Monday, 27 October 2014

Cash for diagnosis won’t help people sailing into the darkness of dementia or their families.

Under a plan put forward by NHS England last week GPs could be paid £55 for every patient they diagnose with dementia. This, it is hoped, will help to reduce the 90,000 or more people currently living with the debilitating condition who have not been given an official diagnosis.

The money will go towards providing improved care for suffers, Dr Martin Mc Shane, national director for long term conditions for NHS England, told the BBC ‘We know that more needs to be done across the health service to ensure that people living with dementia are identified so they can get the tailored care and support they need.’

He denied the proposal was ‘payment for diagnosis’ and said that it was ‘part of a larger range of measures to support GPs in their work tackling dementia.’

These measures include £42million available to help GP practices carry out assessment of people with suspected memory problems and a further £31million to provide appropriate care.

Criticism of the plan has come from the Patients Association; chief executive Katherine Murphy called it a ‘step too far’, saying that it would place a ‘bounty on the head’ of certain patients. Good GP practices, she told the BBC, would ‘be diagnosing their dementia patients already. This seems to be rewarding poor GPs.’

Professor Sir Simon Wessley of the Royal College of Psychiatrists said, also speaking to the BBC, the government had ‘done well’ when it came to improving awareness and funding for dementia care. However, he added, at present ‘evidence favours either improving social care, or investing in research to find new treatments that actually modify the course of the disease. Until that happens I can see little point in this exercise.’

Having spent the last two years watching my father sail into the darkness of dementia I welcome any initiative that raises the profile of a sadly ignored and stigmatised condition. This plan though goes too far down a route we shouldn’t even be considering.

Caring for someone with dementia is a lonely and terrifying experience; actually having dementia must be a thousand times worse. At no stage along the associated trail of tears can I imagine anyone saying that what would make things better would be for medical professionals to be incentivised like used car salespeople.

What patients and carers alike want is quicker diagnosis, the remaining sentience someone with dementia has is precious and passes so swiftly, knowing they’re ill allows them and carers to make plans and say their goodbyes. A system of social care that doesn’t make vulnerable people into participants in a bureaucratic obstacle race would be helpful too.

Neither of those objectives will be achieved by loading yet more perverse incentives onto the already tottering NHS. As Katherine Murphy rightly says cash for diagnosis will just provide the handful of lazy GPs with another system to game, whilst grinding out of the responsible majority the idealistic desire to help others that brought them into medicine in the first place.

That such a suggestion is even being considered is all too sadly symptomatic of a political system that has become witlessly enthralled to the idea that for every problem there must be a market based solution. There are many things the market does brilliantly; delivering healthcare isn’t one of them.

The result of bringing the market in to solve healthcare problems is at best a two tier system that is the unfair antithesis of everything the NHS stands for; the worst case scenario is the sort of target driven madness that destroyed Stafford hospital. If your answer to the problems of the NHS is more marketisation, then you’re asking the wrong questions.

What is needed is a concerted effort to remove the stigma surrounding dementia and other mental health problems. This won’t be an easy sell, unlike with cancer it is impossible to construct a ‘narrative’ about a heroic battle against adversity that can be won through effort. There may be a cure someday, but for now it is all about making the time sufferers have left a little less grim.

A whole lot more respect for carers, both paid and unpaid would be welcome too, they deserve the best support for their own needs as much as those of their loved one; sadly what they get all too often is ignored and left to worry themselves to rags in isolation.

Next year is an election year; expect the three ghost brands that used to trade as Labour, the Tories and the Lib Dems to trot out the same tired platitudes about how only they can be trusted with the NHS, whilst all the time they plan to carry on doing the same destructive things for the same old muddled reasons.

Personally I’d rather see the future of the NHS in the hands of people who don’t think an adding machine is a piece of medical equipment.

Tuesday, 21 October 2014

This is what the revolution might look like.

Think of a political meeting held on a cold October evening and what image comes to mind? Probably one of a dismal little gathering taking place in a dingy room somewhere, everyone going through the motions without feeling they can really change anything.

Attending the monthly meeting of the reinvigorated North Staffs Green Party promised something different, not least because this was to be the meeting at which the party chose its parliamentary candidate for 2015.

The setting was the futuristic new fire station in Sandyford, when I arrived there were already ten people present, an outstanding turnout for a political meeting in a city where civic life is rapidly atrophying, before the seven o’clock start time this number had more than doubled.

Looking around the room the average age of attendees was well over forty, not a surprise, politics is a business for the middle aged. There were though several younger people present, a testimony to the party’s strong following at Keele University and proof that despite the best attempts of the media to say otherwise the young are engaged with politics; at least they are when it takes the trouble to engage with them.

The atmosphere in the room was warm, warmer certainly than that at meetings of larger parties in the city, where the business of politics is done by people with scowls on their faces and all too often either an agenda to push or an axe to grind.

Things got under way with all the usual fuss you’d expect, minutes needing to be gone though and found accurate, apologies to be recorded and drinks doled out. Tea or Coffee such a simple question and yet it manages to cause so much confusion.

It was all done in an amiable and slightly chaotic manner, making a refreshing change from the soul sapping pedantry and point -scoring you get at so many political meetings. In the discussions that followed about the merits and risks associated with coal-bed methane extraction and plans for the forthcoming elections everyone had their say, points were made with passion and conceded without rancour, the stultifying conformity other parties impose was thankfully nowhere to be seen.

Then it was on to the main business of the evening, choosing the party’s first candidate to fight a parliamentary seat in Stoke-on-Trent. The only name on the ticket, the party held an open nominations process in which all members were encouraged to participate, was that of Jan Zablocki. A long time trades union activist and the sort of campaigner who used to be the backbone of the Labour Party, until they decided to first take them for granted and then ignore them completely.

Earlier in the evening Mr Zablocki had been ambling around the room taking orders for tea and coffee and then bustling about the small kitchen with the urn and teabags. This is something of a first; in my experience prospective parliamentary candidates tend to have a more highly developed estimation of their own importance, particularly if they also have a fraction of the life experience and have notched up far fewer miles on the campaign trail.

In his nomination statement Mr Zablocki spoke about his belief that the representation of the people of this city by its current MPs as being ‘feeble and ineffective’ and being ‘driven by a desire to satisfy the narrow, entrenched agendas of their political masters rather than a genuine desire to speak out for improvements to the lives of local people.’

The Green Party, he said, represented a form of political representation that was ‘more closely in touch with the real needs’ of local people and ‘more sincere and determined about dealing with the issues that have blighted the lives of the people of our city and increasingly divided the nation between those with great wealth and power and those without.’

He ended by saying ‘we need a powerful voice closely connected with local people, their history, their everyday lives and an understanding of their aspirations for a better future. I believe I can be that voice for the North Staffs Green Party.’

The speech was delivered with a passion I have encountered on previous occasions when I have heard Jan Zablocki speak, the last being at the recent public meeting on the proposed sell off of cancer services. This is a man to whom politics matters deeply and he is refreshingly unashamed about saying so.

His is a voice as far from the patrician tones of the candidates parachuted in to the city by the three main parties as New York is from Newcastle under Lyme. This is very much the voice of the man in the street; but don’t let that fool you, behind it is a sharp intellect and an assured ability to pose questions that leave his opponents twisting in the wind, as happened to the hapless stuffed suits from the CCG at that meeting on cancer services.

After a secret ballot Mr Zablocki was endorsed as the Green Party candidate without a vote being cast against him. His wasn’t a slick performance and he stumbled a little when taking questions from the floor, but it was an honest one given by a man who clearly believes in what he is doing.

I have attended political meetings across the city for the best part of a decade and much of what I have seen has left me feeling disheartened. All too often it feels like being a witness to the end of something; this felt like it might be the beginning.

The Greens have a steep hill to climb, the first past the post electoral system we were all scared into hanging onto in 2011 works against them, as does the electoral inertia that sends a dwindling number of active voters out to tick the Labour box every few years. And yet there is a feeling that something has changed in the political life of the UK, the Scottish independence referendum showed that people will engage with politics when it takes the trouble to engage with them.

If Ukip, a party distinguished chiefly by what it is against can come as far as it has in such a short space of time, how far can a party that believes in things and has the courage to talk about them go? This really could be what the revolution looks like.

Saturday, 11 October 2014

Political turmoil, independence debates and a big disease with a little name

The nights are drawing in, the leaves have turned and there is a definite nip in the air, autumn is here and therefore this is a good time to sit back and take a look at some of the events that have interested, amused and occasionally scared us over the past few months.

The other season that starts when the leaves turn is the party conference season, I’ve largely given up on these as meaningful political events since they have long since come to resemble an awkward hybrid stitched together out of a trade fair and a revivalist meeting. Next year being an election year should have given this year’s offering a little more oomph, but it didn’t, they were, alas, as tepid as ever.

For the record what little insight they offered can be summed up fairly succinctly. Labour dropped the ball, again, spending all week waffling around the edges of policies they don’t actually have. Ed Milliband’s big speech was by turns dull and then disastrous, any credibility he had gained at the start of the week by calling for the minimum wage to be raised was blown away by his forgetting to mention the economy in his speech. Open mouth, insert foot; watch your party’s chances of winning the next election vanish.

The Tories played squarely to their core vote promising more austerity and benefit cuts along with a tax cut for anyone earning over forty thousand a year. As ever David Cameron made the best conference speech, not a surprise really since he is the only one of the three main party leaders who can do that sort of thing with any level of ability. The right wing media, which is most of the media of course, lapped it up though I’m not at all sure his message of playing to the base instinct of the electorate and letting the consequences for society go hang plays all that well outside the Westminster bubble.

The Liberal Democrats made a lot of noise and even bit the Tory hand that has fed them governmental titbits for the past five years. Listening to them you couldn’t help feeling they were whistling in the graveyard, mostly to keep up their own spirits because the wider public aren’t that interested.

As a curtain raiser for the forthcoming election all three party conferences were a total dud, none of the three main political parties inspire much in the way of confidence, mostly because they lack both policies and a vision for the sort of country they want Britain to be.

Perhaps that explains the rise and rise of UKIP as a political force, they have had strong showings in the recent European and local elections and the day before I wrote this article won their first seat at Westminster in the Clacton by-election. They are certainly attractive to disgruntled Tory voters and are starting to make inroads into Labour’s neglected northern heartlands.

There is a possibility that they have peaked too soon and won’t be able to maintain their current momentum; it is also notable that aside from leader Nigel Farage the party lacks any figures with much in the way of talent or charisma. It is also certain that once in office, at any level, UKIP will find it harder to be distinctive when weighted down by the demands of day to day politics.

For now though they are managing to connect with the public, largely through trading on their collective anxieties and distrust of the political elite, in a way the three main parties just can’t. That might not give Nigel Farage the keys to Downing Street next May, but it could make his party a major player in a future coalition government.

The independence referendum in Scotland offered a more positive and hopeful vision of what politics could be like. Ultimately Alex Salmond wasn’t able to seal the deal for the ‘yes’ campaign, but he did manage to instigate an open, constructive and mostly temperate debate about what sort of country Scotland wants to be, best of all the debate was driven by the Scottish people and not the political establishment.

This gave the political elite another unwelcome shock and although the union has survived they have been forced to promise greater devolution of power to Edinburgh and may have to open discussions about giving other parts of the UK more autonomy. In recent weeks there have been some attempts to slow the process of devolving power away from the centre down and return to business as usual, this is a grave mistake, the old way of doing things no longer works and now the democratic genie is out of the bottle it cannot be put back in again.

Ukraine and the violent separation of Crimea from the rest of the country showed what happens when a people seek independence by any other than democratic means, chaos, bloodshed and suffering. It also demonstrated the impotence of the EU and the United States in the face of a newly emboldened Russia determined to support the claims of the Crimean separatists, despite shrill protests both backed down meaning that when or if the times comes when there is no way to avoid standing up to Mr Putin the consequences of doing so will be all the worse.

The impotence of the EU and America over Ukraine may explain why there has been such enthusiasm for military action against Islamic State forces based in Syria. As the jet fighters scream through the air and the politicians promise it will all be over by Christmas and with no casualties too I am put in mind of the advice wise old doctors used to give to their eager interns, don’t just do something; stand there.

At the moment we seem to be doing all the wrong things and in an unholy rush too. It is by no means clear that the people we are supporting are any better than IS, just different, it is also a fallacy to think we can get away without putting troops on the ground and when we do being prepared to take substantial casualties.

Anyway all the above might not matter if Ebola, to quote the eighties Prince song a big disease with a little name, takes hold. There seems to be a worrying touch of complacency to the West’s response to what is seen as an African problem. We are told repeatedly that the disease will be easily contained by our more developed health services; I’m not so sure, the more complex a system is the more prone it is to breaking down.