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Labour shouldn’t increase National Insurance contributions to fund the NHS

August 28, 2014

Originally published at http://labourlist.org/2014/08/labour-shouldnt-increase-national-insurance-contributions-to-fund-the-nhs/

What’s safer, more appealing and more likely to guarantee electoral victory than the clinical and antiseptic interpretation of a ComRes survey? Expensive American politicos-for-hire might have a claim to the title. Still, the news that 49% of people would pay more [tax] if the money was going directly to the National Health Service (NHS) should be taken with a daily recommended amount of salt.

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People might say to a nice young surveyor, “Sure, I don’t mind paying a little more tax…” but then these people get into a polling booth and the first thing they feel for are their pockets; first for their wallets, then for a pen to strike against the party that makes their lives ‘easier’. People vote for the party who elicits the right feelings, not the party who presents the best arguments.

The public may be sceptical about a tax increase, even though it could have an immediate and significant role in reducing the NHS’ funding gap, and keep the NHS free at the point of need. It has been well documented that the NHS is facing a serious funding gap if demand continues to increase and budgets remain frozen – up to £30bn by 2021 according to NHS England. Surely, people chiefly need to feel like they are getting value for money from the nation’s beloved institution and that Labour can deal with its problems.

The shadow health secretary Andy Burnham has been working hard to demonstrate causation between problems in the NHS and the increasing use of the private sector. However, voters don’t really care about the politics of NHS funding. They want to be able to see a GP, get hospital appointments in reasonable times and have their operation(s) quickly and safely.

Just attacking the privatisation element of the NHS can paint future ministers into tight corners so perhaps the Labour message should shift away from the fiscal management side of things. The Mid-Staffs episode was a dark period in the history of the NHS, but rightfully, the Conservative propaganda has largely failed to have any imprint on the wider public. So, the NHS continues to be one of Labour’s trump cards, firmly standing as an area people regard the Labour party strong on. Tinkering with tax to keep the NHS going as it is, may not necessarily elicit the right feelings with the general public. Surely, there are other fronts worth fighting on.

Well, at least the Labour party is going out of its way to convince the electorate that they’re fiscally prudent and are not rushing into any spending decisions. However, we have a National Health Service not a National Hospital Service and entertaining NI tax talk threatens to deepen mistrust in politicians and undermine public confidence in the welfare state. Furthermore, what of all the other state services? If all that new NI revenue is just for NHS spending, then wouldn’t Labour still end up implementing the coalition’s plans to cut public services?

The Labour party should try not indulging ‘A penny on National Insurance for the NHS’, mainly because such taxes are unprincipled and unfair in an era of cuts and because frankly, National Insurance is one of the worst taxes with which to fund the NHS. Why focus on a tax that only hits wages, to the exclusion of other capital income streams like dividends and rent? Why would the Labour party, the party founded by the working-class, shift taxation more towards earned income rather than capital? Why suggest an increase in a tax paid by people aged under 65 (and employers) even though a majority of NHS spending goes to the elderly, the main users of the NHS? Oh yes, forgot, it’s because they vote right?

What’s more, NI incentivises the use of zero-hour contracts and will further incentivise employers to replace full time jobs with multiple part-time jobs. Which although will be of some benefit to some, may be of detriment and unsustainability to more. And again, does it elicit the right feelings when it comes to Labour’s overarching message?

Sure, the key concern is solving the NHS’ funding crises, but this needs to be done in a way that fits well with Labour’s 2015 narrative. Most people might prefer to pay £10 to see a GP than 1% extra NI that could cost an extra £500 per year. Disclaimer: That was a crude back of the envelope calculation, but not too dissimilar to the one people might do in the pooling booth were they voting tomorrow.

In any event, an ‘NHS Tax’ would never last long really, as a Labour government might not be able to resist taking the money into the central pot for over things. On one hand, it pays for Labour to confront the issue now rather than deal with something unexpected if and when it party forms a government. On the other, people vote for the party who elicits the right feelings, not the party who presents the best arguments.

Picture that. Book it

August 22, 2014

Our earliest years are spent, without our ever acknowledging or being aware of the process, learning to communicate and form relationships. Then, when children enter the educational realm, they begin perfecting those skills and gradually begin to acknowledge and embrace how to communicate and form relationships – and what works best for them.

Effective communication can be achieved in many ways, whether it’s through an astute command of language; an intuitive grasp of the underlying meaning of another’s spoken or written words; the ability to use a combination of words, facial expressions, gestures and other means to convey understanding; or through the unspoken and unseen energetic communication transmitted through the electromagnetic fields that all living things generate. You know “vibes”.

Carved in stone at the entrance of a school founded by Plato were the words of his teacher, Socrates: “Know thyself.”

A relationship is a connection and exchange between people. Communication plays a large role in the exchange between people. It exchanges information in the form of ideas, wants, desires, feelings, and much more. Incomplete or stopped communication can create a block in the relationship. The degree of the block can vary with the severity or repeating of the communication stop. A block in the relationship exists or will grow when communication is just flat out avoided.

A communication avoidance or stop will prevent that topic from being shared and gone through. When enough of these areas build up or a couple important ones develop, it behaves as if there were clamps on the lungs of the relationship. The relationship has trouble breathing. Without this exchange of life energy, the relationship cannot grow, it may struggle, and if it is severe enough, then the relationship suffers and dies.

Relying on mind-reading to get your needs fulfilled creates feelings of chronic anger and contempt towards someone, conditions which will almost invariably lead to the demise of a relationship. Don’t cheat yourself. If it’s important for you to talk, expect nothing less. Your happiness relies on it. You deserve stories and not sentences. You deserve to give each other the best of yourselves.

Developing and Managing the Service Redesign

August 14, 2014

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High Impact Thought

July 8, 2014

One High Impact Change – the integration imperative Ade Adeyemi

kopfadeyemi.files.wordpress.com 2014 07 one high impact change the integration imperative ade adeyemi.pdf

Strawberries vs Melons

June 6, 2014

Even if you are the sweetest of all the strawberries, there are people who like melons. I’ve never been one to seek attention but the strongest emotion of acceptance, of love, makes most things fade to black. I’ve been to this room before, but it was darker then, now, the rays of light bounce around the corners.

Only I know how many times I’ve truly been in love. My brother hardly gets in relationships because really, he’s scared of having his heart broken. I tell him the heart is the strongest muscle in the body, London is a big city (there are loads of places you can go and have new experiences) and everybody is unique. Every first date is a first date. Every first kiss is its first kiss.

A bolt of lightning to the head. I’m often scared of my heart; of it’s self assurance and enlightened pursuit of happiness. I don’t have the money to do an MBA at a top business School? Fuck it, let’s do it. I don’t have the clout to change the NHS? Fuck it, let’s get it done. I don’t have the legs to run a marathon. How hard can it be, really? My heart stops and starts for little at all.

The first time i saw her? She looked like a black cold winter night if I’m being honest. I could sleep in the cold of her but I didn’t think about it then. Now. I think about it all the time. She could have mused to herself; “there’s no point in waiting for someone who hasn’t asked and no point in wishing for things you hadn’t thought about”. Yet she didn’t. I’ve romanticised my parent’s marriage enough so I check myself.

Her stature deceived. Not the corporate crow. And I thought I was a great judge of character. I went home tormented by the little devil who whispers into your ear the devastatingly charming responses we could have given. Fuck it. My heart reset, only to be sparked again a few weeks later.

Whenever I talk she has the habit of gazing at my now thinning hair with a curious half-mocking, almost daring provocation; that I’m in a dissociative state of my youth. She also darts her eyes to my lips, with an almost impertinent intentness, as if she’s waiting for me to pause so she can interject or point out the fallacy in my logic. Scratch that. Fallacies.

Diplomatic immunity. The rap album by Juelz Santana, Cam’ron et al. And Illmatic. And Newham Generalz and Wiley Tunnel Vision volume 1; eskiboy. On the train on way to a sixth form school outside of east London. If indeed it it all began at this point I have forgotten the specific context, I only remember the resolve in my heart to forget grievances at the drop of a hat and enjoy the one life I have.

Do they sense it, these urban legends, when their songs are played? Does a pinprick of light pierce their darkness in the night when I press play? Is their soul stirred by the gentle head nodding off their song? Doubt it.

She’s fallen in love the way you fall asleep; slowly, then all at once. I’ve fallen in love a different way this time. With my head and heart in tandem, all at once.

You can do anything, if you stop trying to do everything. Now that I think about it, I do feel sorry for her. Yes, her. It was an excuse that probably makes little sense at all. Not surprisingly, with the muscle memory of a body building strongman, but the knowledge of a child I turned to my best friend and the wisdom of council and moved on quickly. She lost out for a reason.

Self-awareness is the lubricant to all social friction. If I can see myself the way others truly see me, I’m well on my way to getting along with others. In seeing yourself for what you are, you can laugh at yourself.

If you cannot picture your life partner making you laugh 50 years from now, bail out. That’s my thought. Humor rekindles love and warmth. Humor brings you back to earth and humbles you. Humor depends on insights and timing, something hugely important in truly intimate relationships. Not just wit, but humor that depends on understanding you, your tastes, your psyche. Life can become very tough and your body will surely degenerate. Humor looks past all of that and heals with resilience. It always stops when the laughter does. Or gets very irritating when they can’t figure out when it should.

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We are all bundles of biases that filter and skew all that comes to us. No opinion you shape, no decision you make will be free of those biases. Yet knowing this to be so will liberate you to make better decisions. Here’s hoping she really really likes strawberries. Else we’ll feel, I don’t know – meloncholy. LoL!

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Patient voice – ensuring popular accountability and ownership

May 23, 2014

Originally published via Fabians Society http://www.fabians.org.uk/health-and-care-engaging-empowering-and-listening-to-patients/

 

Though it is important to offer specific positions, Labour’s policy on health could be used to shout about its principles on patient voice that show a future for the NHS. Patient voice and accountability should play the leading role in Labour health and care policy, but currently the party’s policy review consultation ‘Your Britain’ lacks focus in this area.

Operational and logistical rejigging services is important, but pivotal to everything is authentic patient participation. What use is investment in world-leading medicinal Research & Development if patients continue to take only 50% of their medicines[1],[2]? What use is overhauling emergency care if the general public aren’t empowered to look after themselves more effectively? What use is suggesting the elderly can be treated at home if they cannot be meaningfully engaged in the design of local services? Purposeful patient accountability and ownership should be at the heart of Labour’s Health and Care policy.

The British electorate will vote for the party that elicits the right feelings about the future of their healthcare, not necessarily the party that presents the best arguments on service redesign, commissioning or market competition in the NHS. Labour’s view on personal control over care (P8 L2) needs a higher billing and should perhaps also include increasing patient choice since empowering patients means nothing if they cannot make different choices.

Given the tidal wave of abuse led by sections of the British press that has focussed on NHS failings, it appears that the case for a fundamentally flawed NHS is being set out. If Labour is to argue against this, they must recognise the public will respond to an ideologically driven agenda that signals hope and a better modern way of engaging with the NHS.

Policy around A&E services and primary care are important sections of Labour’s health policy, but if the NHS isn’t engaging, empowering and hearing patients and their carers throughout the whole system, then the case for a modern NHS becomes harder to make.

The Labour party (P7 L36) is right to suggest the Government adopted a pick and mix approach to the Francis Report’s recommendations, as the coalition government failed to go much beyond the usual ‘lessons must be learned, procedures should be tightened’ platitudes. Furthermore, Labour is right to suggest the redirection of £3 billion from frontline care risks causing more failures in the future (P7 L45). Whichever unfortunate hospital scandals one references (e.g. Winterbourne View, Mid Staffordshire) Labour must continue to press home the message that regardless the human failings, NHS staff have not gotten worse, the financial burden has.

65 years ago, Labour won the moral argument with the British electorate for a National Health Service that drove socialist ideals forward. Today, Labour’s policy around ensuring popular accountability and ownership needs to be just as innovative to modernise and progress the social ownership and co-operative management ideals of a public health service. For much of the debate surrounding the NHS for the past 10 years has centred on its capital structure and how its inadequate funding impacts on quality of service delivery. Notwithstanding these critical issues, I believe that the main challenges facing UK health policy over the next few years lie not on the finance and transactional side, but on the relational, with patients.

Empowering, engaging and communicating are all strategies that other industries such as retail, mobile technology and travel use to improve the services they provide. Whilst healthcare offers unique problems, there are lessons about transformational change The Labour party can learn about the ways we listen and involve our patients, their carers and the public.

Giving patients greater access to information about their care and enabling them to carry out tasks, such as managing prescriptions or booking appointments, would be both informing and empowering as well as reducing the burden on the NHS. In a time of financial constraint, policy ideas can lean more on ‘patient voice’, turning patients and their communities into active partners in planning and managing their own care. With smartphones and tablets becoming ubiquitous, and social networks connecting us more and more, health and technology security policy needs more attention.

Critics might worry that the proposed shifting of power could reduce governments’ responsibilities, but many experts argue that “we cannot afford not to self-empower”[3]. Of course, there are also practical challenges to encouraging an increased patient voice, particularly as not all patients can, or want to be empowered. And though a more engaged patient can never substitute professional acute care, meaningful and innovative policies in this area can speak volumes to the British public.

So this is why I think more focus could be added here. In the long-run, the extrinsically-competitive, free-market notion that drives right-wing ideology advocates for individuals to provide their own healthcare. Against this, we must consider the huge amount of evidence that shows quality of healthcare and outcomes are better for patients if they take on greater responsibility[4],[5],[6]. Against this, the future of the NHS can be made secure for all.

 

[1] The ‘cost’ of medication nonadherence: consequences we cannot afford to accept MA Chisholm-Burns, CA Spivey Journal of the American Pharmacists Association Nov-Dec 2012;52(6):823-826

[2] Langley, C., Bush, J., Harvey, J., Patel, A. and Marriott, J. 2012. Establishing the extent of patient nonadherence to prescribed medication in the Heart of Birmingham teaching Primary Care Trust (HoBtPCT): the Aston Medication Adherence Study (AMAS). Heart of Birmingham Teaching Primary Care Trust

[3] The Lancet, Volume 379, Issue 9827, Page 1677, 5 May 2012

[4] aujoulat a, d’hoore w. deccachea(2007) patient empowerment in theory and practice: polysemy or cacophony? patient education counselling 66(1)13-20

[5] wallerstein n (2006) what is the evidence on effectiveness of empowerment to improve health? who Regional office for europe’s health evidence network

[6] glyn e, laitner s, coulter a, walker e, watson p, thomson R (2010) implementing shared decision making in the nhs, british medical Journal, vol 341, 971-972.

Q1 2014 – Analysis

April 29, 2014

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