Last weekend, I attended the Welsh Conservative Party Conference in Cardiff. Seeing the many friends I made during my campaign there two years ago was a real pleasure. In 2005, I had the honour of representing the Conservative Party as its candidate for Blaenau Gwent in that year’s General Election. The constituency had been previously represented by that undeniably talented Labour politician, Aneurin Bevan. The area was rightly proud of a local man who shaped the health service for the country, and celebrated his connections at a monument erected beside the road between Ebbw Vale and Tredegar (picture above).

My latest visit to South Wales got me to thinking abour Bevan’s legacy. In the light of recent NHS woes, the MMC controversy being just the latest, should we still celebrate the service that Bevan bequeathed to us? Or, should we consign it to the past, and start developing a health service fit for the 21^st century?

On July 5th 1948, having overcome political opposition from both the Conservative Party and from within his own party, and persuaded the medical profession by “stuffing their mouths with gold”, Nye Bevan’s National Health Service Act of 1946 came into force. It had taken eighteen months of heated discussions between the Ministry of Health and the British Medical Association, to win over the support of the vast majority of the medical profession. Some 2,688 voluntary and municipal hospitals in England and Wales were nationalised and came under Bevan’s supervisory control as Health Minister. Socialised healthcare had arrived in Britain.

To understand why the NHS is structured the way it is, one has to remember what Britain was like at the time of the service’s inception. An appalling World War was fresh in the minds of the public. Much sacrifice in blood and money had created a strong desire to want security for family and friends. That security did not just include protection from foreign foes, it also involved personal security at home. And because the suffering had been felt by all, the health service should be ‘free’ for all, irrespective of personal means.

Bevan, a passionate Socialist, created a nationalised service that has grown inexorably over the years into a vast, unwieldy organisation. Each year of its existence, spending on healthcare has increased, so that today it continues to outstrip our taxable resources. The selfless service of the staff, an admirable quality that once ran through the fabric of the NHS, is increasingly becoming thin on the ground. Doctors are becoming disillusioned, so much so that they are leaving the service, their country and in some cases, the profession itself. If there is not a change in policy direction, I fear that we are witnessing the slow death of the health service. Despite what you might of read about the importance of all “healthcare professionals”, the reality is that doctors make the NHS tick. Nothing happens clinically without a decision being made by a doctor. So, if the medical profession is contemplating abandoning ship, the political classes need to take note.

It is an article of faith in the Labour Party that nothing of Bevan’s legacy should be touched. This is nonsense, and the great majority of the public know it. Rather unfortunately, therefore, it falls to the Conservative Party to “get its hands dirty”. I believe that the answer rests with increasing personal responsibility for health. The NHS is crying out for a new source of money and it is best raised by encouraging people to share the burden of escalating health costs. As a country, we have to realise that the bill for healthcare increases the more irresponsibly we choose to behave. And for those of you who cling to the outdated political view that there are no Conservative votes in addressing this issue, I would strongly argue that for us not to address this domestic challenge would make us look weak. The Conservative Party has a recent track record of taking tough decisions on domestic policy which are initially unpopular. In time though, the British public have come to accept many of them. No one likes change, least of all to health services. People are at their most vulnerable when sick, particularly those of modest means. However, for politicians to continue blindly pursuing Bevan-like policies is criminal. As WF Deedes wrote recently,

Yes, people will resent any charge on what has once been free for all. But unless we can swallow our political prejudices and move on, we shall assuredly destroy a wonderful medical service.

For those of you who are interested, I will be appearing on 18 Doughty Street Talk TV next Monday evening at 8pm to discuss the on-going controversy over the MMC affair affecting ‘junior’ doctors in the NHS. You can watch the programme here.

We make a living by what we get, but we make a life by what we give – Winston Churchill

Much has been written of late about the ‘obscene’ city bonuses paid out at the end of last year. It has been claimed that over 4000 city workers took home more than £1 million each in bonuses. Along with that have come the increased pay packets of ‘top bosses’, which according to some sources, have grown by over 40% in the last 12 months. Peter Hain, Northern Ireland Secretary, and more importantly, candidate for the Deputy Leadership of the Labour Party, tapped into the ‘Left’s’ disgust at the size of these financial rewards by calling for the recipients to give two-thirds of their windfalls to charities that help the poor.

Ignoring the blatant attempt to woo the left of his party, Mr Hain’s call should strike fear into the hearts of city folk. He implied that a future Labour administration could increase tax and regulation on the City if those who have have received a bumper Christmas bonus were not charitable enough. In saying this, Mr Hain revealed his Old Labour heart.

I recognise that the City of London, and its enlightened regulatory structure, are of great importance to the British economy. The high-bonus earners in the City that Mr Hain so despises are wealth creators – for example, making vast sums of money for pension funds. They also generate the wealth that would be taxed so heavily by the likes of Hain, Johnson and Cruddas to pay for their proposed increase in the size of the state. My fear would be that an increase in the burden of that taxation would lead to the capital, offices and jobs moving abroad. We could easily see London’s pre-eminence as a financial centre disappear should private equity and other such financial organisations be singled out for more punitive taxation. Private equity funds increase their financial returns by increasing companies’ profitability. They achieve this by increasing efficiency and improving output, beyond the plans of the established management team. This, in turn, increases capital, thereby benefitting the whole British economy.

However, I also recognise that the image of a successful few, spending their money ostentatiously, can lead to social imbalance, and the politics of envy. The recipients of these bonuses should be encouraged to earn more, but in doing so, be also encouraged to spend their hard-earned wealth with more social responsibility. That is why I think Boris Johnson has a point in yesterday’s Telegraph. The successful few have benefitted greatly from our capital city’s historic location near the centre of the global economy. That position will only be strengthened and maintained by proper investment in the talent of the future. What better way to spend a proportion of a city bonus than on investing in university education. Not only do I think it would be more worthy of each individual, it would also have a better long-term reward for their families than a new yacht. Philanthropy is commonplace in America. It should become so here.

Described by one leading surgeon as “the biggest crisis to hit British medicine since the start of the NHS”¹, the MMC (Modernising Medical Careers) government-lead programme has preciptated the most recent Labour climbdown. Yesterday, they were forced to announce an urgent review of the whole MMC programme following the deluge of complaints from doctors who had apparently been left with careers shattered.

The report in today’s Telegraph is another example of government mismanagement, following the (too) fast introduction of a centralised job allocation scheme for doctors. The MMC programme has been introduced to nationalise medical job allocation in true Labour style. When will these socialists ever learn? The only positive outcome of this debacle that I can discern is that few doctors will ever vote Labour again.

For those of you who do not know what MMC is all about read the following (copied from here):

(MMC) aims to improve patient care by delivering a modernised and focused career structure for doctors through a major reform of postgraduate medical education. It aims to develop demonstrably competent doctors who are skilled at communicating and working as effective members of a team. As training and education are central to the work of doctors and their role in delivering patient care, MMC will also bring about significant changes to career structures, providing qualified staff who are able to meet the needs of patients.

Inspiring management-speak!! What about the needs of doctors? Where are the Royal Colleges? And what about the lamentable BMA, an organisation that I very quickly realised after graduation was toothless. Touchingly, the BMA spokesperson was quoted yesterday as saying, “We have been warning since last summer that these reforms were being rushed through too quickly. From the point of view of the thousands of doctors who’ve been messed around, given incorrect information, or denied job opportunities that they deserved, it’s a shame the Government didn’t listen then.” Why didn’t the BMA do something about it? Typical.

MMC has been brought in using the MTAS system. Like most IT systems set up by this government it has not worked terribly well. There have been reports of information being lost or misinterpreted. Furthermore, doctors have been given interviews for specialities they had not applied for! A sadly amusing example is presented below:

A fellow Psychiatry SHO received an interview for ST2 Paediatrics, which came as a surprise to him as he had not even applied for this (we’re familiar with these stories by now…no surprise there).
Easy mistake to have been made by the MMC/MTAS authorities I hear you cry – after all both specialities begin with the letter p.
I did not get shortlisted for any psychiatry interviews in round 1. I’m already on a London training rotation, I can string together two sentences fairly easily, and have picked up a few prizes, qualifications and publications along the way. My strategy for round 2 – to apply for Podiatry, Physiotherapy or even Payroll in the hope that the clever little MTAS people might accidentally slip me a Psychiatry interview instead. A tactic worth considering…

The government’s climbdown was precipitated by the news that a group of surgeons in the West Midlands had refused to proceed with the selection procedure. Bob Spychal, chairman of the interview team and a consultant surgeon at the City Hospital, Birmingham said, “The 10 surgeons (on the panel) were unanimous. We know we have disappointed the candidates and we have spoken to all of them, but we have no confidence that the system is robust and fair. It is not fit for purpose. Someone had to do something. Perhaps other panels in other specialities will do the same thing.”

Let’s hope Mr Spychal is correct. I fear though, that doctors have never been terribly good at representing themselves. They are not a militant bunch. There is little appetite for strike action and the government knows it. MMC was not about serving doctors’ interests. It was dressed up as being about patients, when in fact, it was about a centralising government wresting control of medical careers from the Royal Colleges. The Labour Party has no history of devolving power to professionals.

So, why did the Royal Colleges appear to roll over so easily? It is about time they stood up for doctors’ best interests, and consequently, the best interests of patients. For the government to say that MMC is about improving patient care is spurious. From what I have heard, progress in the MTAS system had little to do with surgical/medical acumen, it had more to do with answering managment consultant-type questions in a particular way. Well, that’s reassuring. Next time I’m under the knife, I’ll be wondering whether he/she is there because he/she ‘works well’ with his/her colleagues. Forget about surgical ability…….

This government has to be the worst in living memory. This whole affair was predictable, and has ended up quashing the professional hopes of many talented and hard-working doctors, some of whom are my close friends. I could not be angrier about the whole affair. The sooner we get rid of these muppets from government, the better.

¹ Prof Gus McGrouther, professor of plastic and reconstructive surgery at the University of Manchester

Today is my dad’s birthday. After a brief internet search, it was interesting to discover the variety of people who have the honour of sharing their date of birth with my father.

Of the many individuals who were born on March 6th, those pictured above struck me as having had the greatest impact on those alive today. Alan Greenspan was Chairman of the Federal Reserve from 1987 until 2006 and hence had a significant influence on the world economy that most of us benefit from today. John Noakes (and Shep) undoubtedly brought joy to the childhood of many who were fortunate enough to have been born in the late 1960s and early 1970s. And any visit to the Sistine Chapel must leave one in awe of the artistic skill of Michelangelo.

I must say though, the person who struck me as the one who should be remembered by at least 50% of the world’s population was Valentina Vladimirovna Tereshkova, the cosmonaut who became the first woman in space. In 1963, she was blasted into orbit aboard Vostok 6. Today, she remains a Russian hero. Putting her Communist beliefs to one side, no one can doubt her bravery. To my mind, her achievement ranks along side any other in the battle to win equality for women.