Showing posts with label emergency. Show all posts
Showing posts with label emergency. Show all posts
Wednesday, 24 April 2024
Sunday, 19 December 2021
Saturday, 23 May 2020
Why Sweden is unlikely to make a U-turn on its controversial Covid-19 strategy
For a foreigner living here, the country’s approach to handling the crisis is worrying, but it is partly explained by its history writes Tae Hoon Kim in The Guardian
Just 7.3% of Stockholm had Covid-19 antibodies by end of April, study shows
Whereas this might explain the lack of opposition, it is far from exhaustive. For example, Norway, Denmark and Finland are also known as high-trust societies. But all three have imposed far more restrictive measures, ranging from lockdowns to declaring a national emergency.
Second, the fact that some of the people most affected by the high death rate are from the poorest immigrant groups, such as the Somali community, whose voice is not always well represented in the media, goes against this image of a universally trusting and transparent society.
Perhaps another explanation is that Sweden has a very different way of perceiving the current crisis. Instead of seeing it as a national emergency or a fight against an “invisible enemy”, there seems to be a tendency to regard coronavirus just as a serious public health problem. It is viewed as something that requires the careful observance of rules set out by health experts, rather than an existential problem that calls for the state to suspend civil liberties for the sake of national security. Indeed, whenever a non-scientific expert such as me criticises the Swedish strategy, the response has often been that I am not an expert.
This is where Sweden is unique, something that may be attributable to its history. The country has not experienced a national emergency or crisis for more than 100 years. Since around the Swedish general strike of 1909, it has not seen any profound social conflicts, for example the miners’ strike in Britain, or a civil war, as in Spain or Finland. Any foreigner who has lived in Sweden will know how conflict-adverse Swedish people seem to be. Furthermore, Sweden has not engaged in any armed disputes since the 1810s. This is in contrast to Denmark and Norway, which were occupied by Germany in the second world war, and Finland, invaded by the USSR in the same period. A rallying cry of unity in the face of national adversity isn’t part of the collective cultural fabric in Sweden.
This lack of experience with handling national crises goes some way to explaining why there is a technocratic and dispassionate outlook to Covid-19, as opposed to a sense of urgency. It is also why the public health agency in Sweden seems to have few qualms about “herd immunity”. Whereas other countries see it as a dangerous national experiment, Swedish health officials regard it more as a type of medical prescription. It might not be 100% effective and some deaths might occur, as in any medical situation. But in the long run, it could work in mitigating the negative effects of the virus, without mass social disruption.
It is for this reason that the denial by the Swedish government and health officials that it is actually pursuing “herd immunity” seem so halfhearted, a rebuttal to critical foreign press rather than its citizens. For a foreigner living in Sweden like me, it is not entirely reassuring. How long Sweden will continue with this policy is difficult to ascertain. But as long as Covid-19 is seen in this light, and it looks as if it will, a U-turn seems unlikely.
People enjoy a warm spring day in Ralambshovsparken park, Stockholm, 8 May. Photograph: IBL/REX/Shutterstock
Sweden has received considerable media scrutiny in recent days. According to figures published on Tuesday, it now has the highest coronavirus-per-capita death rate in the world, with an average of 6.08 deaths per million inhabitants a day on a rolling seven-day average between 13 and 20 May. As of 22 May, Sweden has had 32,172 confirmed cases and 3,871 deaths. These figures are lower than those of Italy or the UK. But they are higher than those of Portugal and Greece, two countries with a similar size of population to Sweden. The figures are also much higher than Sweden’s Nordic neighbours, with Denmark at 11,182 cases and 561 deaths, Norway at 8,309 and 235, and Finland at 6,537 and 306.
International observers and critics within Sweden blame these depressing figures on its controversial Covid-19 strategy. Unlike the rest of Europe, or what is often cited as the exemplar nation of South Korea, Sweden has not imposed any lockdowns nor carried out mass testing. Its policy has been to slow the spread of the virus by exhorting its citizens to practise voluntary social distancing.
Some restrictions have been enforced, such as a ban on gatherings of more than 50 people, and a stipulation that drinks can only be served on seated tables as opposed to bars. Everyday life in Sweden is not the same as before. There are fewer people in shopping centres and public transport. Working from home has become the new normal for those who can. But people continue to socialise outdoors freely, while primary schools, hairdressers and shopping centres remain open.
But despite the high number of deaths, about 70% of Swedes support their government’s approach. In fact, there has not been much public debate or organised opposition to the strategy. The deaths have indeed shocked many Swedes, especially the disproportionately high number of deaths among those over 70 in care homes and those from working-class, immigrant backgrounds. The debates, however, seem to be taking a more socioeconomic angle. In other words, the reasons for these deaths are being blamed on structural, economic, and social deficiencies – but not on the strategy itself.
Why is this so? One explanation that has been aired frequently points to the high degree of trust between government agencies and citizens. The argument is that the level of government transparency and the state’s service-mindedness has created an environment where the people trust their government and experts.
Sweden has received considerable media scrutiny in recent days. According to figures published on Tuesday, it now has the highest coronavirus-per-capita death rate in the world, with an average of 6.08 deaths per million inhabitants a day on a rolling seven-day average between 13 and 20 May. As of 22 May, Sweden has had 32,172 confirmed cases and 3,871 deaths. These figures are lower than those of Italy or the UK. But they are higher than those of Portugal and Greece, two countries with a similar size of population to Sweden. The figures are also much higher than Sweden’s Nordic neighbours, with Denmark at 11,182 cases and 561 deaths, Norway at 8,309 and 235, and Finland at 6,537 and 306.
International observers and critics within Sweden blame these depressing figures on its controversial Covid-19 strategy. Unlike the rest of Europe, or what is often cited as the exemplar nation of South Korea, Sweden has not imposed any lockdowns nor carried out mass testing. Its policy has been to slow the spread of the virus by exhorting its citizens to practise voluntary social distancing.
Some restrictions have been enforced, such as a ban on gatherings of more than 50 people, and a stipulation that drinks can only be served on seated tables as opposed to bars. Everyday life in Sweden is not the same as before. There are fewer people in shopping centres and public transport. Working from home has become the new normal for those who can. But people continue to socialise outdoors freely, while primary schools, hairdressers and shopping centres remain open.
But despite the high number of deaths, about 70% of Swedes support their government’s approach. In fact, there has not been much public debate or organised opposition to the strategy. The deaths have indeed shocked many Swedes, especially the disproportionately high number of deaths among those over 70 in care homes and those from working-class, immigrant backgrounds. The debates, however, seem to be taking a more socioeconomic angle. In other words, the reasons for these deaths are being blamed on structural, economic, and social deficiencies – but not on the strategy itself.
Why is this so? One explanation that has been aired frequently points to the high degree of trust between government agencies and citizens. The argument is that the level of government transparency and the state’s service-mindedness has created an environment where the people trust their government and experts.
Just 7.3% of Stockholm had Covid-19 antibodies by end of April, study shows
Whereas this might explain the lack of opposition, it is far from exhaustive. For example, Norway, Denmark and Finland are also known as high-trust societies. But all three have imposed far more restrictive measures, ranging from lockdowns to declaring a national emergency.
Second, the fact that some of the people most affected by the high death rate are from the poorest immigrant groups, such as the Somali community, whose voice is not always well represented in the media, goes against this image of a universally trusting and transparent society.
Perhaps another explanation is that Sweden has a very different way of perceiving the current crisis. Instead of seeing it as a national emergency or a fight against an “invisible enemy”, there seems to be a tendency to regard coronavirus just as a serious public health problem. It is viewed as something that requires the careful observance of rules set out by health experts, rather than an existential problem that calls for the state to suspend civil liberties for the sake of national security. Indeed, whenever a non-scientific expert such as me criticises the Swedish strategy, the response has often been that I am not an expert.
This is where Sweden is unique, something that may be attributable to its history. The country has not experienced a national emergency or crisis for more than 100 years. Since around the Swedish general strike of 1909, it has not seen any profound social conflicts, for example the miners’ strike in Britain, or a civil war, as in Spain or Finland. Any foreigner who has lived in Sweden will know how conflict-adverse Swedish people seem to be. Furthermore, Sweden has not engaged in any armed disputes since the 1810s. This is in contrast to Denmark and Norway, which were occupied by Germany in the second world war, and Finland, invaded by the USSR in the same period. A rallying cry of unity in the face of national adversity isn’t part of the collective cultural fabric in Sweden.
This lack of experience with handling national crises goes some way to explaining why there is a technocratic and dispassionate outlook to Covid-19, as opposed to a sense of urgency. It is also why the public health agency in Sweden seems to have few qualms about “herd immunity”. Whereas other countries see it as a dangerous national experiment, Swedish health officials regard it more as a type of medical prescription. It might not be 100% effective and some deaths might occur, as in any medical situation. But in the long run, it could work in mitigating the negative effects of the virus, without mass social disruption.
It is for this reason that the denial by the Swedish government and health officials that it is actually pursuing “herd immunity” seem so halfhearted, a rebuttal to critical foreign press rather than its citizens. For a foreigner living in Sweden like me, it is not entirely reassuring. How long Sweden will continue with this policy is difficult to ascertain. But as long as Covid-19 is seen in this light, and it looks as if it will, a U-turn seems unlikely.
Wednesday, 13 February 2019
Dark money is pushing for a no-deal Brexit. Who is behind it?
Targeted no-deal Brexit ads are funded opaquely, yet the government has failed to bring in new laws writes George Monbiot in The Guardian
Modern governments respond to only two varieties of emergency: those whose solution is bombs and bullets, and those whose solution is bailouts for the banks. But what if they decided to take other threats as seriously?
This week’s revelations of a catastrophic collapse in insect populations, jeopardising all terrestrial life, would prompt the equivalent of an emergency meeting of the UN security council. The escalating disasters of climate breakdown and soil loss would trigger spending at least as great as the quantitative easing after the financial crisis. Instead, politicians carry on as if nothing is amiss.
The same goes for the democratic emergency. Almost everywhere trust in governments, parliaments and elections is collapsing. Shared civic life is replaced by closed social circles that receive entirely different, often false, information. The widespread sense that politics has become so corrupted that it can no longer respond to ordinary people’s needs has provoked a demagogic backlash that in some countries begins to slide into fascism. But despite years of revelations about hidden spending, fake news, front groups and micro-targeted ads on social media, almost nothing has changed.
In Britain, for example, we now know that the EU referendum was won with the help of widespread cheating. We still don’t know the origins of much of the money spent by the leave campaigns. For example, we have no idea who provided the £435,000 channelled through Scotland, into Northern Ireland, through the coffers of the Democratic Unionist party and back into Scotland and England, to pay for pro-Brexit ads. Nor do we know the original source of the £8m that Arron Banks delivered to the Leave.EU campaign. We do know that both of the main leave campaigns have been fined for illegal activities, and that the conduct of the referendum has damaged many people’s faith in the political system. But, astonishingly, the government has so far failed to introduce a single new law in response to these events. And now it’s happening again.
Since mid-January an organisation called Britain’s Future has spent £125,000 on Facebook ads demanding a hard or no-deal Brexit. Most of them target particular constituencies. Where an MP is deemed sympathetic to the organisation’s aims, the voters who receive these ads are urged to tell him or her to “remove the backstop, rule out a customs union, deliver Brexit without delay”. Where the MP is deemed unsympathetic, the message is: “Don’t let them steal Brexit; Don’t let them ignore your vote.”
So who or what is Britain’s Future? Sorry, I have no idea. As openDemocracy points out, it has no published address and releases no information about who founded it, who controls it and who has been paying for these advertisements. The only person publicly associated with it is a journalist called Tim Dawson, who edits its website. Dawson has not yet replied to the questions I have sent him. It is, in other words, highly opaque. The anti-Brexit campaigns are not much better. People’s Vote and Best for Britain have also been spending heavily on Facebook ads, though not as much in recent weeks as Britain’s Future.
At least we know who is involved in these remain campaigns and where they are based, but both refuse to reveal their full sources of funding. People’s Vote says “the majority of our funding comes from small donors”. It also receives larger donations but says “it’s a matter for the donors if they want to go public”. Best for Britain says that some of its funders want to remain anonymous, and “we understand that”. But it seems to me that that transparent and accountable campaigns would identify anyone paying more than a certain amount (perhaps £1,000). If people don’t want to be named, they shouldn’t use their money to influence our politics. Both campaigns insist that they abide by the rules governing funding for political parties, elections and referendums.
As they must know better than most, the rules on such spending are next to useless. They were last redrafted 19 years ago, when online campaigning had scarcely begun. It’s as if current traffic regulations insisted only that you water your horses every few hours and check the struts on your cartwheels for woodworm. The Electoral Commission has none of the powers required to regulate online campaigning or to extract information from companies such as Facebook. Nor does it have the power to determine the original sources of money spent on political campaigns. So it is unable to tell whether or not the law that says funders must be based in the UK has been broken. The maximum fines it can levy are pathetic: £20,000 for each offence. That’s a small price to pay for winning an election.
Since 2003, the commission has been asking, with an ever greater sense of urgency, for basic changes in the law. But it has been stonewalled by successive governments. The exposés of Carole Cadwalladr, the Guardian, openDemocracy and Channel 4 News about the conduct of the referendum have so far made no meaningful difference to government policy. We have local elections in May and there could be a general election at any time. The old, defunct rules still apply.
Our politicians have instead left it to Facebook to do the right thing. Which is, shall we say, an unreliable strategy. In response to the public outcry, Facebook now insists that organisations placing political ads provide it (but not us) with a contact based in the UK. Since October, it has archived their advertisements and the amount they spend. But there is no requirement that its advertisers reveal who provides the funding. An organisation’s name means nothing if the organisation is opaque. The way Facebook presents the data makes it impossible to determine spending trends, unless you check the entries every week. And its new rules apply only in the US, the UK and Brazil. In the rest of the world, it remains a regulatory black hole.
So why won’t the government act? Partly because, regardless of the corrosive impacts on public life, it wants to keep the system as it is. The current rules favour the parties with the most money to spend, which tends to mean the parties that appeal to the rich. But mostly, I think, it’s because, like other governments, it has become institutionally incapable of responding to our emergencies. It won’t rescue democracy because it can’t. The system in which it is embedded seems destined to escalate rather than dampen disasters.
Ecologically, economically and politically, capitalism is failing as catastrophically as communism failed. Like state communism, it is beset by unacknowledged but fatal contradictions. It is inherently corrupt and corrupting. But its mesmerising power, and the vast infrastructure of thought that seeks to justify it, makes any challenge to the model almost impossible to contemplate. Even to acknowledge the emergencies it causes, let alone to act on them, feels like electoral suicide. As the famous saying goes: “It is easier to imagine the end of the world than to imagine the end of capitalism.” Our urgent task is to turn this the other way round.
Modern governments respond to only two varieties of emergency: those whose solution is bombs and bullets, and those whose solution is bailouts for the banks. But what if they decided to take other threats as seriously?
This week’s revelations of a catastrophic collapse in insect populations, jeopardising all terrestrial life, would prompt the equivalent of an emergency meeting of the UN security council. The escalating disasters of climate breakdown and soil loss would trigger spending at least as great as the quantitative easing after the financial crisis. Instead, politicians carry on as if nothing is amiss.
The same goes for the democratic emergency. Almost everywhere trust in governments, parliaments and elections is collapsing. Shared civic life is replaced by closed social circles that receive entirely different, often false, information. The widespread sense that politics has become so corrupted that it can no longer respond to ordinary people’s needs has provoked a demagogic backlash that in some countries begins to slide into fascism. But despite years of revelations about hidden spending, fake news, front groups and micro-targeted ads on social media, almost nothing has changed.
In Britain, for example, we now know that the EU referendum was won with the help of widespread cheating. We still don’t know the origins of much of the money spent by the leave campaigns. For example, we have no idea who provided the £435,000 channelled through Scotland, into Northern Ireland, through the coffers of the Democratic Unionist party and back into Scotland and England, to pay for pro-Brexit ads. Nor do we know the original source of the £8m that Arron Banks delivered to the Leave.EU campaign. We do know that both of the main leave campaigns have been fined for illegal activities, and that the conduct of the referendum has damaged many people’s faith in the political system. But, astonishingly, the government has so far failed to introduce a single new law in response to these events. And now it’s happening again.
Since mid-January an organisation called Britain’s Future has spent £125,000 on Facebook ads demanding a hard or no-deal Brexit. Most of them target particular constituencies. Where an MP is deemed sympathetic to the organisation’s aims, the voters who receive these ads are urged to tell him or her to “remove the backstop, rule out a customs union, deliver Brexit without delay”. Where the MP is deemed unsympathetic, the message is: “Don’t let them steal Brexit; Don’t let them ignore your vote.”
So who or what is Britain’s Future? Sorry, I have no idea. As openDemocracy points out, it has no published address and releases no information about who founded it, who controls it and who has been paying for these advertisements. The only person publicly associated with it is a journalist called Tim Dawson, who edits its website. Dawson has not yet replied to the questions I have sent him. It is, in other words, highly opaque. The anti-Brexit campaigns are not much better. People’s Vote and Best for Britain have also been spending heavily on Facebook ads, though not as much in recent weeks as Britain’s Future.
At least we know who is involved in these remain campaigns and where they are based, but both refuse to reveal their full sources of funding. People’s Vote says “the majority of our funding comes from small donors”. It also receives larger donations but says “it’s a matter for the donors if they want to go public”. Best for Britain says that some of its funders want to remain anonymous, and “we understand that”. But it seems to me that that transparent and accountable campaigns would identify anyone paying more than a certain amount (perhaps £1,000). If people don’t want to be named, they shouldn’t use their money to influence our politics. Both campaigns insist that they abide by the rules governing funding for political parties, elections and referendums.
As they must know better than most, the rules on such spending are next to useless. They were last redrafted 19 years ago, when online campaigning had scarcely begun. It’s as if current traffic regulations insisted only that you water your horses every few hours and check the struts on your cartwheels for woodworm. The Electoral Commission has none of the powers required to regulate online campaigning or to extract information from companies such as Facebook. Nor does it have the power to determine the original sources of money spent on political campaigns. So it is unable to tell whether or not the law that says funders must be based in the UK has been broken. The maximum fines it can levy are pathetic: £20,000 for each offence. That’s a small price to pay for winning an election.
Since 2003, the commission has been asking, with an ever greater sense of urgency, for basic changes in the law. But it has been stonewalled by successive governments. The exposés of Carole Cadwalladr, the Guardian, openDemocracy and Channel 4 News about the conduct of the referendum have so far made no meaningful difference to government policy. We have local elections in May and there could be a general election at any time. The old, defunct rules still apply.
Our politicians have instead left it to Facebook to do the right thing. Which is, shall we say, an unreliable strategy. In response to the public outcry, Facebook now insists that organisations placing political ads provide it (but not us) with a contact based in the UK. Since October, it has archived their advertisements and the amount they spend. But there is no requirement that its advertisers reveal who provides the funding. An organisation’s name means nothing if the organisation is opaque. The way Facebook presents the data makes it impossible to determine spending trends, unless you check the entries every week. And its new rules apply only in the US, the UK and Brazil. In the rest of the world, it remains a regulatory black hole.
So why won’t the government act? Partly because, regardless of the corrosive impacts on public life, it wants to keep the system as it is. The current rules favour the parties with the most money to spend, which tends to mean the parties that appeal to the rich. But mostly, I think, it’s because, like other governments, it has become institutionally incapable of responding to our emergencies. It won’t rescue democracy because it can’t. The system in which it is embedded seems destined to escalate rather than dampen disasters.
Ecologically, economically and politically, capitalism is failing as catastrophically as communism failed. Like state communism, it is beset by unacknowledged but fatal contradictions. It is inherently corrupt and corrupting. But its mesmerising power, and the vast infrastructure of thought that seeks to justify it, makes any challenge to the model almost impossible to contemplate. Even to acknowledge the emergencies it causes, let alone to act on them, feels like electoral suicide. As the famous saying goes: “It is easier to imagine the end of the world than to imagine the end of capitalism.” Our urgent task is to turn this the other way round.
Tuesday, 20 November 2018
In Britain’s boardrooms, Brexit is already here. And the warning is stark
For Westminster, leaving Europe is months away: for business, it’s the present. And our prospects are already dwindling writes Aditya Chakrabortty in The Guardian
Those investors don’t come here out of charity. Our government competes with others around the world to lure in cash from overseas. But look what inducements we offer. Just weeks before the Brexit referendum, David Cameron’s government published its Invest in the UK brochure, promising “the most competitive” labour costs in western Europe, and “the least strict regulation in the EU.”. Why buy euros when you can have Poundland?
No other country does this. Analysis by Kevin Farnsworth at York University shows that, while all states assure investors they’re competitive locations, Sweden boasts of its “anti-corruption” and “good industrial relations”, while Germany highlights its “efficiency” and “training”. The UK, he writes, “uniquely competes for international capital by offering a package of a low-tax, low-cost, low regulatory business environment”.
Here, whether Conservative or Labour, successive governments have marketed us as the open-all-hours, bargain-basement landing strip off mainland Europe. Until, that is, Britons vote in a referendum to kick away two of the three legs of the post-Thatcherite economic model, namely openness and closeness to the continent. What’s left then is our cheapness – in taxes, in wages and in regulation.
This is Britain in 2018, paying the price for decades of underinvestment and cutprice competition. We have a highly skilled workforce, with almost half of Britain’s young people holding a university degree. And yet in 2014, Charlie Mayfield, former boss of John Lewis and then head of the UK Commission on Employment and Skills, pointed out that over one in five British jobs required only primary-school education. We have a world-class car-manufacturing industry, yet over half of the components in the cars that roll off the lines in Sunderland or Ellesmere Port come from abroad.
This is the point at which the kindness of strangers starts to get rather strained. In a survey this spring, well before the chaos of the past few weeks, EY found that 30% of foreign investors now expect to move money out of the UK after Brexit. The current value of foreign direct investment in the UK is estimated by the government to be over £1 trillion. If even a quarter of that were to move abroad, then £75 billion of assets are already at risk. No wonder the Welsh government is offering sweeteners to Ford to stay at Bridgend. No wonder when Nissan made noises about scaling back at Sunderland, May immediately opened the door of No 10 and offered some kind of deal – although precisely what, the voting public was never told.
You can expect a lot more of this over coming months and years: panicky politicians paying your tax money to grumpy-looking corporate executives. You can expect other countries to try to poach our businesses, just as after the 2016 vote Paris began advertising itself as the ideal post-Brexit corporate headquarters. Their posters read: “Tired of fog? Try the frogs”
You can also expect this government to press even harder the case that Britain is the low-tax, low-wage capital of the rich world. But ministers will get a disappointing response from businesses, believes EY’s chief economist in the UK, Mark Gregory. He thinks multinationals will shift away from using Britain as a stepping stone into Europe and the rest of the world – which is logical, given that any new trading arrangements will take years to settle and will almost certainly not be as smooth as the regime Britain currently has. Instead of building factories to make things to sell to the world, big businesses will instead put their money into storage and showrooms to sell things to Britons. The UK will become, Gregory says, “a warehouse economy: low skills, low productivity and low growth”.
That projection was already a reality for lots of people I met who plumped for Brexit in 2016. They were on minimum wage and had minimum rights and minimum prospects. If Brexit is to be radically changed now, it is those voters – the disenfranchised Labourites, the sod-them-all brigade – whose support is needed. A second referendum, in which well-meaning metropolitans offer those in the Rhondda the status quo, probably deserves to fail. Instead, any remain option will have to come with a worked-out argument about rebalancing power in this country. And that means reshaping the relationship between capital and the rest of us.
Part-built private housing development project on the outskirts of Llanelli, Wales, which was abandoned after the developer went bust. Photograph: Alamy
On the one hand, you have the self-inflating chaos at Westminster, the fever dreams of Jacob Rees-Mogg’s gang and the rehearsed rage of the Democratic Unionists. And on the other, you have the truth nailed by Philip K Dick. “Reality,” he wrote, “is that which, when you stop believing it, doesn’t go away.” So let’s remind ourselves of some reality.
While Tory MPs jostled over a replacement for Theresa May the head of the Confederation of British Industry, Carolyn Fairbairn, warned that millions of pounds were “flooding out” of business investment and into preparing for Britain crashing out of Europe with no deal. Food warehouses said they were running out of space. And auto-parts manufacturer Schaeffler announced that it would shut factories in Plymouth and Llanelli, leaving more than 600 workers facing the dole.
An entire rotten political-corporate regime is crumbling away – and its replacement threatens to be even worse
Even as politicians and the press fantasise about how Britain will leave Europe, big business is already at the departure gate. For Westminster, Brexit is months in the future; for boardrooms making plans, it is the present. Big carmakers have this year halved their investment in new models and factory machinery. The consultancy EY records a 31% slump in the number of foreign businesses setting up headquarters in Britain. Boris Johnson certainly makes good copy – but money talks much louder.
“The banks and insurers are moving, the big pharmaceutical firms are investing abroad,” says Paul Drechsler, who was CBI president until June and now chairs London First. “These trains are leaving the station, and when they leave, they won’t come back.” The country he describes is already shrinking, its job opportunities dwindling, its reputation abroad in eclipse.
This is the real national emergency. An entire rotten political-corporate regime is crumbling away – and its replacement threatens to be even worse. It will be worse, specifically, for those parts of the country, like Llanelli and Plymouth, that voted leave as the ultimate kick against the pricks of a hollow economy and a deaf government.
The succinct definition of our current model comes from the head of the Bank of England. The UK relies, said Mark Carney in 2016, on the “kindness of strangers”. The willingness of overseas investors to keep ploughing in their cash keeps us in the style to which we’ve grown accustomed. Out of all the 28 members of the European Union, the UK is second only to Ireland in its dependence on investment from abroad. Margaret Thatcher’s eagerness to sell off whatever she could get her hands on and her mandarins’ carelessness over ownership has turned us into one of the biggest foreign-capital junkies in the developed world.
On the one hand, you have the self-inflating chaos at Westminster, the fever dreams of Jacob Rees-Mogg’s gang and the rehearsed rage of the Democratic Unionists. And on the other, you have the truth nailed by Philip K Dick. “Reality,” he wrote, “is that which, when you stop believing it, doesn’t go away.” So let’s remind ourselves of some reality.
While Tory MPs jostled over a replacement for Theresa May the head of the Confederation of British Industry, Carolyn Fairbairn, warned that millions of pounds were “flooding out” of business investment and into preparing for Britain crashing out of Europe with no deal. Food warehouses said they were running out of space. And auto-parts manufacturer Schaeffler announced that it would shut factories in Plymouth and Llanelli, leaving more than 600 workers facing the dole.
An entire rotten political-corporate regime is crumbling away – and its replacement threatens to be even worse
Even as politicians and the press fantasise about how Britain will leave Europe, big business is already at the departure gate. For Westminster, Brexit is months in the future; for boardrooms making plans, it is the present. Big carmakers have this year halved their investment in new models and factory machinery. The consultancy EY records a 31% slump in the number of foreign businesses setting up headquarters in Britain. Boris Johnson certainly makes good copy – but money talks much louder.
“The banks and insurers are moving, the big pharmaceutical firms are investing abroad,” says Paul Drechsler, who was CBI president until June and now chairs London First. “These trains are leaving the station, and when they leave, they won’t come back.” The country he describes is already shrinking, its job opportunities dwindling, its reputation abroad in eclipse.
This is the real national emergency. An entire rotten political-corporate regime is crumbling away – and its replacement threatens to be even worse. It will be worse, specifically, for those parts of the country, like Llanelli and Plymouth, that voted leave as the ultimate kick against the pricks of a hollow economy and a deaf government.
The succinct definition of our current model comes from the head of the Bank of England. The UK relies, said Mark Carney in 2016, on the “kindness of strangers”. The willingness of overseas investors to keep ploughing in their cash keeps us in the style to which we’ve grown accustomed. Out of all the 28 members of the European Union, the UK is second only to Ireland in its dependence on investment from abroad. Margaret Thatcher’s eagerness to sell off whatever she could get her hands on and her mandarins’ carelessness over ownership has turned us into one of the biggest foreign-capital junkies in the developed world.
Those investors don’t come here out of charity. Our government competes with others around the world to lure in cash from overseas. But look what inducements we offer. Just weeks before the Brexit referendum, David Cameron’s government published its Invest in the UK brochure, promising “the most competitive” labour costs in western Europe, and “the least strict regulation in the EU.”. Why buy euros when you can have Poundland?
No other country does this. Analysis by Kevin Farnsworth at York University shows that, while all states assure investors they’re competitive locations, Sweden boasts of its “anti-corruption” and “good industrial relations”, while Germany highlights its “efficiency” and “training”. The UK, he writes, “uniquely competes for international capital by offering a package of a low-tax, low-cost, low regulatory business environment”.
Here, whether Conservative or Labour, successive governments have marketed us as the open-all-hours, bargain-basement landing strip off mainland Europe. Until, that is, Britons vote in a referendum to kick away two of the three legs of the post-Thatcherite economic model, namely openness and closeness to the continent. What’s left then is our cheapness – in taxes, in wages and in regulation.
This is Britain in 2018, paying the price for decades of underinvestment and cutprice competition. We have a highly skilled workforce, with almost half of Britain’s young people holding a university degree. And yet in 2014, Charlie Mayfield, former boss of John Lewis and then head of the UK Commission on Employment and Skills, pointed out that over one in five British jobs required only primary-school education. We have a world-class car-manufacturing industry, yet over half of the components in the cars that roll off the lines in Sunderland or Ellesmere Port come from abroad.
This is the point at which the kindness of strangers starts to get rather strained. In a survey this spring, well before the chaos of the past few weeks, EY found that 30% of foreign investors now expect to move money out of the UK after Brexit. The current value of foreign direct investment in the UK is estimated by the government to be over £1 trillion. If even a quarter of that were to move abroad, then £75 billion of assets are already at risk. No wonder the Welsh government is offering sweeteners to Ford to stay at Bridgend. No wonder when Nissan made noises about scaling back at Sunderland, May immediately opened the door of No 10 and offered some kind of deal – although precisely what, the voting public was never told.
You can expect a lot more of this over coming months and years: panicky politicians paying your tax money to grumpy-looking corporate executives. You can expect other countries to try to poach our businesses, just as after the 2016 vote Paris began advertising itself as the ideal post-Brexit corporate headquarters. Their posters read: “Tired of fog? Try the frogs”
You can also expect this government to press even harder the case that Britain is the low-tax, low-wage capital of the rich world. But ministers will get a disappointing response from businesses, believes EY’s chief economist in the UK, Mark Gregory. He thinks multinationals will shift away from using Britain as a stepping stone into Europe and the rest of the world – which is logical, given that any new trading arrangements will take years to settle and will almost certainly not be as smooth as the regime Britain currently has. Instead of building factories to make things to sell to the world, big businesses will instead put their money into storage and showrooms to sell things to Britons. The UK will become, Gregory says, “a warehouse economy: low skills, low productivity and low growth”.
That projection was already a reality for lots of people I met who plumped for Brexit in 2016. They were on minimum wage and had minimum rights and minimum prospects. If Brexit is to be radically changed now, it is those voters – the disenfranchised Labourites, the sod-them-all brigade – whose support is needed. A second referendum, in which well-meaning metropolitans offer those in the Rhondda the status quo, probably deserves to fail. Instead, any remain option will have to come with a worked-out argument about rebalancing power in this country. And that means reshaping the relationship between capital and the rest of us.
Thursday, 25 February 2016
The final offer made to junior doctors was too generous – they should stop striking and get on with it
Mary Dejevsky in The Independent
You know things have reached a pretty pass in any dispute when the combatants start to invoke the spirit of deceased politicians. But when two men who have reached the top of their political trees also start invoking their own mothers – as Jeremy Corbyn and David Cameron did at Prime Minister’s Questions – well, the possibility of any agreement looks remote indeed.
Yes, after a merciful, but all too brief, period of remission, we are back in the heat of the junior doctors’ dispute. The Labour leader accused the Government of showing bad faith and “misrepresenting” statistics (about hospital deaths at weekends); the Prime Minister returned to his mantra about people not getting sick only on weekdays. Whatever else the Government may be ready to compromise on, it appears not to be a “seven-day NHS”.
And quite right, too.
“Our” NHS is not run for the benefit of the staff, however long they have spent in training, however mountainous their student loans, however arduous and responsible their work. A great many people would probably like to work only Monday to Friday, 9 to 5, especially if highly-paid overtime for additional hours comes virtually guaranteed. But this is not the reality for most people, and there is no reason, when so much in this country now functions 24/7 – with the staff on rotas and little, if any, overtime paid – why it should still be such a struggle to get the emergency services to do the same. Yet it is here the overtime culture has proved most resilient.
There will be those – and I admit to being among them – who saw the final offer to the junior doctors as too generous. By preserving a system of overtime, for Saturdays after 5pm and all Sundays, it leaves in place the idea that doctors can expect to work something like traditional office or factory hours with additional rewards for anything else. Those expectations need to be scotched.
Junior doctors, and their many vocal supporters, have tried to turn the contested statistics about weekend fatalities to their advantage, suggesting that a “cut-price” seven-day NHS would simply raise death rates around the week. Anyone who visits hospitals on weekdays and at weekends, however, will be familiar with the glaring disparity in staffing – at every level, and what sometimes appears to be a surfeit of employees, especially in the least skilled jobs, during standard working hours. There is surely money to be saved here, that could offset the cost of more staff at weekends.
Nor can the junior doctors’ dispute be seen in isolation. Their new contract is just one part – if a large part – of reform of the NHS that is yet to come. If next in line are to be the consultants, for whom the junior doctors are often deputising at nights and weekends, you can understand why the Government might be keen to hold the line.
What occasioned the latest sword-crossing in the Commons was the announcement by the British Medical Association earlier this week that the junior doctors would hold three more days of strikes, and would fight the Health Secretary’s imposition of the new contract through the courts. In the first instance, this means seeking a judicial review.
On precisely what legal grounds the BMA intends to fight is not yet clear. For all the perception that the English judiciary has become more politically engaged in recent years, it is hard to see a judge ruling that an elected government is not within its rights to set the terms of a contract for public sector employees, particular when in line with a manifesto commitment. Going to court is only going to inject more poison into this already toxic dispute.
It is beyond time that the BMA called it a day and recognised that the junior doctors have won as much as they are going to – more than they could have expected at the outset and more, indeed, than may be wise for the future health of the NHS. The BMA’s continued insistence a “safe” seven-day NHS is somehow beyond the country’s means is defeatism of the first order, and really not junior doctors’ call to make. It is the stated policy of an elected government.
That said, the extent to which this dispute has become politicised has made it infinitely harder to resolve. Jeremy Hunt has not just been defending his government’s policy of a seven-day NHS, he has been engaged directly in negotiating the small print of a new contract. This has enabled junior doctors, and the BMA on their behalf, to cast the project as a heartless Tory plot.
The most senior non-politicians – the chief executive of NHS England, Simon Stevens, and the medical director, Sir Bruce Keogh – have both been conspicuously absent from the fray. This may be because, if heads had to roll, the Health Secretary is deemed more dispensable than either of them. But here, perhaps, also lies the key to change. For 10 years or more – most recently in the Conservatives’ 2010 election manifesto – proposals have been mooted to separate the NHS from politics by placing it under an independent board. Policy, such as the creation of seven-day service, and the overall NHS budget would be set by central government, leaving the rest to professionals. Each time, however, a consensus evolved to the effect that the NHS was so integral a part of national life and the sums of money allocated so vast, that there had to be direct political accountability. The scandal at Mid-Staffs augmented that view.
But the downside of the argument is again before us. Junior doctors and a Conservative government at loggerheads; there is talk of relations blighted for a generation. One solution might be for the Government to return to its election manifesto of 2010 and divest itself of managerial responsibility for the NHS. If junior doctors can cast that as a victory, so be it. But there is no reason why the sort of hands-off arrangement that is considered good for the BBC and – increasingly – for schools should not be good for the NHS, too.
You know things have reached a pretty pass in any dispute when the combatants start to invoke the spirit of deceased politicians. But when two men who have reached the top of their political trees also start invoking their own mothers – as Jeremy Corbyn and David Cameron did at Prime Minister’s Questions – well, the possibility of any agreement looks remote indeed.
Yes, after a merciful, but all too brief, period of remission, we are back in the heat of the junior doctors’ dispute. The Labour leader accused the Government of showing bad faith and “misrepresenting” statistics (about hospital deaths at weekends); the Prime Minister returned to his mantra about people not getting sick only on weekdays. Whatever else the Government may be ready to compromise on, it appears not to be a “seven-day NHS”.
And quite right, too.
“Our” NHS is not run for the benefit of the staff, however long they have spent in training, however mountainous their student loans, however arduous and responsible their work. A great many people would probably like to work only Monday to Friday, 9 to 5, especially if highly-paid overtime for additional hours comes virtually guaranteed. But this is not the reality for most people, and there is no reason, when so much in this country now functions 24/7 – with the staff on rotas and little, if any, overtime paid – why it should still be such a struggle to get the emergency services to do the same. Yet it is here the overtime culture has proved most resilient.
There will be those – and I admit to being among them – who saw the final offer to the junior doctors as too generous. By preserving a system of overtime, for Saturdays after 5pm and all Sundays, it leaves in place the idea that doctors can expect to work something like traditional office or factory hours with additional rewards for anything else. Those expectations need to be scotched.
Junior doctors, and their many vocal supporters, have tried to turn the contested statistics about weekend fatalities to their advantage, suggesting that a “cut-price” seven-day NHS would simply raise death rates around the week. Anyone who visits hospitals on weekdays and at weekends, however, will be familiar with the glaring disparity in staffing – at every level, and what sometimes appears to be a surfeit of employees, especially in the least skilled jobs, during standard working hours. There is surely money to be saved here, that could offset the cost of more staff at weekends.
Nor can the junior doctors’ dispute be seen in isolation. Their new contract is just one part – if a large part – of reform of the NHS that is yet to come. If next in line are to be the consultants, for whom the junior doctors are often deputising at nights and weekends, you can understand why the Government might be keen to hold the line.
What occasioned the latest sword-crossing in the Commons was the announcement by the British Medical Association earlier this week that the junior doctors would hold three more days of strikes, and would fight the Health Secretary’s imposition of the new contract through the courts. In the first instance, this means seeking a judicial review.
On precisely what legal grounds the BMA intends to fight is not yet clear. For all the perception that the English judiciary has become more politically engaged in recent years, it is hard to see a judge ruling that an elected government is not within its rights to set the terms of a contract for public sector employees, particular when in line with a manifesto commitment. Going to court is only going to inject more poison into this already toxic dispute.
It is beyond time that the BMA called it a day and recognised that the junior doctors have won as much as they are going to – more than they could have expected at the outset and more, indeed, than may be wise for the future health of the NHS. The BMA’s continued insistence a “safe” seven-day NHS is somehow beyond the country’s means is defeatism of the first order, and really not junior doctors’ call to make. It is the stated policy of an elected government.
That said, the extent to which this dispute has become politicised has made it infinitely harder to resolve. Jeremy Hunt has not just been defending his government’s policy of a seven-day NHS, he has been engaged directly in negotiating the small print of a new contract. This has enabled junior doctors, and the BMA on their behalf, to cast the project as a heartless Tory plot.
The most senior non-politicians – the chief executive of NHS England, Simon Stevens, and the medical director, Sir Bruce Keogh – have both been conspicuously absent from the fray. This may be because, if heads had to roll, the Health Secretary is deemed more dispensable than either of them. But here, perhaps, also lies the key to change. For 10 years or more – most recently in the Conservatives’ 2010 election manifesto – proposals have been mooted to separate the NHS from politics by placing it under an independent board. Policy, such as the creation of seven-day service, and the overall NHS budget would be set by central government, leaving the rest to professionals. Each time, however, a consensus evolved to the effect that the NHS was so integral a part of national life and the sums of money allocated so vast, that there had to be direct political accountability. The scandal at Mid-Staffs augmented that view.
But the downside of the argument is again before us. Junior doctors and a Conservative government at loggerheads; there is talk of relations blighted for a generation. One solution might be for the Government to return to its election manifesto of 2010 and divest itself of managerial responsibility for the NHS. If junior doctors can cast that as a victory, so be it. But there is no reason why the sort of hands-off arrangement that is considered good for the BBC and – increasingly – for schools should not be good for the NHS, too.
Thursday, 6 November 2014
Nehru and Indira laid down principles of secularism and nationalism that today’s politicians can’t ignore
Vinod Mehta in The Times of India
It is open season on Jawaharlal Nehru and Indira Gandhi. No opportunity is lost to demonise and denigrate father and daughter. Even October 31, the day the lady was assassinated, became a day-long festival for celebrating her wickedness, besides proclaiming she was no martyr but a case of self-destruction. Fortunately, we are told, a set of rulers, or shall i say ruler, is at hand, with the wisdom and vision to repair the damage.
We need to talk about Jawaharlal and Indira. That’s for sure. But we also need to keep some touch with historical veracity. For their lifelong opponents truth lies in the eye of the beholder. Consequently, 2014 onwards provides an excellent window to demolish once and for all the myth about their contribution to nation-building. What they built, so the argument goes, is their family dynasty.
Party politics can and is used to float falsehoods with the help of state power. Witness how the fable concerning our glorious Vedic past is being represented triumphantly (in which allegedly plastic surgery and stem cell research flourished) without a murmur of incredulity, or a titter of mirth. If truth is the first casualty in war, it is the second casualty in times when, as Lawrence Durrell puts it, “truth is what contradicts itself”.
The systematic and organised campaign to vilify the Nehru legacy and replace it with the more ‘muscular and patriotic’ legacy of Sardar Patel is top of the agenda. The exercise is ludicrous and an insult to the great Sardar. But let us leave that falsehood alone for the moment.
At the heart of the demolition project is the announcement that a new Idea of India, contrary to the one proposed by Nehru, is available, and in need of urgent execution. It is an abiding irony that the sole politician in the current pantheon of saffron leaders the present prime minister pays obeisance to is Atal Bihari Vajpayee, who ruled the country with Nehru as his lodestar.
What is this new Idea of India? I think we should be told. Alas, its architects have provided no blueprint except to declare it exists. If i were say Mani Shankar Aiyar, i would argue it consists of one part jingoism and one part xenophobia. Perhaps that is a slight exaggeration. More accurately, it rejects the legendary poet Raghupati Sahay aka Firaq Gorakhpuri’s thesis, “Sar zamiin-e hind par aqwaam-e alam ke Firaq/ Kaafile baste gae, Hindustan bantaa gayaa”. (In the sacred land of Hind, caravans of the world Firaq went on settling, and Hindustan kept on being formed.)
If one takes the short view of history, Nehru is an easy target, and Indira even easier. To compile a list of ‘sins’ the duo committed would be superfluous since the compilation has already been lovingly done by the Sangh Parivar. Many of the sins are not without basis but they are not black and white either, except the Emergency. They were committed at a specific moment in history. Happily, we have access to material which provides us with full, balanced assessments – warts and all. We are therefore neither astonished nor shocked when these transgressions are presented. No verdict on Nehru or Indira is possible without its share of criticism.
Perhaps this is the right time to ask the hunters looking for two prized scalps some questions. Where did Narayana Murthy and the entire information technology industry come from? Where did Indra Nooyi come from? Where did Warren Buffett’s financial wizard, Ajit Jain, come from? They all came from the IITs, IIMs and other world-class education centres Nehru had the foresight to set up.
If India has the ‘bomb’ and internationally renowned research labs, the credit must go to the same man. At a time when the republic struggled, he insisted a newly independent, backward nation be fully engaged with the contemporary first world through advanced learning and progressive thinking. Nehru ensured a society steeped in superstition, ritual, religious dogma and belief in kismet embraced a scientific temper so that the temptation to wallow in a mythical ‘glorious’ past could be resisted. The modern nation state – outward-looking, open, rational, argumentative, sceptical – armed with universal adult franchise, is the creation of Jawaharlal Nehru. Rubbish that if you like.
I yield to no one in my abhorrence for aspects of Indira Gandhi’s prime ministership. Because i entered journalism in 1974, i experienced the full horrors of civilian dictatorship. That she wrecked critical democratic institutions is undeniable. But we must also remember she dismembered Pakistan and made sure it could never pose a threat. There is a good Indira and a bad Indira.
Incidentally, when i read opinion polls reveal she is easily the most popular prime minister the country has produced, when i see long queues outside her Safdarjung Memorial, I wonder if our Iron Lady needs more than one yardstick (Emergency) to assess her term in office.
If Nehru’s legacy is the real obstacle holding India back, why don’t its adversaries throw it into the wastepaper basket? And govern on the majoritarian doctrine? Not a chance. When it comes to self-preservation, the new rulers are wise. They know they would soon be out of a job, if they abandoned the idea (secularism) which has held the country together.
Sunday, 9 March 2014
On the NHS frontline: 'being a doctor in A&E is like being a medic in a war zone'
Doctor explains why she decided to make a film depicting the real-life drama of targets and staff pushed to the limit
The start of a shift and I brace myself as I walk into the waiting area. A huge number of people are already there, waiting to be called. I try to avoid eye contact. It's like entering an arena but I feel more like the sacrificial lamb than a gladiator. Entering the main area of the emergency department, a scene of chaos. All available space to see patients is occupied. Staff shout instructions to each other above the noise. I hear a patient vomiting, another is crying out in pain and an elderly woman's voice cuts through, confused and repeating that she wants to go home. "So do I," I whisper to myself.
Colleagues run between cubicles with clean sheets, urine pots and trays for taking blood. Ambulance sirens heard above the noise signal that more patients are coming. A cardiac arrest case is sped into the resuscitation room with paramedics pumping the chest of a patient as the rest of the crash team run through. The atmosphere is explosive and adrenaline charged.
A senior doctor in the middle of the storm tries to bring order in a place that refuses to be controlled. Junior doctors are flushed, red in the face, eyes wide with a hint of panic. I find a tearful one at the computer. She is new and hating every second of it. There isn't time or even space to console her with a pep talk. Give her a few more weeks and the hard outer shell will develop like body armour.
My first patient of the shift needs a full neurological exam. I hunt around for a pen torch to shine into her eyes. "Make sure you have your weapons before you go to war," says a fellow registrar, wryly, handing over the torch. I smile. This is not Palestine, Libya or Syria. This is a hospital on the eastern outskirts of London.
The A&E department at Queen's hospital in Romford deals with 400 patients a day.
Being a doctor in accident and emergency has at times resembled being a medic in a war zone. I have worked as a doctor in various conflicts and yet some of my most stressful moments, facing a tidal wave of pressure, have happened closer to home, in Queen's hospital, Romford.
The UK's A&E departments have been described by the College of Emergency Medicine (CEM) as facing a crisis. The term was specifically chosen to describe the situation that everyone from the most senior consultant to the most junior nurse is experiencing. Last year Dr Cliff Mann, the CEM president, wrote in a press release: "A lack of a plan for resolution [is] an existential threat to emergency medicine."
There are recurrent themes causing the crisis: more people are coming to A&E; a falling number of doctors want to work there because of the pressures involved and the poor work/life balance; and hospitals are increasingly full – resulting in bottlenecks that back up into the emergency department.
Over the past four progressively worse winters I came to a tipping point. Nothing in the media was reflecting the daily realities of being a doctor on the shop floor. Last April, when the CEM's press release hit the headlines, I took my cue.
I divide my time as an A&E doctor and film-maker. I wanted to make something honest and reflective of the reality.
After a year's worth of access negotiation, I began filming with the Guardian this winter in two hospitals – Queen's where I work as a middle-grade locum, and Musgrove Park, in Taunton, Somerset, where Cliff Mann also works.
"For a long time we were like John the Baptist, crying into the wilderness and no one was listening," Mann said to me, while on shift at Musgrove Park. The most senior consultant within emergency medicine leads from the front, including a Friday shift that runs from 3pm to midnight. "No one goes into emergency medicine thinking it's going to be easy and calm – that would be bizarre. But if you push the individual with persistently increasing intensity levels they will start to fade."
The TV stories of George Clooney and the ER cast don't come close to reality. My research into the speciality obviously went beyond watching medical dramas but nothing prepared me for what it was actually like.
Attending conferences in emergency medicine becomes almost therapeutic in its sharing of experiences. At an emergency medicine conference, Expanding Scientific Horizons, held in Twickenham, south-west London, last year, it was telling that the sessions entitled Creating Satisfaction and Maintaining Wellbeing in Emergency Medicine were standing room only.
One of the speakers, Susie Hewitt, a consultant from Derby, spoke about her battle with depression during the time she was appointed head of service for the introduction of the four-hour target – the government's instruction that 95% of patients should be seen within four hours of arriving at A&E.
The culmination of work and personal pressures resulted in what Hewitt describes as being "hit with what felt like a big freight train".
Many of us recognised ourselves in that. At the conference leaflets for well-being support and therapies were being distributed widely. We are clearly not a very healthy bunch right now.
The CEM warned the government three years ago that there was a problem with falling numbers of staff, but no concrete solutions emerged. I began to see my own consultants and middle-grade colleagues make plans to fly to the other side of the world.
Medics with a patient at Queen's hospital. The hospital was built for 90,000 patients a year but receives 140,000.
Queen's A&E, part of the Barking, Havering and Redbridge University Trust, sees about 400 patients a day and its sister hospital, King George's, sees 200. The trust serves a population of 750,000 and is one of the UK's largest. It also has one of the highest elderly populations in London. Following a report by the Care Quality Commission (CQC) that its A&E was "at times unsafe because of the lack of full-time consultants and middle-grade doctors", Queen's became the 14th hospital to be put into special measures last December. Filming with the Guardian inside its A&E began the next day.
The hospital was built for 90,000 patients a year but receives 140,000. Ironically, King George's A&E, which performs better against targets, is scheduled for closure in 2015, after a unanimous vote by local primary care trusts. Queen's is expected to absorb the extra numbers. Queen's is understaffed, with only eight full-time consultants where it requires 21 in order to provide 24-hour cover, seven days a week. Four consultants left last year.
One of them, Dr Rosie Furse, described the pressure of targets. Battles with certain specialities to accept patients on to their wards are also a common complaint. She left for a post on the island of Mustique before being recruited to a hospital in Bath.
David Prior, chairman of the CQC, was reported in the Guardian in May 2013 as saying too many patients were arriving at hospital as emergency cases, and improved earlier care in the community was needed. He suggested more acute beds should be closed. "Emergency admissions through accident and emergency are out of control in large parts of the country," he said.
That prompted memories of a recent bed-blocked day in Queen's. Matron Mary Feeney rushed into A&E having secured a bed on the intensive therapy unit for an unwell patient in an A&E cubicle.
"They say bring him in half an hour – half an hour we have not got," and with that the patient was out of the door on the way with matron off to negotiate access at the hallowed gates of ITU.
A significant contributor to breaches of the four-hour target is the quest to find a bed for someone who is clearly not well enough to go home. Over Christmas one woman was brought in with diarrhoea and a ruptured bowel requiring a surgical side room. She waited in A&E for 17 hours until a room became available. Another woman was brought in with high blood sugars and needed an acute medical bed. I saw her when she arrived in the evening and then met her the next morning when I came back to work. That's when A&E becomes a ward.
On the first day of filming we had four intubated, unconscious patients in the resuscitation room at the same time, all of them requiring critical beds. The rest of the room was full of acutely unwell patients being redistributed around A&E as more room was needed with each new ambulance arrival.
Finding alternatives to A&E through improved care in the community is essential but if more acute beds close the A&E waits will get longer for sick patients requiring admission.
Staff at work at Queen's hospital. The hospital has only eight full-time consultants.
I went through a period of having palpitations during a stretch of extremely challenging shifts last winter. It was when I had a palpitation and nearly passed out while driving that I decided to step down my intensity of work. I had further investigations but the remedy was obvious. I reduced my shifts and the palpitations have stopped.
Over the past three years I have worked harder than in my previous life in the army. I went through the Sandhurst commissioning course, renowned for its tough schedule, but in accident and emergency medicine at its peak, the intensity is tougher.
The CEM published an aptly named report – Stretched to the limit – in October last year. It described a consultant workforce under pressure. As a middle grade I wonder if actually I can physically do the job of a consultant.
The report said: "Evidence confirms that burnout among physicians in emergency medicine occurs at the highest rate of all medical specialities. There is also a very worrying trend developing of consultants seeking to move abroad after having been trained in the NHS."
The report details 21 consultants having left the UK in 2013 with an overall exodus of 78 since 2008.
Within the report details of a survey reveal that consultants on average plan to retire at 60 with the current job not compatible with advancing age. "Doing four nights in a row when you are 50 or 55 is physically impossible," said Dr Antoine Azzi, a specialist registrar working at Queen's at the very end of his training and soon to be a consultant.
He hopes for a less intense workload as a consultant, but it appears that is not going to be the case. The report said that 40% of the consultant workforce were on call one night in every six. The average age of emergency medicine consultants is 43 and the survey showed most plan to retire at 60.
The things that make a difference include access to training, which provides juniors with skills they need and reduces a layer of stress.
Before she left, Furse, like many other consultants, was dedicated to improving the working lives of her trainees and colleagues.
On one occasion I placed a chest drain into a patient with a spontaneous pneumothorax – a collection of air between the lung and the chest wall. If I failed, he could go into respiratory arrest, which could lead to death.
Furse stood by, calm and instructive. "Get it in quick, Saleyha," was all she said. I urged the drain's tube into his chest and the moment I saw the swinging bubble of the drain, signalling a successful placement I allowed myself to breathe and the patient was stabilised.
Moments like that are what makes being a doctor count but opportunities for training are few as workload grows.
The constant turnover of new junior doctors hits the department, too. Most junior doctors who spend six months in A&E leave at the end of their assignment with a lot of experience, but they are relieved to be going and they won't be coming back.
Mann says: "They come and do their six-month attachment and at the end say, "Thank you very much, it was interesting but I am moving on because it nearly killed me.'"
There is a quote from Hippocrates that says: "Where there is a love of medicine, there is a love of humanity." I see this every day to some degree in A&E. Before she left Furse reminded us during a teaching session: "Patients are key to everything we do and if you stop caring about them – well you should not be here any more."
Looking back on diary entries related to shifts I did last year during the spell when I was having palpitations I was reminded why I put myself through it. It's what makes us go back the next day no matter how awful the shift has been.
I wrote: "It was hard, I am tired and I was pushed but I feel alive. Today counted. I cared for patients and they remained the main focus of my day. Nothing else. Patients arrive here to be seen on possibly the worst days of their lives and through them we learn so much about our art. They teach us how to be doctors. As I walked into work today I was hit by reflection of all the patients who have left their mark – the ones that didn't make it.
"They stay with you, like companions. I shared the last few hours of their lives with them … forming a bond that transcends into something almost spiritual even for those that don't believe. Above all else, that is what counts and it remains a privilege."
Saturday, 24 November 2012
Thackeray's Historical Record - Lest We Forget
- October 30, 1966 Thackeray's first Dusshera rally. A mob leaves the rally later to attack and burn south Indian shops and restaurants. The rally was also addressed by Congress leader Ramrao Adik. Attacks on south Indians were with the backing of CM Vasantrao Naik.
- Mumbai 1968 Hindi films brought out by south Indian producers are stopped by Thackeray's Shiv Sainiks.
- February 1969 Thackeray unleashes his goons against Kannadigas. 59 dead, 274 wounded, 151 cops injured in week of riots.
- June 6, 1970 CPI MLA and trade unionist Krishna Desai murdered in first political assassination in the city since 1947.
- January 1974 Dalit Panther leader Bhagwat Jadhav brutally killed by Thackeray's men, sparks off war with Dalits.
- 1975-76 Thackeray shocks colleagues, praises Sanjay Gandhi during the Emergency. By 1977, changes tack.
- Jan 1982 Thackeray supports Congress in Great Textile Strike. Breaks ties under duress, goes back three years later.
- From 1984 Shiv Sena carries out attacks on Dalit farmers in Vidarbha and Marathwada, destroying crops, burning huts.
- 1985 Thackeray calls for expulsion of 'outsiders’, proposes 1972 as cut-off date for having moved to Maharashtra.
- 1985 Cong CM Vasantdada Patil connives to help Shiv Sena win BMC polls with ‘Bombay part of Maharashtra’ issue.
- March 1988 The wonderful “saviour of Sikhs” Thackeray calls for a boycott of Sikh businesses in Maharashtra.
- 1988 Thackeray's 'boycott of Sikhs businesses' idea is quietly abandoned after extorting crores from Sikhs in Mumbai.
- Post 1989 + Mandal riots Thackeray finds a more convenient target for his political purposes: Indian Muslims.
- October 1991 Thackeray's thugs attack journalists, fracturing one woman's (Manimala) skull with a crowbar.
- 1991 Thackeray takes it one step further, threatens a local judge who had ruled against his goons with blinding.
- 1991 Thackeray's Dopahar ka Saamna editorial very sweetly compares women journalists to prostitutes.
- 1995 Thackeray: "If they have their Dawood, then we have our Arun Gawli." Because all politicos need a personal mafia.
- July 1996 The Ramesh Kini murder after long term intimidation. SS-BJP state govt tries to bury investigation.
- 1997 Kini's wife accuses Raj Thackeray of his murder. HC asked CBI to investigate but Mumbai police destroys evidence.
- July 11, 1997 Ten Dalits are killed and over 30 wounded at the Ramabai Ambedkar Nagar massacre. None were armed.
- Republic Day, 1997 Two adivasi youths murdered. Adivasi women sexually assaulted by police and SS workers at Talasari.
- Late 1990s SS-BJP goverment summarily withdraws over 1,100 cases of atrocities against Dalits in Marathwada.
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It’s a sight, ‘progressives’ adding to Thackeray’s iconisation
The mammoth size of the crowd of mourners who congregated at Shivaji Park in Mumbai last Sunday to bid a final adieu to Bal Thackeray foxed many of his long-time critics. They had assumed that, in his waning years, the Shiv Sena chieftain had become a pale and tragic shadow of his former, feisty self and was therefore a figure of no consequence. The assumption was well founded. A series of political setbacks and personal tragedies, followed by age-related illnesses, had taken their toll.
In his last video address, Thackeray appealed to the Sainiks to “take care” of his anointed heirs—son Uddhav and grandson Aditya—once he exited the scene. It was a pitiable sight: the patriarch, who once held his audience in thrall with his vitriolic oratory, now appeared to be frail and exhausted as he gasped for breath while he searched for the right words. The critics had therefore concluded that he was well and truly a spent force.
But by the time the funeral ended, the critics began to sing a different tune. The presence of lakhs of people, as well as that of political leaders from several parties, corporate heads and leading film stars, they acknowledged, contained a message about Thackeray’s enduring appeal, which had thus far eluded them. It related partly to his great capacity to strike bonds of friendship even with his rivals in the spheres of politics, the media, sports and cinema. He castigated them in the most acerbic terms in his public speeches, but in private, treated them with much warmth and courtesy.
Partly, too, the critics argued, Thackeray’s candour—a marked penchant to always call a spade a bloody shovel—set him apart from politicians who can rarely, if ever, mean what they say or say what they mean. The Sena patriarch’s forthrightness, often expressed in a language that bordered on the obscene, outraged his adversaries, embarrassed his allies and compelled his party leaders to squirm in their seats. But, the neo-converts claimed, it was music to the ears of his followers. They revelled in every sentence he uttered for, in their reckoning, Thackeray dared to articulate their very own sentiments.
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The neo-converts to identity politics went on to assert that throughout his public life Thackeray exploited these insecurities with such consummate skill that an average Maharashtrian readily looked the other way when he promoted his political agenda with a brazen, often callous, disregard for constitutional niceties. They knew that the Sena patriarch’s single obsession was to instil a sense of pride in the Marathi manoos, to seek his social and economic advancement and to give him the confidence to face the dreaded “outsiders” with courage and fortitude.
It is these virtues that Thackeray’s once-strident critics extolled as they witnessed the scenes at Shivaji Park. The thought did not cross their minds that the grouses of the Maharashtrians had little to do with the malignant “outsiders”. If few of them were at the commanding heights of trade and commerce, the all-India civil services, the English media, Bollywood, PSUs, the armed forces, the academic world or even the cultural one at the pan-India level, the reasons had to be sought in their own character and attitude and in the neglect of quality education in the state.
The neo-converts couldn’t summon the nerve to admit that Maharashtrians lacked—or had failed to exhibit—the entrepreneurial skills of the Gujaratis, Marwaris, Kutchis, Jains, Sindhis and Parsis; that they didn’t venture out of their towns and cities to earn a livelihood in distant states as south Indians, Punjabis, north Indian Hindus and Muslims and the bhadralok Bengalis did with gusto; that their innately cautious, understated nature did not allow them to engage in the highly competitive market of arts and ideas.
The neo-converts to identity politics also chose to ignore two other factors. Few, if any, thought it fit to point to the terrible cost Maharashtra had to pay for Thackeray’s brand of politics: a lethal mix of regional chauvinism, communalism and rank opportunism. Its victims weren’t heard in TV studio discussions or in the columns of newspapers. Nor was another, younger breed of Maharashtrians, who are carving a niche for themselves in just about every field, ranging from food and fashion to scholarship, business, media and the arts. They don’t suffer from a sense of victimhood. It is therefore a matter of time before the newly minted admirers of Bal Thackeray—most of them “progressives”—are forced to eat their words.
That time may indeed have come much sooner than any of them would have anticipated. Even as the mammoth crowd had begun to disperse from Shivaji Park, a group of Shiv Sainiks flexed their muscles in Palghar. They forced a 21-year old woman, Shaheen Dhada, to tender an apology for a comment she had posted on her Facebook page. Her crime? She had raised questions about how and why Mumbai had shut down in the wake of Thackeray’s death—without naming him once. This perfectly innocuous comment had riled the Sainiks for, in their eyes, Shaheen, like her friend, Rini Srinivasan, who had endorsed the comment, had insulted their leader. After some reluctance, Shaheen did post an apology on her Facebook page, but that brought her no respite.
The Sainiks vandalised a hospital run by her uncle and roughed up staff and patients alike. Late that night, the police, instead of hunting for the vandals, took the two young women in custody and next morning pressed charges against them for “outraging religious feelings”. The charges were subsequently whittled down and the women were released on bail. Such was the nation-wide outcry against the conduct of both, the Sainiks and the police, that the state government was compelled to order an inquiry.
But their reputation was in tatters: the former, because they had demonstrated how they proposed to uphold the legacy of Thackeray; and the latter, for making it obvious that, faced with the wrath of the Sainiks, their spine was akin to the spine of an eel. They had shown this propensity to kowtow to the Sena time and again in the past. Not once did they seriously press charges against Thackeray for his inflammatory speeches against “Madrasis”, Muslims, Biharis and against artists, writers, film stars and journalists who had questioned his policies and tactics. Will the recent adherents of the Shiv Sena patriarch’s brand of identity politics now run for cover? This is far from certain. No long-time practitioner of a faith—religious or secular—can hope to match the zeal of a neo-convert to sap the foundations of the republic.
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Ashis Nandy on Thackeray - 'He may have believed in nothing'
It is not my job to pay tributes to dead politicians, nor is it to do a hatchet job on them. I have learnt to look at human beings without being terribly judgemental, since I still retain something of my clinical training. Therefore, I shall look at Bal Thackeray from a distance. He was a product of a period of Indian politics during which his kind thrived. It was the time when leaders like Datta Samant emerged but, unlike him, Thackeray’s instinct for survival was stronger and he negotiated the world of Indian politics with greater skill despite his—and this is a gross understatement—many angularities.
Actually, Thackeray believed in nothing. Many people think he believed in Hindutva, something that he exploited very successfully to further his career, but it perhaps did not mean anything at all to him. He spewed hatred against Hindus liberally—and frequently. When they were not the south Indians, they were the Gujaratis and the Marwaris and, later in his life, the migrants from UP and Bihar. It would be wrong to presume that Balasaheb spoke for the Hindus; he only spoke up for those who supported him. Chameleon-like, he changed colours and always looked ready for different occasions. It is being said that he cemented Marathi identity, but even that is doubtful. Marathi identity was something already there; it did not have to be reinforced by Thackeray. Balasaheb only took advantage of its existence and rode its crest to political power.
The glowing tributes that have poured in for Thackeray are not easy to explain at short notice. We shall have to wait to assess their resilience. Indians avoid speaking ill of the dead. A careful enumeration might reveal some day that Thackeray’s victims among the Marathi people, for whom he reportedly toiled all his life, were more numerous than Ajmal Kasab’s (whose hanging has prompted not lamentation, but jubilation). It is probable that Thackeray’s legacy of violence has been overlooked as most of his victims have come from the bottom strata of society, whose deaths do not make much of a difference to a media-exposed public.
After saying all this, I must hasten to add that there is in Thackeray another trait that may explain the eulogies he has received from various quarters. One can accuse him of having run a criminal enterprise, but the political culture of it did not seem criminal because there was an element of juvenile delinquency in it. The use of the term juvenile is deliberate; there was something innocent about his project, something that reminded one of the playfulness of a teenager. What would have otherwise looked like a criminal enterprise ended up looking like the forgiveable naughtiness of a teenager. For many, he was always playing a game, he made it clear to his galaxy of friends and followers, in Mario Puzo style.
In him, there was a little bit of playacting. Not surprisingly, his circle of friends included people from different religious, educational and linguistic backgrounds. Not only that, they even included those who opposed every canon of the different ideologies he has espoused in his entire political life. How else can one explain the friendship between R.K. Laxman, a classical liberal (and a south Indian!), and Thackeray? He reportedly even called him up days before he died just so that he could hear his voice once. Their relationship was described as ‘apolitical’, and it endorses what I said.
This is why I say he believed in nothing. There was something iconoclastic about him. He cared two hoots for ideologies. He saw through the hypocrisy of ideologies that political leaders employ on the national scene. For him, politics was just a game and he beat others at it. He didn’t even take himself as seriously as many would like to believe. People who knew him reasonably well probably suspected in their hearts that he never believed in any of what he said publicly. I think their tributes discounted the element of violence, given that there was something juvenile about his political enterprise. They would rather remember it as something slightly naughty.
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Ashis Nandy on Thackeray - 'He may have believed in nothing'
It is not my job to pay tributes to dead politicians, nor is it to do a hatchet job on them. I have learnt to look at human beings without being terribly judgemental, since I still retain something of my clinical training. Therefore, I shall look at Bal Thackeray from a distance. He was a product of a period of Indian politics during which his kind thrived. It was the time when leaders like Datta Samant emerged but, unlike him, Thackeray’s instinct for survival was stronger and he negotiated the world of Indian politics with greater skill despite his—and this is a gross understatement—many angularities.
Actually, Thackeray believed in nothing. Many people think he believed in Hindutva, something that he exploited very successfully to further his career, but it perhaps did not mean anything at all to him. He spewed hatred against Hindus liberally—and frequently. When they were not the south Indians, they were the Gujaratis and the Marwaris and, later in his life, the migrants from UP and Bihar. It would be wrong to presume that Balasaheb spoke for the Hindus; he only spoke up for those who supported him. Chameleon-like, he changed colours and always looked ready for different occasions. It is being said that he cemented Marathi identity, but even that is doubtful. Marathi identity was something already there; it did not have to be reinforced by Thackeray. Balasaheb only took advantage of its existence and rode its crest to political power.
The glowing tributes that have poured in for Thackeray are not easy to explain at short notice. We shall have to wait to assess their resilience. Indians avoid speaking ill of the dead. A careful enumeration might reveal some day that Thackeray’s victims among the Marathi people, for whom he reportedly toiled all his life, were more numerous than Ajmal Kasab’s (whose hanging has prompted not lamentation, but jubilation). It is probable that Thackeray’s legacy of violence has been overlooked as most of his victims have come from the bottom strata of society, whose deaths do not make much of a difference to a media-exposed public.
After saying all this, I must hasten to add that there is in Thackeray another trait that may explain the eulogies he has received from various quarters. One can accuse him of having run a criminal enterprise, but the political culture of it did not seem criminal because there was an element of juvenile delinquency in it. The use of the term juvenile is deliberate; there was something innocent about his project, something that reminded one of the playfulness of a teenager. What would have otherwise looked like a criminal enterprise ended up looking like the forgiveable naughtiness of a teenager. For many, he was always playing a game, he made it clear to his galaxy of friends and followers, in Mario Puzo style.
In him, there was a little bit of playacting. Not surprisingly, his circle of friends included people from different religious, educational and linguistic backgrounds. Not only that, they even included those who opposed every canon of the different ideologies he has espoused in his entire political life. How else can one explain the friendship between R.K. Laxman, a classical liberal (and a south Indian!), and Thackeray? He reportedly even called him up days before he died just so that he could hear his voice once. Their relationship was described as ‘apolitical’, and it endorses what I said.
This is why I say he believed in nothing. There was something iconoclastic about him. He cared two hoots for ideologies. He saw through the hypocrisy of ideologies that political leaders employ on the national scene. For him, politics was just a game and he beat others at it. He didn’t even take himself as seriously as many would like to believe. People who knew him reasonably well probably suspected in their hearts that he never believed in any of what he said publicly. I think their tributes discounted the element of violence, given that there was something juvenile about his political enterprise. They would rather remember it as something slightly naughty.
Thursday, 25 August 2011
UK TOURISTS BEWARE – Cambridge Hospital Staff Demand Instant Money from Sick and Ailing Indian Tourist
Cambridge Hospital Staff Demand Instant Money from Sick and Ailing Indian Tourist
The UK likes to portray itself as a friendly and inviting place for tourists. Its visa regime informs tourists who possess medical insurance that in case of an emergency they will receive adequate medical treatment without any need to pay the money upfront. But this is not true in reality as the following story illustrates.
VM, aged 73, is an Indian tourist visiting her family in Cambridge UK since June 2011. On Thursday 18 Aug she was admitted to Cambridge's famous Addenbrooke's hospital for an emergency illness and she received good medical care. Her medical insurers contacted the hospital on Friday 19 August in order to confirm her medical insurance cover and to guarantee payment. Yet on Tuesday 23 August and Wednesday 24 August VM received a rude shock in her hospital bed. Staff from the finance department beseiged her sick bed and demanded that she sign a carte blanche document agreeing to pay any/all charges the NHS may levy for her treatment. When it was pointed out that her insurance company was willing to offer a payment guarantee for her treatment they refused to listen and threatened to deport the tourist.
This issue becomes even more important as London prepares to invite tourists for the 2012 Olympic games. As the following article shows, NHS hospitals have made it a policy to use such high handed behaviour to extort cash from patients in their ailing beds.
http://www.dailymail.co.uk/news/article-562980/Foreigners-asked-produce-cash-hospital-beds-crackdown-health-tourists.html
In short if this behaviour is allowed to continue, if a luckless tourist finds himself in an NHS hospital s/he will not only have to hope to get better soon in a foreign land, but also try to figure out how to arrange large amounts of cash to fob of the finance staff of these hospitals.
You have been warned, visit the UK only if you or your relatives have large amounts of instant cash. Else you and your relatives will be in peril should you have a medical emergency as NHS hospitals fail to honour the legal commitment made when you obtained your visa.
THE DAILY MAIL ARTICLE
Foreigners asked to produce cash in their hospital beds in crackdown on 'health tourists'
By OLINKA KOSTERLast updated at 17:54 30 April 2008
A hospital is pioneering a "get tough" attitude on health tourists - by throwing them out of hospital before their treatment is complete unless they pay up.
It means that foreigners who travel to Britain to get free care on the NHS will now be asked to produce cash or a credit card at their hospital bed.
The new approach has already saved the West Middlesex University Hospital in Isleworth up to £700,000 a year. Its proximity to Heathrow Airport makes it a particular target for immigrants.
If all hospitals did the same, the NHS could recoup tens of millions of pounds a year from health tourists.
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Crackdown: West Middlessex University Hospital is getting tough on illegal 'health tourists'"We will discharge a patient before they are well," he insisted.
"We will discharge a patient when they are stable, when we have provided what we have to provide - the minimum benchmark.
"Generally, within the first 48 hours after admission they will be given a price on how much, roughly, their treatment is going to cost.
"If I'm interviewing an inpatient I will be at that patient's bedside and I will ask them there and then for a visa, MasterCard, debit card, or cash. We don't take cheques."
Under the current system, anyone who needs emergency care, such as for a heart attack or accident and emergency treatment after an accident, does not have to pay.
But patients not eligible for free care who attempt to use the NHS for ongoing care or treatment that is not immediately necessary have to pay.
These so-called health tourists normally receive a bill on departure from hospital - but only an estimated 30 per cent of the money is recovered.
Under the pilot scheme, they will be asked to pay at their hospital bed for non-emergency care, or told to leave.
However, they would only be discharged after three consultants have agreed their condition is stable.
In the case of a heart attack victim, NHS patients would normally stay in hospital for 10 days. But anyone not eligible for free care could be asked to leave after 48 hours if they are judged stable.
Most patients told to leave did so willingly, Mr Finlay added - but not all of them.
"I've had two death threats, I've been held up against a wall, I've been grabbed round the throat, I've been manhandled by relatives - verbal abuse is almost day-to-day," he said.
"You have to have a very thick skin."
Last year, a secret Government report based on figures from 12 NHS trusts suggested that the bill for treating health tourists was at least £62million a year.
This did not include the cost of treating foreigners entitled to free healthcare, such as asylum seekers and students.
Health tourists not entitled to free treatment include pregnant women who arrive on holiday visas and give birth here.
Many foreign HIV sufferers also target UK hospitals for treatment, the study from 2005 revealed.
In the case of an HIV patient, a clinical decision would be made as to whether emergency care was needed.
At the time the figures were revealed, Conservative MP Ben Wallace said hospitals appeared to be pursuing a "don't ask, don't charge and don't chase policy".
Cash-strapped hospitals are being pushed further into debt because they are failing to claim the millions owed to them by those abusing the system.
As well as the West Middlesex University Hospital, the Leeds Teaching Hospitals NHS Trust and the Luton and Dunstable NHS Foundation Trust have been chosen to take part in the pilot scheme because their catchment areas contain both a "major point of entry to the UK" and a large proportion of asylum seekers.
Mr Finlay said his methods had received an enthusiastic response from across Whitehall - and saved the trust between £600,000 and £700,000-a-year.
"They think it is a fantastic idea, a solution to a relatively new problem," he said.
"It is up to the Department of Health to see how brave they will be to use innovative ways to tackle health tourism."
A spokesman for the Department of Health said: "It is important that those who are not entitled to NHS services pay for any they receive.
"The Government is currently reviewing access to primary and secondary care for all foreign nationals.
"In doing this we must take into account the implications of any such decisions on the key preventative and public health responsibilities of the NHS.
"We always treat people and do not charge them for emergency treatment, but the thinking behind the pilot schemes is that the NHS is there first and foremost for people who live here."
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