Repeat Prescription

The time is coming when normal politics may have to be put on hold in the national interest. Yes, just like wartime. The implications of a bad Brexit will transcend partisan considerations. The people will look into the abyss and demur. Save us, they will demand.

At least the sensible ones will. We currently have a large schadenfreude minority apparently prepared for the country to really suffer to justify their own position and others so lost in parochialism they will take the plunge hoping someone will appear from nowhere with a soft mattress to land on.

The logic of the Brexit orbit is to pull us irresistibly to the EU centre. Every cause and effect points to retaining the current position. What’s to be done about the medicines agency and the banking authority based in London, for example? They will depart taking with them highly paid jobs and 40,000 hotel nights a year. But still the UK will need to replace them and replicate their work and meet the EU’s standards anyway. Logic? Stay in the EU and keep them and their jobs and economic spin off here.

The tragedy for the UK is that both major parties at Westminster, for differing ideological reasons, are on the same side – isolationism. Those in both Tory and Labour parties who can see the unfolding disaster will have to put country first and join with the pro-Europeans in Liberals, SNP, Greens and Plaid to mount a UK-wide save-the-country campaign. It could lead to a new politics. *

But there is another area where big tent politics is becoming critical in order to save us from catastrophe – the state of the NHS. To many, the health service is in its way as important as EU membership, perhaps more so. It represents something about Britain, its past and future, which binds us together beyond borders, albeit managed territorially. It is one of those areas of life that gives us quiet satisfaction, pride even. It makes us not only feel well but feel good, like a full stomach or money in the bank. I think that’s why in public debate it is treated like a new-born baby, precious yet vulnerable.

But just as warm words are soothing when ill, they won’t replace a blood transfusion or perform a hip replacement. Talking up the NHS, despite its many shortcomings, is applying ointment to a broken arm. More fundamental surgery is required.

The evidence mounts that this most essential of services is in serious trouble; that the management knows it, that the politicians are transfixed. Like Brexit, the first requirement is honesty. From health professionals to civil servants to ministers and MSPs, there has to be a clear-sighted view and an admission that the present funding of the NHS cannot go on, if we wish it to survive.

Throughout the devolution years the warning lights have been flashing on every front – the rising cost of medicines, the increase in prescriptions, an ageing demographic, an unfit population, new systems and equipment at exorbitant cost, fewer students entering medical degrees, pay not keeping pace, the growth in contract nursing and the rise in administration and management – 18 per cent of the workforce total last year, easily second to the number of nurses (43%).

The flashing lights are now accompanied by a klaxon. Holes are appearing in care. Services are being withdrawn, both in hospital and GP form.

The recent case in the south-west is part of a trend. The BBC reported that NHS Dumfries and Galloway was forced to suspend admissions for a week and downgrade the casualty unit to a minor injuries facility because of a shortage of doctors.They said the hospital was open and fully staffed but that a challenge remained in securing medical cover on an on-going basis.

A doctor from elsewhere in Scotland contacted me this week. Even in our highly regarded and respected practice we have been unable to recruit to a 5-session (two and a half days) GP post. We already have 3 practice nurses, 2 health care assistants and an advanced nurse practitioner. We are now going to advertise for an unscheduled care practitioner and I hope we might get one. But even if we do that, if another GP partner leaves the practice soon, we are unlikely to recruit and, as a result, we could go under.

Recruitment, instead of access to a prized profession, is stalling. As are genuine attempts to streamline and improve provision by the merger of health and social work organisations.

But why is this happening? I’m afraid it’s the same problem as Brexit – the politicians are afraid to confront the reality because to them the costs are too high, both literally and politically. Finding the money means changing priorities which in turn means disappointing others and fire-fighting. Altering how things are done and removing facilities to centre them more sensibly, causes heated reactions in communities where there is already evidence of under investment. No politician wants to face the wrath of the voters and no amount of cold logic will convince an inflamed crowd.

So cowardice is part of the story but so is irresponsible scaremongering.

Here’s my doctor again: All of them – Tories, Labour, LibDems, Greens, SNP – are in denial about it. Instead of coming together to forge a way through the crisis they continue to use it as a political football. At the same time the Scottish Government is in paralysis and reluctant to change because of the appalling behaviour of the Scottish media.

The hysterical and deliberate misreporting by journalists of issues in the NHS doesn’t just terrify those about to use hospital services. It forces professionals on to the defensive. Opposition politicians, while justified in pointing out deficiencies, play to the media with hyperbole. This was the point made by the Nuffield Trust which found much pioneering work in Scotland that could be replicated elsewhere in the UK but, crucially, deduced that: The Scottish NHS faces a serious financial predicament. The need for savings is at least as great as for other UK countries, and health boards are struggling to find ways to deliver them. Limited national planning for the next few years and a polarised, hostile political context make an honest national debate difficult. While the strengths of the Scottish NHS could help it to save money, there is also a risk that they are undermined by the intense financial squeeze. It adds: Several interviewees from across the spectrum of roles referred to a polarised political culture, with the SNP Government seeking majority support for independence and a largely hostile press looking to attack their record on the NHS.

This is the result of an infantilised political culture where mouthy politicos seek not to uncover truth and find remedy but to stoke resentment via a trivialising media. The result is a failure of nerve, a lack of honesty and operational stasis. Pursuing independence does not mean sidelining essential services.

An offer to help the SNP out of its difficulty, a government acceptance that the opposition might have something positive to contribute and a limited truce on horror attacks would release everyone from their silo and bring a much needed improvement to the quality of politics and ultimately to the health service.

But why should we let them off the hook? The answer is simple – for the national good. Just like the need to confront Brexit. And here’s the news: maybe the public are smart enough to recognise the altruistic effort without being bludgeoned by soundbite. Maybe they will reward after all the ones who had the vision and integrity to act before it was too late. Wouldn’t that be a prize?

Last word to my GP. The media have to take a huge share of the blame for where we are now because they constantly do down the NHS and those that work in it, especially doctors, and they crucify any politician who tries to suggest different ways of delivering the service. It’s time to call for a national consensus and to tell politicians to knock their heads together instead of using the NHS to score childish cheap points off each other. I am sorry to lump this on you but I care so dearly about the NHS and the principal of universalism that under-pins it.

*Disappointed to see Jo Swinson trying to carve out a Liberal-only position for staying in the EU and shunning everyone else. Claiming to be the only UK party that’s pro EU is cheap  and out of keeping with the times. Party before country is never a good look (as she did in voting with the Tories in the coalition on among others, tribunal fees)

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37 thoughts on “Repeat Prescription

  1. Well said Derek (perhaps more in hope than expectation – see my last para).

    It’s clear, of course, that all the UK health and care services need more funds – and it’s equally clear that the UK can provide those funds. This is true regardless of whether you believe (as I do) in the Richard Murphy version of the Magic Money Tree, otherwise known as Modern Monetary Theory (amusing that the initials are identical).

    Given the relatively better performance of the Scottish NHS, our pro-rata share of those funds would enable us to increase the performance differential – and we’d be doing it deliberately. However, I’m reminded of a speech by the great Dr Philippa Whitford in the HoC, where her offer to help the English NHS was well received (I think it was one of those debates where the usual suspects had gone home). This would just be extending your munificent offer to the UK level.

    Mind you, on a sour note, I’ve never been a believer in the idea that taking politics out of the NHS could work. The parties will always want to cling to the idea that they each know best, and attack the other side(s) to gain electoral advantage. It seems to me that this is even more true at the Scottish level.

  2. This is my despair about all politics, not just the politics of the NHS, It’s rife in Westminster, and to a lesser extent in Holyrood, as well as in the US. Government has become an extremely partisan business which regularly sacrifices the common good for diversionary scapegoating and point-scoring. The mainstream media is part of the game because it is interwoven with politics through blood, marriage, or self-interest.

    Government is set up like a sporting match. In Westminster there are two sides of the house; there is the ‘Official Opposition’; there is even a referee with the grand title of Speaker. Very little going on in that house benefits those outside of it. Government needs a change of focus, but what impetus do they have to change when they don’t look beyond the status quo and their own gravy train?
    And the people who lose out are the same people who vote for these pathetic team members, known as (unionist) party MPs. Many of them work in the NHS. Go figure.

  3. your comments strike a note, i feel the snp have let us down by being too pc
    we should have moved then with 56 of 59 we had it all
    e mailing my mp only gave a response “im sorry you cant believe in snp OR independence”
    i now feel rudderless without a party whom i can believe, or get some sense from
    Viva le revolucion

  4. Sounds like an entirely reasonable argument you have there, Derek.

    But it’s hard to see the opposition parties wanting to do anything to help ScotGov, were the former asked by the latter.

    Much more likely they will think ‘a few more pushes on such issues as the NHS, and we can dethrone them at last!’.

    I’d like to be wrong but I don’t see anything in any of the mannerisms or words of Dugdale, Davidson or Rennie that suggests any spirit of co-operation is ever likely. I’d like to meet the person who has room for such a reading though – they must be a huge optimist!

  5. As measured as your article is, I would respectfully suggest it encourages a rearranging of the deck chairs on the titanic.

    The big game afoot, is the one highlighted by Prof Allyson Pollock on You Tube TED talk Essex.

    Over 200 polititans in Westminster (from the red and the blue benches) openly declare their takings from Private Health Care Companies – as long as they declare them they commit no offence – the oft times clear conflict of interest with the Public’s Assets is by the by.

    The NHS is frequently found to be very well and efficiently run. The American one is the most expensive and with the poorest ratings. The admin costs for a patient on the NHS are below 5%, in America it stands at 20% – and before you see a Dr, you see an Insurance Broker. The Insurance Broker will determine what avenue of medical treatment you will be channelled towards.

    American Health care bills are the top causes (1 and 2) for bankruptcy and homelessness – what a cost to their economy and society. What a bloody waste of people.

    Our hospitals in the NHS broker good deals for the buying of medicines. In America – this is illegal, and each hospital has to negotiate separately.

    And if we look a little closer to home, our GP’s wages are extremely high. Can’t really blame them for taking it, but in all honesty, this was not always the case, do they really deserve that much. The biggest obstacle to the building of the NHS were the Doctors.

    None of the above will be of any interest to our media – printed or Beeb’d. No doubt the billionaire, tax dodging media barons will have a few fingers in the pies of private health care. Certainly Richard Branson does.

    And your likes of Eleanor Bradford kens fine what side her bread’s buttered, as she fires in all the FOI requests for another SNP Baaad story.

    Your pal who’s the GP will be right enough – and I’m not decrying him. But the media have a very real and different agenda other than just reporting the news.

  6. Fine noble thoughts Derek, logical and the right thing to do , for adults .

    Then i look at the grand coalition at Holyrood , all the unionists sticking together , then i think oh f/k what a bloody spineless shower , sitting on their fat arses pulling in a very good wage for spouting total garbage ,

    Just look at the reaction from them – the new forth crossing opposed by all but first i believe proposed by the old tory party when Anabel Goldie had a bit of sense and had a few good people around her ,

    Then the latest one just to score a hit bloody baby boxes god how low can they sink , every single thing the SNP want to change for the better they oppose it everything . Just because its the SNP .

    The unity seen after the brexit vote has all but disappeared as usual , as with everything with these charlatans .

    First they show lukewarm support then disappear when suggestions are called for , more than once i have heard Nicola Sturgeon openly ask for their proposals & input , then the silence . we are no helping you .

    As i first said Fine Noble Thoughts — FOR ADULTS — .

  7. I’m unclear which NHS your talking about – the increasingly privatised English one or the Scottish one, and who you are blaming for it’s alleged inadequacies.

    The funding problem highlighted by the Nuffield report is entirely the responsibility of the UK government who provide the funds for the Scottish Government. Since Thatcher, successive UK Governments have been following a zombie economic model which reached its nadir with the Coalition and Tory Governments of Cameron & Osborn who decided to promote the lie that too much had been spent on public services which had crashed to economy and that to “balance the books” public expenditure would have to be torched.

    This is the “Good Housekeeping” model of economic management, where a country’s economy is assumed to be the same as a household’s – (remember Mr Macawber). Of course, their real intention is to shrink the state and hand everything they can over to their chums in the private sector.

    Contrary to what Osborn and co preached, their is no shortage of funds, just a shortage of intelligence and political will. The lack of funding for public services in a rich country is a matter of political choice. Hence the attacks on the poor and the rewards for the rich. Those are the Tory priorities.

    I recommend a blog by Richard Murphy (who also has an article in The National today) where he attacks the absurdity of the propaganda that we can no longer afford what we could afford when we were poorer.

    • @ broadbield

      100% agree that we are not a household. I note that Richard Murphy intends to provide further support on this issue in his blog.

      I made the same point about funding and MMT very briefly in the first comment here – it’s still *awaiting moderation” by Derek. Not sure whether he disapproves, or has missed it.

  8. Why is your GP unable to recruit?

    • There’s a shortage of GPs in general – most medical graduates prefer hospital specialism / super-specialism and most of the more recently qualified GPs are not interested in working full time so much as previous generations, so it’s difficult to recruit anywhere. If your surgery is in any way less attractive – e.g. remote and rural, committed to onerous service provision (5 day week or Out of Hours commitment) or hard to make profitable without some sort of extra work – you can find applicants very hard to come by. Even highly profitable / well paying practices are struggling. Contractual improvements on 1960s and 70s as well as an initiative to recruit from overseas led to vastly increased uptake of the profession, but this GP cohort is now heading for / already at retirement age and there’s no mass of new recruits to fill the gap left. Add Brexit to the mix and you’ve got a future with very few GPs being chased by lots of vacancies rather than the other way round.

    • @MBC
      Big question this one, socioeconomic in nature.

      Practice too small too remote too few family opportunities restricted professional development available housing / schooling unsuitable. And more. Suffice to say this could be big problem.

      • And yet according to statistics Scotland has the highest Dr/patient ratio in the uk.

        There is no simple answer, as your comment points out. And money is only part of the issue.

      • Yes but I was asking Derek. I am assuming his correspondent is in Glasgow in a good area. I’m aware that it’s difficult to recruit GPs in more remote areas because there are no suitable jobs for partners.

  9. Alasdair Macdonald.

    This is a sensible article and the GP with whom the author is in contact has described things well.

    There is a significant problem with our politics both in Scotland and in Westminster and its relationship with the media and how the media fails in their ‘public education’ duty (to use the Riethian ideal, although the man himself was a propagandist on behalf of the establishment.) There is huge ego involvement.

    To change one’s mind or to say something which is even a little different from what one has said before is a U-TURN!!!!!!! and, by implication, shows that judgement is flawed and that this applies to every thing in that person’s previous life.

    The Scottish Government is in fact doing, and has done, many good things with regard to health in Scotland (I include all Scottish Governments since 1998). But, the media and the opposition look for faults however small and this is pushed to the exclusion of anything else. The professional unions like RCN and BMA are as guilty of this as the politicians and the media and are usually the sources of such ‘bad’ news.

    As someone who is entering my eighth decade, I have increasing contact with the NHS and my experiences continue to be good. I have always taken a responsibility for my own health with regard to things like exercise diet and moderation in lifestyle. I do not consider myself as untypical because I am in contact with many contemporaries who have similar experiences with the NHS and a similar attitude to our responsibilities for our own health. On the whole, the general public comprises pretty well-informed, intelligent people who are capable of handling complex issues. But, with the weakening of local Government and the aggressive centralisation of powers by Westminster and increasingly unaccountability (think Henry VII clauses, and he was not even the king of Scots!) it is difficult to establish the kind of collective units to fight our case. Trade Unions were a good example of this,

    Nevertheless, people are inventive and creative. Young people voted heavily in the last GE and are becoming more active. There are many innovative schemes right across Britain, but the BBC and the other major media will seldom report them unless some person is caught with her fingers in the till.

    There are politicians in Council chambers, in Holyrood, Cardiff and Belfast and in Westminster, who are clear about the issues and have the courage to act. Indeed, I suspect they might be a majority. However, most of them are not in positions of power in their parties and are seldom go-to rentaquotes so favoured by the media.

    As more people become increasingly worried about impending disaster, then they will react and seek to turn things around. Only 51.9% voted LEAVE on a turnout of a little above 70%, that is less than 40% of an electorate, which excluded 16/18 year olds and EU nationals who live and work here. Yet, the very wealthy who promoted this action push the line that this decision is the decision of ALL of us.

    There was a decision to LEAVE, but there was no real discussion about what that entailed or will entail. That is what we have to debate and that is what our markedly authoritarian and intolerant Prime Minister intends that we will not have.

    Sadly, like at the time of the financial collapse in 2008, when Labour had the opportunity to change the system, the current Labour leadership seems to be prepared to support Mrs May’s main thrust – ‘hard’ Brexit’. Do the hundreds of thousands of young people in Momentum support this. I think not.

    So, on balance, optimism of the will!!

  10. Steve Asaneilean

    @ MBC – whilst I cannot comment on this individual case, there is a world-wide issue of difficulties in recruiting GPs. This is particularly the case in rural areas. In rural parts of western Europe, especially in Germany and Austria, rural Gps have all but disappeared. In rural parts of Australia, New Zealand and Canada there is a real struggle to find enough GPs.

    The same goes for Scotland and the rest of the UK.

    GPs are well-paid but not, in real terms, as well-paid as they used to be.Their work has become significantly more complicated and onerous as conditions that were previously only managed in a secondary care hospital setting are now managed almost entirely in primary care – diabetics on insulin, rheumatoid disease, chronic lung disease, kidney failure, cancer, etc. This shift of workload has never been accompanied by a shift of resources and primary care’s share of the overall NHS budget has actually fallen while their workload has increased.

    Within some of our medical schools very little is done to promote general practice as a career choice for young doctors. There is still an attitude in some quarters that GPs are doctors who could not hack it in hospital medicine. In one Scottish medical school a few years back the then Dean stood up in front of the new first year class and told them his medical school was not there to train people to be GPs.

    As a consequence of all this GP has become a less attractive career option. Last year 25% of Scottish GP training posts went unfilled and in the more rural areas of Highland and Grampian the figure was close to 30%. At the same time there is a bottle neck of GPs over 50 who could all retire in under 10 years. It takes a minimum of 10 years to train a first year medical student to be a GP. At present it estimated that as many as 25% of practices in Scotland have a GP vacancy and the closure of practices, even in places like Edinburgh, has been well-documented.

    In terms of rural areas the situation is even worse and here it reflects the increasing urbanisation and desire for “amenity” of our society. If you are thinking of working as a GP in remote rural Scotland (or, indeed, as a nurse or social worker or teacher) you have to contemplate the prospects of: limited employment opportunities for your partner/spouse; poor access to public transport (esp. trains and planes); limited and often unaffordable housing choices; excessive distances to both primary and secondary schools; the worst access to mobile phone signals and broadband in the country; and so on.

    Another issue for young doctors is that GPs are not included in the NHS Crown indemnity scheme so must take out their own insurance against litigation. With litigation settlements in the NHS now running into tens of millions of pounds each the cost of litigation insurance is rising almost exponentially and now equivalent to about 5% of total earnings being spent to protect a GP from litigation.

    When it comes to tackling recruitment issues everyone is still looking at each individual situation in isolation – “why is your GP unable to recruit?” – when what is really needed is an over-arching approach that addresses the undermining of general practice as a career choice that still goes on at medical school and in hospital medicine as well as tackling all the amenity and other issues which hamper recruitment especially in more remote or less desirable communities.

    • Thanks for this detailed reply.

      It begs a lot of questions though.

      The first one is: does society need GPs? Assuming the answer is Yes, then it follows that governments need to do far more to attract medical students to general practice and GPs to set up in more rural areas. Better insurance, better broadband, better resources, more holidays, better pay or assistance with moving costs. Whatever would help attract.

      As regards resources, would it help what they do in Norway? Which is that GP practices seem to be more like mini hospitals in that they employ their own nurses and lab technicians to run their own tests and do other things that hospitals and out patient departments might do. That makes the GP surgery more of a collegiate environment. More of medical centre. So less remote.

      • Steve Asaneilean

        Hi MBC – happy to help.

        The reality in Scotland is that many rural GPs in Scotland do this already. They employ their own nurses, advanced nurse practitioners and pharmacists as well as looking after their own patients in their local community hospital (where the GPs also provide a basic A&E service and have some limited access to on site X-rays and blood tests which help diagnose things like heart attacks or blood clots on the lung).

  11. What should happen and what will happen are sadly two different roads. The unionist parties see their chums in the media as their road to power so not even the wellbeing of people will stop them in their quest to find something, anything with which to lambast the SNP. Trashing the Scottish government, the SNP who for years have been anathema to Slab, even dismantling the Scottish devolution settlement which the Tories never wanted in the first place, all take precedence over what’s best for country and people.

    The Scottish government got where they are through talking to other parties, persuading, urging their backing during that first minority government, so they know the value of working with others. But the unionists see a bigger goal, that of power, even if it’s power for power’s sake. They want power, whether it’s Kezia on the back of Corbyn or Davisdon on the back of her tank. Power is now all that matters.

  12. Steve Asaneilean

    On a more prosaic level (and at the risk of sound like a conspiracy theorist) I think what we are actually witnessing is the large-scale end of state-funded public service as a quite deliberate end-game in the Capitalist ascendancy. This can be clearly seen in what it happening to the NHS in England and everything that happens in NHS England ultimately has a knock on effect for Scotland – if less state money is spent there less comes our way too.

    Of course it is dressed up as necessary austerity but it isn’t that at all. It’s not even something being played out at Government level really. Rather it’s the multinational super-rich who are dealing the cards and playing with a loaded deck.

    It’s a very simple formula. First you bring about a financial crash which, of course, doesn’t impinge on you at all. Then you persuade Governments that austerity is the answer. This is then used to grind down state-funded services until they can no longer function and, at the same time, softens up the public who come to believe that the state-funded service is rubbish.

    The Government then says the only salvation lies in bringing in the private sector and – voila – you have GP surgeries in England taken over by Virgin, Atos, Sainsburys, United Health, Circle Health, Bridgepoint, etc.

    These companies fund the political parties and many of those parties’ MPs have links to these companies.

    It may sound like conspiracy theory gone mad – but if so I’d like to see a better explanation.

    • The only part I would disagree with is the implication that a crash was deliberately created. I would suggest the crash was the apotheosis of the hubris of neoliberalism and the bankers’ belief that they were the “masters of the universe”, together with unbridled greed, the collapse of business ethics as a social imperative, downright criminality in some cases and politicians’ craven submission to the interests of wealth in preference to the interests of the majority of citizens which led them to remove robust regulation of finance.

      As you say, the fallen but not cowed bankers quickly regrouped and over a pizza advised the one time socialist revolutionary turned ermine-seeking functionary to “give us the money” – no conditions attached – and he duly obliged.

      The lie that too much public spending was the root cause of all our problems was then put about by Osborn and his willing accomplices in deceit from the media to the zombie economists, and austerity was prescribed as the cure, a prescription even less effective than blood-letting, but good for shrinking the State and transferring wealth upwards.

      There are those who have seen through this whole pernicious charade, but none of them are politicians. If we want a new kind of politics we have to start by getting rid of the contemptible careerists totally lacking in political imagination and devoid of any conception of fairness and equity, or truthfulness, that fill Westminster as HMG and HMLO and bring about a democratic revolution where the people are truly sovereign – and in charge.

    • Heidstaethefire

      If you listen closely, you can hear the found of U.S health insurance companies rubbing their piggy wee hands together at the prospect of getting their hands on the N.H.S. as part of any putative post Brexit deal with Trump.

  13. Orlando Quarmby

    Not a word on Independence from Derek Bateman. His whole piece is focused on knocking political heads together to save the UK from stepping over the precipice of Brexit, and for the Scottish Government to take on board the critics of NHS Scotland like the fatuous Rennie, the vacuous Dugdale, and the destructive Davidson. Jeez – when’d you give up on #ScotRef and an Indy Scotland finding its own solutions once it has its hands on all the levers of economic control, with the ability to prioritise health and education over the likes of Trident, foreign wars, and huge infrastructure projects in the south of England? A thoroughly pessimistic and disappointing article from a Scottish perspective.

  14. I liked Picketty’s ideas that modern capitalism is ultimately doomed and is currently in crisis because at the end of the day its own greed will starve itself of the very oxygen and nutrients it needs to thrive.

    His idea is that in la longue duree of history, human progress is based on intellectual advance and innovation. On free circulation of ideas. That is what has actually built economies. The industrial revolution. The development of science. New technologies.

    But capitalism establishes monopolies over intellectual property. Ergo innovation cannot prosper without investment in experimentation and pure science, which might not turn an immediate profit and is basically unprofitable except in the long term.

    He says the idea that free markets create a trickle down is an illusion caused by war. The fact that there were two major wars in the twentieth century aided redistribution either in the munitions industries during the wars or else in the post-war reconstruction. Or in soldiers for armies. It all employed people. The research and development of things like radar and electronics after WW2 had civilian offshoots but represented investment by governments on the science during the war. The fact that there hasn’t been a major all-out war in 70 years shows that capitalism’s long term pattern is to engross and monopolise wealth, concentrating it in the hands of the few and locking it up where it is not socially useful and that this acts against innovation and intellectual development. Which capitalism needs to prosper.

    • There’s an interesting book by W Scheidel on “the four horsemen” who have been the vectors for levelling: War, revolution, pandemics and system collapse – all of which have achieved a (temporary) levelling of inequality at a great cost in terms of human suffering. As he says: depressing. (The great leveller by Walter Scheidel) There may be a fifth yet to come, imho: Anthropogenic Climate Change.

      • When you think about it logically, capitalism (unbridled capitalism that is) is fundamentally incompatible with democracy. You cannot be both a democrat and a capitalist. Unbridled capitalism creates growing, and uncontrollable, inequality, but democracy is a peer to peer relation. Democracy needs a degree of relative equality to thrive. For everyone to be able to understand one another and agree on common objectives. There can be a certain degree of relative inequality and that won’t affect democracy. In fact it aids it, as it brings about a degree of diversity and choice, drive and incentive, within a society. But once the rising inequality created by unbridled capitalism goes off the scale, as it does now, it can only erode democracy as the super rich become an immovable elite and the left behind people cannot rise. There is no trickle down without a disaster, an accident. The elite stifles conditions for the poor majority at the lowest levels and dictates the government agenda to suit elite needs, not those of the majority.

        It’s depressing that only the shock of a massive tragedy can destabilise the system and allow for the redistribution that allows green shoots to grow again.

        • Steve Asaneilean

          Spot on MBC – couldn’t have put it better myself.

          • Very much agree. Much of the argument for full-blooded capitalism is along the lines of, it’s natural to human beings to compete. However, many social anthropologists would disagree and point instead to the theory that humans evolved to be empathetic. Their survival in a challenging world depended on co-operation.

            I have come more and more to the opinion that large countries are actually beyond the capabilities of democracy to manage. Small countries are better able to respond to voters and achieve something like an equilibrium. There is too much of a predisposition in large polities to produce elites which are too distant from the majority and serve their own interests at the expense of others.

          • Again, several recent books argue for deliberative democracy rather than the emasculated version we have where the citizen is virtually disenfranchised from the process.

  15. On EU membership, I think the Lib Dems have a point. The SNP no longer argue for EU membership – too many votes to potentially lose – but for access to the single market. That could come through the EEA/EFTA route.

    On health policy, it would be good to see cross-party, non-partisan working. It’s been a disappointment that Holyrood has replicated some of the worst elements of Westminster. A first step towards improvement would be to stop “whipping” the committees.

    For GPs in rural areas, is it time to say that the private sector won’t deliver and have NHS-operated services instead? Possibly allocating and rotating a central pool of staff?

    • Steve Asaneilean

      Hi Crubag – I am not quite sure what you mean re. rural GPs being NHS-operated services. They already are. The majority of the remoter practices are already directly run by the NHS.

      Even those practices which have the traditional model of self-employed contractor status all contract themselves almost exclusively to the NHS.

      Such GPs can only charge patients for those services which are not and should not be paid for by the NHS – insurance medicals, solicitor’s reports, etc.

      It’s also worth pointing out that GP practices run directly by the NHS cost the NHS twice as much than an equivalent practice of self-employed partners.

  16. How can you act before its too late when you have no real agency?

    In the name of the “common good” we need to pull together? How?

    In Scotland we have opposition parties that openly campaigned with one another to deprive the SNP of seats. Blurring the lines between them so completely, that the very idea that we should consider them separate parties, with different ideas and solutions to problems to be an utter nonsense. We have a deranged and demented press constantly on the attack. A dysfunctional Westminster that clearly has no idea how to get itself or the UK out of Europe without bringing the whole house down around our heads.

    If we try to seek common cause with them, they’ll rally round and tear into us and say that it is abject surrender and that we now coming back to the fold. Their hatred of us is so intense that labour has literally been reduced to a foaming mouthed simpleton. How do you seek common cause in the face of constant 24/7 provocation?

    Anyone with eyes can see Brexit will fail. There is nothing we can do to stop it. But we’re expected to take part and help it fail. Facing the soul crushing moment, that when it does, we will face their sudden yet inevitable cries that is all somehow all our fault.

    If we had a decent media and not the black hearted, SNP-BAD pedlars that we do have. If we had a decent set of opposition parties who stood by what they openly campaigned for, instead of meekly going with their Westminster bosses. If we had a decent functioning UKgov that was willing to listen, instead of ignoring everyone. And if everyone agreed what the NHS should look like, it could be possible to rally round to protect services. Problem is, we don’t agree on it at all. Tories think that selling vital services is a form of protection. Labour is only too willing to look the other way while the tories do it, remember they are paid up believers in TINA. It should also be noted that the party that began Austerity is also a believer in Brexit. For different reasons maybe, but just as deluded as to what they can achieve with Brexit.
    The Lib dems to willing to go along with whoever can give them a seat at the table. They might talk the talk but when it comes to the walk, they’d rather sell out for a ministerial car.

    As it stands Scotland’s only chance to avoid this travesty would have been to get out in 2014. We’re stuck with it now. We are now riding the crest of a high and awful wave. Desperate not to fall off. Wondering if we could not find common cause with the sharks following in our wake. All we can do is hold on till this wave crashes and breaks against the cliffs. Hope that the damage done is not so great that we cannot fix it. What we can’t do is put our trust in the sharks. They will and are doing terrible things to everything we value most.They’ll destroy us whole. Its in their nature to do so.

    We can’t pull together to protect what matters most. We’re all pulling in different directions. Have been for some time. Our notions of what makes an NHS differ wildly from theirs now.

    Like it or not, the Scottish parliament is a pocket money parliament. We exist on a grant which is set by Westminster – which has clearly signalled its intent to drag Scotland out of Europe, regardless of what we voted for. A parliament it should be noted, took Scotland to the supreme court to get permission to ignore her voters. The SNP has done a good job so far but as the insanity starts to bite into budgets, it knows from experience that it can’t put its faith in the other parties. Its going to have to find solutions itself. We’re just going to have hope they can do it and not make too many mistakes along the way.

  17. They’ve come for everyone at this point right enough. They’ve used and abused every service, every institution and all of their members and workers as political punch bags. They’ve used them for their own agenda, their own political gain and never gave a second thought for those they have abused. They haven’t even paused to consider the effects on the general public at large, that this undermining of trust in our services and institutions puts people in harms way. But here’s the thing, and there’s no getting round it.

    Each and every service. Each and every institution. All of their members and workers? They ALL have a vote and their families and friends will have votes too I’d imagine. Pretty sure they’ll all have a good memory and a long one for those who have abused or wronged them. One other thing to remember, is that governments aren’t just there to carry the can for mistakes or be a target for the meeja, but also take the plaudits for acting responsibly and correctly when things go right.

    Despite the very bestest efforts of the establishment parties and their buds in the meeja. The workers of Scotland’s institutions and services have performed miracles in some of the toughest financial circumstances imaginable. That’s not a fluke. It took work, sacrifice, consensus and a willingness to come halfway with government. It was a joint effort. Mibbies the Conservatives, Labour and the other lot should remember that if you want someone’s vote and their efforts in the future? Insulting and undermining those efforts on a daily basis is perhaps not the bestest plan.

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