Is the NHS beyond repair?

The National Health Service (NHS) is a national institution It's held up around the world as an example of how healthcare can be provided free for all at the point of need. Founded in post-war Britain by the Labour government in 1948, it is a socialist's dream designed to ensure everyone is treated equally. It's been a huge success, but its not without its problems. Whether it's the inability to get a GP appointment or the infected blood scandal, everyone has a view on the NHS and isn't afraid to vocalise it.

The NHS is a big organisation. It employs 1.5 million employed in 10,000 buildings, including 1140 hospitals, and treats 1.3 million people daily. Treatment covers everything from ingrowing toenails to life threatening illnesses. It employs not only doctors and nurses. Dentists, physiotherapists, social workers, GPs, hospital porters, receptionists, pharmacists, and midwifes or just some of the professions.

In human terms if you're 78 years old, things start to go wrong with you. As you get older you need more help with your health. So just how healthy is the NHS? People today are quick to criticise it when they fail to get a dentist appointment or wait five hours in A&E. We all know the NHS isn't perfect, so just how good or bad is it?

My experiences of it are mixed. Yes I have issues getting a GP appointment when I need it. Yes my family have experienced poor service from healthcare professionals. Here's the thing though. I've also experienced some first class healthcare when I've needed it most.

To illustrate the good and bad NHS service, take one of my experiences. I fell over heavily whilst out running. I quickly realised I had an issue and unable to walk. Unfortunately I fell on a path where virtually no one went on. I had my phone and phoned 999 only to be told that I had to wait three hours for an ambulance. As I got colder and started to shiver, I rang again only to be told there was nothing they could do. I crawled in a lot of pain down to the street where I was able to hail a cab to take me to hospital. Once there I received good care, even if the x-rays and scans took a total of seven hours, and I was admitted to a ward with a pelvic fracture. Although the care I received on the ward from the nurses was largely exceptional, the service by the orthopedic surgeon was the opposite. This was partly due to it being a weekend, and that my bone fracture was in an unusual position requiring a second opinion. It took four days for anything to decide on my course of treatment.

On leaving hospital I had physiotherapy sessions, but this was done privately. I'm fortunate to have private health care through my job, and will more than likely continue to pay for this when I retire. It doesn't cover everything. It has it's limits, but it does provide a safety net for when you may have issues getting NHS treatment. I also have private dental cover as NHS dentists where I live are as rare as a Donald Trump admission of a lie. For most though, private healthcare doesn't provide full health care. It's OK for small elective procedures like cataracts and frozen shoulders, but it won't cover you for heart attacks or major cancer treatment. That is where the NHS must take the brunt.

So is the NHS is crisis? It depends on your view. If it is there to fund universal healthcare for all, the current taxation model could change to ensure it has the funds to meet demand. You could add top up fees or levels of health insurance in the same way as my private health care provider does. The problem is that drives a coach and horses through the NHS's original aim of free healthcare for all. It would also likely be political suicide for the government who made that decision.

It's not just healthcare that's the issue. Decades of under investment by successive governments in infrastructure, has left many healthcare facilities in a woeful state of disrepair. footing the bill to bring them up to scratch whilst ensuring the technology and drugs are available to treat patients will require massive investment. Who'll pay for that? We will of course, but will be want to?

The risk is that unless there is the required investment, the NHS will steadily turn into an organisation with poor service for those unable to afford private health care. The UK government is making efforts to reduce the time patients wait for treatment. According to Private Eye magazine, there are nearly 7.5 million cases waiting for treatment, with a wait of 14 weeks for elective consultant treatment and two months for cancer treatment!

The 2023 social attitudes survey reported that only 24% of people are satisfied with the NHS, and only 13% with social care. It also reported that 48% said they'd support further taxation to spend on the NHS, but just how much would they be willing to give up and would it be enough?

Trump: The thin line between politics and business

Yesterday's extraordinary White House press conference between Presidents Trump and Zelensky was a watershed moment in US politics. We know Trump treats everything and everyone like a business transaction. What's more he likes to win, and at all costs. He's a really sore loser. That means he willing to see someone get hurt to get his way.

This approach goes against all negotiation training I've ever been on. The aim of any negotiation is should be for both sides to come away believing they've got something out of it. Both parties should be willing to give and take to get an agreement. What we witnessed yesterday was a indication that the Trump administration is willing to do whatever it takes to humiliate whoever doesn't do what they want.

What was yesterday's objective?

Let's look at what Trump wanted. He wanted a large slice of Ukraine's mineral reserves. It isn't immediately obvious what he was willing to give Ukraine in return. It seems to be financial not military support, and you can bet it wasn't as much as Ukraine thinks it's worth. Trump likes to use his muscle to get a deal, and to be seen as getting a slightly better deal than the other guy. Zelensky wanted US military support, but was willing to give up some of his mineral reserves in return. Trump didn't want to budge on his offer. It was his way or the by-way!

What was odd about yesterday's meeting was that both sides seemed to have different expectations about what the meeting was about. Was it about peace, or was it about trade? The objective seemed confused. Trump wanted peace, but only if someone else sorted out the mess. It seems clear that he just wanted to get his hands on the mineral reserves. Zelensky and Europe in return needed US military support to secure peace.

It is quite normal for two negotiating sides to want slightly different things of course, but the norm is to try and find some middle ground where you can both meet. That's what is called negotiation. It's about understanding the red lines each side can't or won't cross, and talking about what they can do. Yesterday's spectacle was anything but. It showed Trump's approach as being, "Do it my way or there's no deal". It was a perfect example of how he like to belittle folk with less than him.

Trade or peace?

What I found strange about the whole event was why trade was part of the deal. It was the first time I've ever heard of anyone saying, I'll get your adversary to stop killing you if you give me something in return. Normally a peace deal is agreed to end human suffering. It should be about doing the right thing for humanity. The conflict is inflicting massive suffering to the Ukrainians. Even the Russians are suffering, albeit to a lesser degree.

The spectacle of seeing President Zelensky humiliated in that way perfectly showed how tough Trump can be. It showed that to him there was no difference between politics and business. There is no room for diplomacy when it comes to business. It's win or lose, and he doesn't like to lose. There's no middle ground. 

What now for Ukraine?

It remains to be seen if yesterday's shenanigans were all part of a US negotiating tactic. Maybe they'll come around to supporting Ukraine militarily, but that looks unlikely. It looks like the US has left Europe to do the dirty work.

Yesterday's news was unedifying and cruel. Who knows whether similar discussions have taken place between world leaders behind closed doors before, but it should never have happened in front of the world's media. The sinister part of me thinks this was all part of Trump's master plan to get his way and humiliate someone who really needed his help. Trump doesn't suffer fools gladly, and relations with Ukraine had soured in recent weeks.

What is clear for almost everyone apart from Trump, is that you can't negotiate a peace deal without both sides at the table. This whole deal started with a meeting with only one adversary, and now looks like continuing in the same vein. If something is agreed out of it, it's not a deal, it's an ultimatum.

Europe must circle the wagons and decide their next steps. Perhaps they've been complacent in thinking the US would always step up with military support when it's needed. In the world of Trump, that will only happen if the US and Trump gets something in return.

The day that changed Ireland

On this day in 1921, a treaty was signed by representatives of Britain and the Irish parliament (Dáil Éireann) that would have ramifications to this day. A war of independence had been grinding its way to a stalemate between the Irish Republican Army (IRA) and British forces. Over three years, the violence escalated to a point where it became clear neither side was likely to win. Against this background talks took place to end the conflict.

The IRA's objective was to win independence from Britain. Britain on the other hand was recovering from a long conflict itself in Europe, and was beginning to see the demise of its empire. Much has been written about the peace talks and the politics at play, particularly about the role of the two main Irish figures, Michael Collins and Eamon de Valera. They didn't agree on a strategy for the talks, and the British exploited this.

The talks resulted in a proposal to grant independence to the 26 counties in the south of Ireland. The remaining six (Northern Ireland) would remain part of the United Kingdom. The population of those six counties was largely Protestant following >hundreds of years of emigration from Britain. The proposal didn't sit well with the IRA. They saw the six counties remaining as British as a betrayal of their objective. The problem was Britain was unwilling to grant independence to the whole of Ireland. It was a "take it or leave it' proposal.

Early in 1922 a fractious and emotional debate on the proposal resulted in a majority voting to ratify the treaty, passing it into law. The war of independence was over and most of Ireland had independence. The problem was Ireland went from one conflict to another, only this time between Irishman and Irishman. The Irish Civil War started.

Although the conflict was relatively short, the ramifications of it can be felt to this day. Those who fought are no longer with us, but Irish politics is still mired in it. The three main parties in Ireland are:

• Fianna Fail: Founded by Eamon de Velara after a split with Sinn Fein, it was opposed to the treaty.
• Fine Gael: Originated out of the independence struggle and the pro treaty members of the Dáil.
• Sinn Fein: The political wing of the IRA was founded in 1905 as part of the independence movement.

Some say there isn't a lot of difference politically these days between Fianna Fail and Fine Gael. Both are centre right parties, but for many decades men and women voted for them based on which side of the treaty debate they agreed with. Recently, Sinn Fein has enjoyed a resurgence of popularity in the 26 and 6 counties. As a socialist party, they've positioned themselves on the left of Irish politics. They pick up votes as a reaction to what people see as two parties arguing over just who's the more conservative.

With the six counties still part of the United Kingdom, and Sinn Fein unwilling to relinquish its claim for independence for the whole of Ireland, Irish politics looks likely to continue in the same vein for years to come. Let's hope any major change that comes the way of Ireland in peaceful.

The influence of church or state

Today in the UK House of Commons our MPs voted in favour, by a margin of 330 to 275, of a bill calling for assisted dying. This free vote, meaning an MP was not obliged to vote a particular way by their party’s whip, means that the first steps in changing the law have passed. It now need to go through the rest of the parliamentary process, including a vote in the House of Lords, before it can become a reality. 

I’m unsure which way I’d have voted given the chance. I’ve watched relatives and friends with serious illness suffer towards the end of their life, so I understand why this debate happened. However, I’d want to ensure that the appropriate safeguards were in place to prevent people being forced or coerced into accepted their fate. There seems to be sufficient thought made to this. For example, it will only be available to those who are terminally ill and must be approved by two doctors and a judge.
 
The issue for me is that I can’t be sure what I’d want until faced with the reality of a terminal diagnosis. It’s all right saying I’m in favour of having the option of an assisted death, but I may think differently when faced with making the choice. Having the option is very different from saying you want it, so that’s OK, and you can always change your mind. That’s why I’m sympathetic.
 
As someone brought up in religious household, what is interesting is the disconnect between the church and state. In the UK the monarch is head of the Church of England, but thanks to Oliver Cromwell, no longer has control over their government’s policies. That said, I doubt this vote would have even taken place, let alone pass, 50 years ago. Attitudes have changed, and so has the power of the religious bodies to influence how we think. 
 
We’ve seen religious influence wain in other countries also. In my homeland Ireland, the pull of the Catholic churches influence is nothing like it was when I was growing up. Recent years have seen votes pass there on same sex marriage and abortion. My aunt, a missionary nun, would be proud of her church if she’d have lived to see the law pass! She was an educated lady, who saw firsthand what the absence of choice did to people. In her own way she was able to voice her thoughts within the confines of her role.
 
Whatever your thoughts on assisted dying, remember that people are coming from the right place. It’s a complicated topic, with different experiences and emotions. Whatever the result of this vote, let’s remember that this is about peace and dignity at the end of a person’s life.