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Excess deaths in 2015 (30,000) may be linked to failures in health and social care

A recent paper published in the Journal of the Royal Society has claimed that a recent rise in the number of deaths in January of 2015  may be down to cuts in health and social care funding . With the current level of funding the NHS and social care in the UK is on a trajectory towards catastrophic failure , perhaps that is all part of the envisaged endgame of  Tory health policy. Abandonment of the health and social safety net and the return of fear ? Conspiracy or neglect? Denial either way…

Image result for death by neglect cartoon

Reporting their analysis in the Journal of the Royal Society of Medicine, Professor Danny Dorling, and colleagues from the London School of Hygiene and Tropical Medicine…….

“The year 2015 saw an unprecedented rise in mortality in England and Wales – the greatest rise for almost 50 years – with a particularly large spike seen in January. Explanations presented up until now do not conclusively explain that rise, but do provide serious cause for concern, with the deaths occurring in the context of massive disinvestment in both health and social care, and almost all NHS performance markers falling below their targets. The possibility that the cuts to health and social care are implicated in almost 30,000 excess deaths is one that needs further exploration. Given the relentless nature of the cuts, and potential link to rising mortality, we ask why is the search for a cause not being pursued with more urgency? Rising mortality is concentrated amongst those groups most reliant on such spending.”

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Risk of developing Motor neurone disease and possible link to contamination of the water supply, particularly in Pembrokeshire

It has been postulated that neurotoxins from blue-green algae blooms are linked to the development of Motor Neurone disease (MND) ¹ also known as Amyotrophic lateral sclerosis in the U.S. , failure to  prevent nitrates, and particularly phosphates, entering the ground water and hence the drinking water supply in Pembrokeshire may be increasing the risk of developing serious neurological conditions  in the local population. The Mayo clinic lists “Environmental toxin exposure“, as a possible cause. NHSreality understands that we have a local “cluster” and we also have one of the highest concentrations of Blue Green Algae in our reservoir. Other clusters have been noted around the world, but none where NVZ (Nitrate Vulnerable Zones) have been established around drinking water reservoirs. Is the incidence rising?

In several geographical locations dietary intake of BMAA (β-N-methylamino-L-alanine) has been associated with clusters of MND/ALS ². 

B-G Algae in N Wales

In Wales the Welsh Government is about to announce the result of it’s consultation on NVZ introduction. Environmentalists contend that without addressing the region as a whole, there will be no significant benefit, and policing would be impossible. Wales, and West Wales in particular, is heavy wet agricultural land unsuited to arable crops. This means that West Wales farmers focus on growing grass for silage for animal feed, producing more animal protein per acre than most parts of Europe. Modern chemical fertilizers can give up to 4 crops of silage a year, allowing more animals to be fed, and this means more slurry and animal waste, which has to be disposed of – usually on the land. This drains into rivers and the sea.

In Pembrokeshire animals along the Eastern Cleddau river bank have died on more than one occasion as a result of poisoning from the reservoir release. This got less attention in 2015 than the mythical Puma killing Welsh Hill Sheep. Yet it is the water supply of 120,000 people who are actually in an unofficial experiment. Fish in both reservoirs and the sea have been poisoned to the point where they are unsafe to eat.

Giant methane gas producing plants is one suggestion, but the transportation costs might make this impractical. Whatever, the potential cost on a population for MND risk, and also for the butterflies and birds, fish and aquatic invertebrates is disastrous. The precautionary principle alone says we should have a NVZ in the whole of Wales. It begins to look as if genetic predisposition, allied to toxin exposure is the cause.

“…….it is possible that biomagnification of BMAA could occur in marine ecosystems similar to the biomagnification of BMAA in terrestrial ecosystems. Production of BMAA by marine cyanobacteria may represent another route of human exposure to BMAA. Since BMAA at low concentrations causes the death of motor neurons, low levels of BMAA exposure may trigger motor neuron disease in genetically vulnerable individuals.”²

The physiological mechanism by which it may cause disease in humans is described thus “BMAA has a number of toxic effects on motor neurons including direct agonist action on NMDA and AMPA receptors, induction of oxidative stress, and depletion of glutathione. As a non-protein amino acid, there is also the strong possibility that BMAA could cause intraneuronal protein misfolding, the hallmark of neurodegeneration. While an animal model for BMAA-induced ALS is lacking, there is substantial evidence to support a link between this toxin and ALS.”³

In 2007 the UK Parliament discussed the legislation at the Environment ,Food and rural affairs committee the following is an extract from that report:

“5. There are health and environmental reasons for concern about the level of nitrates in water. Under the Drinking Water Directives of 1980 and 1998, drinking water is required to have a nitrate concentration of less than 50 mg/l.4 Defra estimates that, between 2005 and 2010, the cost of treating nitrates in drinking water will be £288 million in capital expenditure and £6 million a year in operating costs.5 In addition, nutrients such as nitrates can contribute to the eutrophication, or enrichment, of water.6 Eutrophication can lead to the accelerated growth of plant life such as algae, which in turn can have a negative impact on biodiversity and affect the recreational value of the water. At the time of the Directive’s introduction, the Council of Ministers judged it necessary “in order to protect human health and living resources and aquatic ecosystems and to safeguard other legitimate uses of water”

 

Failure to prevent nitrate contamination of drinking water sources by full implementation of the EU  Water directives since 1991 in Wales and in particular in Pembrokeshire  may possibly    increase risk of  MND/ALS through contamination of the water supply by blue green algae derived neurotoxins .

 

1: Bradley WG, Borenstein AR, Nelson LM, Codd GA, Rosen BH, Stommel EW, Cox PA. Is exposure to cyanobacteria an environmental risk factor for amyotrophic lateral sclerosis and other neurodegenerative diseases? Amyotroph Lateral Scler Frontotemporal Degener. 2013 Sep;14(5-6):325-33. doi: 10.3109/21678421.2012.750364. Review. PubMed PMID: 23286757.

2: Masseret E, Banack S, Boumédiène F, Abadie E, Brient L, Pernet F, Juntas-Morales R, Pageot N, Metcalf J, Cox P, Camu W; French Network on ALS Clusters Detection and Investigation.. Dietary BMAA exposure in an amyotrophic lateral sclerosis cluster from southern France. PLoS One. 2013 Dec 13;8(12):e83406. doi: 10.1371/journal.pone.0083406. PubMed PMID: 24349504; PubMed Central PMCID: PMC3862759.

2: BMAA – an unusual cyanobacterial neurotoxin, Kaivalya J. Vyas & John H. Weiss. Pages 50-55 | Received 27 Apr 2009, Accepted 18 Aug 2009, Published online: 25 Nov 2009 . http://dx.doi.org/10.3109/17482960903268742

3: Banack SA, Caller TA, Stommel EW. The cyanobacteria derived toxin Beta-N-methylamino-L-alanine and amyotrophic lateral sclerosis. Toxins (Basel). 2010 Dec;2(12):2837-50. doi: 10.3390/toxins2122837. Review. PubMed PMID: 22069578; PubMed Central PMCID: PMC3153186.

Blue-Green Algae (Cyanobacteria) and their Toxins

Lindsey Konkel reports in Environmental Health News December 2014: Closing in on ALS? Link between lethal disease and algae

Kathleen McAuliffe reports in “Discover” magazine 2011: Are Toxins in Seafood Causing ALS, Alzheimer’s, and Parkinson’s?

Motor Neurone Disease Association

Motor neurone disease – NHS Choices

Epidemiology of ALS and Suspected Clusters

Motor Neurone Disease – Patient

Motor neurone disease: assessment and management …

The Mayo Clinic overview includes the paragraphs below (note environmental toxin exposure):

Causes

ALS is inherited in 5 to 10 percent of cases, while the rest have no known cause.

Researchers are studying several possible causes of ALS, including:

  • Gene mutation. Various genetic mutations can lead to inherited ALS, which causes nearly the same symptoms as the noninherited form.
  • Chemical imbalance. People with ALS generally have higher than normal levels of glutamate, a chemical messenger in the brain, around the nerve cells in their spinal fluid. Too much glutamate is known to be toxic to some nerve cells.
  • Disorganized immune response. Sometimes a person’s immune system begins attacking some of his or her body’s own normal cells, which may lead to the death of nerve cells.
  • Protein mishandling. Mishandled proteins within the nerve cells may lead to a gradual accumulation of abnormal forms of these proteins in the cells, destroying the nerve cells.

Risk factors

Established risk factors for ALS include:

  • Heredity. Five to 10 percent of the people with ALS inherited it (familial ALS). In most people with familial ALS, their children have a 50-50 chance of developing the disease.
  • Age. ALS risk increases with age, and is most common between the ages of 40 and 60.
  • Sex. Before the age of 65, slightly more men than women develop ALS. This sex difference disappears after age 70.
  • Genetics. Some studies examining the entire human genome (genomewide association studies) found many similarities in the genetic variations of people with familial ALS and some people with noninherited ALS. These genetic variations might make people more susceptible to ALS.

Environmental factors may trigger ALS. Some that may affect ALS risk include:

  • Smoking. Smoking is the only likely environmental risk factor for ALS. The risk seems to be greatest for women, particularly after menopause.
  • Environmental toxin exposure. Some evidence suggests that exposure to lead or other substances in the workplace or at home may be linked to ALS. Much study has been done, but no single agent or chemical has been consistently associated with ALS.
  • Military service. Recent studies indicate that people who have served in the military are at higher risk of ALS. It’s unclear exactly what about military service may trigger the development of ALS. It may include exposure to certain metals or chemicals, traumatic injuries, viral infections, and intense exertion.

Algal blooms in the Waikato region and NZ Marlborough region: Cluster investigation into motor neuron disease may 05

BLUE GREEN ALGAE – New Mexico Environment Department

Toxic Blue-Green Algae Blooms – Washington State

Cornwall: Warning issued over toxic algaeBBC News

Pembrokeshire Rivers trust: Blue Green Algae at Llys Y Fran and Warning over toxic algae – Wales Online and it reaches the sea: Warning after harmful blue-green algae found at Freshwater

Australia: Blue-green algae (cyanobacteria) – health.vic

England: A Case-Study Survey of an Eight-year Cluster of Motor

JAMA article 1982: A Cluster of Amyotrophic Lateral Sclerosis says incidence is “four to six per 100,000 population. The age-adjusted incidence is 1.8 per 100,000 in white Americans.”

Lakeside ALS cluster draws attention but is still unexplained

Huge ALS cluster at Kelly AFB ignored by authorities

South East France: A Clustering of Conjugal Amyotrophic Lateral Sclerosis in …

Als Cluster Finland – scribd.com

Clusters : National Multiple Sclerosis Society

Sunday 29th Jan 2017: Alzheimer’s ’cause’ discovered: Poisonous algae found in UK freshwater lakes and reservoirs could be fuelling dementia epidemic afflicting one million people

 

 

Image result for poison cartoonOverview of Algal Poisoning – Toxicology – Veterinary Manual

algal poisoning animals

How to avoid poisoning of livestock by blue-green algae

Clusters of amyotrophic lateral sclerosis (MND)

Clusters of MND

Blue Green Algae Poisoning Frequently Asked Questions

 

 

 

 

 

Ship arriving too late to save a drowning witch

 

 

Too little too  late ……

http://www.bbc.co.uk/news/health-37546360

This article from the BBC reports that medical school training places are set to rise in 2018 …. 

The number of medical school places will increase by 25% from 2018 under plans to make England “self-sufficient” in training doctors.Graphic

Health Secretary Jeremy Hunt is to announce an expansion in training places from 6,000 to 7,500 a year.

He believes increasing the number of home-grown doctors will be essential given the ageing population.

There is also concern it will become more difficult to recruit doctors trained abroad in the future.

About a quarter of the medical workforce is trained outside the UK, but the impact of Brexit and a global shortage of doctors could make it harder to recruit so many in the future.

Prime Minister Theresa May told the BBC: “We want to see the NHS able to recruit doctors from this country. We want to see more British doctors in the NHS.”

The increase also comes after the health secretary has spent a year at loggerheads with junior doctors over the pressures being placed on them to fill rota gaps.

Doctor’s Regulatory Quango once again threatens the Junior Doctors over strikes

Doctor’s Regulatory Quango ” The General Medical Council”  once again blackmails the Junior Doctors with veiled threat , as outlined in the letter to the Junior Doctor’s from the GMC  below , this organisation acts with impunity to intimidate doctors and goes  far beyond its mandate. It has become a vacuum for power and  money with doctors footing the bill for its extravagant salaries. The safety of those treated by the NHS as an organisation was the duty of the Secretary of state for health not the employees who have withdrawn their labour using their rights under the law. It seems the GMC are failing to take the government to task as they see the poor plebs that pay their whopping salaries as an easier target.

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Why the strikes are about safety …. from Keep our NHS public

Keep Our NHS Public recognises the courage of the BMA and the junior doctors in postponing their strike action[1] because it was unsafe not to. But the government plays a dangerous game with us all.

The decision to call off next week’s strike was taken for exactly the same reasons as those behind the strike in the first place: safety of patients.  Despite the fact that an increasing number of expert opinions were supporting the strike…………………… The juniors are only the beginning. It will end with the ending of the NHS as a public service for all.

Which is why the junior doctors and all NHS staff fighting for the NHS have our full support.

All Jeremy Hunt has to do is return to negotiating. But he refuses to do so. His party is committed to dismantling the NHS, as last week’s disclosure about the true nature of the ‘STP’ plans showed clearly. ……..

Keith Venables, Keep Our NHS Public’s Co-Chair, said:

“We know that this imposition is about undermining the terms and conditions of all health service staff, and part of the drive towards privatization. The junior doctors have decided to suspend their strike action in September on the grounds of patient safety and I understand and respect that. It is their decision to make – not ours. Keep Our NHS Public activists across the country will continue to campaign for the NHS and prepare to support the juniors in the very near future.”

 

Responsibilities

Secretary of State for Health

The Secretary of State for Health has overall charge of all areas of health policy with a particular focus on financial control and oversight of all  NHS delivery and performance.

Jeremy also leads on all aspects of mental health and championing patient safety.( That last bit must be a joke).

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(http://www.pulsetoday.co.uk/your-practice/regulation/gps-to-face-8-rise-in-gmc-fees-from-april/20008717.fullarticle)

 

A statement from Professor Terence Stephenson, Chair of the General Medical Council:

 

We recognise the frustration and alienation of doctors in training and indeed their legal right to take industrial action. However, we are extremely concerned about the impact which this prolonged campaign of industrial action in England will have on patients’ care and on the public’s trust in doctors.

 

The further action announced by the BMA will inevitably add to the cumulative impact of past industrial action on patients’ care. Further, the BMA’s announcement marks a substantial escalation of the previous industrial action in that it involves: the removal of emergency care (as well as routine appointments); a rolling programme of action of indefinite duration; the removal of junior doctors’ services for five days of each month (rather than one-off days of action); and much shorter notice to NHS employers of the first bout of action which leaves little time to prepare.

 

The health service is under huge pressure. During previous industrial action all doctors went to considerable lengths to make sure that patients continued to receive a good and safe level of care. We know that doctors will again want to do their utmost to reduce the risk of harm and suffering to patients. However, for the reasons given above, it is hard to see how this can be avoided this time around. To suggest otherwise would be a disservice to the enormous contribution made by doctors in training to the care and treatment of NHS patients every day. We therefore do not believe that the scale of action planned at such short notice can be justified and we are now calling on every doctor in training to pause and consider the implications for patients.

 

The GMC has no role in contract negotiations between the doctors’ trade union and NHS Employers but we do know that many doctors in training feel alienated, undervalued and deeply frustrated about many aspects of their professional lives. We are committed to playing our part in addressing these wider issues. Over the past few months, progress has been made on several non-contractual issues, including Health Education England’s recent announcement that it will strengthen its whistleblowing protection for doctors in training. The GMC agreed in April this year to take forward a review that will explore how we can make postgraduate training more flexible and we have already started discussing the scope of that review with representatives of doctors in training.

 

As the regulator responsible for doctors’ postgraduate education, we are committed to protecting the quality of their training. We will do so with the aid of our new education standards which we published earlier this year and, if we feel issues with training are not being addressed at a local level, we will act through our enhanced monitoring process as we have done on behalf of trainee doctors successfully in the past.

 

For every doctor affected, these are difficult and worrying times and feelings are understandably running high. The advice we have issued today is based on the GMC’s guidance, Good medical practice. It is important that we make clear doctors’ continuing professional obligations and set out the various challenges facing doctors with leadership responsibilities, employers, doctors in training and senior doctors as well as those in non-training roles.

 

We understand that the government and the BMA have held talks about the small number of remaining issues and we hope that talks can resume in order to avoid plunging the health service into a further crisis which is in no-one’s interests.

 

 

Advice from the General Medical Council

 

Today, Niall Dickson, Chief Executive and Registrar, has set out the latest GMC advice for doctors. It covers those contemplating industrial action as well as doctors in leadership roles, senior doctors and those not in training.

 

Niall Dickson said:

 

The duties of a doctor are set out in Good medical practice, which says that doctors must make the care of their patient their first concern.

 

At this difficult time, everyone in the profession must remember their responsibilities – to each other and to their patients – respecting each other’s views and decisions in person, in print and online.

 

Parliament has not fettered the right of doctors to take industrial action, unlike some other professions and occupations. Doctors therefore have a right to strike and take industrial action. The question each doctor must ask, however, before taking action is whether what they are proposing to do is likely to cause significant harm to patients under his or her care or who otherwise would have come under his or her care. This is a matter of professional duty and we expect each doctor to comply with it.

 

This advice is issued under the authority of the 1983 Medical Act which governs the behaviour of all doctors practising in the UK. The Act and the accompanying guidance require doctors to exercise their professional responsibilities in the interests of their patients, to put their patients first and protect them from harm. The GMC has powers under the Act to investigate and apply sanctions to any doctor whose behaviour has fallen consistently or seriously below the standards required. Where we are presented with evidence that a doctor’s actions may have directly led to a patient or patients coming to significant harm, we would be obliged to investigate and if necessary take appropriate action.

 

Advice for doctors contemplating industrial action

 

We ask every doctor contemplating further and escalated industrial action to pause and consider the possible implications for patients. Not only in terms of the immediate action but also in terms of the cumulative impact on patients, the additional risk posed by the withdrawal of emergency cover and the effect of removing all doctors in training every day for five days every month.

 

This will mean the cancellation of tens of thousands of operations and procedures, outpatient appointments and tests. The GMC cannot second guess the situation facing each doctor in training in England – that must be a matter for individual judgement. But given the scale and repeated nature of what is proposed, we believe that, despite everyone’s best efforts, patients will suffer. In light of this, the right option may be not to take action that results in the withdrawal of services for patients.

 

Any doctor who does decide to take action must take reasonable steps to satisfy themselves about the arrangements being made during the period when they are withdrawing their labour. This means making sure that senior doctors and managers have enough time to make alternative arrangements – action without warning or with inadequate warning is not acceptable. They should engage constructively and at an early stage with those planning for the care of patients during industrial action to make sure that patients are protected. They have a responsibility for continuity and co-ordination of care, and for the safe transfer of patients between different teams.

 

If, during the industrial action, it becomes clear that patients are at risk in a local area because of inadequate medical cover, and doctors in training are asked in good faith to return to work by employers, we expect they would fulfil this request. In the event of an emergency, we know doctors in training will always come forward. Where contingency plans are overwhelmed, it is vital that doctors taking action can be contacted and are available to help.

 

Advice for doctors in leadership roles

 

Doctors in leadership positions should do everything possible to organise services during the industrial action to make sure that patients are protected, as they have done during the action to date. They should assist employers, who will have been preparing for this action and putting in place other options for emergency care.

 

Although hospitals will inevitably face increased pressure during any period of industrial action, doctors in leadership positions should only call doctors in training back to work where there are genuine and significant concerns about the ability of the hospital to provide safe care to patients.

 

Doctors who have a management role or responsibility must support their organisations in acting immediately on any patient safety concerns.

 

Doctors in leadership roles should encourage an open, respectful culture and take action about any concerns about bullying raised with them, including online harassment.

 

Advice for senior doctors and those not in training

 

Senior doctors and those not involved in the dispute should continue to provide medical care during the industrial action and, as far as is possible, make sure that patients are protected, where necessary providing cover in place of those taking action. They should assist employers and clinical managers who will have been preparing for this action and putting in place other options for emergency care.

 

Advice for employers

 

The GMC does not regulate employers but we would expect them to engage with their medical workforce to develop robust plans that protect emergency services and minimise the impact on patients. Where there are concerns about the capacity of the organisation to cope, these concerns should be raised at the earliest opportunity with doctors, including those taking action.

 

Employers are required to meet our standards in relation to doctors in training. In particular, they should make sure that doctors are supported in the learning environment and given appropriate clinical supervision, including during a period of industrial action.

 

During the industrial action, concerns have been expressed about the design of rotas for doctors in training. We would therefore remind employers, who will be working hard to make sure patients continue to receive safe, high quality care during the action, that our new standards for medical education and training – Promoting Excellence – require organisations to design rotas that make sure doctors in training have appropriate clinical supervision and minimise the adverse effects of fatigue and workload. Where there are concerns, we expect postgraduate deans to address these with their local NHS Trusts or GP surgeries.

Lords to investigate NHS sustainability

Lords to investigate NHS sustainability

Mark Gould writing for Onmedica.. link above

Tuesday, 19 July 2016

 

The House of Lords Committee on the Long-term Sustainability of the NHS wants to hear submissions to its inquiry which hopes to identify what the NHS of the future may look like.

The Committee’s inquiry is set against the backdrop of an annual deficit of £1.85bn, imminent demographic changes that promise an older population and more patients with increasingly complex long-term health needs.

These challenges come alongside changes in healthcare and medical technology which may lead to more personalised prevention and treatment of diseases.

The Committee has divided its inquiry into five themes which it will consider in public evidence sessions:

  • Resourcing issues – including funding, productivity and demand management. Is the current funding model for the NHS realistic in the long-term? Should new models be considered? Is it time to review exactly what is provided free-at-the-point of use?
  • Workforce – including supply, retention and skills. How can an adequate supply of appropriately trained healthcare professionals be guaranteed? Are enough being trained and how can they be retained? Do staff in the NHS have the right skills for future health care needs?
  • Models of service delivery and integration. How can the move be made to an integrated National Health and Care Service? How can organisations in health and social care be incentivised to work together?
  • Prevention and public engagement. How can people be motivated to take greater responsibility for their own health? How can people be kept healthier for longer?
  • Digitisation, big data and informatics. How can new technology be used to ensure sustainability of the NHS?

The Committee are inviting written evidence to be received Friday 23 September. Evidence can cover one or more of the themes and should focus on the long-term sustainability of the NHS rather than short-term issues.

The Committee will take oral evidence on resourcing issues throughout September and October before moving to the workforce theme in November. The Committee will agree its report by the end of March 2017…..

 

The plan for the Junior doctors that have failed to behave …

Eventually the government will crush the Junior doctors as they have crushed all trade union opposition previously by using the Judiciary as a cosh to  reduce civil rights and liberties….

“Writing in the Daily Telegraph, James Kirkup gives the recalcitrant medics a warning from history. He warns that the BMA is repeating the mistakes of the National Union of Mineworkers, over-estimating the nation’s dependency on their members.

That Britain’s economy could survive without British coal was unthinkable, right up until it wasn’t. Kirkup argues that technological progress and competing models of provision mean that our monolithic state healthcare provider may soon find itself similarly outflanked.

But whilst that might be true, it is by no means certain that we have reached this point now. For all that Arthur Scargill’s attempt to topple Margaret Thatcher is the stuff of legend, it shouldn’t eclipse the fact that there were plenty of miners’ strikes before that final confrontation and the miners won most of them, enjoying public sympathy as they did so.

Jeremy Hunt could end up being a modern-day Margaret Thatcher, bringing truculent trades unionists to heel and unleashing modernity on one of the UK’s totemic industries. Or he could be Edward Heath.

As Simon Jenkins points out in today’s Daily Mail, public support for the NHS is currently bulletproof. This makes it incredibly hard to reform: in fact, the public health lobby have convinced many politicians that it is easier to reform the public than to make a serious attempt to reform public services.

“Cost to the NHS” is thus one of the main pillars of modern drives against smoking and obesity. But setting aside any liberal qualms we might have about that, it isn’t clear that this represents a viable long-term solution.”

Full article from the link below…….

 http://www.conservativehome.com/thetorydiary/2016/03/how-a-government-can-beat-the-bma.html

Writing in the Daily Telegraph, James Kirkup gives the recalcitrant medics a warning from history. He warns that the BMA is repeating the mistakes of the National Union of Mineworkers, over-estimating the nation’s dependency on their members.

This piece leads on from a Guardian article

from the DOCTORSNET website

Leaks reveal contract dispute secrets 2327/05/2016

BMA leaders brushed aside embarrassing revelations last night about junior doctor discussions during the contract dispute.

A leak of 1,000 pages of messages suggests the BMA junior doctors committee planned to “tie the Department of Health up in knots for the next 16-18 months.”

The plan was to draw the dispute out with “punctuated action for a prolonged period,” the Health Service Journal, which obtained the messages, claimed.

The BMA said the messages reflected the “anger and frustration felt by junior doctors across the country due to the government’s refusal to listen to their concerns.”

The journal said the messages highlighted divisions in the BMA. Two members of the junior doctor committee’s executive resigned earlier this month – and messages criticised the BMA leadership.

It says the messages show that some committee members felt pay was the key issue, not safety. One executive member described weekend pay as “the only real red line.”

Committee chair Dr Johann Malawana is cited as discussing an overall increase in pay that might lead the juniors to concede on the weekend issue.

But he told members that the abortive talks in January were “rubbish” and the BMA should only take part to “play the political game of always looking reasonable.”

The greatest burden is on child rearing parents in the UK

Why do families in the UK face such enormous costs to bring up their children ?

the tax and benefit system will still cease recognising the costs of raising children.

CPAG research has calculated that it costs £164 a week to cover the costs of the basics for children; child benefit (£20.70 for a first child, £13.70 for subsequent children)

During pregnancy and childbirth, mothers and families receive a lot of support, but this ends abruptly after a baby’s birth. Yet the emotional, financial and social pressures continue and can be immense (interview with Dan Poulter CON MP in the Guardian)

 

The cost of raising a child as estimated at a whopping  £231,843 according to the Daily Telegraph

Surging childcare fees and expenses linked to education mean the basic cost of bringing up a child in the UK has risen 50 per cent faster than inflation over more than a decade.

The study, carried out by the Centre of Economic and Business Research (CEBR) for the insurer Liverpool Victoria (also known as LV=) suggests that parents have cut back spending on toys and even food but any savings have been swallowed up by other rising costs.

It also points to evidence that the expense of raising children could be shaping the population, with some parents actively postponing of ruling out having a second child because of the cost.

Stay at home parents heavily penalised since 2008 

More than half of traditional single-earner households with children no longer have enough money coming in each month to maintain a decent – but far from luxurious – lifestyle, the study by the respected Joseph Rowntree Foundation think-tank shows.

The proportion of such families struggling to get by has jumped by 36 per cent since 2009, and as much as a quarter since 2012.

It threatens to reignite the row over the Coalition’s changes to child benefit and new childcare tax breaks which led to accusations the Government was forcing middle-class stay-at-home mothers back into employment.

The study details how households with children are falling behind the rest of society in maintaining a basic “socially acceptable” standard of living, amid changes to Government support for families.

 

The Taxation of Families – International Comparisons 2013“…the OECD average wage for the UK (£35,548), one-earner married couples with two children paid 35% more than the OECD average.  Single parents with two children paid 24% more.  This contrasts with the situation of low income families who broadly compare favourably with their OECD counterparts as tax credits and child benefit often exceed income tax and National Insurance Contributions.

The report also highlights the way in which many one-earner and single-parent families are trapped in poverty as a result of very high effective marginal tax rates which ultimately fail to make work pay and crucially stifle aspiration.  Many UK families have an effective marginal tax rate of 73%, meaning that only 27p of every additional pound earned is retained.  Marginal rates on low to middle income families are higher than in all comparable OECD countries.”

Traditional families shouldering heavier tax burden than global average

Campaigners say the OECD figures are more evidence that Britain has an “unfair” tax system, giving traditional families a greater tax burden than the global average….

 Apr 2014

British families with two children and one earner face a tax burden of 27 per cent, the OECD said the average rate for such families across the group is 26.4 per cent.

By contrast, British families where both parents work face an overall tax rate well below the international average: their tax burden is 23.5 per cent, compared to 28.3 per cent across the OECD.

The figures also showed that a British single earner on the average wage pays a tax rate of 31.5 per cent, well below the OECD average of 35.9 per cent.

Who pays the most tax ? the rich or the poor ?