrase Margo McDonald, ain't going away. So what happened and what's going on?
I confess I have more questions than answers. Although I expected the bill to be defeated, I didn't expect it to be quite so comprehensive. There were several obvious reasons for its defeat. First and foremost, it wasn't going to do what it said on the tin. It was called 'End of Life Assistance' when in fact the bill allowed those who were not at the end of their lives, but who could not live independently (whatever that meant) and found life intolerable, to avail themselves of this. Politicians had been given comparisons with Oregon, when it actually should have been compared with the Netherlands and they don't like being misled. Secondly, Care Not Killing played a big role in leading the opposition. It is a combination of religious and non religious organisations and includes amongst its membership the National Palliative Care Council for Great Britain and Northern Ireland, Inclusion Scotland and RADAR, which is an umbrella disability organisation representing 900 disability groups. So the opposition got their sh*t together. Finally, Margo McDonald herself didn't perform well. She spent most of her opening speech attacking Care not Killing and made this comment;
The vote was a free one and I expected it to go against the bill, as I say. But I didn't expect 85/16 (and it would have been 87 if Karen Whitefield and Elaine Smith, my local MSPs hadn't been snowed in and who had declared their intentions). And it has left me with an intriguing problem. I thought that all the media attention and sympathy for euthanasia was being driven by the political classes. But in this vote, the political class has turned its face against it. I'm not sorry to be wrong on this, but it leaves me asking; who is driving the media on this? Who invited an English ethicist to a Scottish committee? Who ensured that the programme 'A Journey to Switzerland' was shown twice up here during the bill's passage? Who ensured that cases like Stafford and Dr Jane Barton got the minimum of coverage whereas Diane Pretty and others got the maximum? Who is doing this?
It may be that there is a difference between Scotland and England on this. We do have a higher church -going population, but Holyrood is quite capable of ignoring opinion from the churches. It is also quite capable of ignoring opinion from disability groups. There is a huge financial reason to legalise euthanasia; as it said in the explanatory notes to the bill;
Mike Rumbles did give a hint as to what had happened. He quoted Burke in his speech
But this ain't enough. So - any thoughts? Is it the media class themselves running this perhaps? Or them, plus some political friends? Or is this perhaps a zeitgeist, a debate that surfaces every generation, when we have forgotten all the reasons why we do not and should not go down this path? That will be my next post..
I confess I have more questions than answers. Although I expected the bill to be defeated, I didn't expect it to be quite so comprehensive. There were several obvious reasons for its defeat. First and foremost, it wasn't going to do what it said on the tin. It was called 'End of Life Assistance' when in fact the bill allowed those who were not at the end of their lives, but who could not live independently (whatever that meant) and found life intolerable, to avail themselves of this. Politicians had been given comparisons with Oregon, when it actually should have been compared with the Netherlands and they don't like being misled. Secondly, Care Not Killing played a big role in leading the opposition. It is a combination of religious and non religious organisations and includes amongst its membership the National Palliative Care Council for Great Britain and Northern Ireland, Inclusion Scotland and RADAR, which is an umbrella disability organisation representing 900 disability groups. So the opposition got their sh*t together. Finally, Margo McDonald herself didn't perform well. She spent most of her opening speech attacking Care not Killing and made this comment;
According to Care Not Killing, elderly people in care will feel that it their duty to die. Some elderly people stuck in below-standard care homes do wish for an early death, but the bill's provisions do not cover them. I hope that we do not hear a litany of sanctimonious remarks about improving care provision. We have had more than enough time to do that.
The vote was a free one and I expected it to go against the bill, as I say. But I didn't expect 85/16 (and it would have been 87 if Karen Whitefield and Elaine Smith, my local MSPs hadn't been snowed in and who had declared their intentions). And it has left me with an intriguing problem. I thought that all the media attention and sympathy for euthanasia was being driven by the political classes. But in this vote, the political class has turned its face against it. I'm not sorry to be wrong on this, but it leaves me asking; who is driving the media on this? Who invited an English ethicist to a Scottish committee? Who ensured that the programme 'A Journey to Switzerland' was shown twice up here during the bill's passage? Who ensured that cases like Stafford and Dr Jane Barton got the minimum of coverage whereas Diane Pretty and others got the maximum? Who is doing this?
It may be that there is a difference between Scotland and England on this. We do have a higher church -going population, but Holyrood is quite capable of ignoring opinion from the churches. It is also quite capable of ignoring opinion from disability groups. There is a huge financial reason to legalise euthanasia; as it said in the explanatory notes to the bill;
Cost of means required to assist in death
97. The costs required to deliver an assisted death will be minimal and will inevitably be less
than those associated with providing ongoing medication and care.
Mike Rumbles did give a hint as to what had happened. He quoted Burke in his speech
As parliamentary representatives, we must resist the temptation to legislate because of opinion polls. In a representative parliamentary democracy such as ours, we are required to use our judgment. As long ago as 1774, the classical liberal Edmund Burke said:
"Your representative owes you, not his industry only, but his judgement; and he betrays ... you, if he sacrifices it to your opinion."
But this ain't enough. So - any thoughts? Is it the media class themselves running this perhaps? Or them, plus some political friends? Or is this perhaps a zeitgeist, a debate that surfaces every generation, when we have forgotten all the reasons why we do not and should not go down this path? That will be my next post..
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