Monthly Archives: September 2018

Ban gambling adverts during live TV sport

There is a general consensus on this matter. It is immoral to encourage gambling in children and young adults who are not mature enough to be able to balance their judgement.  There is still an issue around gaming on pads and phones which needs to be controlled.

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The Guardian: Labour pledges ban on TV gambling adverts during live sports

Andrew Ellison for the Times 20th September 2018: Labour vows to ban gambling adverts during live TV sport

Gambling adverts during live televised sports would be banned and bookmakers made to pay more than £140 million towards helping to treat addicts under a Labour government.

The opposition will announce a series of measures today designed to deal with Britain’s “hidden epidemic”.

Tom Watson, the shadow secretary for digital, culture, media and sport, said: “We must treat problem gambling as a public health emergency. Current regulation is not up to the job of protecting addicts and those at risk of addiction. Treatment is patchy across the country and too often patients are misdiagnosed.

“Gambling companies have to take more responsibility for harms caused by their products and contribute more to research and treatment.

“We must also face up to the negative effect the explosion in gambling advertising has had and act accordingly.” During the football World Cup almost one in five adverts shown were for betting websites. Experts say they fuel addiction and normalise betting among children. Over the past ten years, the number of gambling adverts on TV has risen by more than 600 per cent.

Labour’s “whistle to whistle” ban would stop adverts immediately before, during and after games.

The opposition also announced that the gambling industry would be forced to pay 1 per cent of profits — more than £140 million — to help to pay for better treatment for addicts. At present, there is a voluntary levy of 0.1 per cent and many companies do not contribute at all. Last year, it raised only £9 million.

A Labour spokesman said: “The increase in funding could be used to better train existing mental health staff and clinicians to diagnose and treat gambling disorder, as well as increase the number of specialist clinics around the country.” Labour would also ban credit card betting.

The proposals were welcomed by campaigners but questioned by advertisers. Henrietta Bowden-Jones, the Royal College of Psychiatrists’ spokeswoman on behavioural addictions, said: “A ban on gambling adverts during live sports matches is welcome and in line with the recent national drive to treat gambling-related harm.

“The plans to introduce a statutory levy in order to increase funding for treatment services will be welcomed by all those who wish to see an adequate, well-funded, evidence-based provision of problem gambling services.”

A spokesman for the Campaign for Fairer Gambling added: “Most people will wonder why Labour’s common sense proposals weren’t implemented a long time ago.”

Stephen Woodford, of the Advertising Association, said: “Ultimately, gambling operators should be allowed, within a framework of responsibility, to advertise freely — the funding from these businesses contributes greatly to the high quality sports programming enjoyed by millions.”

Comment from letters 25th (The Bishop of St Albans)

Sir, Labour’s report on problem gambling is welcome, although its stance is perhaps ironic given that Labour’s liberalisation a decade ago led to the present problems (“Labour vows to ban gambling adverts during live TV sport”, Sep 20). Although the report refers to a “hidden” epidemic, we know from experience that it is sadly anything but hidden.

This is a public health issue: two suicides every working day are linked to gambling, as are higher rates of divorce and family breakdown, not to mention that gambling problems costs the NHS at least £610 million a year. I support the proposals for a whistle-to-whistle ban on advertising during sporting events, something for which all political parties are calling. I also back the proposal for gambling companies to pay a compulsory 1 per cent levy. The £10 million currently raised through a voluntary levy is insulting to both the victims and taxpayers, who pick up the tab.

Society has a moral responsibility to protect the vulnerable from becoming gambling addicts and to support those who are addicted with treatment. I hope that we will not have to wait for a new government to implement these ideas. The present administration must act now.
The Right Rev Alan Smith

Bishop of St Albans

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Taxes must rise to pay for NHS funding, Lagarde says. Tax changes need to be considered as a whole.

With councils such as my own threatening to “ration” social care, and having a one year £7m deficit I am not surprised, what is the argument for not rationing health care. Liberals believe that there has to be encouragement for self sufficiency and autonomy and choice at an individual level. Co-Payments for health is another form of taxation, and if universal and equal will be regressive. The answer is to have means tested co-payments, and of course an opt out: private.

There is no need for basic level tax to rise if we embrace changes elsewhere in the tax system. Land rental tax could replace inheritance tax, or this could change to a gift tax to be more redistributive. VAT is itself regressive…. It could be lower.

Philip Aldrick in the Times opines 18th September 2018: Taxes must rise to pay for NHS funding, Lagarde says

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Taxes should rise to pay for the government’s £20 billion gift for the NHS, the International Monetary Fund has said as it urged Britain not to take a chance with the public finances.

Britain’s national debt remains “relatively high” and bringing it down “is important to create buffers that will allow the public finances to weather future shocks”, the world’s financial and economic watchdog said in its annual health check on the UK economy.

Its recommendations will be welcomed in the Treasury, which is intent on shrinking the debt as a share of GDP. It is also expected to raise taxes in the autumn budget to pay for the additional health spending announced earlier this year.

However, the IMF’s proposals went further than the chancellor might like. It claimed that the UK had effectively run out of spending that can be cut so should instead raise taxes to meet the mounting costs of an ageing population and to pay for any giveaways.

“After several years of primarily expenditure-based consolidation, identifying further efficiency gains could become difficult. Absent a fundamental rethinking of the size and role of the public sector, revenue measures will therefore need to occupy a more prominent place in deficit reduction efforts going forward,” the Fund said.

Its revenue-raising proposals include aligning the tax treatment of the employed and self-employed, “scaling back preferential VAT rates”, moving from stamp duty to a land value tax and removing the “tax bias towards debt” in interest relief. Past attempts to harmonise employment tax, by Philip Hammond, and VAT rates, by George Osborne, both ran into political minefields and were reversed.

Health should be the first test of the IMF’s strict fiscal principles. the IMF said: “The recently-announced increase in public health spending should be financed from new revenue sources and offsetting spending cuts elsewhere in the budget.”

Areas where savings on spending might still be found are in NHS efficiencies and eliminating the “triple lock” on pensions, the IMF said.

The prime minister’s claim that the new NHS funds would be met by a “Brexit dividend” was dismissed by Christine Lagarde, the IMF’s managing director. “I’m hesitant to allocate any Brexit dividend to the NHS. It’s an issue of timing. You’re comparing apples with oranges. They don’t actually coincide, in timing and in scale,” she said.

The fund made it clear that there would be no Brexit dividend because the fiscal costs of Brexit would outweigh reclaimed budget contributions of around £10 billion a year. Ms Lagarde added that any gains from Brexit would come in the future but the funding demands from the NHS were immediate.

Changes to its GDP forecasts since Brexit show the economy will be about 2.5 per cent smaller than had been expected by 2020, which equates to roughly £20 billion in forgone tax revenue.

“Steady fiscal consolidation remains critical,” the Fund said. Even if there is a messy Brexit, it sees little benefit in launching a fiscal stimulus to cushion a slowdown. “I don’t think that a massive fiscal stimulus would address the nature and the root of the problem,” Ms Lagarde said.

The problem, as the IMF sees it, would be a crisis in the supply side of the economy that would not be helped by pumping up demand. Policies that might help would be to bring forward infrastructure spending but “any easing of fiscal policy should be temporary and embedded in a credible medium-term consolidation plan”, the IMF said.

The Bank of England should provide support instead. “Further withdrawal of monetary stimulus should await clear confirmation of a durable rise in domestic cost pressures,” the paper argued.

• Having more women in banking makes the financial system safer, according to a study by the International Monetary Fund. The presence of women and a higher share of women on bank boards “appears associated with greater financial resilience”, its research found. Having more female regulators is also “associated with greater bank stability”, the IMF said. Christine Lagarde, the organisation’s managing director, said: “I think it is clear that finance would benefit enormously from this greater diversity.” Worldwide “women accounted for less than 2 per cent of financial institutions’ chief executives and less than 20 per cent of executive board members”, the IMF found.

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BMJ comment: Taxes must rise to fund 5% budget increase the NHS

BBC News: Tax rise need to help pay for £20bn NHS boost, says PM …


The disintegration of professionals – is happenning all at once. Standards are falling in general, but in exceptional cases they have fallen drastically.

Older people consume more services. Health and social care services. Whilst Health is free and not means tested, Social Care is means tested and only free when down to the last £17.000 or thereabouts. The disintegration of social services, of the ambulance service, and lack of standards in Hospitals is coming all at once. At my own surgery in West Wales the patients today are concerned about the same issues as they were 20 years ago when the PPG ( patient Participation Group) started: Access and appointments… The standard of politicians and politics is the real underlying problem. As a country with short term first past the post politics, we can only expect short term decision making. The quality of life improvement for GPs, who now do little out of hours, has led to NHS111 (useless) and an overworked ambulance service using up vast resources inefficiently.. Continuing undersupply of doctors, despite the applicants to medical school has been rationing of the most inexcusable sort. It is in Primary Care that the big savings in demand can be made, but it needs more GPs and nurse practitioners. How much of the new £20m will go to primary care?

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The Nuffield Trust and the Kings Fund: Reports show it is dangerous to dodge decisions any longer: Nuffield Trust response to Skills for Care data – Unless social care becomes a more attractive sector to work in, ongoing migration will be necessary

The Kings Fund talks about “home truths” through a combination of stats and interviews.

Tom Houghton for the Liverpool Echo reports 15th September: Ambulance service slammed for “continuous failures” as serious incidents soar.The North West Ambulance Service (NWAS) has failed to hit crucial targets in recent months

and in Wales 4th February: Thousands of complaints made against the Welsh Ambulance Service

Today the Neil Johnson of Times’ reports: Shrewsbury and Telford Hospital baby deaths inquiry to cover two decades (This is possibly the result of weak management, and of a midwife led service – lets await the report!!)

The Times 26th September: £20bn cash boost for NHS ‘could be lost to waste’

On September 18th Chris Smyth for the Times Crisis team sent into St George’s cardiac unit

and 10 days later, on 28th September: Doctors fear NHS catastrophe as early retirement depletes surgeries (And this excludes Wales and Scotland and Northern Ireland, emphasising that there is no “N” HS)

More than 2.5 million patients are at risk of losing their family doctor as GPs retire early, according to the Royal College of General Practitioners.

Hundreds of surgeries are likely to close because three quarters of their GPs are close to retirement and not enough younger doctors are coming through to replace them, the college calculates. Falling numbers threaten a collapse of the family doctor system, senior doctors said as they lobby for a bigger share of a promised boost to the NHS budget to go to local surgeries.

However, NHS leaders dismissed the claims as scaremongering. They acknowledged three years ago that a lack of qualified GPs was a key problem for the health system, promising to recruit 5,000 more by 2020. GP numbers have since fallen by more than 1,000, accelerating

the closure of surgeries. (Here there is a map of England with colour coded areas of shortage)

Last year 458,000 patients in England had to find a new practice because their existing surgery shut, up from 38,000 in 2013. The college has found that 762 UK practices are relying on an ageing workforce, with three quarters of doctors aged over 55. The 625 practices in England alone care for 2.5 million people, with a further 71 surgeries in Scotland, 37 in Wales and 29 in Northern Ireland at risk.

“These new figures paint an extremely bleak picture of the scale of the GP workforce crisis,” Helen Stokes-Lampard, chairwoman of the college, said. “If these GPs do leave and these practices do close, it will have a catastrophic impact on our profession and the patient care we are able to provide.”

GPs can start to claim their pension at 55 and the average age at which they retire has fallen to 58, down two years since 2011. Simon Stevens, head of NHS England, has previously blamed rules that cap tax-free pension pots at £1 million for encouraging GPs to retire early.

In Southend, more than a third of surgeries are at risk of closure from an ageing workforce, covering 39,000 people, more than a fifth of the population, the college estimates. In Sandwell and west Birmingham, 85,105 patients, or one in seven, could lose their doctor because a quarter of surgeries are at risk of closure. Only a quarter of England has no surgeries at risk.

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The Tayside scandal: and resignations

BBC News 6th April 2018: The papers: NHS Tayside boss asked to step down

Holyrood committees asked to investigate. The Scotsman 8th April 2018

The Sunday Post: NHS Tayside health board chief quits three months after charity cash scandal 5th August 2018 

Lesley McLay left her £125,000 role at NHS Tayside on Tuesday but bosses are refusing to say if she got a payoff.

She has not been at work since April after it was revealed the board bent its own rules to use charitable donations to pay for essential services.

NHS Tayside yesterday confirmed she has now left the organisation but refused to reveal any severance package.

A number of other chief executives have left failing health boards with six-figure pay outs in recent years and Jenny Marra, convenor of Holyrood’s public audit committee, yesterday said there should be no “golden goodbye” for Ms McLay.

The Labour MSP said: “The committee could not have been clearer as we worked through the mess that has been created at NHS Tayside that there should be no golden goodbyes or golden handshakes for people leaving the health board who helped to put it in such a poor condition.

“Lesley McLay was at the helm of the organisation when it was getting into difficulty and we were of the view that any generous severance package would be wholly inappropriate.

“We need greater clarity from NHS Tayside and if it turns out there has been some form of golden handshake then we will pursue this matter through the committee.”

Earlier this year it emerged that NHS Tayside took more than £2 million from its endowment fund – which is made up of donations from the public or bequests in wills – to cover running costs such as IT systems.

The health board, which was bailed out with a Scottish Government loan of £33.2m in 2016-17, was reported to have used the endowment fund when “faced with a funding deficit” in 2013/14.

Public spending watchdog Audit Scotland has delivered a series of damning verdicts on NHS Tayside’s finances and the running of the health board, which Ms McLay – a former nurse – took over in 2014.

The chairman of NHS Tayside, Professor John Connell, said his board had taken charge of a difficult situation and the endowment money was spent before he took up his role as chairman.

He stood down after Health Secretary Shona Robison wrote to him asking him to resign. She also said Ms McLay’s position was untenable.

The focus on any form of severance deal for Ms McLay comes as other NHS chief executives received substantial payouts when they left under controversial circumstances in recent years.

Richard Carey pocketed a £255,789 “compensation payment” when he retired from NHS Grampian in 2014 after being embroiled in a staffing controversy, while James Barbour received £100,000 when he left NHS Lothian in 2012 just a month after the board was criticised by then Health Secretary Nicola Sturgeon for manipulating waiting times.

Next month public spending watchdog Audit Scotland is expected to deliver its latest report on NHS Tayside, which is now run by Malcolm Wright, who is also chief executive of NHS Grampian but due to retire in December.

NHS Tayside said: “Lesley McLay, former Chief Executive, left the board on July 31 2018.”

Whistleblowing champion quits….

Whistleblowing champion quit NHS Tayside board ‘because of failure to probe bullying culture’

Gareth McPherson reports 20th September on the resignation of a “Board Member” in Tayside. This is as near as we get to an exit interview. Would that the media chased every resigning board member to get their opinions. The reason “Failure to probe the bullying culture”.

NHS Tayside faces a fresh crisis after its whistleblowing champion revealed he is quitting over the board’s failure to investigate bullying.

Munwar Hussain said allegations that were brought to him by a junior doctor about the abuse of trainees were among the issues not taken seriously enough.

The suicide of a doctor in training at Ninewells is linked to the bullying culture, Mr Hussain claimed.

His concerns were raised by Labour MSP Anas Sarwar following a ministerial statement by Health Secretary Jeane Freeman in Holyrood on Thursday afternoon.

It emerged over the weekend that Mr Hussain and two other board members were standing down.

Another two non-executive members of the board have also left the board in the last few months.

Mr Sarwar told MSPs that he had seen a letter from Mr Hussain sent to the cabinet secretary explaining his reasons for leaving the board.

In that letter, the whistleblower champion revealed how he was told by an ex-doctor in training that they left the NHS due “to issues of systematic bullying and negative cliques”.

Mr Hussain wrote: “Further there were claims that people were raising issues, but these were not being acted upon by managers, including allegations in the email that a previous trainee took their own life and the stress was unbearable for some.”

Mr Sarwar described it as a “serious set of allegations including a claim that a trainee took their own life due to stress”

“He (Mr Hussain) goes on to say that he asked for this to be raised at a board meeting but was told that he could not.

“He attempted twice to meet the strategic director of workforce in August, but both times the meetings were cancelled.

“And he did eventually raise the matter at a staff governance committee, but felt in his words that this is ‘viewed as an ongoing issue that is tolerated’.”

Ms Freeman, who said she received the correspondence from Mr Hussain on September 3, insisted the matter was being properly dealt with by the health board.

“The specific allegations that were reported via that whistleblowing are currently under investigation,” the SNP minister said.

“This chamber should rest assured – and I will give them my absolute assurance – that I will continue to monitor how these matters progress.

“But it is on the basis of this board responding appropriately in my opinion, to what the whistleblowing issues have been raised with them, that I have the assurance that they are being dealt with.”

An NHS Tayside spokeswoman said: “Bullying in any form is never tolerated and all concerns are taken seriously, with the NHS Tayside medical director taking a lead on matters relating to doctors in training.

“We can confirm that all allegations raised in Mr Hussain’s letter to the cabinet secretary are currently being investigated through the appropriate channels.”

Tayside bullying

Concerns raised with Tayside NHS over systematic bullying, MSPs are told. The Courier 20th September 2018. .

Allegations of “systematic bullying” at NHS Tayside and the stress-related suicide of a trainee doctor there prompted the resignation of the health board’s whistleblowing champion, MSPs were told.

Munwar Hussain was one of three non-executive directors of the troubled health board who quit in the wake of what was branded a “crisis of public confidence” there.

Labour health spokesman Anas Sarwar said Mr Hussain had been frustrated that concerns raised were “not being acted upon by managers”.

Mr Hussain was contacted by a former trainee doctor who said they “left the NHS due to issues of systematic bullying and negative cliques”, Mr Sarwar said.

There is a crisis of public confidence with NHS Tayside following a series of issues

Labour health spokesman Anas Sarwar

The Labour MSP continued: “There were claims that people were raising issues but these were not being acted upon by managers, including allegations in the email that a previous trainee took their own life and the stress was unbearable for some.

“A serious set of allegations including that a trainee took their own life due to stress.

“He (Mr Hussasin) goes on to say that he asked for this to be raised at a board meeting but was told that he could not.”

Mr Sarwar said Mr Hussain “eventually” raised concerns at a staff governance committee meeting but said he felt “this is viewed as an ongoing issue which is tolerated”.

It emerged at the weekend that Mr Hussain had decided to resign from NHS Tayside – along with colleagues Stephen Hay and Doug Cross – but he did not make public the reason for his decision.

Health Secretary Jeane Freeman told MSPs she was aware “other board members are considering their future plans”.

But she stressed she had “immediately followed up” the issues Mr Hussain raised with her.

These included concerns about “doctors in training” as well as senior management pay, the use of public funds, and CAMHS (Child and Adolescent Mental Health Services) issues, she said.

Mr Sarwar said he had seen the letter Mr Hussain sent to the Health Secretary, as he claimed: “There is a crisis of public confidence with NHS Tayside following a series of issues, including financial mismanagement leading to brokerage loans, raiding of the charity endowment fund, a chief executive and chair forced to resign.”

Ms Freeman conceded there were “undoubtedly challenges for NHS Tayside”, adding she “would not underestimate those in any respect”.

She insisted the “appropriate place” for Mr Hussain to have raised his concerns was at the staff governance committee meeting “and not in the wider public board meeting”.

And the Health Secretary said the board at NHS Tayside – which had a new chief executive and chairman appointed in April – were “responding appropriately in my opinion to the whistleblowing issues that have been raised with them”.

Ms Freeman pledged: “I will continue to monitor how the board deals with those and what the end result will be.”

Liberal Democrat health spokesman Alex Cole-Hamilton later pressed the Health Secretary on the “revelations” from Mr Sarwar.

The Lib Dem MSP asked: “On something this serious, on a failure of whistle-blowing systems this serious, can we really expect the board to mark it’s own homework on this?”

He argued it was “in our national interest” for the Health Secretary to “instruct a full, independent public inquiry” into whistle-blowing in NHS Tayside.

But Ms Freeman told him: “I do not believe that is necessary.”

She added: “We have a set of very serious claims by a member of NHS Tayside’s board which was communicated to me via email on September 3. That member then indicated his intention to resign following his period of ill health absence on September 11.

“The board has acted on these concerns. I have seen the actions they have taken prior to Mr Hussain being in touch with me and I have made a commitment I will keep a very close eye on how the matters progress.”

A new West Wales Hospital – an inevitable utilitarian decision. Today’s children are going to live shorter lives than their parents. Todays West Wales adults could also live shorter lives than their parents.

The decision to commit to a new hospital in West Wales has been inevitable – since the WG has no intention of combining Hywel Dda and Abertawe Bro Morgannwg (ABMU) and providing a sensible solution, a mistake is being made. Recruitment to West Wales has been poor at the best of times, and now that the rationing of medical school places over the last 30 years is coming home to roost, the Hywel Dda board have no other option. There are not enough professionals ready and willing to work in West Wales, and not enough money to fund them if there were. There is an ethical argument, from a population perspective, that rationing covertly )whereby nobody knows what is not available until they need it) is better than rationing covertly (whereby citizens know in advance what is not available in their post code). But from a liberal and individual perspective, this is unethical, as it discourages autonomy and choice. It seems some choices have to be planned for by saving money, and of course this option divides us into the haves and the have nots. Exactly what Aneurin Bevan tried to avoid. Medical professionals accept that the pace of advance of medical technology is faster than any states’ ability to pay, and that rationing is inevitable and endemic already. Politicians deny the need to ration, and until this becomes honest and overt, the hearts and minds of the caring professions will be disengaged from the politics.

It has been a “least harm for the greatest number” decision that Hywel Dda has been asked to make. It will please nobody. It will satisfy nobody. It may lead to more emergency deaths. As the population ages and the demographic suggests this will be for several decades, the problems of type 2 diabetes and dementia will become worse. The Welsh Health Service costs more per capita than the English because of poverty, and yet the WG takes more from the overall budget by top slicing. When dealing with a population as low as 3 million, this really matters and adversely affects the options in devolution. That is just one of the reasons devolution has failed.

Aberystwyth finds it even harder to attract staff, and the longer term prospects for their people are worse. Llanelli and Carmarthen citizens have speedy access to Swansea, and NHSreality, and most GPs in Pembrokeshire, feel that joining the two boards would be best. The decisions to build relatively new A&E and Renal units at Withybush in the last decade now seem very strange.

Is the fact that every county wants the new hospital the opposite of NIMBYism?

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Today’s children are going to live shorter lives than their parents. Todays West Wales adults could also live shorter lives than their parents.

…Babies of both sexes in Scotland and Wales and baby boys in Northern Ireland are even projected to live shorter lives than their parents do after average longevity dropped slightly in parts of the UK.

Experts said that the government must investigate the reasons behind the stalling of life expectancy, which some have blamed on cuts to public services.

Between 2015 and 2017 the average life expectancy remained at 79.2 years for men and 82.9 for women, the Office for National Statistics said. There were falls in Scotland and Wales for both men and women, and among men in Northern Ireland, averaging 0.1 years.

Greg Hurst September 26th in the Times: Today’s children set to live shorter lives than parents

Nicola Davis in the Guardian 25th September: Children becoming physically weaker found team who measured handgrip, arm-hangs and sit-ups in Essex children

Western Mail (Walesonline) 26th September: Hywel Dda Board in shake up decisison

May 4th 2018: The agony of Damocles sword hangs over West Wales..

The fourth option for West Wales? Do we want “soft lies and gentle indifference”, until we realise the safety net is failing for us personally?

February 2018: A bigger and bigger deficit in West Wales…… Now at £600 per head……

January 2018: The West Wales options.

West Wales Health has to have a future – somewhere in the “middle” ground… Back to 2006 and reversing the wrong decision taken then not to build a new Hospital.

Leimyoscarcoma treatment options unfair…. in west Wales where choice is anathema.

Banal and sanitised Drakeford interview shames the local press in West Wales

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