Wednesday, September 28, 2016

The junior doctors strike has been called off. What shall we do instead?

The Problem
As a doctor I am fully and passionately behind the junior doctors in their dispute with the indisputably awful Jeremy Hunt, who is trying to impose a contract on them that penalises doctors who work part time.

Hunt's contract will have a negative impact on those working less than full time, a majority of whom are women, and also on junior doctors working the most weekends, typically in specialities where there is already a shortage of doctors.

Jeremy Hunt argues that a new contract is needed to deliver seven-day services, but the department of health’s own documents show that the NHS does not have a plan as to how it will staff or fund further seven-day services. [Source: BMA]

Hunt and the Tories claim that they are trying to produce a 7-day NHS as per their election manifesto, which is OK;but  without providing any new resources, which is not OK. 

This is all happening at a time when the NHS is suffering a loss of more than £10 billion every year, a reduction in income of about 8% every year :

Thanks to @cpeedell 

So there is a big unresolved dispute.

The junior doctors were prepared to strike, but they have mercifully decided not to carry it out. 

Calling off the strike was wise, not least because a strike is exactly what Hunt wants. He does not agree with the principle of the  NHS, and he probably hoped that a strike would both make the service worse (by lengthening the waiting times), and by weakening the public's trust in the NHS.

It is regrettable that the commentariat has not reacted more positively to the turning away from strike action. A nod of appreciation would have been a decent reaction, a reward for a good decision. But journalism doesn't want ethical behaviour, it wants something it can scream blue murder about.

The question now is what the doctors should do instead? 
Or, better, what should we do instead? We, the users of the NHS? Because this is not just an issue for the juniors, it is an issue for the NHS as a service, as a whole system. Disgruntled and miserable doctors do not practice good medicine. They tend to move to countries where their skills are more wanted and appreciated, adding to the chronic shortages that are beginning to affect the service, notably in dermatology and A&E.

We need to help the doctors. Here is something that we can do:

The BMA and all people of good will should call for a regular weekly demonstration outside all Conservative Party headquarters or offices, calling for a better contract, new resources for the 7-day NHS idea, and restoration of the budget losses that are happening. Time and place of the demonstrations are to be chosen on a basis of getting the best turnout and making maximal inconvenience to the Tories. A few weeks of demonstrations will see pressure passing up through the Tory Party to make Hunt negotiate, or even to force his resignation.

Let's do it.

Monday, September 26, 2016

Left, Right, Centre - and an advertising boycott of the Daily Mail

A poll by Opinium and the Social Market Foundation
looked at where people place themselves on the political spectrum.

    10% left wing
  15% centre left
45%  in the centre
  17% centre right
    13% right wing

Now, what is everyone reading in their newspapers?
3 British people are reading right wing/centre right newspapers for every one British person who is reading a centre-left paper.

Three quarters to one quarter.
75% right, 25% left.

Now, what were those Opinium numbers again?
25% of people are leftish, 30% are rightish, and 40% are centre.

This means that the centre is reading right leaning papers on a daily basis, getting their heads filled with right wing memes, but still they see themselves as in the centre.
If British newspapers were divided evenly across the spectrum, the Tory and Ukip parties would shrink. Their political dominance would fade away, and we would have a far more balanced politics in our country.

We are governed by tabloid editors. They set the agenda, they tell the electorate what is important and what is not. Most of all, they determine what is the centre. Only the self confessed left falls outside of their area of control.

What can we do about this? They are beyond reason. We cannot present an argument to them, as they will not print it.

Therefore we can only hit them where it hurts - in the pocket. If ethical corporations stop advertising in right wing papers because, for instance, they keep publishing inaccurate pieces about climate change, we could make a difference. The #Deadvertise campaign is the way to go.

Wednesday, September 21, 2016

Why did Chris Brennan not get efficient care?

Chris Brennan (from family archive)

The coroner says that "neglect" by staff in a psychiatric unit at Bethlem Royal Hospital, South London, contributed to the death of 15-year old Chris Brennan.

The coroner noted under-staffing, which contributed to low morale and poor performance.

It is easy for lawyers to pronounce after hours, days or even weeks of deliberation on medical decisions that are taken in sub-optimal conditions.

Psychiatric services are a neglected part of the NHS, which is underfunded overall.

Here are the bare bones of the situation in the NHS, dug up by Dr Clive Peedell of the NHS Action Party:

Those deductions add up to at least £10 billion a year, about 8% of the notional NHS budget.
This deficit, happening year on year, are bound to have an effect on services, and Jeremy Hunt's idea of stretching an already overstretched 5-day service out to 7 days, without offering extra resources, is simply going to make the situation worse.

Coroners are going to see a lot more cases like poor Chris Brennan, unless and until people start to camp outside local Conservative Party Association HQs.

Why climate change "scepticism" is not science

Climate change "scepticism" is an a priori argument; it stems from absolute belief in the free market, and belief in the principle is so strong, it can allow the believer to override a complete body of science.

One of the features of mature science is that it builds a coherent picture of the systems it is studying.

For example,  in the case of scientific medicine, we have a clear idea of how the human body functions - how respiration, hydration, nutrition, metabolism, reproduction, perception and excretion work together in a unitary system to produce a living human person. There are areas of uncertainty in medicine and human biology because that is the nature of science, but the uncertainty is at the periphery where the specialist scientists are working; alongside the peripheral uncertainties, we still have the central certainty that if there is a pulse, breathing, good colour and verbal responses we can be pretty sure that the patient is not dead.

Coherence is one of the ways we know that climate science is right and climate scepticism is wrong. This is important, because some journalists and broadcasters seem to think that science happens when people use long, perhaps incomprehensible, words and can refer to papers. It is not. Climate science creates a coherent picture of the planet in the following way:
  1. The greenhouse effect is real 
  2. CO2 is a greenhouse gas
  3. We have already increased CO2 levels by 40%
  4. The earth surface temperature has already risen by nearly 1*C
  5. Already we are seeing weather changes in terms of heatwaves and floods. 
  6. If we continue to pump CO2 into the atmosphere, we, our children and our grandchildren are going to suffer significantly
Climate sceptics on the other hand just have a number of criticisms and talking points that they raise over and again: climate is not changing, it is changing but not because of CO2, it is due to the Sun, it is due to volcanoes, it is due to the little ice age, cloud cover will cool us down, it is due to cosmic rays etc etc. There is no consistency, no attempt to construct a coherent picture of the world. 

The only fairly constant concept in the climate science sceptic armoury is that the free market is an inviolable principle, and if anthropogenic climate change were true it would mean that the free market will have to be replaced with measures to end the free market in carbon fuel. 

The sooner that the mainstream media grasps this reality, the safer we will all be.

Tuesday, September 20, 2016

The climate has always changed. But then, so has the economy.

Most climate change "skeptics" deny that climate is changing because of our CO2 emissions because they think that to change from a carbon-based economy to a solar based economy would be a total catastrophe. In fact it wont: energy is energy, wherever it is sourced, and in fact renewables are coming on much faster than I for one ever expected.

But the real irony is that the deniers whose present mantra is "The climate is always changing" is that they don't understand is that the economy has always changed and always will change. The global economy has , over the centuries, been powered by muscle, wind, water, coal, oil, nuclear and now it will be powered by the sun (with a bit of help from hot rocks).