I dislike Valentine’s Day and will now try to make you feel bad about it

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In what seems like a lifetime ago, I attended an intervarsity debating competition where I watched a final on the motion “This house would ban Valentine’s Day”. It was on Valentine’s Day. I was single. Everybody in room knew they were really cool.

I remember little to nothing of the debate but it did make me think about Valentine’s Day a lot. It even became a bit of stand-up when I still did stand-up. It went something like this:

“I hate Valentine’s Day. It’s the only day dedicated to making happy people happier. There’s no International Rich and Happy day where rich people rub money in the faces of the poor. Or People Who Don’t Have Cancer day where people who don’t have cancer go to chemotherapy units to have dinner without vomiting or losing their hair.”

Now whether you find that funny, offensive or both (NB: it is not a joke a about cancer), it hopefully demonstrates my point. But I want to expand on it which is less funny but possibly more interesting. I’m going to generalise about people in three different statuses of relationship: single, traditional monogamous and non-traditional relationships.

Single

This one’s easy. See the quote above. If you’re in a relationship, why on Earth do you feel the need the to rub this in the face of people who are single? What kind of narcissist are you? Unless you literally never mention your Valentine’s plans to anybody.

Sure, a lot of single people don’t care. But a lot do. Some will be recently divorced. Some will have had a partner who has died. Some will have just broken up. Some will be lonely. All these people are made to feel bad on Valentine’s Day. Thanks, people in a relationship!

Traditional relationships

Here, I’m talking about monogamous relationships of all sexualities and all genders. One person who is an exclusive romantic relationship with another person.

If your relationship is currently a happy one, Valentine’s Day makes no difference to you. You don’t need a special day where you get together with everybody else to celebrate how great you are because you found somebody else. Well done on attempting to make the entire world your awkward third wheel.

If however your relationship is going through a difficult time, what Valentine’s Day does is says, “if your Valentine’s Day is unsuccessful, you are in a bad relationship”. Clearly, this is ridiculous. Outside of film, TV and books, all relationships have ups and down. All Valentine’s Day does is force these couples to focus on the failings in their relationships, whether they want to or not. It may even break relationships.

Non-traditional relationships

 

Valentine’s Day perpetuates the notion the road to happiness is through monogamy. “Will you be my valentine?” implies one person, not many. And it goes further.

There is a general perception that being in a monogamous relationship is not just about happiness – it’s about virtue. That there is something fundamentally morally superior about those us in monogamous relationships than those of the us that aren’t.

First of all, this is awful for people who aren’t in monogamous relationships. Secondly, it means that single people may not look at either being single or being in polyamorous relationships are legitimate routes to happiness.

(As an aside, the “most virtuous” relationship is arguably the heterosexual, cis, monogamous relationship but sexuality and gender aren’t Valentine’s Day’s biggest issue.)

So basically, by celebrating Valentine’s Day, you’re making single people lonely, potentially destroying relationships, marginalising the polyamorous and closing off paths to happiness for everybody.

Well, at least I was considerate enough to post this after February 14th.

Happy Valentine’s Day.

The NHS needs money. It also needs to change

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In 2011, the UK had 2.8 physicians/1000 population compared with Germany 3.8, France 3.4 and Australia 3.3. The UK spent 9.4% of its GDP on health compared with France 11.5, Germany 11.3 and Australia 9.4; the UK’s spending was forecast to drop to 6.6% by 2020/21 though all bets are off with Brexit looming.

The NHS in England needs more doctors. I work for a large trust across two hospitals where the 6 different anaesthetic rotas at middle grade/registrar level should theoretically provide plenty of cross-cover. It doesn’t: I regularly receive requests to fill gaps in rotas, often with “HELP!!!!” in the subject line. This is no different at smaller district general hospitals.

Criticisms from the BMA of Jeremy Hunt during the doctors’ strike and Theresa May are correct. Seven-day elective services do little for emergency care provision. Moving GP opening hours to 8-8pm is not the same as increasing capacity. If two GPs work 9-5 and then change their working hours to 8-4 and 12-8, the surgery will still be open 8-8 but there will be the same number of appointments.

Opposition to change in the NHS is widespread

That said, trying to change something in the NHS is nigh-on impossible. Healthcare professionals blame managers. Managers blame healthcare professionals. Everybody blames IT.

Let me give you an example. Patients in acute medicine are allocated to consultants in 24 hour blocks, 8am-8am. Patients who arrive in that time, fall under that so-called “take” consultant. If not discharged on the day, they are added to a “post-take” ward round the day after.

There is software which produces an active list of patients who need to and have been seen by Acute Medicine. There is a list for yesterday and today. From 0800-0900, it moves forward to the next day. The issue is, at 0730, secretaries print the previous day’s “take” list. Between 0730-0900, patient’s deemed seen by a junior doctor may get added to the previous day’s list after it has been printed. Today’s take consultant thinks the patient has been seen by the previous day’s consultant. The previous day’s consultant – now on the post-take ward round – doesn’t know about the patient

This could be solved simply by having the system refresh at 0630-0730. However, this doesn’t happen. Instead, at 8am, junior doctors print a physical list and after 0900, add the information. Of course, doctors may forget, may be new and not realise or there may simply be a clerical error on paper leading to patient not being seen.

At another hospital, the portering system had gone electronic and theatres had lost their dedicated porter. If there were no operations, previously that porter went and helped with other portering jobs.

On the new system, the most urgent your patient will be picked up is “urgent”. However, I have frequently waited an hour or more for patients who were acutely unwell. Theatre staff were instructed they should not be leaving theatres to collect patients – this makes sense as if the patients arrived in a timely fashion, theatre staff would be preparing theatre. This was not an issue prior to the introduction of the electronic system.

These issues may seem minor but they are legion. Each one adds a layer of inefficiency. Occasionally, you get workarounds (like in the first example) but these aren’t really solving the problem. Steven J. Spear’s excellent book The High-Velocity Edge looks at how to improve processes – to paraphrase him, this is not a solution, rather solving the same problem every day.

Efficiency savings or quality improvement?

As a junior doctor, largely you feel powerless to change these things. You usually spend 4-6 months per placement, too little time to effect change. This is made worse by healthcare professionals who aren’t willing to at least try change. Change is not always good – yes – but that’s necessary risk to take. Indeed, in research, it’s acknowledged that change is necessary. Without it, we would not have seen the medical advances of the last 70 years. Ultimately, the “low-hanging fruit” of research have been taken. With quality improvement, we have barely scratched the surface of what the NHS is capable.

The difficulty is two-fold. First, any criticism of the NHS is perceived as bad. “Efficiency savings” have become a euphemism for cuts. However, what kind of organisation isn’t constantly trying to make efficiency savings?

Under Tony Blair, healthcare organisations worked on expanding services, a very different set of managerial skills to improving current ones. It takes time and effort but mindless calls to #SaveOurNHS, whilst useful at times, perpetuate the image that the NHS doesn’t need change, it just needs more money.

Secondly, many healthcare professionals engage in management begrudgingly, interested in clinical practice only. Though we receive little training in management, our reluctance to change processes kils our patients as much as any funding gap. They are as important as our clinical skills.

To be effective, these changes need to solve problems from the bottom up. Managers should call for small problems to be highlighted and praise staff for doing so. Staff, when change is implemented, should go with it, at least at first. And managers should listen to the things that do and do not work. No amount of money can change this.

A really fun post about death

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Last year, there was quite a bit of chat about famous people dying. The BBC examined this and found they had published more pre-prepared obituaries than usual in the first 4 months of last year in particular.

This sounds callous but I find it difficult to care.

Don’t get me wrong – if Sarah Michelle Gellar (I liked Buffy) or Claire Danes (I like Homeland) die, I will be taken aback. However, I am not going to be personally affected should Gellar die. And whilst it would be sad if Homeland got cancelled due to Danes’ untimely demise, this is not reason to grieve.

When people on social media express their sadness at a celebrity’s death, mostly this is in tribute to their body of work. However, there sometimes seem to be genuine expressions of grief as though they were a loved one.

In hospital, whilst most relatives are realistic, it is not uncommon to encounter impossible expectations of healthcare. Arguably the most challenging aspect of critical care medicine is making the decision about when to provide or more crucially when not to provide critical care.

Being on a Critical Care Unit/Intensive Care Unit (vs being on a standard ward) involves a host of unpleasant interventions. Whilst this is worthwhile if a patient has a reasonable chance of survival, in futile cases, this is tantamount to torture, a word I use when explaining ceilings of care.

I worry that both the unrealistic expectations and grieving for celebrities are symptoms of our general aversion to discussing death. How can one seriously grieve for somebody unknown to them?

In the original Get Carter (1971), Michael Caine’s character (the titular Jack Carter) has to attend his brother’s funeral. The body is kept in the family home. These days, bodies are kept in mortuaries and taken by funeral directors prior to burial or cremation. It would be unheard of to keep a body in the family home.

I am not trying to make you feel bad for your sadness at George Michael/Alan Rickman/Victoria Wood’s death. Still, posts can seem as grief-stricken as those from the genuinely bereaved.

Death is a fact and it is something we consider too little and discuss too infrequently. It leads to the situations where people with cancer are abandoned by their friends. I have had multiple conversations where bereaved friends have found others unable or unwilling to discuss the death of a loved one.

And because of this, it seems uncouth and unhealthy to act as though a celebrity death should be treated similarly to personal bereavement.

Talk about death; when your relatives became unwell, doctors are going to ask what you think they wanted. That is a much easier discussion if you have had the decency to talk about it. It is for them as much as you.

You and everybody you know and love is going to die: get comfortable with that. On that note, I am going to have a banana and go to bed.

 

The moral failure of Stronger In

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Not seen this in a while…

The EU referendum was a major campaigning failure on both sides. Whilst Leave won, much of the press has analysed its moral failings; lying red buses, racist posters and the conspicuous absence of even an inkling of a model for Brexit.

Remain’s failure is more obvious: they lost. This failure is practical one. Listless and crippled by its de facto figurehead David Cameron’s inability to be positive, particularly on immigration given his previous anti-immigrant rhetoric instead Stronger In avoided the issue. Labour’s lacklustre campaign in its heartlands exacerbated this, whether you blame Jeremy Corbyn, Alan Johnson or both.

Unfortunately, Bremoaning won’t change the future. Theresa May’s path is unlikely to be swayed from what looks to be a hard Brexit. Largely, all of the above is academic.

There were reasons Stronger In didn’t campaign in poor areas…

There were two reasons for not targeting the poor. Firstly, that it would be ineffective.

The theory: Leave voters were more likely to be poor and fewer would vote except a small, dedicated core of Leavers. Remain voters were more numerous, richer and normally more likely to vote at elections. However, they were less enthused than Leavers on this issue.

Run a good Get Out The Vote (GOTV) campaign in affluent areas and turnout would be high; Remain would win. With a low turnout, this dedicated core of Leavers would outnumber the Remain equivalent.

Secondly, there were safety issues. Attempts to set up a stall in a South Yorkshire town were abandoned due to a ream of abuse. A woman I was with was assaulted (though she was not badly hurt) whilst slightly away from the main campaign group in a city centre. On referendum day, a campaigner talking to parents outside a school was accused of being a paedophile by a local. They then threatened to call the police. Outside the largely good-natured shouts of ‘Brexit’ – from largely from white van men apparently unaware of or uncaring for their stereotype – one group of builders physically threatened a campaign group in a leafy suburb of Sheffield. A local politician placated them with a selfie.

And all in the wake of the death of Jo Cox, herself a passionate Remainer.

…but Stronger In still should have campaigned to the poor

Having discussed the issue since, I know many campaigners – in South Yorkshire in particular – were frustrated that they weren’t talking to the poor. Stronger In’s leadership made its decisions for the reasons outlined but they lost. Turnout was high at 72% and 17.1m voted Leave; in practical terms, they are to blame.

But I’m talking about a moral failing. It comes down to this: we had a duty to talk to the poor about why immigration was good.

I understand why Remain needed to win. I also get this is a very easy decision to make in hindsight. But ultimately it was the right thing to do.

Why? Britain is rarely transfixed by politics but the EU referendum had managed it. We squandered that opportunity to talk to the poor about why immigration mattered to them. Would we have convinced all of them? No. But maybe some. Maybe 600000. Maybe our campaign wouldn’t have looked and felt so insipid.

Labour probably ought to take some blame for this. They could venture into areas Tories, Lib Dems and Stronger In campaigners could not. But the blame cannot lie solely at their feet.

I am a doctor. The most affluent place I’ve worked is Nottingham for 1 year. I spent the other 3½ years full-time in Boston, Barnsley, Doncaster and Rotherham, excluding a further 1½ years part-time.

My patients are largely poor and they need the NHS more than anybody. I’d far rather work in an area with those who truly need my help. It makes me feel like it’s worth being a doctor.

That’s what the Stronger In campaign could have been – an attempt to at least partially reverse the trend of assuming every poor person hates immigrants. It wasn’t first-past-the-post, there were no marginal seats. And the theory that we would have “woken up” Leave voters was both wrong and offensive.

I don’t know what will happen with Open Britain, the European Movement, Britain for Europe or the British People Who Think Europe Is Really Ace Or At Least Sort Of Alright And Not As Bad As That Floppy-Haired Chap Heavily Implied. I hope above all, that it talks to the poorest in society about immigration. They’re the ones that need it most.

Rage Against The NHS Fax Machine

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So I haven’t posted on this blog in a while, largely due to recently getting my first full-time position in a year as a Specialty Trainee in Critical Care i.e. the path to becoming a consultant in Intensive Care Medicine (yay!). Also, there’s been a lot of depressing Brexit chat to avoid.

This post is just me complaining about a relatively minor but still important thing.

I hate fax machines

To become a critical care trainee, you need a background in internal medicine, emergency medicine or anaesthetics. It’s all very complicated but because my background is anaesthetics, I don’t have the requisite competencies in medicine. This August, I started work on an acute medical unit doing acute medicine, a specialty I’ve not been involved with for three years.

One of the frustrating things about working in acute medicine is drug histories. Trying to determine what drugs a patient is on is difficult if they don’t bring a prescription or their medications with them. Trust me, no doctor knows what “the little blue pill” is unless they’re science-fiction fans and you happen to be Neo from The Matrix.

As such, during the day if you’re seeing a patient, you’ll often have to phone their GP’s surgery (though now some trusts have a centralised record system). If the list of drugs is long, rather than bother a GP, secretaries will often just send you the list.

However, they always, always insist on fax. I had to organise this for the first time in a long time a couple of weeks ago; fax is bad for a number of reasons.

Why not just use email?

Evidently, confidentiality is an issue in healthcare. Clearly, you shouldn’t send confidential information via Facebook chat. However, we have trust NHS email addresses. These end .nhs.uk and generally have the initialisation of the trust ie Leeds Teaching Hospitals use @lth.nhs.uk, Nottingham University Hospitals @nuh.nhs.uk etc. These are given to staff when they start at a particular trust and deleted when their contract ends.

It’s generally considered safe to send confidential information via email within the trust using this system (though nobody has actually confirmed this with me). However, for sending information outside of the trust, you need an NHSmail email address. These end @nhs.net and are personal ie they go with you as long as you work within the NHS.

At least, that’s my understanding. A few days ago, I tweeted NHS England and received a response from @grant_me who according to his bio is an “IT Professional working in NHS Primary Care”. That’s the best I’ve got to go on after not really trying very hard.

Given the lack of clarity about this, secretaries stick to the tried and trusted method of fax.

What’s wrong with fax?

1. It’s really annoying

I don’t use fax machines because it’s not 1992. I’m not particularly technophobic, I like my smartphone. However, I’ve used a fax machine about twice in my entire life.

Whenever a doctor needs to use the fax machine, we find a friendly ward clerk or secretary and look forlorn at them until they realise we’re not going away until they send the fax. I can be very good at looking forlorn.

(NB: any medical students reading this: make friends with the secretaries. I’ve seen them ignore a surgeon they didn’t like who asked for a form, saying they didn’t know where it was. They then found the exact same form for me 10 minutes later, and sent it for me because I’m all sweetness and light.)

2. It’s hilariously unsecure

I rang the GP. I explained I was a doctor at the local hospital on the acute medical unit. I gave my name and – after them insisting they wouldn’t send it to an email address – faxed me a copy after I eventually found out the fax number.

I could have been any muppet who bought a fax machine. There was no security or check to see if had gone to the right machine. No check to see I was actually a doctor. Literally, you could ring up a GP and do this yourself if you have a fax machine (but don’t because you’ll go to jail).

3. It can be incredibly complicated

At the hospital I work at, to make a referral to the anticoagulation clinic on discharge, you have to fill out a form, fax it to the clinic then ring them to make sure they’ve received the fax. This means that if you discharge a patient at 6pm, after the clinic has closed, you can’t ensure a referral unless you’re in the next working day.

There’s no guarantee you’re going to be in. The patient will have gone home. If it’s a Friday and you’re on nights the next week, it means you may not be able to check for about 10 days at which point, the patient hasn’t got their anticoagulation appointment and they’re at risk of stroke or blood clots or being struck by lightning. OK, anticoagulation does not decrease lightning strike risk but it is important.

Communication within the NHS

This is generally bad, particularly because we deal with a lot of sensitive data. I have worked in hospitals where non-urgent referrals were done by an A6 piece of card to the secretary of the relevant specialty. Like they never got lost. Some services ask for fax (like anticoagluation). Some are on the hospital intranet. Some are Word forms filled out and sent via email. Some are via an online request system. And don’t get me started on the bleep system (something for another time I feel).

I worked with a cardiology team who set up an email address at the trust that was “cardiology@trust.nhs.uk” to replace the aforementioned card system. They went from seeing something like 60-70% of their referrals within 24 hours to seeing 100% of their referrals by the end of the next day, and 100% within the same day if the referral was sent by email.

Firstly, given NHSmail exists, all NHS staff who handle confidential information should have an NHS.net account. This should be the standard form of written communication between NHS bodies. Fax should be banned. Tomorrow.

Secondly, trust emails should exist for all specialties and services to which referrals can be made, with delivery reports. This gives a clear trail as to whether a service has received an email. Creating an email address is presumably not a massive step for an IT dept and it’s a familiar system to most people.

Obviously, this is more complicated than I’m making out. But also, you know, it’s not. Especially, given it’s been done already. Pff. Unfortunately, I’m not sure anybody’s that bothered and so many people seem to love fax machines. Sigh.

We are screwed

Britain has voted for self-harm. That probably sounds like hyperbole but both economically and politically, the news today is bearing this out.

The pound has dropped to a 30 year low. The Financial Times Stock Exchange 100 (more commonly FTSE, or FTSE 100 or “Footsie”) fell 8.7% and recovered to 4.2% (as of this writing). Consider that ordinarily, a fall in half a percent is a significant event.

Scientists tell me their funding is partly or wholly from the European Union. Lawyers and accountants point out that much of their business relies on free access to Europe. I worry about the fate of my fellow healthcare professionals when 1 in 10 doctors and 1 in 25 nurses are from the EU. At a time when we need more, how are we going to fill those gaps? Pensions, savings, house prices all are at risk and the fruit of many lifetimes’ of hard graft will go to waste.

Economics though, is only part of the story.

Westminster
David Cameron has resigned and will step down in October. He is either a coward, naive or a naive coward. He is at best an average but more accurately a bad politician.

Against a weak Gordon Brown, he failed to achieve a majority in 2010, needing the Liberal Democrats to hold his hand. He used the Lib Dems as an excuse to tame the Tory right. In 2015, he managed only a pathetic majority of 12 against an awful Ed Miliband campaign, again thanks largely to the Liberal Democrat annihilation and the SNPs yellow-wash of Scotland, taking many Labour heartlands.

In light of UKIP success in the 2014 European elections, the Prime Minister called for this referendum. He much fanfare of a renegotiation with Brussels – though these changes were of importance, they were rather minor (and now irrelevant). After years of promising to bring migration into the tens of thousands, that Mr Cameron led the Remain campaign at all now seems utterly misjudged.

These vacuous promises undermined any chance of him running a pro-immigration campaign. He meekly said his renegotiation would lead to a reduction in migration, a laughable claim to even a casual observer. He tried to steer the debate towards economics but picked the most ridiculous claims, rather than sticking to the facts that were already stark enough.

Then, after the referendum result, at a time when Britain needs stability, he has run away. Even Conservatives and Leave supporters are glad to see the back of him – he epitomises what happens when average people are allowed to make difficult decisions. History may remember him as a man who destroyed Britain’s economy.

Scotland and Northern Ireland
Nicola Sturgeon has all but announced a second referendum on independence. Rightly so. Scotland voted to Remain. She will want to join the euro, a currency arguably more stable than the pound. This eliminates a primary argument against leaving. The economic security of British union is gone too.

As for Northern Ireland, the only path to prosperity seems to be remaining in the EU. The only way to do that is as a united Ireland. The border between Northern Ireland and the Republic must be kept open. Customs officials and soldiers with guns will revive tensions that have largely though not completely been quelled. There may be a referendum there too it seems. It is not out of the question that will bring with it violence.

Jeremy Corbyn
“Spineless”, in the words of Tim Farron, the Liberal Democrat leader. Labour MPs are currently working to remove him. He failed to share a platform with David Cameron until Jo Cox was shot dead. He failed to passionately make the case to stay in, meaning many Labour voters stayed home. His first real challenge as party leader, he has been an abject, abject failure.

Identity

Fundamentally though, this debate came down to immigration vs the economy. By the end of the campaign, Vote Leave largely avoided talking about the economy, Remain campaigners avoided talking about immigration. Britain chose, albeit by a whisker, immigration.

The poorest in Britain have been sold a lie. Immigrants have not made them poorer. Their impact on public finances is small and they are net contributors to the Treasury. They are also vital in aforementioned sectors such as healthcare – they tend to do jobs where the supply is low. Pressure in local areas can be mitigated by funding public services proportionally to the change in migrant population – this is a domestic issue, not an international one.

I always thought of this country as an open place. Yes, all places have problems with race and immigration. Much of the issue with migration is a belief that immigrants cause economic problems. But there is no doubt some of it is simply a desire to not have people who are different living near you. What is a British Asian man supposed to do about that?

As though trying to fulfil a stereotype, most shouts of “Leave” and “Out” were from white white van men and builders. Ironically, it is precisely these sort of services which will be hit. We have failed for decades to have a sensible conversation about immigration. We failed to do it in the campaign. We have failed to remain members of the EU.

There are many, many Leave voters who have legitimate reason for voting that way. Still, I cannot shake the feeling that there are Leave voters would be happy to see anybody who isn’t white and British gone as well.

“No Black No Dogs No Irish” and other thoughts on the EU

I am scared of leaving the European Union.

A not insignificant number of my friends are Leave supporters. I have little doubt they genuinely believe leaving the EU will be of benefit to them. Whether their arguments are about sovereignty or the economy, they’re intelligent people who are appalled they are on the same side as Nigel Farage and George Galloway.

However, there is an undercurrent of fear of the other percolating Leave. Regardless of Boris Johnson opining his love of immigration or indeed that an Australian-style points system would lead to more immigration, much of Leave’s support comes from those who are scared that foreign people make things worse.

To a certain extent, I’m not making a logical argument. It’s that if a politics of populist fear succeeds, it paves the way for more. Fear of the other is the cause of your problems. We need less ‘other people’ and more ‘your kind of people’.

That was, when my parents came to the UK and my brothers grew up, the norm. The National Front were popular in the 1970s. Rivers Of Blood and “if you want a nigger for a neighbour, vote Liberal or Labour” still echoed in the ears of immigrants. Even today, for 10 years David Cameron has espoused anti-immigration rhetoric that has now undermined anybody’s belief he supports any pan-European project.

I worry that that social progress will go backwards, even just a little bit. I don’t want to live in a country where that fear is stoked and where that is a legitimate way to win elections.

This referendum is for me whether Britain feels it wants me to be here. So I will campaign for Remain tomorrow. Largely, this will be genuine passion for the EU; partly though it will be out of fear.

 

 

Is it OK for Remain to mention Jo Cox?

For anybody who has been living under a rock in a cave that is underwater in Vanuatu, Jo Cox, the Labour MP for Batley and Spen in Leeds, was shot at a constituency surgery and later died from her injuries. She is the first sitting MP to have been killed since Ian Gow in 1990 who was murdered by the IRA.

She supported remaining within the European Union. This creates an issue – when is it OK for Remain supporters to mention her?

The late MP wrote an article advocating Remain and Britain Stronger In Europe – the official Remain campaign – shared this on their Facebook page. David Cameron then also shared this on Twitter.

What I’m about to say may sound flippant but it’s not meant to be – it is ridiculous to illustrate a point. Obviously, it would be offensive to produce and deliver leaflets with pictures of her and her children and with “Vote Remain or hate Jo Cox” or something similar.

What should we say?

David Cameron and Stronger In both have obligations to discuss Jo Cox. It would be bizarre not to mention an article she had written on the EU referendum. Clearly, Jo Cox wanted this article shared. Not only was it reasonable to do so, it was an obligation of both the campaign and the Prime Minister to ensure her voice was heard; indeed, it is the last time it ever will be.

However, “win it for Jo” is not OK. Voters should listen to the strength of her arguments, not the pang of grief at her death.

Claiming that one should not vote Leave because a proponent of Leave murdered her is also not OK. Whatever unpalatable statements Leave campaigners make, they are not murderers. To paint them as implicit accessories to such a tragedy cheapens Jo Cox’s death and unfairly denigrates those who simply believe something different.

I think when speaking to voters, Remain campaigners should concentrate on the issues. However, if Jo Cox’s death comes up, it is not unreasonable to mention she was a Remain campaigner. Campaigners should be careful not to guilt-trip voters into voting Remain nor should they labour the issue of her death.

It is sad that many voters have changed their minds on the basis that a Remain campaigner died but this does not affect the legitimacy of the result. All elections and referendums can be won and lost on events ultimately irrelevant to question at hand. It is rare the event is so tragic.

A simple(-ish) summary of Vote Remain

 

This is meant to be a simple summary of the Remain arguments and touches on some of the Leave campaign’s key points but is not supposed to be comprehensive.

Security

Lord Evans and Sir John Sawers, heads of MI5 and MI6 respectively until 2013 say leaving is a bad idea. The lack of a formal intelligence sharing agreement with the EU is irrelevant – we share lots of data which are key to many intelligence operations.

Ex-Met police chiefs Lord Condon and Lord Blair say the European Arrest Warrant speeds up the process of deporting European criminals (over 5000 2010-14) and extraditing British ones (675 2010-15). This includes failed 21 July London bomber Hussain Osman, extradited from Italy in 8 weeks.

Sir Richard Dearlove, who was head of MI6 until 2004, disagrees. However, he’s been a teacher since then so his views are out of date.

Border control

  • Britain is not a part of the Schengen area, the EU’s passport-free zone. As such, we have as much control over our borders, in or out of the EU.
  • The system of France and Belgium checking entrants to the UK before they come here – called juxtaposed controls – is indirectly threatened. That could see Calais migrants arriving on our shores as France and Belgium have less incentive to manage this problem for us.

Economy

This is difficult because Leave have made many different proposals. America, Canada, India, Australia and New Zealand‘s leaders have all supported Remain.

Some Leave campaigners argue Brexit would allow us to negotiate trade deals with Commonwealth countries more easily. The last four of the aforementioned countries are in the Commonwealth, support Remain and make up the lion’s share of non-UK Commonwealth GDP. It gives them access to the single market; a trade deal with the Commonwealth is best achieved through Remain.

(Leave also say we pay £350m/week (£18.7bn/year) to the EU, a claim for which the UK Statistics Authority have reprimanded them. Net, we pay £161/week (£8.3bn/year). This gives us access to the single market.)

Why does the single market matter?

It allows free trade with 440 million Europeans. This means British business can buy and sell in Europe without having to pay a tariff to do so. It also means regulation across Europe is the same.

Often, Leave campaigners cite this as ‘red tape’. However, it means with one set of regulations across Europe; if your product is legal in the UK, it’s legal  in the EU with no modifications. 44% of exports and 50% of goods exports from the UK go to the EU. That’s a massive part of trade to put at risk.

Won’t we just get another trade deal?

Vote Leave – the primary Leave campaign – say we would leave the single market. That would mean tariffs on British business of some description. Leave campaigners have proposed a variety of trade deals but if we do not negotiate within 2 years of voting to leave, we will have no trade deal.

Whilst the EU will want to trade with us, it also has an incentive to make things as painful as possible. Leave supporters argue the EU is undemocratic (to which I’ll come) and too centralised. Thus, on their own terms it makes sense that the EU will want to consolidate power by making Brexit a costly affair. British failure would make it less likely other members try and leave.

Immigration

A net 330000 immigrants came to the UK in 2015. Leave supporters argue for an Australian-style points system. Intuitively, this makes sense – let’s get immigrants who actually fill gaps in the market rather than a large number of unregulated EU migrants

However, immigration’s impact on public finances is “relatively small. Further, in certain sectors, EU migration has a major impact. 1 in 10 doctors and 1 in 25 nurses are EU migrants.  93% of research scientists say the EU is a “major benefit“. The bureacracy of a points system would discourage EU migrants from trying to work here.

Identity

There are Leave campaigners who want Britain to resemble a 1950s idyll which probably never existed. However, Remain campaigners often forget that particularly in poorer communities large migrant communities put pressure on public services like schools and hospitals.

Though nationally migrants are net contributors, we should not forget these local effects. This is however a problem of domestic policy – money should be focussed on ensuring adequate public services and education are available to both British citizens and immigrants. Brexit does not solve the problem.

Sovereignty

I don’t think this is as complicated as is often made out. Sovereignty is our ability to govern ourselves, ostensibly by electing a government. Leave argue we have lost control and ceded power to Brussels.

Firstly, we vote for MEPs directly who stand in the European Parliament. We are represented on the European Commission and Council of the EU. Whilst it’s beyond this post to explain how laws are passed in the EU, this graphic from Simple Politics hopefully explains:

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Apologies for the terrible blue-on-grey; I didn’t make the image.

Secondly, even if we had ceded power to a massively undemocratic organisation, we chose to do that. We keep voting for parties who want to remain in the EU. We can leave and reclaim those powers. If the powers were really gone, the EU would prevents from having a referendum. It’s just that we’re better off in the EU.

Thirdly, there are democratic deficits at Westminster and in councils. Few argue we should scrap councils on the basis only 30% of voters elect them, roughly the same as the number who elect MEPs. The UK sometimes disagrees with Brussels – disagreements are a sign of a healthy democracy.

(NB: Eurosceptics often slate the European Commission for being an undemocratic and overreaching behemoth of an organisation. It has 23000 staff, less than half that of HMRC‘s 56000 and almost a twentieth of the 406 140 who work in Whitehall.)

Conclusion

The EU is an imperfect organisation. It needs reform. Britain knows too little about how it works. But these are not arguments for Brexit.

Remaining in the EU is the only road to prosperity.

What do the election results actually mean?

For the really lazy amongst you, scroll to the bottom. There is a tl;dr.

So, if you’re an interested-in-politics type person, you’ll already know the answer to this. If you’re not, hopefully, this will give you an idea of what has been happening.

So, the following elections happened on Thursday:

  • English local council elections
  • Scottish Parliamentary elections
  • National Assembly of Wales elections
  • Northern Ireland Assembly (yet to be determined)
  • Police and Crime Commissioner elections
  • Mayoral elections
  • Greater London Assembly elections

Hopefully, I’ve not missed any. I’ve put London at the bottom because I live in the North and London is basically in Calais as far as I’m concerned.

How important are these elections?

Councils control a lot of things: housing, council tax, parking, planning permission, road maintenance, schools and school catchment areas, local health and social care policy. Indeed, the majority of issues which people complain about are controlled by councils, not the UK Parliament at Westminster.

The Scottish Parliament has more regional powers. Local elections happen in Scotland too though not this year. The same is true of the Welsh Assembly (though it has fewer powers) and then again of the London Assembly (with fewer powers still).

I’m going to start with the Liberal Democrats because I’m a Liberal Democrat, I’m very important and therefore this must be the most important party. Parliamentary representation be damned.

NB: ‘net’ is how much is gained or lost, not the total number. For things like council seats, that is a more important number than the total as not all council seats are up for election.

Liberal Democrats

  • Net +44 council seats
  • Net +1 council
  • Scottish Parliament: net 0 seats, stayed at 5/129
  • Welsh Assembly: net -4 seats, down to 1/60
  • London Mayor: Caroline Pidgeon 4.6%
  • London Assembly: net -1 seat, down to 1 seat
  • Northern Ireland Assembly: N/A

So what does all that rubbish mean?

Last year, the Liberal Democrats were – to anybody not a weird optimist like most Lib Dems – dead in the water. Now, not every council seat in England was up for grabs and most years only around a third are. Which ones depend on local conditions.

As such, we had the biggest gains of any party in England albeit for a limited slice of voters and offices. For a party  that has not won for 6 years, these were modest gains, but gains nonetheless. Firstly, it means we were actually discussed in the post-election coverage. Secondly, for party activists, it’s a boon to be trying to win rather than merely hold on.

The Scottish Parliament election is notable as, though there was no net change, we took seats from the SNP. Until now, the nationalists were a seemingly invincible force. Though we lost two other seats, it’s nice to know we can win.

Wales was the not insignificant fly in the ointment. Although Kirstie Williams, leader of the Welsh Lib Dems, managed to win a seat, the loss of 4 seats was stark. She has now stepped down and been replaced by Mark Williams, MP for Ceredigion.

London was much of a muchness. Our performance in the mayoral election was as expected – we largely don’t do well.

Summary: not bad. Shame about Wales.

Labour

  • Net -18 council seats
  • Net 0 councils
  • Scottish Parliament: net -13 seats to 24/129 seats
  • Welsh Assembly: net -1 seats to 29/60 seats
  • London Mayor: Sadiq Khan 56.8% (43.2% 1st round)
  • London Assembly: net 0 seats change, 12/25 seats
  • Northern Ireland Assembly: N/A

Ah, Labour. So Corbyn and his allies believe that Labour ‘grew support in a lot of places’. Indeed, you may have seen comments that the negativity around Corbyn’s performance is largely spin. You may have even seen a meme comparing Corbyn’s performance to those of Blair in 1995 and Cameron in 2006.
image

It’s not. These results are bad. Really quite bad. Oddly, the examples are excellent ones of how badly Corbyn did.

To put them into context, consider this. The last time an opposition lost council seats outside a general election was 1985. Michael Foot, leader of the opposition, went on to a landslide (read: massive) defeat to Margaret Thatcher.

In 1995 local elections, Tony Blair achieved net +1800 councillors; in 2006, Cameron +300 councillors. These numbers – not the percentages – are the legitimate comparators to Corbyn’s measly -18.

The only saving grace is the prediction of 150 seats lost was wrong. This served to lower expectations. In politics, the aim is often to play to expectations rather than numbers. Appear to do well rather than do well and the positive press will follow.

In Scotland, they again floundered against the SNP, a place where they were once assured. And Wales was, though not as bad, an indifferent showing.

In contrast, Sadiq Khan smashed Zac Goldsmith to become London mayor. He has the biggest mandate of any directly elected British politician in history (the Prime Minister is not directly elected) in a fairytale story. The son of an immigrant bus driver from a London council estate who defeated the billionaire running an (allegedly) racist campaign.

Summary: Corbyn bad, Khan good.

A word on the BBC

Corbynistas suggest the BBC, specifically former Conservative and current  Political Editor Laura Kuenssberg, are biased against Corbyn’s Labour. The coverage of Khan’s victorious campaign suggests otherwise.

Jeremy Corbyn has been under fire from the Parliamentary Labour Party (PLP, the Labour MPs) for some time. They detest him. They think he’s unelectable and may render the party obsolete. Kuenssberg’s appointment coincided with Corbyn’s. It may feel as though she does nothing but bash Corbyn but in the end, it’s simply her job, one I’m sure she’ll continue regardless of whom future Labour leaders are.

Conservatives

  • Net -48 council seats
  • Net -1 councils
  • Scottish Parliament: net +16 seats to 31/129 seats
  • Welsh Assembly: net -3 to 11/60 seats
  • London Mayor: Zac Goldsmith 43.2% (36.5% 1st round)
  • London Assembly: net -1 seats to 8/25 seats
  • Northern Ireland: net 0 seats to 0/108 seats

The council results were OK. As I’ve alluded to, in the same way oppositions should win council seats in a non-general election year, governments usually lose them. Exactly why this happens is debatable but often it’s because voters want to give governments a kicking but don’t want to remove them from power.

That the Tories haven’t been destroyed at the ballot box is remarkable. They are at war over Europe; in conflict with doctors over hours and pay; with teachers of over academies; George Osborne has failed to meet his own budget targets; not to mention Tory MPs rebelling on welfare changes. It highlights the abject failure of Labour to provide meaningful opposition.

Tories – for the first time in a generation – have been victorious in Scotland; they are the official oppositionin the Scottish Parliament. Their new leader, Ruth Davidson, provides a real contrast to the SNP. Many centre-left voters will have voted SNP rather than Labour. However, unionists have a new home, even if they don’t agree with all Conservative policy.

Rather like Labour, the Welsh Conservatives produced an indifferent performance. It pales in comparison to their performance north of the border.

London has been a disaster. Lynton Crosby, a political strategist, has been castigated for running a racist campaign. He specifically targeted the British Hindu community on the basis they would not vote for a Muslim. Tory peer Baroness Sayeeda Warsi has criticised Zac Goldsmith. Even sister Jemima Goldsmith has criticised the campaign.

The real sadness is, Goldsmith had the potential to be an excellent candidate. Despite his inherited wealth, he cut a less arrogant figure than previous Conservative mayor Boris Johnson. Instead, a debate about racial division replaced one on the key issues of transport and housing.

After Labour’s anti-Semitism debacle, Goldsmith has somehow managed to out-racist Ken Livingstone.

(I just found out that the Conservative Party existed in Northern Ireland. It didn’t do well.)

Summary: did alright except for the racism in London thing.

UKIP

  • Net +25 council seats
  • Net 0 councils
  • Scottish Parliament: net 0 seats to 0/129 seats
  • Welsh Assembly: net +7 seats to 7/60 seats
  • London Mayor: Peter Whittle 3.6%
  • London Assembly: net 0 to 0/25
  • Northern Ireland Assembly: net 0 to 0/108

UKIP made reasonable gains in English councils which will worry Labour. They made some in Labour strongholds.

They have little presence in Scotland but their Welsh performance was remarkable, gaining 7 assembly seats. Until then, ‘Celtic UKIP supporter’ was almost a contradiction in terms. (Interestingly, disgraced former Conservative MP Neil Hamilton won a seat for UKIP and may be their Welsh leader.)

Their performance in London fits with their anti-cosmopolitan ethos. Bizarrely, UKIP also has candidates for the Northern Ireland assembly who were unsurprisingly unsuccessful given much of the place doesn’t even want to be British.

Summary: impressive performance in Wales, should worry Labour in England.

The Green Party

  • Net -3 council seats
  • Net 0 councils
  • Scottish Parliament: net +4 seats to 6/129 seats
  • Welsh Assembly: net 0 seats to 0/60
  • London mayor: Sian Berry 5.8%
  • London Assembly: net 0 seats to 2/25 seats
  • Northern Ireland Assembly: net +1 seat to 2/108 seats

Yeah, they did alright. Not great in England but pretty good in Scotland – managing to push the Liberal Democrats in to 4th. They have little presence in Wales (which slightly surprises me) and their London performance is about expected. I have no idea what to make of the fact they have 2 seats in Northern Ireland. But they do. So there.

Nationalists

Scottish National Party

  • Scottish Parliament: net -6 to 59/129 seats

For an incumbent party to only lose 6 seats is remarkable but they are showing signs of weakness. They tackled Labour by dominating the centre-left of Scottish politics. It will be interesting to see how a party which sold itself as anti-establishment will perform as a minority government against Ruth Davidson’s now much stronger Tories.

The contrast between the two is much starker and so I imagine Davidson will find it easier to highlight failings of Nicola Sturgeon’s administration.

Plaid Cymru

  • Welsh Assembly: net +1 to 12/60 seats

Still some way behind Labour, it bodes well that Plaid’s only gain was from Labour. Labour are now in a minority with Plaid the official opposition. It’s not a meteoric performance but not an awful on either.

Northern Ireland Assembly

The Northern Ireland Assembly is complicated and beyond what I can cover in this post. Suffice it to say the three primary parties the Democratic Unionist Party (DUP), Ulster Unionist Party (UUP) (both loyalist ie want to stay in the UK) and Sinn Féin (republican ie wants to join Ireland) have to work in a power-sharing agreement.

Sinn Féin now have a small but significant presence within Republic of Ireland politics. It remains to be seen how power-sharing will fare following this election.

Police and Crime Commissioner

The problem with this is, nobody cares. It’s not that it isn’t an important position but it just doesn’t make the headlines. Indeed the only one that did was Dr Alan Billings, PCC for South Yorkshire and that’s largely due to the release of the conclusions of the Hillsborough inquiry.

Summary/tl;dr

  • Lib Dems: starts of a recovery
  • Labour: awful but saved by Khan
  • Conservatives: great in Scotland, awful in London
  • UKIP: impressive in Wales
  • Greens: good in Scotland, unremarkable everywhere else
  • SNP: did well but no invulnerable any more
  • Plaid: meh

Hope that helps!

Please register to vote in the EU referendum. I’ll be writing some things about it to try and make it a little less impenetrable.