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James' interview with the Lib Dem and Labour candidates - questions

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Wednesday 29 April 2015 10.12pm
Theresa May would be no bona fide in my book. Tory apologists for wealthy non-doms, reducing tax for their mates and persecuting the poor with the bedroom tax, benefit sanctions and systematically wrecking the NHS.

Cameron ' no top down reorganisation of the NHS' - what did we get from the coalition? The biggest reorganisation in NHS history, destroying efficiency, loosing high quality staff and enshrining in law competitive tendering of NHS contracts to the private sector. Since when did the Lib Dems have privatisation of the NHS in their 2010 manifesto??
I voted for Simon then and feel bitterly betrayed by his support of the H&SCA.

Weasel words about separating family members from the company they run and accolades given by Theresa May are just trying to justify the LDs selling out their principles in my view.

EDITED later -
Someone has some principles it seems...
http://www.theguardian.com/politics/2015/apr/29/danny-alexander-tory-plans-welfare-cuts-child-benefits
Wednesday 29 April 2015 10.35pm
Brendan

All I've done is proffer a viewpoint which differs from yours. I'm in no way attempting to justify anything. I am merely picking the holes in what I perceive to be your fundamentally flawed attempt to somehow link a less than positive CQC report to Simon Hughes, a tenuous link if ever there was one.

Might I suggest you're approaching this as a bitter healthcare professional. I seem to recall from posts elsewhere that you're a GP. I'll approach this from a lay perspective.

As I see it, the Labour government brought the NHS to its knees. Tony Blair's government sought to mix a publicly funded health service with privately funded buildings and facilities. He installed thousands of bureaucratic managers earning wild salaries, whilst staff-grade nurses earned less than a clerical worker in a council - notwithstanding that the nurses did the most important job for the patients (along of course with doctors).

Do you remember when your old gran could call her own GP out at midnight in a real emergency? Same Labour Government absolved GPs of that responsibility. GPs, most of whom who have always been their own bosses under the auspices of contracts to provide services to the NHS, were wildly incentivised with additional bonuses available for things like signing patients up for contraceptive implants, smoking cessation clinics and other such rubbish. NHS trusts were paying exorbitant locum fees for nurses and doctors, in some cases up to 3,000 for a single shift - this still continues - because of a short-sighted approach in not paying regular staff a decent wage.

On a local level, we had an excellent A&E department at Guy's. Labour closed it. Simon fought to keep it open when I was still at school to keep it open - a big campaign - but to no avail.

Bearing in mind all of that, why not contract out certain functions of a wildly inefficient NHS? As Nigel Farage sagely said quite recently, the NHS is excellent in reactive/emergency situations but not so good in planned/elective ones. If a private provider can provide an equal service and the cost is less - bearing in mind what I have said about profligate spending and thousands of middle managers - and the end result is as good, if not better, for the patient, then why not?

This is my view and how I see it, not as some sort of Lib Dem apologist. For the record, I'm interested in things that happen here in Southwark and SE1. I was born here and I live here now. Going back to the Lib Dems, Simon has always fought for his constituents and those living here and that is why he has my backing.

The above is probably not very well articulated as I'm working and typing this quickly.
Wednesday 29 April 2015 10.58pm
Gavin Smith wrote:
Brendan
All I've done is proffer a viewpoint which differs from yours. I'm in no way attempting to justify anything. I am merely picking the holes in what I perceive to be your fundamentally flawed attempt to somehow link a less than positive CQC report to Simon Hughes, a tenuous link if ever there was one.

Might I suggest you're approaching this as a bitter healthcare professional. I seem to recall from posts elsewhere that you're a GP. I'll approach this from a lay perspective.

As I see it, the Labour government brought the NHS to its knees. Tony Blair's government sought to mix a publicly funded health service with privately funded buildings and facilities. He installed thousands of bureaucratic managers earning wild salaries, whilst staff-grade nurses earned less than a clerical worker in a council - notwithstanding that the nurses did the most important job for the patients (along of course with doctors).

Do you remember when your old gran could call her own GP out at midnight in a real emergency? Same Labour Government absolved GPs of that responsibility. GPs, most of whom who have always been their own bosses under the auspices of contracts to provide services to the NHS, were wildly incentivised with additional bonuses available for things like signing patients up for contraceptive implants, smoking cessation clinics and other such rubbish. NHS trusts were paying exorbitant locum fees for nurses and doctors, in some cases up to 3,000 for a single shift - this still continues - because of a short-sighted approach in not paying regular staff a decent wage.

On a local level, we had an excellent A&E department at Guy's. Labour closed it. Simon fought to keep it open when I was still at school to keep it open - a big campaign - but to no avail.

Bearing in mind all of that, why not contract out certain functions of a wildly inefficient NHS? As Nigel Farage sagely said quite recently, the NHS is excellent in reactive/emergency situations but not so good in planned/elective ones. If a private provider can provide an equal service and the cost is less - bearing in mind what I have said about profligate spending and thousands of middle managers - and the end result is as good, if not better, for the patient, then why not?

This is my view and how I see it, not as some sort of Lib Dem apologist. For the record, I'm interested in things that happen here in Southwark and SE1. I was born here and I live here now. Going back to the Lib Dems, Simon has always fought for his constituents and those living here and that is why he has my backing.

The above is probably not very well articulated as I'm working and typing this quickly.

I've never voted for him, but I do recognise his work for the community ( although the Labour mob always accused him of doing the work of a councillor, perhaps unfairly and maybe with a tinge of envy).
I was involved in the campaign to save guy's A&E, we marched to Parliament and into the lobby halls, Simon was called out.
I was disappointed with the turnout and didn't feel enough was being done to whip up support/anger, so I said this to Simon and his reply was along the lines of not wanting to peak too soon. I didn't hear anything after that, although that could be because a Labour government was imminent (the Tories actually announced the closure)and he trusted that it would change things (on that march, Margaret Beckett, who was running for leadership, promised us that "No way under a Labour government will Guy's A&E close"), you know the rest.
Wednesday 29 April 2015 11.01pm
Gavin,
I am a GP (not in SE1) and I've worked in the NHS for 30 years. I'm a passionate supporter of 'socialised' healthcare. I think you are wrong, very wrong about the recent history of the NHS.

When Labour came to power in 97, the NHS was on its knees through 17 years of underinvestment. There comes a point that you just can't run the service that people expect. We had to wait 2 years for Brown to start putting that right and it did come, alongside sure start centres, working family tax credits and a raft of initiatives aimed at ending child poverty.

Back to the NHS: There has been a steady rise in both 'managerialism' and 'control' - many useful public health initiatives like smoking cessation, teenage contraception clinics, targeted disease management that have hugely improved the health of the people I see. I hardly see a new heart attack now as angina gets rapidly and effectively dealt with - under Major people were dying on waiting lists for angiography. Yes the 2004 GP contract did pay GPs more than intended for a couple of years (the Dept of health didn't believe we would hit all the targets), but since then incomes have steadily declined and workload has gone up massively - so much so that we now have a huge morale and recruitment problem.

In 2010 we had a recently re-organised NHS that was just starting to settle and get to grips with the huge issues of costly technology and an ageing population. We needed a steady as it goes, improve efficiency and think hard about resources approach...

What happened was chaos.. everything was broken up, all the good managers left (after 3 cycles of re-applying for their own jobs) and any ability to control the NHS as a public service was lost. So now costs are going up and efficiency going down.

The private sector does not hold some magic solution to efficient and good services. Competition might do, but that rarely exists even in wholly private sectors. The NHS it can never be truly competitive as its bought FOR the public. So introducing private providers simply screws down wages and conditions for the lowest paid workers - cleaners on zero hour contracts - and extracts profits that could have gone on patient care. It also leaves patients facing fragmented care and guess who picks up all the pieces, trying to sort out complex problems for people whose 'provider' only works to their bit of the contract. GPs....

Social care is even worse. I see carers with a caseload 'overbooked' by their managers. Five 15 min visits per hour and no travelling time. I see carers coming back in their own time to help people as they care even if their employer doesn't.

The H&SCA has made life infinitely harder for anyone who wants to do the best for their patients. It was unnecessary and pointless - unless you are United or Virgin Health or C&C Alpha... Someone has to be made politically responsible for that, or are we all going to be sleep walking into some Murdoch/Daily Mail La La land?
Wednesday 29 April 2015 11.28pm
Brendan, I'll read your post in full shortly, but as someone earning potentially upwards of 100,000 a year, possibly more, I think you're looking at things through rose-tinted glasses.

How did gimmicky Surestart prevent child poverty? It didn't. The answer is to go to work and if that doesn't pay enough then work some more. That's what I do. It's what my wife does. My father, a working class man without the proverbial pot, lost his wife and was left with three young children all under the age of six to care for, two of whom were terminally ill with cystic fibrosis. He worked two jobs, day and night, to ensure that we were provided for. We didn't have much but we got by. I follow the same ethos in my life. Child poverty is still alive and kicking to this day. No government has successfully tackled it.

Social care: you're out of touch. 15-minute appointments don't exist any more and haven't done for almost two years - certainly in Southwark. I know because my wife is a Southwark domiciliary carer working for one of the contractors. Travel time has been paid since December last year.

If the NHS was run for the public, we wouldn't have the masses of managers to begin with. I'm glad they're out of jobs. Their salaries would be better spent on frontline staff. Would said "good managers" be the ones who spend their entire working lives preparing datasets, root cause analyses, never coming into contact with patients and making the lives of frontline staff unbearable? Yes, there is a morale problem and it's caused by these middle managers who have no clinical experience. I speak from experience due to my work for one of the healthcare regulators where this comes up daily. All of the experienced and dedicated clinical staff have had enough and are flocking to join private healthcare providers because of the better pay and conditions. Seems to me that the loss of bureaucrats is no bad thing.

As for cleaning staff and other support roles, most trusts outsource this function in any event and have done since the late 1980s. Their staff are in some cases similarly employed on zero-hour contracts on very low rates. Why aren't you complaining about your beloved NHS doing that?
Thursday 30 April 2015 6.57am
Gavin,
I agree about child poverty, but its getting worse.
I need to see some patients, but this strikes me as a pretty balanced article.
http://www.theguardian.com/politics/2015/apr/30/nhs-gps-are-exhausted-ae-is-overrun-and-hospitals-are-broke-what-went-wrong
Sunday 3 May 2015 3.47pm
The interviews with Simon Hughes and Neil Coyle are now online:

Simon: http://www.london-se1.co.uk/news/view/8231
Neil: http://www.london-se1.co.uk/news/view/8230

At the bottom of each page are the links to the interviews with the other candidates (apart from one who hasn't responded to my email).

Editor of the London SE1 website.
Subscribe to our SE1 Direct weekly newsletter.
Zoe
Monday 4 May 2015 11.17am
Gavin, the admin at Guys and St Thomas is terrible, some back office managers are needed. One of the major criticisms of the NHS recently is their inability to manage complaints and learn from them. You need managers to do this.

I agree with everyone who have said that we don't need managers who focus purely on targets, but don't ever imagine we don't need a 'back office', that's a fools paradise where organisations are run chaotically. We want to free up the front line to treat patients, not do admin.

Just to change the subject, I am disappointed to see that Neil Coyle supports the garden bridge.
Monday 4 May 2015 1.15pm
Zoe, I agree to a point. A back office function is absolutely required. It's the size of that function. Millions of pounds each year are spent on pointless roles such as: "community transformation manager", "lead for change management", "lead statistician" I could go on.
Monday 4 May 2015 1.45pm
I was working at St Thomas a few months back, honestly, the waste is in your face.
We had a group chat with some consultant (non medical) which was aimed at improving the service we provided, suggestions from the group etc. This lasted for about 2 hours with plenty of suggestions from people on the ground. It was all well received by the consultant and he was going off to get these suggestions implemented.

I was told by an old hand there, that this was in fact the 5th such meeting that they'd had in the last 2 years, that the consultant was on something like 50 per hour and that not one of the suggestions will be implemented.
I found myself questioning everything, especially after pat testing a microwave and delivering it to a department and seeing the receipt on the box, bog standard microwave, 170.

Madness.
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