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Archive - Year: 2018

September 4, 2018

Turning healthcare on its head: the bidet revolution (feat. CLANGERS)
Filed under: #health4all — Dr. Phil @ 8:54 am

‘Why treat people and send them back to the conditions that make them sick?’
Michael Marmot

Universal healthcare in a society that is poor at prevention and in denial about death is like attempting to rescue a never ending stream of people from a river of illness. As science advances, we dive deeper and deeper into the river to pull out people who are sicker and sicker. The right to healthcare for all means that all too often, we treat the untreatable. Just because we can do something doesn’t mean it’s kind or wise to do so. A high-tech death can be very unkind. We spend so much time, effort and money pulling bodies to the riverbank, that we have no energy left to wander upstream and stop them falling in.

We live in a very unequal society, with huge disparities in both life expectancy and years lived in good health. Unless we can improve living and working conditions as well as lifestyle, with a strong emphasis on helping people to build resilience and stay mentally healthy, then no system of universal healthcare can cope, no matter how it is designed or funded. Those of us who are lucky enough to be healthy at present have a responsibility to try to remain so for as long as we can. The best hope for the NHS lies outside its structures. We must reduce poverty, promote healthy minds as well as bodies, lessen the burden of avoidable illness and permit choice in dying. There’s more than enough unavoidable illness to keep the NHS in business.

This burden of avoidable illness could be further reduced by being honest about medical harm and the limits of medicine, and restricting over-medicalisation. Too many serious errors have been covered up and repeated in healthcare systems primed to protect professional, institutional, corporate and political reputations. Too many tests and treatments of marginal benefit turn healthy people into anxious patients. Enough people fall into the river of illness without being sucked in by the health industry.

There simply isn’t a sound evidence base for the mass medication of the elderly, many of whom are either unable or unwilling to take so many drugs as prescribed. Waste due to ineffective treatments, non- attendance and non-adherence is significant. When patients are given the time and opportunity to fully understand and participate in decisions about their care, taking in the likely long-term risks and benefits in absolute as well as relative terms, they often choose less medicine, not more. Universal healthcare must also be prudent healthcare, using the minimal effective intervention wherever possible. Sound evidence based on real life data, as well as compassion, must inform health policy and provision.

Above all we must see healthcare in the context of all care. The boundaries between self, health and social care are entirely superficial, and we must extend our circles of collaboration and compassion as widely as possible and consider the environmental impact of what we do. Indigenous populations have a better understanding of how to live on this planet without taking so much as to threaten the health of future generations, and how to die. We only die once, and a gentle death for as many people as possible is the kindest service society can offer. As the Australian Aboriginal elder Dr Noel Nannup explains: ‘Human beings are the carers of everything.’ But to care for everything, we must first care for ourselves and build our own resilience. The NHS has had enough top down ‘re-disorganisations’. It’s time for a bidet revolution. From the bottom up.

Healthcare begins with self-care

‘Tell me, what is it you plan to do with your one wild and precious life?’
Mary Oliver

Self-care requires time to reflect and to do some ‘self- work’. What are our goals, values, passions and purpose? Can we get near them without burning out? How can we be kind to our minds? How will we cope with pressure, failure, and adversity? Is our current lifestyle making avoidable disease more likely or even inevitable? Physical health stems from mental health, and learning how to be happy, how to self-care and how to cope under pressure should be taught and revisited at every stage of our lives. And we need to build happy and resilient cities, communities and organizations that promote mental health and allow individuals to flourish.

And yet as a society, we aren’t great at talking about what matters most (mental health, sexual health, how we want to die). Self-care needs the self-knowledge that comes from these difficult conversations, and also self- love. Can you disappear inside your mind and like what you find there? Enjoying our own company is key to happiness and resilience. Accepting responsibility for self-care is also fundamental to the sustainability of universal healthcare. Every day we don’t need to use the NHS, someone who does benefits.

The CLANGERS self-care model

Universal healthcare must embrace the continuum of self-care to intensive care, and I would restructure it around the CLANGERS model. The Clangers of the children’s television series were, and probably still are, a community of mauve mice who spoke in whistles and ate sensible portions of soup, made by a dragon, and blue-string pudding, none of which was processed. They lived a simple yet serene life built around friendship, collaboration and enjoying the little things. Very seldom, if ever, did they need to go to hospital or indeed die, because they were so good at self-care and pleasuring themselves in a safe and sustainable way.

The Clangers’ habit for a satisfying and meaningful life can be learned by anyone, at any age:

Connect with the world around you. Reach out to people, pets, plants and places. We like to feel as if we belong, as part of something bigger. These connections are the cornerstones of your life. Take time and care to nurture them. And don’t forget to connect with yourself.

Learn. A purpose in life often stems from learning what matters most to you, developing a passion for learning and keeping your curiosity alive. Why do you get out of bed in the morning?

• be Active, in mind and body. Rediscover activities and passions you left behind, and have the courage to try new ones. Aim for five portions of fun a day, each different, at least one outdoors and one that involves getting pleasantly breathless.

Notice, and be present in, the world around you. Fill up your senses. Catch sight of the beautiful. Remark on the unusual. Enjoy the everyday. Savour the moment, and your place in it.

Give back. Helping and caring for friends, strangers and those less fortunate than ourselves is fundamental to good emotional health. It cements us as part of a community and develops more meaningful connections and insights. The joy of being human is to be humane.

Eat well. Learn what’s good and enjoyable to eat, and in what quantities. Learn how to grow it, where to buy it and how to prepare it. Set time aside to sit and eat with friends and family. Eating well on a budget isn’t easy. For excellent help try Cooking on a Bootstrap by Jack Munroe

Relax. Take time to rest and reflect on the day you’ve had, reliving and re-savouring the happy memories and having gratitude for friends and family. Learn to meditate. Be kind to your mind and let it wind down and de-clutter.

Sleep. Don’t cheat on your sleep. It’s vital recovery time for mind and body, and boosts your energy, creativity and productivity. You eat better and exercise more when you’re well rested. Relaxing and winding down beforehand is key. Learning to housekeep your mind and deal with stress is vital. If you doubt the power of sleep, read Why We Sleep by Mathew Walker

Some lucky people will do all eight steps intuitively, partly out of habit. Others will struggle through sickness and circumstance but with support and time, can continuously improve and slowly raise their own bar – hopefully without the stress of comparing themselves to others. If you need more detailed help with your CLANGERS, I recommend the book The 4 Pillar Plan – Eat, Sleep, Relax, Move – by Dr Rangan Chatterjee. He is one of the few lifestyle medicine gurus who isn’t trying to sell you a fad diet or his own brand of nutritional supplements, and his enthusiasm is infectious. You can also check out his podcasts here.

Your Clangers may be very different to my Clangers, the only rule is that we should try not to harm ourselves or others. The ‘clang’ in CLANGERS comes from the government-funded Foresight report, ‘Mental capital and wellbeing: making the most of ourselves in the 21st century’. It gathered the evidence on simple ways to a fulfilling life that just about anyone can do, irrespective of wealth or health. I added the ‘ers’ because they’re also fundamental to living well and slowing down the rust.

CLANGERS works not just as a model for living well, but also as a way of coping in adversity. When I interviewed patients and carers for a book about how to get the best from the NHS, it was striking how it fitted in with a successful model of patient engagement.

• Connect with the team treating you, and get to know them if you can. Know their names and something about them. It’s easier to ask questions when you know someone.

• Learn as much as you can about your illness, the treatment options, what you are entitled to, the standards of care you should be getting, what you can do to improve your odds and who to speak to if you have concerns.

• Be Active, both in the management of your illness and preventing further illness, be your own advocate when you can, have others to act for you when you can’t. The five portions of fun a day may be different to the ones you might enjoy when you’re well, but still try to have the energy for joy, warmth and purpose each day.

• Notice the good and bad in your care, and speak up if you have any questions or concerns. Notice the little acts of kindness that make illness bearable, and be thankful for them.

• Give back to the NHS and your carers by providing thanks and constructive feedback. Share vital information with other patients and carers. Get involved in research, service improvement and design and volunteering for your local NHS and charities.

• Eat well, Relax, Sleep – even more important when you’re ill.

The CLANGERS model equally applies to staff engagement and wellbeing. Health systems will always be high pressure places to work and so need to comprise of resilient organisations that support the mental health of the staff, encourage learning, are free from fear, bullying and blame and encourage everyone – patients, carers and staff alike – to speak up, feedback and continuously improve.

Ultimately, patients and carers must be handed as much control and responsibility as they want, and supported to live lives governed by their own goals and values, not the mass-produced end points of clinical trials. The best population evidence has to be combined with empathy for the individual. There is no single structure for healthcare provision that works in any context, and to continually seek the perfect structure in the NHS has proven to be hugely disruptive and disastrous for morale. Different models and structures will work in different parts of the country, but they must be built around common values and understanding of the needs of the individual. If each person can go about their daily CLANGERS, united by compassion, candour, competence and collaboration, then we can rediscover a values based service that is also effective and affordable.

Conclusion: competent, compassionate, cost-effective collaboration

In the 34 years since I first set foot on an NHS ward, I’ve lived through a dozen major structural reforms, more ideological than evidence-based, seldom embedded long enough to prove their worth before being uprooted by the next political vanity project. So I’m loathe to suggest any structural miracle pill for universal healthcare. Continuous evidence-based improvement is far more likely to work, raising the quality bar a little at a time, as resources allow. Consultations – or rather meetings between experts – must be long enough to be safe, effective, enjoyable and meaningful. Transparency and accountability must embrace innovation and learning from failure. The spirit of competent and compassionate collaboration must triumph over competition.

Patients and carers must have as much choice and control over their illnesses as they – and a fair system – can manage. Anyone must feel free to speak up and challenge, knowing their concerns will be acted on. Pure knowledge, like pure water, must be available to all who need it. Communities must promote health and meaningful work for all, and we should all be taught the skills of resilience from a young age. The healthy must accept responsibility for trying to remain so, and society must support them. Artificial divisions must melt away (self-care, healthcare and social care are all care). And all of this care must be prudent, and mindful of the cost for the planet and the payer. The minimum necessary intervention is usually the kindest and the least obstructive. We have but one wild and precious life, and we want healthcare to improve us, not imprison us. Release the joy of your inner CLANGERS.

Above all, we need Collaboration to solve the complex problems facing us. It was defined brilliantly by Margaret Heffernan in her book ‘A Bigger Prize

‘Innovative organizations thrive not because they breed superstars but because they cherish, nurture and support the vast range of talents, personalities and skills that true creativity requires. Collaboration is a habit of mind, solidified by routine and prepared on openness, generosity, rigour and patience. It requires precise and fearless communication, without status, awe or intimidation. Everyone must bring their best. And failure is part of the deal, an inevitable part of the process to be greeted with support, encouragement and faith. The safest hospitals are those where it’s easiest to acknowledge an error. The biggest prizes grow as they are shared.’

I believe politics would lead to much more progress if we adopted this constructive, collaborative scientific approach to all the great challenges of our time – Brexit, improving public health, reducing poverty, funding public services and pensions, caring for an older population, Global warming etc. I also believe we need experts rather than politicians overseeing their fields of expertise (education, pensions, health etc). The issues facing us are far too complex for politicians with little or no experience and damaging tribal loyalties to flit in and out of every few months. Time to put some grown-ups in charge.

August 27, 2018

Why go into politics at the age of 56? and other questions…
Filed under: #VoteDrPhil,Private Eye — Dr. Phil @ 4:10 pm

On August 21, I was sacked as a BBC presenter for tweeting I intended to stand against my local MP, Jacob Rees-Mogg, at the next election. Here are the answers to all the questions I’ve been asked since by incredulous journalists, friends, family members, NHS colleagues, patients and potential constituents.

Why on earth would you want to go into politics at the age of 56?

I have had a very lucky, varied and interesting life, and have no great desire to spoil it by a descent into politics when I could be walking the dogs. As others have observed, politics is often just show business for needy narcissists, when it should be a means to change the world for the better. However, I’m so alarmed at the rapid rise to power of my local MP, Jacob Rees-Mogg, and where he may be leading us with his brutal Brexit and endorsements of Boris Johnson and Donald Trump, that I feel compelled to speak up and challenge him. You don’t have to read any further.

For over 30 years, I’ve tried to improve peoples’ lives as a doctor, health writer, journalist, broadcaster, campaigner and comedian. And good politics – the compassionate and responsible way we exert power over one another – is vital to each of these jobs. The UK is a fantastic place to live (I chose it over Australia) and by far the greatest benefits to us – and to mankind – have come from scientific methods and progress. And yet too much politics is bad science or, as George Orwell put it, ‘a mass of lies, evasions, folly and hatred.’ I think there is an urgent need to put science and its humanistic values at the heart of politics, to make decisions based on evidence and empathy, not ideology and bias. It’s an approach I call intelligent kindness, taken from a book of the same name that seeks to reform the culture of healthcare, where continuous untested political reforms and bad science have greatly harmed patients and slowed progress.

It sounds a bit snowflake. Rees-Mogg will eat you alive

He can try, but he’ll find I have a solid Australian spine that relishes a tough fight

What’s so special about the scientific method?

In science, you ask a question that really matters to you and then try to work out what the most probably answer is. So you form a hypothesis, design a fair experiment to test that hypothesis and then modify your hypothesis depending on the results. You may also want to repeat your experiment to test if the results still stand. Crucial to this is that you try to eliminate bias, and admit and learn from error and failure. Indeed, nearly all great progress is made incrementally, with lots of modifications and U-turns on the way. And the spirit of scientific progress demands collaboration, which is brilliantly defined by local hero Margaret Heffernan:

‘Innovative organizations thrive not because they breed superstars but because they cherish, nurture and support the vast range of talents, personalities and skills that true creativity requires. Collaboration is a habit of mind, solidified by routine and prepared on openness, generosity, rigour and patience. It requires precise and fearless communication, without status, awe or intimidation. Everyone must bring their best. And failure is part of the deal, an inevitable part of the process to be greeted with support, encouragement and faith. The safest hospitals are those where it’s easiest to acknowledge an error. The biggest prizes grow as they are shared.’

I believe politics would lead to much more progress if we adopted this constructive, collaborative scientific approach to all the great challenges of our time – Brexit, the NHS, social care, pensions, Global warming etc etc. And that’s what I’ll be campaigning for.

So how would you have done the EU referendum better?

The NHS has a vital organization called the National Institute of Health and Care Excellence (NICE), which examines all the available evidence and reaches a collaborative decision on what treatments have been proven to work and whether they offer sufficient value to the taxpayer based on their cost. The process is very open, transparent and the evidence can be challenged by anyone. I have chaired the NICE annual conference for over 10 years and it is an excellent example of helping healthcare get the best for patients using proper science.

I would argue that we also need a truly independent political equivalent which examines all relevant evidence on any particular issue with equal scientific rigour to inform policymakers and the public. Had such an organization been in place prior to the Brexit referendum, people would have been better able to make a more informed choice. As it was, the referendum could be summarised in the line: ‘Do you like your life as it is, or do you want what’s in the magical mystery box?’ (knowing that whatever’s in it, you’re going to make life really tough for decades for those awful politicians.’) Everybody loses in this game.

Like forming the NHS and joining the EU, Brexit is a huge social experiment, the evidence for which will unfold over time and we need to adjust our position as it does, even if it means admitting error and failure, and changing direction. That is not project fear, it is simply good science. As Winston Churchill observed; ‘Those who never change their mind never change anything.’

How did you vote on Brexit?

I voted to remain in the EU, because I inhabit an NHS and science ‘bubble’ where people whose opinion I trust and value were saying that, on balance, it would probably to more harm than good to leave not least because of the opportunity cost of diverting all that time, money, effort and manpower to trying to solve and extremely complex problem, when our public services are in dire need of attention and improvement after such prolonged austerity. Also, we need close collaboration with Europe to staff our public services and develop new drugs and treatments, and to have to re-negotiate new collaborative partnerships could jeopardise progress. And if the economy struggles after Brexit, so will the NHS.

The referendum should have included those aged 16 and above, as they will have to live through the long term consequences, both good and bad. However I accept the democratic vote, and had I voted to leave I would be furious at the tribal incompetence our politicians have shown since. The best chance Brexit ever had was if grown-up politicians who strongly supported it from all parties worked together to come up with the best possible evidence-led plan. The fact that this hasn’t happened shows how hopeless our tribal system of politics is in tackling such complex problems. What matters to politicians is what team you’re on, not what the science shows or what’s best for the people.

Should there be a People’s Vote on the final Brexit deal?

There will be a vote either way, specifically on the Brexit outcome or more broadly at a general election, and I would welcome either eventuality. If there is a People’s Vote it must include those aged 16 and above, many of whom care passionately about, and want to have a say in, their future.

Can we trust a comedy doctor to have serious beliefs?

I hope so. I’ve always done comedy with a message. I believe that the central ethical dilemma in life – politics, healthcare, business, comedy, sex – is the compassionate and responsible use of power. Every decision or behaviour can be usefully analysed in this way. Has my MP/GP/husband/boss used his or her power compassionately and responsibly?

I believe all citizens should be taught, encouraged and permitted to think critically and demand evidence, so they can use their own power responsibly and not fall victim to abuses of power.

I believe science is the best method we have for understanding the world and predicting the future, and politics must fully endorse and embrace its methods.

I believe health is our freedom to live a life we have reason to value, and we should all have that opportunity. Politics should relentlessly focus on adding value to people’s lives through proper science, rather than waging tribal war.

I believe good public services are the cornerstone of a healthy, happy, productive society and we should see our taxes as a badge of honour for living in such a civilised society rather than something the government grabs off us.

I believe there is good evidence that investing in public services is a boost to the economy rather than a drain on it. Better education leads to better health and life circumstances, and the effect on the economy of people unable to work because the NHS cannot treat them is a timely way is significant.

I believe we should be prepared to pay more tax – particularly those of us on higher incomes and large corporations who use any number of accountant-driven off-shore ruses to avoid tax. In return we should insist the tax is spent wisely and fairly on evidence-based and properly trialled interventions that are proven to work. There is no evidence that the marketization and widespread outsourcing of healthcare in the NHS under Labour, the Coalition and the Conservatives has been money wisely spent. We should be able to see precisely where our tax is being spent, locally and nationally.

I believe the government has seriously overdone austerity to the extent that it has caused widespread avoidable harm to many peoples’ health and livelihoods, as well as for public services, and strangled economic recovery.

I believe all major political parties, by their constant infighting and failure to collaborate, have left us ruinously ill-prepared for Brexit

I believe any Brexit will make the parlous state of the NHS worse in terms of finances, staffing, research and access to drugs and treatments

I believe the harder Brexit and no-deal scenarios endorsed by Jacob Rees-Mogg, risk being especially harmful to the economy, peoples’ livelihoods and public services for some years to come, and certainly before major benefits accrue (which even JRM admits could take up to 50 years)

I believe Jacob Rees-Mogg’s endorsement of Boris Johnson and Donald Trump would – if he continues his ascent to power –send this country in a disastrous direction. I doubt people voted to take back control only to put America first. Throw in a car-crash Brexit and a desperation to strike any trade deal going, and Trump could crush us. I’d far rather stay close to Europe, for all its flaws, than snuggle up to Trump.

I believe all this bad news would be better coming from a doctor. And even though I’m very unlikely to win, I have plenty of positive ‘health for all’ messages I want to spread wider, particularly about the importance of sufficient sleep and intelligent kindness to our personal and economic survival in tough times.

I believe the voting age should be lowered to 16, especially for any vote on the Brexit outcome. Those likely to be most affected in the future must be heard,, and should have been allowed to vote in the initial referendum

I believe we need to put ‘soil before oil’ to ensure our economic policies are also safe and sustainable for our planet.

I believe all patients should be fully involved in decisions about their care, if they want to be, and that all of the scientific studies for all treatments currently in use should be published and freely available to all. The more information patients are given, the more likely they are to decline treatments of marginal or unproven benefit.

I believe we should cherish bona-fide whistle-blowers in all walks of life. People who risk their health, job, wealth and family relationships to raise concerns about potential serious wrongdoing or harm are my heroes. None of the scandals I have exposed in 26 years as an investigative journalist would not have come to light were it not for the combination of brave and determined relatives and whistle-blowers. They are the canaries in the mine, and we need to protect and listen to them.

I believe people should have more choice over how and when they die, and am a patron of My Death, My Decision.

I believe politicians and doctors should be allowed to be human, and to make human errors, provided they admit to and learn from them, not cover them up. Like all doctors, I don’t always take my own advice but I always strive to learn from failure and error, to continuously improve, to be kind to those in need and to stand up to bullies and those who would harm us. I have a track record for doing this both as an NHS doctor and an investigative journalist

Why have you decided to stand for the National Health Action Party?

The NHA Party was founded by passionate doctors who felt it was their moral, as well as professional, duty to speak up for proper science and tell the truth about the state of the nations’ health and health services, and the danger this posed – and still poses – to patients. It has a broad agenda reaching far beyond the NHS and it’s excellent 2017 manifesto is downloadable here.

The NHA Party’s aims are my aims

• To campaign on the social determinants of health, for improved public health and for a healthier society.
• To campaign for a high quality, publicly funded, publicly provided and publicly accountable NHS which will entail:
• renationalisation in order to regain a universal and comprehensive National Health Service
• opposition to privatisation and outsourcing, especially to profit-based companies,
• adequate funding and staffing for the NHS, so as to achieve optimal cost effective health and social care
• To campaign for our positive vision for the NHS and social care.
• To work towards a fairer, more accountable political system with greater democratic involvement of the people, especially by making evidence-based information easily accessible to all.
• To call for greater investment in public services, and campaign against the privatisation of public services and government austerity policies.

The founders of the NHA Party also felt that all of the major political parties had let the NHS down badly in recent times. The Labour of Tony Blair and Gordon Brown invested significantly more in the NHS, which drove up standards and reduced waiting times, but also introduced ‘the constructive discomfort of market competition’. This lead to a large number of corporations plundering the public sector, with rip-off Private Finance Initiative deals and crippling interest rates that have left many hospitals drowning in debt for quarter of a century. And when the loans are finally paid off by us, we won’t even own the buildings. It would be hard to imagine a worse use of public money.

The Conservatives, with the collusion of the Liberal Democrats, then introduced the Health And Social Care Act 2012 – probably the most disastrous piece of legislation ever for the NHS – which heralded a hugely wasteful acceleration of market competition, widespread poor quality, profit-driven outsourcing, and a fragmentation of the service that has made joined up care for patients near impossible. Just servicing the administration costs of this unnecessary market, including repeated competitive tendering, legal and accountancy fees, has diverted billions away from patient care. And the management consultancy fees handed over by baffled and fearful NHS managers trying to make sense of this ever changing chaos, are staggering.

Since 2010, just about every important measure of quality and safety in the NHS – from waiting times in casualty, to waiting times to for cancer care, to time taken to see a GP, to access to mental health services or new drugs and treatments, to the overall satisfaction of patients with the care they are receiving – has deteriorated badly. The political right use this as a weapon against the NHS and an excuse to introduce an insurance-based system (the classic ‘run down a system to make it fail, then sell it off’ tactic). There is no perfect health service anywhere. Not one delivers the highest quality care to all its citizens but – in terms of value for money – the NHS is one of the best and on outcomes, one of the worst. I believe this is due to a combination of poor public health, widespread poverty, understaffing and underfunding – rather than a problem with the structure and funding streams of the NHS. A single payer universal health system will always be more efficient and fairer than a multi-insurance system.

Hasn’t the Government just put a lot more money into the NHS?

In its 70 year history, the average annual funding increase has been 3.7%, to absorb the costs of inflation, new treatments and the demands of patients living longer with diseases that previously killed them. From 2010 we have had eight years at 1% funding growth, the strictest politically-enforced rationing program in its history. This year, the Office for Budget Responsibility concluded the NHS would need 4.3% growth a year to stay on the road. The Government has pledged 3.4% for the next 5 years, which isn’t enough to halt the decline of universal care, and insisted the money be ‘wisely spent’ after wasting billions on the marketization and fragmentation of its disastrous Health and Social Care Act.

The ‘birthday present’ applies to the NHS England budget only, and omits any funding increases for health education, training, public health or social care, all of which are critical to NHS survival. The economic argument for investing more in health remains strong, particularly with the workforce gaps created by Brexit. In December 2017, there were 97,000 vacancies in hospitals alone according to NHS Improvement, and 4 million people on NHS waiting lists, many of whom will be hampered in their ability to work until they are treated. Others will be taking time off work to care for them and for nearly 1 million older people who no longer get access to the social care they need. At around £2000 a treatment, it would cost £8 billion just to clear the waiting list. English hospitals are currently £2 billion in debt, and GP practices and care homes are closing every week. Add in the promised staff increases, pay awards, building repairs, ‘transformation funding’, working capital loans and IT funding, and that adds another £8 billion to find. And yet the government is offering £4-£4.5 billion a year extra, and simply can’t recruit and retain sufficient staff. So I welcome any increase in NHS funding but don’t expect massive improvements, not least because funding won’t kick in until 2019

Are you blaming anyone for the state of the NHS?

I think it’s all our responsibility. We have consistently voted to live in a low tax economy for over 30 years, so unsurprisingly our public services are in a far worse state than our EU neighbours who invest more. If we’d matched Germany’s GDP spend on health since 2000, we’d have invested an extra £260 billion into the NHS. Imagine how good our NHS could have been? Instead, we are facing another winter of queues around the lock in emergency departments, patients denied vital cancer drugs and having to crowd-fund out of desperation and deaths on waiting lists.

So the NHS is just simply wonderful and all it needs is more money?

No, it too needs a more scientific approach. Billions have been wasted on pointless reorganizations, terrible value outsourcing and PFI deals, IT failures, management consultancy, litigation and mass screening, over-investigation and over-treatment of no proven value. I am certainly not an apologist for the flaws in the NHS. As well as working in it over 31 years, I have investigated it for Private Eye for 26 of those years. When necessary, I am highly critical of the NHS and my own profession. I broke the story of the Bristol heart scandal back in 1992, thanks to a very brave whistleblowing anaesthetist called Steve Bolsin, and advised parents not to take their children to Bristol for complex heart surgery because too many babies were dying and being brain damaged. It lead to what was then the largest public inquiry in British history, to which I was asked to give evidence.

I have sent my life as a journalist supporting NHS whistle-blowers and concerned relatives to help expose wrong doing and unsafe care in the NHS. I passionately believe the NHS needs to adopt a universal safety culture with zero avoidable harm to patients. But I know this will never happen without sufficient staff and legally mandated safe staffing levels so doctors and nurses aren’t overwhelmed by the demands of a dangerous workload. The NHS is so understaffed that it causes widespread harm to staff as well as patients. This can only end if we pay for more staff to cope with our ageing population. And we allow them to admit to failure and honest mistakes without fear of criminalisation.

The scandals I have exposed in the NHS are not because people have made errors or mistakes, but because these errors have been covered up systematically and repeatedly to protect professional, political and institutional reputations. In the case of Bristol, the department of health was well aware that the results for heart surgery from the late eighties to the mid- nineties were truly shocking, and yet gave the unit the green light and the funding to carry on. This scandal was, in my view, corporate manslaughter that could be traced right up to the government. Many scandals since have followed a similar ‘pass the buck for the blame’ onto the lowly NHS worker (e.g. Dr Hadiza Bawa-Garba) to protect the reputations and cover up the failings of those higher up the food chain. So yes, there is still plenty to do to improve the NHS, and to introduce a proper duty of candour into public and professional life. As Maria Shortis, a Bristol heart baby mum and campaigner told me; ‘You can’t trust anyone who doesn’t tell you the truth’. The harm caused by cover-ups in the NHS and elsewhere is usually far greater than the harm caused by the initial error or failure. And if you don’t admit error and failure, you can never learn from it and stop it happening to others.

Are you afraid being put on the spot and not knowing an answer?

No. One of the absurdities of politics – and to some extent doctoring – is that you’re expected to know everything and have an answer to everything, and not to make mistakes or ever admit failure. These are simply ludicrous expectations that have to change. In every other walk of life, we learn by admitting our ignorance and our failures, accepting uncertainty and then working collaboratively to solve complex issues rather than view them through the childishly simplistic prism of left or right politics.

I don’t know how to solve the Brexit Irish border problem, and if someone asks me that’s what I’ll say. But the answers to complex problems only come when intelligent, compassionate people of whatever political persuasion are free to admit ignorance and work collaboratively. And crucially, if an experiment or proposal cannot be shown to work, it’s vital to change your mind rather than repeating your failures to destruction. So much of our politics is simply bad science.

Why did you announce you were going to stand for Parliament when the election may not be until 2022?

This may well have been my first big mistake, given that it’s cost me a job as a BBC radio presenter that I absolutely loved. Given the parlous, Brexit-obsessed state of British politics, there could be another election at any time in the next three years. So at the risk of annoying the wonderful Brenda from Bristol, I thought it was better to declare my intent to stand now, while the boundary changes are still being decided and I can steal a march on the other parties, who can’t select candidates until parliament has approved the changes. When the election is announced, every man and his dog may want to stand against Rees-Mogg, so small party and independent candidates will just get drowned out in all the angry anti-Mogg shouting.

Aren’t you nearly as posh as Jacob Rees-Mogg?

I’m more of your faux posh. My CV smells posh – Marlborough College, Cambridge and St Thomas’ Hospital – but my background is mixed. I was born in Marlborough in 1962, and my parents were teachers. My Dad was a very unposh Australian but a brilliant chemist, who got an international scholarship to do a PhD at Cambridge in the fifties where he met my mum, who was doing her teacher training at Homerton. Dad then got a job teaching chemistry at Marlborough College whilst trying to persuade Mum to move to Australia. He found Marlborough a bizarre and superior place – the teachers, all ex-public school and Oxbridge, were called ‘beaks’, the years were called ‘hundreds’ and ‘remove’, and the school even had its own pack of beagles. But he was a highly committed workaholic and a brilliant teacher, and he just got on with it.

We moved to Perth in 1964 (when I was two) and my Dad – then a senior lecturer in chemistry – took his life in 1969. My wonderful Mum scooped my brother and I up, and brought us back to Marlborough, where I went to the Grammar School which went Comprehensive. The Master of Marlborough then decided to offer my brother and I funded places in the sixth form, in recognition of my Dad’s service. My brother declined but I took the posh plunge.

And what did you learn?

The teachers were still called ‘beaks’, the years were called ‘hundreds’ and ‘remove’ and the beagles hadn’t gone anywhere. The sport and music facilities were outstanding, as you’d expect for the exorbitant fees. The classes were small, the teaching was excellent and I got the three A’s I needed for medicine and Cambridge with relative ease. What I learned most of all is that a very expensive education buys you confidence, that isn’t necessarily matched by competence or compassion. I was soon able to stand up and answer just about any question with supreme eloquence, and even if I was talking complete nonsense it sounded very convincing. To this day, I am very wary of posh, well-mannered, utterly convincing politicians. They are often completely wrong. What matters far more is evidence and compassion.

Which are worse, Boris Johnson’s Burka gags or Jeremy Corbyn’s Zionist remarks?

We are very lucky to live in a country that cherishes free speech. But to repeat, the central ethical dilemma in life is the compassionate and responsible use of power. Men with as much power as Boris Johnson and Jeremy Corbyn have a duty to use it kindly and responsibly, and to apologise if their remarks have hurt or harmed anyone. I learned this lesson early on as a comedian, in a junior doctor double act called Struck Off and Die. In 1992, at the Edinburgh Fringe, we performed a deeply unhelpful sketch about ME (chronic fatigue syndrome), suggesting that it only affected ‘otherwise healthy, semi-intellectual middle class people with high aspirations and low achievements.’ Nothing could be further from the truth (it’s a deeply debilitating and genuine physical illness that can affect anyone) but we were pandering to the ‘Yuppie flu’ prejudices of the time, and playing to our home crowd of an equally ignorant, largely medical audience. We then repeated the harm on a Radio 4 broadcast in 1993.

After that we got letters, some supportive of a comedian’s right to see humour in anything but others detailing the hurt we’d caused. There was one in particular from a young girl housebound because of her ME for whom Radio 4 comedy was her particular joy. We had made her feel suicidal. Not a week goes by when I don’t hang my head in shame at this, not least because I now work in an NHS team helping young people with ME and I hear, first hand, not just the devastation that their illness causes but the devastation that not being believed causes. I’ve even met people who remember what I said 25 years ago, and are still hurt by it. I can’t apologise enough. It was a terrible error of judgement.

Words are how we change the world, for good or ill. And if we’ve chosen the wrong words and caused harm, we should apologize. And the more powerful we are, the more genuine and compassionate that apology needs to be.

What have you contributed to North East Somerset?

I have lived in the Chew Valley since 1996, treating my potential constituents as a GP (in Keynsham and Saltford), a sexual health doctor (in Bristol) and now as part of an NHS team helping children and adolescents with severe fatigue (in Bath). I have been chair of the Chew Magna Society, dedicated to raising funds for local charities and keeping village life alive, and Chair of Governors of Chew Magna Primary School. For five years, I was one of the coaches of a hugely successful youth team at Chew Valley Rugby Club. I write a monthly column in the Mendip Times. I was a founder member of the Stowey-Sutton Action Group, which successfully overturned an application to dump asbestos in Stowey Quarry at a public inquiry. I am a patron of the Valley Arts project, fundraising to create a home for the arts in the Chew Valley. I support many local good causes, such as commentating on the Chew Valley 10K, crowd-sourcing a cancer treatment for a local resident, opening the new Bishop Sutton play area, doing a fundraiser for Bishop Sutton Playgroup and auctioneering to raise funds for Bishop Sutton Primary School and St Peter’s Hospice. And until last week, I had for 12 years broadcast a joyful three hours’ of health and happiness on BBC Radio Bristol as Dr Phil’s Saturday Surgery.

Why did the BBC sack you?

I tweeted this

Honoured to announce that @NHAparty have endorsed me as their prospective Parliamentary candidate for North East Somerset (sitting MP @Jacob_Rees_Mogg) As a believer in progressive alliances, I will stand aside if a stronger candidate declares

I was taken off air the same day, after instructions from BBC high command.

Did the BBC think you would use your Radio Bristol show as a party political broadcast?

I don’t think so. My BBC Radio Bristol boss was well aware of my ‘Keep Our NHS Public-Remain in the EU’ politics, and trusted me over 12 years not to let them encroach on my presenting work, which for the BBC has to be unbiased. The issue was that having declared an intent to stand if no stronger candidate emerges, I might inadvertently use my programme to ‘grow a following’ in a way that would be denied to other candidates. Either they offered JRM his own three hour show or they took me off air with immediate effect. They chose the latter.

And you didn’t see it coming?

No. I’d discussed it with my line-manager who thought I would only have to step down during purdah. Another BBC Bristol radio presenter, John Darvall, had to do this because he was at the time engaged to a Conservative MP (Charlotte Leslie), who would be standing for re-election. However, he was not considered at risk of ‘growing a following’ for her prior to the official election declaration, and no other candidates complained.

So did Rees-Mogg’s people complain to the BBC?

I doubt it. The BBC acted so quickly to take me off air, I can only conclude it was fear of complaints rather than a complaint itself. They said I had a clear ‘conflict of interest’ but in science, you declare a conflict of interest so people can scrutinise your work for bias with that in mind, they don’t punish you for honesty. Ironically, if I’d been dishonest and not declared my intentions until the last minute I could have kept my job and secretly ‘grown a following.’ It seems I have a lot to learn in politics.

On the plus side, I can still be a guest on the BBC and now they’ve accepted I’m a prospective candidate in North East Somerset with something serious to say, they should invite me on every time they invite JRM on (which seems rather a lot for some reason).

Have you stood for parliament before?

Yes. In 1992, I stood as a junior doctor against the Health Secretary William Waldegrave in my constituency of Bristol West. The local Labour party got very annoyed that I would split the left of centre vote, so I campaigned with ‘Don’t Vote For Me but Listen to the Message.’ And the message was simple. Junior doctors were working 120 hours some weeks, killing and harming patients and themselves in the process. I had two strap lines: ‘If junior doctors were prisoners of war, then under the Geneva Convention the sleep deprivation they suffer would be considered torture’ and ‘If we want a better health service, we have to start looking after the people working in it.’ It helped contribute to the subsequent reduction in junior doctors’ hours but I suffered the extreme embarrassment of only getting 87 votes on the night. However, it was worth it not to have to do continuous 81 hour shifts any more.

Surely you only stand a chance if Labour stands aside?

True. Labour and the Lib Dems famously stood aside at Tatton in 1997 to allow Martin Bell a free run at Neil Hamilton, and the local Labour party also agreed to stand aside for Dr Louise Irvine and the National Health Action party challenge to Jeremy Hunt in 2017 in South West Surrey. However, having announced their intent on the Today programme, the three local Labour members were sacked and central Labour imposed their own candidate. Despite Labour’s U turn, the NHA party came a very credible second.

But won’t you just split the centre-left vote and wave Rees-Mogg back in?

Precisely. I’ve said from the outset that if a major centre-left party puts up a stronger candidate, and has the commitment and resources to campaign vigorously, I won’t stand. As a scientist, you have to try to make sense of the psephology and boundary changes in North East Somerset. On September 5th, the Boundary Commissioners will publish their final recommendations. There is likely to be no real changes from the second set of publications that were announced earlier this year, with the DUP now on board and the Conservatives buoyed by suggestions that on a level vote share, they would be 40 seats ahead of Labour. So the review will very likely be passed by Westminster.

In North East Somerset, a large number of wards from Wells constituency (Ashwick, Chilcompton and Stratton, Chewton Mendip and Ston Easton, Shepton East and Shepton West) will be added to the current constituency but the Bathavon North, Bathavon South and Peasedown wards will move to Bath constituency. According to analysis by the NHAP,these changes mean that for Labour to gain the constituency they need a 12.11% swing (which would mean a national Labour lead of 22%). The average polls suggest there is no lead between Conservative and Labour (equivalent to a swing of 1.26% to Lab)

So to win, Labour (and the Lib Dems) need to get their act together now. I hope they choose truly visionary and inspirational female scientists as candidates, perhaps future leaders who can unite their parties and the country (there are far too many posh white men in politics). If I simply get more people to think critically and demand evidence from their politicians as well as their doctors – but in a respectful way – I will judge the campaign a success. Science, not petty tribalism, has to win. And in case Labour and the Lib Dems self-destruct again, I will remain a scientifically-unproven safety-net candidate against the Rees-Mogg superhighway to Johnson and Trump. That’s not a route I want this country to take.

Note: Please don’t donate to my campaign. I would far rather you chose a charity, such as Action for ME, based in Keynsham. Please also take the free Zero Suicide Alliance training. The next ten years could be tough for lots of us, and you could help save a life

August 22, 2018

Filed under: #VoteDrPhil,Private Eye — Dr. Phil @ 9:17 am

Dr Phil Hammond is very sad and a little puzzled to have been dismissed by the BBC from his Saturday morning show on BBC Radio Bristol, which he had greatly enjoyed doing for 12 years without any complaints of political bias.

The dismissal came after Dr Hammond tweeted on August 21 that he had been endorsed by the National Health Action Party as a Prospective Parliamentary Candidate at the next general election for his home constituency of North East Somerset (sitting MP Jacob Rees-Mogg). Dr Hammond added that he was a believer in progressive alliances and would stand aside if a stronger candidate declared. He was sacked the same day.

Dr Hammond had previously announced his intention to stand on BBC 1 (Sunday Live, July 29) with no comeback, and had told the head of BBC Radio Bristol, Jess Rudkin, of his intention. He was advised that it should not be a problem but that he would have to stand down during purdah. Because the date of the next election is very hard to predict, Dr Hammond decided to declare his intent early to be completely open and transparent.

Dr Hammond has worked in the NHS for 31 years (mainly part time) and assumed the same public service rules would apply to the BBC. Doctors are allowed to carry on doctoring if they declare they wish to stand for parliament or become a priest, but they must not let their political or religious views into the consulting room. Likewise, BBC presenters (in this case one with many years’ experience and no previous complaints) should be trusted to broadcast without bias despite their declared political affiliations. Dr Hammond said ‘I strongly suspect whoever made this decision has never listened to any of my broadcasts. Such a sudden decision smells strongly of fear. There is no political bias on the Saturday Surgery, just three hours of health and happiness with some live music. I shall really miss the fantastic team at BBC Radio Bristol and all the loyal listeners. It’s been a hugely enjoyable 12 years.’

You can listen to Dr Phil’s final Saturday Surgery here and judge for yourself

Notes for Editors:

Dr Hammond got the idea to stand for parliament from his audiences.

‘This year, I’ve been touring the UK celebrating 70 years of the NHS and canvassing ideas for a ‘People’s Plan’ to keep the service afloat in the future. So far, the majority of my audience members (admittedly not a random sample) want to restore the government’s legally binding duty to provide universal healthcare rather than just ‘promote’ it, which has allowed a whole range of services to be cut or cut back. They are prepared to pay more for public services, but only if the money was spent on supporting frontline services that are proven to work. They prefer the services to be publicly provided, with outsourcing to the private sector only used if, say, the NHS needed help, and only if the providers were ‘not for profit’ so that any savings go back into the service rather than to shareholders. They want longer consultations with staff they know and who know them (something that’s been proven to improve your care). Above all, they want NHS staff to be safe, unstressed and well-rested, and present in sufficient numbers. Most regular users of the NHS observed staff shortages and exhausted doctors and nurses. My audiences want legally-mandated safe staffing levels for doctors and nurses, starting with emergency care and on-call.

There have been some funny suggestions too. ‘All cabinet members and their families must be treated in the worst performing hospital in the country.’ That could drive up standards faster than anything. I also liked ‘When people who shelter money in tax havens call an ambulance, it has to come from the Cayman Islands.’ There was a strong feeling that tax should be seen as a badge of honour for living in a civilised society rather than money the government grabs off you. If we’d matched the percentage of our GDP that Germany has put into health just since 2000, we’d have put an extra £260 billion into the NHS. Think how fabulous the service could be with that level of investment. A few suggestions were brilliant in their simplicity. ‘For one day a year, doctors and patients should tell each other the truth.’ And ‘Replace hospital beds with bunk beds. Bed crisis sorted.’ One of the most popular suggestions was the most unlikely. ‘Dr Phil for Health Secretary.’

I have promised to give this my best shot, although I’ll somehow have to leapfrog my sitting MP, Jacob Rees Mogg, first. My philosophy is that ‘health for all’ should be the political consideration and ambition that overrides all others. Without health – our freedom to live a life that we have reason to value – then life itself seems pretty pointless. And politicians should relentlessly focus on adding value to all our lives rather than settling their petty personal rivalries. I’ll be standing for the National Health Action Party in North East Somerset. You can read our 2017 Manifesto here. I hope I can count on your vote, whenever it is.’

Dr Phil will be celebrating the NHS in Bradford upon Avon on September 14, Clevedon on September 15 and Bristol on November 18. Come and shape my manifesto

June 28, 2018

Private Eye Medicine Balls 1473 May 11, 2018
Filed under: Private Eye — Dr. Phil @ 3:20 pm

Kids First?

Health and Social Care Secretary Jeremy Hunt has been busily briefing that the NHS will get a substantial funding settlement for its 70th birthday, but how should any extra cash be prioritised for maximum benefit? Hunt is fond of saying that patient safety is ‘paramount’, and yet has singularly failed to enforce legally mandated safe-staffing and skill mix levels that are essential to patient safety. Patients, and members of staff, are avoidably harmed every day in health and social care because of staff shortages right across the service. So where should Hunt and NHS England start to reverse this wholescale avoidable harm?

The law, as enshrined in the 1989 Children’s Act, made it clear that “the welfare of the child is paramount”. Adopting this legal principle would mean that in any situation the right of children to be both protected from avoidable harm and to live healthy lives should override all other concerns in health and social care. So how is England complying with this law? Even if in its narrowest interpretation, protecting children from the risk of abuse, services are struggling. A recent survey by the National Network of Designated Healthcare Professionals for Safeguarding Children (NNDHP) found that there was huge variability across Clinical Commissioning Groups in England in their commitment to resource their statutory obligations, with no logical explanation.

Safeguarding children is highly complex and stressful, and to do it competently costs money that many CCGs are unwilling to commit, even though it is supposed to be their paramount obligation, overriding all others. Doctors, nurses and social workers working is safeguarding are covering populations up to ten times greater than the agreed safe standard. Unsurprisingly, recruitment and retention of staff has become a big problem. CCGs are about to get a big wake-up call as the Children and Social Work Act 2017 kicks in. The Act puts duties on three ‘safeguarding partners’ – the local authority, CCGs and the Chief Officer of Police – ‘to make safeguarding arrangements that respond to the needs of children in their area.’ If they don’t, and failures ensue, all will be held to account for missing child abuse.
Paramountcy for childcare also requires adequately resourced services for children to access. Last year, an angry Justice Munby was forced to blow the whistle to the media to get care for a 17 year old at acute risk of suicide, saying the nation would have ‘blood on its hands’ if a bed could not be found, and that he was ‘ashamed and embarrassed’ at the lack of provision. As the NHS’s longest serving health secretary, Hunt too should be ashamed at embarrassed at the state of child health and welfare.

One in five children in England live in poverty, it’s highest since 2010, and there is clear evidence that the future health of adults is clearly defined by the number of adverse childhood experiences they endure. UK child mortality is not only higher than many other countries but is on the increase, both for the neonatal period and for children under 5. As an excellent review by paediatrician Neena Modi paints a depressing picture. About a third of 10-year-old children are overweight or obese; a quarter of 5-year-olds have tooth decay, self-harm among girls aged 13–16 has risen by two-thirds in the last 3?years and compared with 2015–2016, there has been a decrease in 2016–2017 in coverage of four of the six routine vaccinations at age 1 and 2 years, and coverage for Measles, Mumps and Rubella decreased for the third year in a row, following previous annual increases over 9?years.

Over 80% of obese children will remain obese as they grow older, and this will lead to them losing about 15–20 healthy-life years as adults. Teenagers, even if only at the upper end of normal body weight, have a substantially increased risk of premature death in adulthood. Air pollution experienced in fetal life, infancy and early childhood scars lungs for life, increasing the likelihood of chronic respiratory conditions in old age. As Modi puts it: ‘these are classic examples of societies fouling their own nests, by failing to see the destructive consequences for everyone of not safeguarding child health.’ If child welfare was truly paramount, it would receive ring-fenced funding and all the resources it needed from keeping children safe and secure in the home to providing adequately staffed emergency services when they are admitted with sepsis or meningitis. Hunt, who has overseen the worst decline in NHS performance on record in nearly six years in office, celebrated his longevity (and brass neck) by declaring ‘judge me on my results.’ If he wants to leave a positive legacy, he should ensure the legal paramountcy of child welfare is matched by paramountcy of funding. All our futures depend on it.

Private Eye Medicine Balls 1471 April 27, 2018
Filed under: Private Eye — Dr. Phil @ 3:16 pm

We’re Scamming

Many older people resent being called vulnerable, but to scammers they can be easy prey. Whilst car theft and house burglary have become harder due to improved technology and security, there has been a massive growth in relieving older people of their money, secure in the knowledge that they may be considered unreliable witnesses under fierce cross-examination. Professor Keith Brown from Bournemouth University leads research for the Chartered Trading Standards Institute in the field of financial fraud and scams prevention. He estimates that £10 billion a year may be taken from citizens without their full understanding and consent, and not always by criminals.

Brown cites clear evidence of legitimate companies targeting and repeat selling to vulnerable individuals. He highlights the gap in the protective measures offered by the current definition of mental capacity. People in the early stages of dementia have some form of cognitive impairment, but do not lack capacity as defined by the Mental Capacity Act. Yet they are clearly more vulnerable than the average citizen. Brown cites his own mother, who paid over £3000 for unnecessary vitamin D supplements, and £600 to have her front drive spray-cleaned with a pressure hose, leaving sand all over the road. The law states that an unwise decision is not a reason for intervention if a person has capacity, and is foolish enough to pay way above the odds for something. Governments can legally bankrupt hospitals by signing up to overcharged PFI schemes, just as scammers can charge your mum £500 for gutter clearing.

There are plenty of organisations who charge different rates for the same service or product, simply on the basis that they can get away with it due to the customers’ age, gender, cognitive ability, wealth or relative social isolation. The pension industry runs on differential charging, and many care homes rely on self-funding clients to make up for a shortfall in state funded care. Charities and fundraisers may phone an older person every week for a donation, and it is given each time because the person cannot remember that they already donated last week and the week before. Over 300,000 names have now been identified as circulating on so-called ‘suckers lists’, of predominantly older people who are considered an easy touch. Many of these lists are derived from data shared or sold on by charities and other bodies.

And then there are the sophisticated postal scams driven by criminals. Again, many of these scams rely on people forgetting that they have already bought or contributed, and so respond when asked to pay again. More depressing, a few older people admit to enjoying the social interaction that scamming brings, because it’s the only contact they get. Health and social care services are ideally placed to spot the signs of scamming, but since 2009 the number of people with unmet care needs has grown to 1.2 million. Left alone, people are desperate for company. Professor Brown describes poignant examples of older people pulling out their call blocking device because the only phone calls they get are from scammers. Another man had three garden sheds full of products he’d bought through scamming, and freely admitted that the 10 or more items he received every day by special postal delivery was the highlight of his day. He spent many hours a day responding, believing he was connecting to the outside world in a meaningful way.

The cost of scamming is not just the immediate loss of money. Most people do not enjoy finding out they’ve been scammed, often of their life savings and the loss of confidence and dignity that follows can mean they are no longer able to live independent lives. This has a huge impact on the state in terms of social care provision especially if they can no longer help fund their care if they have been relieved of their wealth. It is currently trading standards who are supposed to prosecute and stop scamming. However, like other local authority services, they have experienced huge cuts in their budgets, with a total spend reduced from £213 million in 2009 to just £124 million now. Five trading standard services have a budget of less than £200,000 a year. Many feel they cannot afford to risk a prosecution that relies on the evidence of a vulnerable older person. And most local authorities lack the forensic capability to submit items for analysis including fingerprinting and DNA, to assist with the identification of offenders. Unsurprisingly, the average number of prosecutions per local authority in England and Wales for scamming has remained at one prosecution per local authority per year.

West Yorkshire Trading Standards have bucked this trend and used a ‘suckers list’ of 4500 people from their area. By supporting these individuals, they have saved over £900,000. They estimate that if scam involvement leads to only 10% of victims in West Yorkshire requiring residential care a year earlier than the average person, this would save the local authority £29 million. Time for a war on scamming and loneliness.

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