The NHS is a real priority for me in this election. As an aging woman I want to know it will be there as I and my friends get older and weaker! And so far, it has been. But more than that, I love the NHS. I worked for it for 30 years, first as a volunteer and then, as a manager and an academic. So, although I’ve never been on the front line, I’ve worked hard to help those who do to understand and apply changing health policies to improve their own services on the ground.

I’m committed to the NHS as a citizen too, not least because I’ve seen the impact of the US healthcare system at closer quarters than I wished: watching my aging and weakening parents, able to choose any form of diagnostic test, any time any place – but this choice meant that they were left having to find out who to turn to get the results interpreted. They had choice aplenty – but not the information they needed to find the best person to diagnose and treat them. All that was down to word-of-mouth, which doctor their friends liked without any way of knowing whether that same doctor had the expertise and experience they needed. And all this at their own cost, because despite good health insurance cover and Medicare top-ups, doctors charged additional top up fees. Added to this, prescription drug costs were very high. And then the home care services, privately provided so outside insurance coverage, were a lottery. Despite paying for them, the carers were of variable standards and seemed to arrive at random times, frequently a different one than the day before, all of which was unsettling and unnerving.

Is this the path we want to continue on for ourselves? Because this is the path we are on now. Is it good enough for you or your friends and family?

Today, NHS waiting times are at their highest for a decade. The Conservatives scrapped targets allright – because their funding levels meant that the targets could no longer be met. This has meant longer and longer waiting times for us patients.

For example, the waiting target for cancer treatment, from diagnosis to treatment, is for 95% of patients to be diagnosed and treatment started within 62 days.  This target was met every year since its introduction in 2009, through to 2013/14.  But it has been missed every year since.   Last year, 2016/17, only 82% of patients were diagnosed and treated within the target time.

The NHS runs on its people – and too many of them are overworked.  Tired doctors mean mistakes -and then the doctor is blamed.  Stressed out nurses get sick – or leave the service. There are not enough GPs in the system now to cope with the demands of an aging population.  None of this is down to immigration.  N HS pay levels  have been capped in the name of Austerity.  Budgets are cut – in real terms – in the name of Austerity.

We spend less on our health care system than do our European counterparts.  From what we can see so far, none of the parties’ promises will bring us up  to their levels of spending on health.

The Liberal Democrats’ promise of 1p on income tax is a good idea because it provides a level of stability for NHS planning here-to-fore unknown.  This would be a big help.

Labour is offering £30 billion – the most of all the parties, as far as can be judged from manifestos.  That £6billion a year will also cover re-instating bursaries for nurse training, which should really help recruitment.  The rest will go a long way to shoring up struggling services.  Labour has also pledged to end the current pay restraint which will help retention too.

The Tories, well, we know what we’re getting now and its not good enough.  The end to nurse training bursaries on top of pay caps on nurses’ salaries is already having an adverse effect – and nurses are leaving, meaning that Hospitals have to plug the gaps with more expensive Agency staff, all to do the same jobs, but adding massively to their deficits.

What do you think? Whose policies do you think will help the NHS most? Whatever you think, do go out and vote on Thursday!

Congratulations to the South Wales Police Heddlu De Cymru for doing such a brilliant job throughout the UEFA Cup Final weekend!  Two thousand police officers worked on what Sky News claims was the biggest security operation in Wales since the NATO meeting in 2014.

The atmosphere in central Cardiff was fun. One hundred and 70,000 football fans poured through the city centre and there was no hint of trouble.  And down at the 4 day Festival in the Bay, the crowds milled round the festival stands and queued up to join in the activities at different stalls along Marina Quay.

The weather helped of course -though at times the big silver replica UEFA Cup swayed in the freshening southwesterly breeze!  But the real heroes of the weekend, to my mind, were the security services and the police.

The security operation was enormous.  I had some qualms, watching it all being set up in the days before the event:  huge black barriers across the routes in the Bay (some of our favourite cycling tracks!), the city centre roads closed completely for 4 days – and even the run down the River Taff  was barred at the Railway Bridge!  All our bags were searched as we walked our bikes through the Festival – and those without bags were frisked – but the whole thing was done quickly and effectively- and with plenty of smiles and laughs.  Grace and professionalism characterised the whole security operation.  Far from being intimidating,  their behaviour and presence only enhanced  the atmosphere.

We are so lucky to be able to say this, on the rainy Monday morning after the event.  In the wake of the terrible events in London that same weekend, coming so quickly after the Manchester Arena and Westminster Bridge attacks, the story could have been so different.  My heart goes out to all the different individuals affected by those tragedies, and to their families and friends, whose lives will never be the same again.

Thanks to the efforts of the Army, the South Wales Police and the countless numbers of volunteer Ambassadors and helpers throughout the weekend their were no adverse incidents, beside a few ticket touts being arrested.

Our police need our support.  It is not enough to say ‘Enough is Enough’ Mrs May.  We need to pay our police adequately for the huge risks they take on our behalf, risks which are increasing every day. Yet under this government, since 2010, and especially under Theresa May as Home Secretary during that period, our police forces have faced more opprobrium than praise.

Over a year ago, in July 2016, the press were reporting that our police forces were being cut.  The BBC reported that we had 20,000 fewer police officers in 2016 than in 2009: a fall of 14%.  The Police Federation noted that its budget had fallen 18% in the same period.  And at the same time the numbers of police officers on long term sick leave have increased during this same period. I recently met a police officer who told me that his colleagues were leaving the force in droves, through early retirement or for other jobs, because they were so stressed by their growing workloads and the expectations on them.  This is a vicious circle which demoralises remaining staff and makes it increasingly difficult for them to keep working effectively.

Of course, changing times need changes in work methods.  According to the Police Federation the 6% drop in crime during this period shows that the police have indeed been able to do more with less.  But we also know that as the nature of crime changes towards more insidious forms, such as the kinds of smaller scale but deadly incidents we are now seeing in the UK, and towards cybercrime, then it is likely that we are going to need more individualised responses from our police and security services.  To my mind, that implies needing more officers on the ground, not less.

I don’t think our police or security services are safe in Mrs May’s hands.  If you don’t either, Vote on Thursday! And vote for some one else!  Jeremy Corbyn’s Labour Party is pledging to add 10,000 new police officers, I’m good with that.

Jeremy Hunt has just produced a White Paper on simplifying the regulatory machinery for health professionals – again. This, on the same day that figures emerged showing that the NHS has faile…

Source: New Regulatory Bodies for health professionals?

Well I am devastated. Sickened in fact; horrified and disappointed and shocked. And that’s not the half of it.  It is indeed Brexit Plus Plus Plus as That Man promised it would be. I can’t face reading the papers. The radio and TV are off unless there is a non-news programme to watch-which means we keep missing the weather forecast. Fortunately the weather is being kind to us and the sunny dry days mean we can keep escaping on our bikes and forget about this awful unbelievable awful event for a while longer.

I didn’t think it could happen in America. I was shocked and shaken by the vote to Leave the European Union but put it down to social conditions peculiar to Britain and our ever widening inequalities.

Now I feel we are in the throes of a major disturbance, politically and socially: a seismic social change seems to be taking place around us. People seem to be digging their heels in, saying ‘I’ve had enough’, ‘I won’t be pushed around any longer’. And, if that’s true, I support that sentiment.

What I can’t accept though is that it comes alongside such hatred and abuse – of women, of blacks, of Muslims. And maybe too of all of us who have enjoyed so much privilege for so long.

Yet, at the same time, I have also been longing for revolution, for so long. I couldn’t understand why no one was rioting in the streets as this narrative of austerity as the only way to handle the Crash was perpetrated and accepted. That workers had to bear the brunt through wage caps while we bailed out and supported the banks. While welfare claimants and the sick and disabled were vilified for needing our financial support. While immigrants were blamed for ‘over-burdening’ our NHS when the real villain was the cap on its resourcing.  Britain is better than this. And so is America.  I thought.

But in trying to understand and come to terms with this outcome, I hit a huge stumbling block.  I am furious. I am revolted to the core.  I can’t look at a picture of That Man without retching yet.  All the while I am trying to find compassion and understanding and acceptance.  Digging deep to try to ‘Be the change I want to see’, to find and to show the grace that Hilary Clinton and Michelle Obama give seemingly so effortlessly.  I will keep digging. There really is no other way through. It sure ain’t easy…

First off, a health warning to readers:  I am a fervent supporter of the NHS, so cannot claim to be unbiassed.  I’ve worked for the NHS since the late 1970s, in England and in Wales.  And of course I’ve been a patient too.

The NHS is unique in being 100% publicly funded.  It is also unique in the way in which it is politically managed.But listening to our politicians’ pronouncements in the run up to this election is worrying.  Both Cameron and Miliband continue speaking in vague generalities, when they can be pushed beyond platitudes.  Both parties box and shuffle around their proposed spending commitments. Jeremy Hunt spouts dogma-driven drivel while Andy Burnham talks of integration as though it will solve everything. I know that we haven’t had formal manifestos yet, but here are some of the issues we need to hear more about from each party before entrusting them with our votes.

Money:  The talk, so far, is all about the mythical magical figure of £8billion and who will/won’t commit to this level of funding.  This figure comes from  estimates produced by the new “NHS Czar”for England, Chief Executive…Stevens, who predicts that the NHS needs £8bn over inflation by the end of the next Parliament (2020/2021) to maintain its present level of services. 

Reports from leading health experts and think tanks suggest this figure is inadequate because:

• it relies on achieving efficiency savings of 2-3% per year
• The proportion of elderly people in the population will continue to grow during that period
• Elderly people, with growing rates of chronic disease, use more health and social care services than the rest of the population.

Efficiency savings in the NHS currently run at 1.5%, so expecting these to increase to 2% is a big ask, let alone expecting 3% per year.

Historically, costs in the NHS tend to rise faster than inflation because of the steadily increasing number of elderly people and because the costs of new medical technologies tend to rise faster than inflation.  Now we have an added factor, as cuts to Social Services budgets begin to hit the NHS. Therefore the supply of places providing rehabilitation facilities is falling.  This leads to back up in NHS acute hospitals and we have all seen the knock on effects of that this winter.

Resources  No place to discharge vulnerable patients to, means that beds in acute hospitals are full; so, no room for new patients, whether from A&E or scheduled admissions.  The whole system grinds to a halt, waiting times increase, staff are over-worked and pressured.  They get sick and are off work, so agency nurses and locum doctors are needed, adding increased and unanticipated spending on hiring short term staff.  And then the hospital emerges over-spent at the end of the financial year.

Performance  By this time with waiting times targets have been missed frequently, staff become stressed and demoralised while politicians wring their hands…

So is there a way out of this vicious cycle?

Funding:  The Health Foundation estimates that, expecting more realistic efficiency savings of 1.5% a year (the rate at which they are currently being achieved), the NHS still needs some £65 billion over and above inflation by 2030.  That means annual funding needs to increase to 2.9% a year, slightly higher than the predicted rise in GDP of 2.3% a year.

So far, spending on the NHS in England has risen by an average of 0.7% per year in real terms over this parliament (2009/10 to 2013/14). This is lower than the average rate of increase for the UK of 3.7% a year in real terms since the NHS was created in 1948. But it has enabled Coalition politicians to claim, rightly, that they have increased spending on the NHS:  from 2010-2013/14, spending on the NHS rose to £112, the highest amount since 1948. Spending increased by 1.1% in real terms in 2013/14. And planned spending is set to increase by 1.3% in real terms in 2015/16.  But the statement above still holds:  this is less than at any time since 1948.  And here are some effects:

• Spending by hospitals increased by 2% a year during this parliament (2010-15).  Now, 4 out of 5 hospitals are expected to be reporting deficits as this financial year ends.
• Meanwhile spending on general practice has fallen by 1.3% a year.  This is unfortunate because primary care is the bedrock of health systems, providing 80% of care. Care provided at primary care level can prevent more expensive care needing to be given at acute hospital level. And so. stresses on this part of the system have the sorts of knock-on effects we’ve all bemoaned this winter:  increased waiting times for GP appointments, A&E attendances up, bed shortages in hospitals and round we go again.

At the same time, NHS spending on care supplied by non-NHS providers (private, voluntary and local authority organisations) has risen by an average of 6.2% a year in real terms between 2009/10 and 2013/14. Services purchased by NHS commissioners (primary care trusts, NHS England and clinical commissioning groups) from non-NHS providers rose from £8.2bn in 2009/10 to £10.4bn in 2013/14 in real terms (see figure 5).www.health.org.uk/ fundingbriefing.

Spending on private providers is meant to bring in a more diverse range of services.  Introducing an element of competition can stimulate quality improvements.  But what it also does, much more inexorably and inevitably, is to increase transaction (administration) costs.  It may increase patient choice but, in my experience, this is a two-edged sword.  The patient also gets the burden of choice: s/he has to take on finding and selecting a provider, despite usually being in a vulnerable position (ill and anxious) when undertaking those roles.  And it makes it very hard to make judgements on relative quality because indicators are different in different systems, and commercial confidentiality concerns limit the information available to would-be service users.  Our system using GPs as gate-keepers provides both advocacy and monitoring of quality.

Miliband’s proposals, announced today, to cap profits made by private providers would ensure that some of the £18 million a day profit currently being made by private providers from the NHS budget (Patrick Wintour, http://www.theguardian.com/electionlive27.03.15) gets ploughed back into the NHS.  This would help to pay back the NHS for its investment in training, developing and employing those who may also work for the private sector…).  In addition his proposals to repeal the Health & Social Care Act, more aptly tagged as Lawnsley’s Disaster, perhaps, and remove the requirement on Commissioners to include private tenders, may also help the NHS to refocus on its core functions.  But more funding and more funding for social care have also got to be part of any package to ensure the NHS remains a viable free-at-the-point-of-access service, regardless of a patient’s locality, age,gender, or means!