A really fun post about death

princess-leia-1

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.

 

Advertisements

The moral failure of Stronger In

10638image_large

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

fax-amarys

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.

“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:

13237805_1238881006156727_1711173659199378614_n

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. 

Ken Livingstone: not a racist but an idiot and maybe a bit racist

For anybody unaware, Ken Livingstone has been suspended from the Labour party. The Guardian timeline summarises the events leading up to this.

My Facebook feed has largely turned into Livingstone-bashing with some misunderstanding why mentioning a historically accurate fact is such a big deal. Like any good debater, I can split this into three main points, primarily using West Wing quotes.

  1. “I don’t care what it is, I care what it looks like.”
  2. The ‘technically not a racist’ defence
  3. “There are only a handful of anti-Semites”

OK. I used one West Wing quote.

Shut up.

1. “I don’t care what it is, I care what it looks like.”

'SlimCity - Managing Urbanization':

No doubt, praying for leniency as the party exercise Jew process

It’s both apt and unsurprising that when I looked up the exact wording of this quote from The West Wing, it’s said by CJ Cregg, the White House press secretary.

On Thursday 28th at 0850 in an interview with Vanessa Feltz on BBC Radio London, Livingstone said:

“When Hitler won his election in 1932 his policy then was that Jews should be moved to Israel. He was supporting Zionism.”

Feltz: What do you think over the top means? Over the top of what? [in reference to Naz Shah’s Facebook posts]

Livingstone: Basically to think of anti-Semitism and racism as exactly the same thing.”

He then followed this up with an interview on The Daily Politics where he said:

“I’m being questioned in an interview I answer the question. You’ve never known me not answer a question you’ve put to me.”

We know there was an agreement between Nazi Germany and some Jewish groups called the Haavara agreement. Let’s assume Ken’s description is accurate.

Let’s also ignore the fact I had no idea that Vanessa Feltz was still a broadcaster or that she was married to the singer on the 1999 single Turn Around by Phats & Small.

This still begs the question, why mention Hitler? (Livingstone’s comments, not Phats & Small who to my knowledge have never mentioned Hitler in relation to anti-Semitism in the Labour party.)

His response – that he was asked that question. Except the question he was asked was

Feltz: She [Shah] talked about relocating Israel to America. She talked about what Hitler did being legal. And she talked about the Jews rallying. And she used the words Jews, not Israelis or Israel. You didn’t find that to be anti-Semitic?”

There are a number of Naz Shah’s comments to which Feltz refers. Livingstone specifically picks out the Hitler comment and then goes on to talk about the Haavara agreement apropros of almost nothing.

Livingstone’s defence is that what he says was true. On mentioning Hitler supported Zionists, there are two possibilites:

  1. He did not realise it would have consequences.
  2. He realised it would have consequences.

Let’s examine scenario 1.

As Livingstone has said, he has spent 47 years in politics. If after 47 years you don’t know that defending the comment ‘what Hitler did was legal’ by arguing that it was technically true on the basis that ‘He [Hitler] was supporting Zionism’ is likely to get you in trouble with Jewish voters, you must be exceedingly stupid.

That it is historically accurate is neither here nor there.

It is accurate to say “there is a higher proportion of black men who commit crime than white men”.

Let’s say somebody asks: “what do you think the main causes of crime are?”
You respond: “there is a higher proportion of black men who commit crime than white men”

It’s likely you’ll get called a racist. It’s a non sequitur and in the context implies, though doesn’t technically state outright, that the problem is black men. The accusation of racism is not unjustified and we could all get round and through a liberal amount of metaphorical rocks at you. Liberal? Liberal? D’you get it? Eh? EH?

(On historical accuracy, I’m no historian. However, I understand arguing ‘Hitler supported Zionism’ is rather like arguing the National Front used the word ‘paki’ and argued for the forced deportation of South Asians in the 1970s because the NF were advocates for Pakistani sovereignty. Hitler would have happily seen Jews deported to Birmingham – he just wanted them out of the country and did not, to the best of my knowledge, support the creation of a Jewish state.)

2. The ‘technically not a racist’ defence

Let’s look at scenario 2. Indeed let’s look at worst-case scenario 2.

Ken Livingstone is an antisemite. He believes that Jews are genuinely ‘rallying’, should stop complaining about being racially abused and doesn’t think the Holocaust is relevant any more. Let’s assume he’s that bad a man. How would that look?

Now, he knows he can’t go on the radio and the TV and say ‘I hate Jews’. Not even the most ardent Livingstone supporter would advocate that unless they too were openly anti-Semitic.

What he can do however is go on the radio and say things that are arguably defensible. So he can say “well, I was just telling the truth”. And that the Labour party have suspended the handful of members who’ve made anti-Semitic comments.

The phrase ‘dog-whistle’ has come back into vogue and would be relevant here. Unwittingly or not, Livingstone’s comments are a dog-whistle to antisemites who believe that Jews simply don’t deserve to be in Israel at all. He’s Labour so the Labour party is for them.

In form

On 24th February 2006, he was suspended from mayoral office for referring to journalist Oliver Finegold as ‘like a concentration camp guard’.

In July 2005, he was pictured embracing Yusuf Al-Qaradawi, who has supported Palestinian suicide bombing and wife-beating (albeit lightly).

Whilst these aren’t recent instances, one would think a politician would be extra careful when talking about anti-Semitism. It suggests a general lack of sympathy and sensitivity for those who are victims of anti-Semitism.

So he’s a racist?

I suspect not. Though he doesn’t help his cause by claiming that anti-Semitism isn’t thing same as racism.

After some discussion with friends, the two possibilities I’ve come to are either that:

  1. He is surrounded by people where suggesting that Hitler supported Zionism would not be considered a controversial thing to say.
  2. Whilst he doesn’t actively hate Jews, he believes that the problems of anti-Semitism are overstated and given the relative affluence of the Jewish community, does not see it as a significant problem

Probably a little from column A, a little from column B.

3. “There are only a handful of anti-Semites”

Does the Labour party in general have a problem with anti-Semitism?

That’s really beyond me to say. Besides Livingstone, the 3.5/4 instances of anti-Semitism I’m aware of are:

Some argue that 5 antisemites in a party of 388407 members does not a problem of anti-Semitism make. Ken Livingstone is an idiot and should be ignored. Wes StreetingJohn Mann and other MPs are merely disgruntled Blairites using the row as a stick with which to beat Jeremy Corbyn.

This slightly misses the point. Individuals making anti-Semitic comments do not do so in a vacuum. To normalise these sentiments even if they are the most extreme exponents of them, it’s likely (but not certain) that others around them and within the party share similar views. Racists tend not to out themselves if their friends aren’t racist too.

In the New Statesman podcast, Helen Lewis points out that there’s a problem on the left of assuming that middle-class women can’t have problems because of their affluence. That attitude, she argues, is one that also pertains to anti-Semitism.

It’s not concrete evidence and Shami Chakrabati is a good person to lead Jeremy Corbyn’s anti-Semitism inquiry. To be honest, whether Labour had a problem with anti-Semitism is now moot; it does now.

“I don’t care what it is, I care what is looks like.”

For many Jewish voters, it will feel like Labour is a party with an anti-Semitism problem. Unless there are visible signs of change, many simply won’t vote for them.

PS: here’s a video of Diane Abbott not helping.

MEDICINE: a complicated guide to junior doctors’ pay

UPDATE 13/2/16: NHS Employers has sent more specifics about the contract out rendering this post somewhat inaccurate. Will be adjusting it soon.

UPDATE 14/2/16: now adjusted to take into consideration the specific changes NHS Employers sent out on 13/2/16 to junior doctors.

A significant component of the current dispute between Health Secretary Jeremy Hunt and junior doctors is pay. It is not the whole dispute.

Part of the new proposals involve a hospital ‘guardian’. The ‘guardian’ would be responsible for ensuring doctors do not breach their hours. Where they do, guardians would enforce financial penalties. (It’s really hard to Google ‘guardian’ and ‘junior doctors’ strike’ without just getting articles from the Guardian.)

However, they would be employed by hospitals; the conflict of interest between an employee deciding whether to fine his or her employer is obvious. As yet, this issue has not been addressed by government. The practical effect on hours worked that having a guardian will have is unclear.

There are many other issues too. However, the question for this post is, what are the differences in pay going to be?

I’m going to use the last full-time rota I was on as an example. (NB: this is not the same rota for the whole country.)

I’m going to be using ‘old’ to represent the system at the moment and ‘new’ to represent to prospective system. Using the term ‘current’ could get a bit confusing.

If you can’t be bothered look at the maths, just go to the end. There’s a section called, The punchline, which summarises the key numbers.

The old system

This worked via something called ‘banding’. If you Google ‘NHS banding’ you get the bands for nursing and other healthcare professions.

The old banding system for doctors looked like this:

OH MY GOD WHAT EVEN IS THAT?

It looks complicated but the hospital tallies up the number of hours you’ve worked, the proportion that’s ‘antisocial’ and gives you a pay supplement based on that proportion.

Antisocial hours are considered the weekend and 1900-0700 during the week.

How do you figure out whether you’re moderately, most or least antisocial? You can use the following helpful chart:

SERIOUSLY THEY ARE JUST TAKING THE MICHAEL NOW!

Suffice it to say, it’s fairly complicated. I say this with some trepidation but most first- and second-year doctors (F1 and F2 or Foundation Year 1 & 2) will be on 1A or 1B. I think.

This means, for the number of antisocial hours they work, they get a pay supplement of 40% of their basic salary.

The F1 year is usually split into 3 x 4-month placements. Assuming that all of these jobs have a fairly standard on-call rota for medicine or surgery, an F1 will receive a 40% supplement on the basic salary of £22,636

They’re paid 22636 x 1.4 = £31690 pa.

Placements vary. F1s often do jobs like medical microbiology or general practice which many only require social hours work – they do not receive a supplement for these jobs.

They may also work in emergency medicine (A&E) where they would receive an even bigger supplement but the shifts are largely antisocial.

The same applies to any hospital medic. They have a basic salary. The hospital calculates the proportion of antisocial hours; determines what band they’re in; and gives them the requisite pay supplement.

The key misunderstanding is that you get a percentage supplement on total hours under the old system, not just on the out-of-hours work as some of the press have suggested.

Now, I hope you enjoyed the arithmetic – there’s loads more to come.

The rise in basic pay 

When I originally wrote this post, the government had been suggesting a 13.5% pay rise. Subsequently, NHS Employers have sent out this pay letter which has more specifics about the new pay scale. The old pay scale can be found here on the BMA website.

I’ve summarised them in this table:

Comparative hours table

Pay and percentage increases relative to year

F1 and F2 refer to the first and second year of the foundation programme. If you look at the old pay scale, these consider pay for up to three years in each of these posts. These are relevant to part-time doctors which I’ve ignored, largely because it’s something I don’t have a lot of experience of.

CT/ST (core/specialty training) year refers to years in specialist training (surgery, internal medicine, pathology etc.). From the point of view of pay, the difference between core and specialty training posts is a technical one, not relevant here.

Otherwise, there are two changes. The first is simply there is an increase in basic salary across the board (though this doesn’t necessarily lead to a final salary increase).

Secondly, you’ll note the new ‘nodes’. Previously, there was a year -on-year increase in salary. Now doctors will have the same salary during certain blocks of training, particularly ST3-7.

Government argues that the responsibility of these doctors is the same regardless of grade. For anaesthetics and critical care, this is true when looking purely at on-call responsibility. However, it doesn’t consider the assessments and exams one has to pass to progress from year to year.

Most doctors require revalidation every 5 years. Junior doctors go through an equivalent process every year which is more onerous that revalidation.

How the new system’s supplements work

Oh, the fun I’ve had with this. My last job was as a CT2 anaesthetist. Looking at the table above, that means I would be paid 7.5% extra basic pay. I’ve also calculated my comparative pay as a CT1 anaesthetist which involves a 16.21% increase.

You can download the spreadsheet here but I’m going to use a couple of screenshots.

I’m not sure how well this will show up on whatever device you’re using. The top row is hours. 0700 means 0700-0800. I’ve put a ‘1’ for every hour I’ve worked and also to make the spreadsheet work.

Hours 1

As a CT2, under the new contract:

  • Basic hours, 0700-2100, Mon-Fri, +7.55% from the old system, dark green
  • Saturday and Sunday, 0700-2100, +30% (on top of the 7.55%), middle green
  • Antisocial hours, 2100-0700 Mon-Sun, +50% (on top of the 7.55%),  light green (this says light green though you probably can’t see it)

(NB: if I were to work fewer the 1 in 4 Saturdays – I work 2 in 7 – I would get no supplement 0700-1700 on a Saturday which would further complicated payment. Also, it’s possible that because one of those shifts is day and one night, that they would be considered different shifts and I would not get a Saturday supplement. That would be pretty shifty.)

So you can see, the arithmetic gets a little complicated.

Broadly my job consists of three different types of shift:

  • Normal day – 0800-1800
  • Long day – 0800-2100
  • Night – 2000-0900

There’s an hour overlap in the morning and evenings between the person coming and the person leaving. This is to facilitate handover. It doesn’t happen in every hospital but we got paid for it.

Hours 2

This is the bottom half of that spreadsheet. I was on a 1 in 7 rota. That means that there were 7 anaesthetists on the rota. Whilst I was on week 1, another was on week 2, another week 3 etc. This works out at 48.14 hours/week.

I should note, rota coordinators get a lot of stick in hospital but trying to design one of these things is hard. This one doesn’t show how, in order to be EWTD compliant (ie <48 hours/week), I have to get days off after weekend days and nights. Booking annual leave on top of that makes these things a nightmare.

In the ‘CT2’ column for Mon-Fri, I’ve used the following formula:

=1.0755*SUM(C2:P2)+1.5*1.0755*SUM(Q2:Z2)

That’s 1.0755 x the number of basic hours (to calculate the 7.55% pay rise) + 1.5 x 1.135 x the number of antisocial hours (to calculate the 7.55% pay rise and 50% antisocial hours supplement).

In the ‘CT2’ column for Saturday and Sunday I’ve used the following formula:

=1.3*1.0755*SUM(C7:P7)+1.5*1.0755*SUM(Q7:Z7)

That’s 1.3 x 1.0755 x the number of weekend day hours (to calculate the 30% supplement for weekend day hours and the 7.5% pay rise) + 1.5 x 1.0755 x the number of antisocial hours (to calculate the 50% antisocial hours supplement and 7.5% pay rise).

Phew!

In the bottom right, in box AA51, there is a number calculated from the formula

=SUM(AC2:AC50)

which is the sum of all the ‘CT2’ hours. I’ve done the same for CT1 except I’ve used the 1.1621 instead of 1.0755 (to indicate the 16.21% basic salary pay rise). This gives total equivalent hours of 443.51 and 410.411 respectively which I will explain shortly.

The old system – calculations

The ‘Old’column is a lot simpler because the supplement is added at the end. Every cell in the ‘Old’ column has the formula:

=1.5*SUM(C2:Z2)

which is 1.5 x the number hours worked that day (for the 50% banding supplement).

Then I’ve used:

=SUM(AD2:AD50)

to add up all the ‘old’ hours.

There is also an ‘hours’ column using:

=SUM(C2:Z2)

for each cell. This is simply to calculate the raw number of hours I worked without any supplementation. These are summed at the bottom of the column with:

=SUM(AA2:AA50)

How have I got more hours under the new system but I’m also working the same hours?

What I’ve calculated is my pay equivalent to basic hours under the old system. It is not the actual hours I worked but is way of comparing the different rates of pay.

The punchline

  • I worked 337 hours in 7 weeks
  • That’s 48.14 hours/week
  • Under the old system, I was paid the equivalent of 505.5 old system basic hours with my 50% banding supplement
  • Under the new system,
    • At CT2 I was paid the equivalent of 410.411 old system basic hours with the plethora of supplement
    • At CT1 I was paid the equivalent of 443.5 old system basic hours with the plethora of supplement
  • That’s an 18% pay cut for CT2 and a 12.27% pay cut CT1

Now, you can’t just average the two pay cuts to get my total pay cut over two years. My pay was different for the two years under the old pay scale but hopefully this gives you an idea of the sort of cuts in pay we’re looking at.

There are caveats. There is a large variation between hospitals and an even bigger one between specialties. Surgeons’ rotas are different to anaesthetists’ rotas are different to medics’ rotas which are all different to the rota of a chemical pathologist.

Further, rotas will change. Given the new obligations, it is highly likely many hospitals will adjust their rotas meaning any sort of calculation based on new or old systems will be rendered irrelevant. That said, I doubt this particular anaesthetic rota will change very much. It already adheres to the new guidelines and it would be considerable hassle to change it.

This post isn’t making a judgement about whether it’s wrong. However, given the number of antisocial hours worked, I cannot fathom a situation where the acute specialties end up getting paid more unless the premiums are quite significant.

What I will say is I’m not sure how the new system is any simpler than the old system. Whatever. Maybe I’ll just go to Canada.

MEDICINE: Why you’ll be safe in hospital during a strike

Thousands of junior doctors will go on strike on Wednesday 10th February from 8am for 24 hours. I used to be one and may be one again. How, if juniors are so important, will a hospital run without them?

Broadly speaking, juniors hold a couple of roles. Firstly, it involves seeing patients every day with a senior doctor, ensuring they have been well since they were last seen and making plans for that patient. This usually takes most of the morning and occasionally into the afternoon.

After the ward round, these plans are put into place. Ordering scans, making referrals, organising discharges, taking bloods, prescribing drugs for discharge.

The more senior ‘juniors’ (for want of a better term) will do other things. A respiratory registrar may be involved in a bronchoscopy list or a clinic; a surgical registrar may have to do a day case list; or an elderly care registrar who needs to see referrals to his team.

If consultant take over this work, who’s going to do their job?

Much of what consultants do is elective work. It’s essential but non-urgent. It’s inconvenient for patients and unfortunately that’s the price of this strike.

Further, the cover that juniors will provide is the same as weekends, Christmas and Easter.

Let me reiterate this – it’s the same cover as every weekend, every bank holiday, Christmas, Easter, New Year. If this is dangerous, it’s dangerous all year round but it demonstrates the problem with the 7-day plan.

edinburghroyalinfirmary

What does 7 day NHS really mean?

Much has been written about the strike. The difficulty is that solving the issue of increased weekend mortality – which many dispute – involves changes to emergency cover. The 7 day plan is not a change to emergency cover. Rather it spreads the juniors covering the day-to-day tasks during the week over the weekend. It’s unclear how increasing elective work over the weekend would improve emergency care.

In other words – how do patients getting bunions removed on a Sunday improve your care if you have a heart attack?

The bottom line: government’s solution doesn’t solve government’s problem.