Tag Archives: NHS

What Boris Johnson should have said to Omar Salem

I have nothing but sympathy for Omar Salem, the dad who confronted Boris Johnson today. Watch the video on the Guardian, here. Omar’s wee one is only a week old, but was admitted as an emergency. When she got to the ward, she wasn’t seen by a doctor for hours. I can’t imagine Omar would have got much in the way of sleep.

It is absolutely terrifying when someone you love is seriously ill. You need to have confidence in the care that they are getting.

I know.

Three years ago, my husband was very seriously ill and spent 51 nights in hospital. He had some superb care from  truly exceptional people. But occasionally things went wrong. This was invariably because of under-resourcing.

I’ll never forget the day that I was on the ward at just before 5pm and I saw one of the health care assistants getting ready to serve dinner. She had been on night shift the day before until 8am that morning. Because the ward was so short staffed, she’d gone home for a couple of hours’ sleep and gone back in to do the lunches because there was nobody else to do it.

That is simply not safe – for her, mostly.

Other stuff went wrong as well. I won’t give you the gory details, but if you only have one person of a particular grade on duty overnight in an entire hospital, they can’t be everywhere they are needed and vital stuff just doesn’t get done.

If Nicola Sturgeon, or then Health Secretary Shona Robison, had turned up on the ward on one of these days, I might well have given them a piece of my mind. As a worried wife, and a human being, not as a Liberal Democrat.

And if I had done that, I reckon Shona and Nicola would have shown me some kindness. They’d have asked questions and listened. Because they are actually kind and empathetic human beings, and because they know that it is important to handle these things well.

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I now know I have PTSD and it is Liberating

I am not quite sure when I first encountered the ‘Black Dog’ but he has pretty much been on the premises for the last ten years. The crash as I like to call it came on 9th October 2009 when the pressures of a full-time job and caring finally took their toll. I remember waking at 3 am, not normal for the heavy sleeper that I always was back then. A trip to the GP surgery, anti-depressants and eventually counselling followed. On Christmas Eve 2010 my employment situation was finally resolved with a redundancy package and with the caring position fairly stable I began the process of coming off the tablets.

In the next five years my sister died aged forty, Daphne’s health worsened resulting in a move to full-time residential care and the senior officer at my old job gave me the run around after I suggested a return in a part-time role. Pretty hard to take from an organisation I gave my life to for more than twenty years. 2015 brought a return to the medication and when Daphne died in 2017 eventually some more counselling. With everything that had happened to me, the professionals had difficulty in identifying my condition so in the circumstances the focus became my recent bereavement.

It was only in the winter of 2018 when I accessed the Time To Talk service again that PTSD was mentioned and everything fell into place. The trauma caused by my work situation was still haunting me particularly through nightmares, whilst the pain of bereavement was easing. Bingo, this new diagnosis was uniquely liberating. On the downside, I waited months for the specialist counselling. The fact that someone has put the finger on what was causing my illness was strangely uplifting.

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Labour claims credit for the NHS, but Liberals laid the foundations

One of the enduring myths of British politics is that the Labour Party was uniquely responsible for founding the National Health Service. “It was the Attlee government’s introduction of the National Health Service which will rightly go down as Labour’s greatest achievement,” says the party’s website. “Labour created the NHS,” maintains the party’s shadow health secretary.

But this partisan, somewhat sentimental version of history has been demolished over the years by historians of the welfare state. In 1995, Nicholas Timmins started his magisterial (and recently updated) study, The Five Giants: A Biography of the Welfare State, by highlighting the vital role …

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Is the Green Paper on Social Care happening or not?

I spent some time yesterday in a long meeting with a local resident. He had cared for his mum for many years and sadly she died. The circumstances leading up to her death and the nursing home care she received tell a grim tale. My local resident called for an investigation and has written numerous letters demanding social care reform. He has written to MPs, Prime Ministers, Parliamentary Health Ombudsmen and the CQC. His activism and call for changes to the system has gone on for fourteen years.

I tell that story to highlight the recent Government announcement that the Social Care Green Paper, which was originally to be published in the summer of 2017, might not be produced after all. There is the suggestion that Boris Johnson’s government might publish a white paper instead.

I think it is all about a General Election – get the white policy paper out with strong proposals so that it looks like the Conservatives are taking action.

However, will it be the right action? The idea of a Green Paper is to bring together experts and have a proper consultation on proposals. One of the things my local resident is calling for is a high-level round-table, cross-party discussion on the best ways forward for social care. There are various views and proposals which should be given careful consideration. I personally like the idea of revisiting the Dilnot Report and capping personal contributions to social care; but I also think basic care should be covered in England as it is in Scotland.

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Chuka’s first parliamentary question as a Lib Dem

Chuka Umunna is no stranger to holding the government to account. He spent four years opposing the Business Secretary, one Vincent Cable. The effect of that seems to have been the formation of a close friendship.

Today he asked his first question as a Lib Dem on a touchstone liberal issue – the benefits of immigration and the awfulness of the Tory Government’s policies:

The King’s Fund says that the earnings threshold in the Government’s immigration proposals, which was mentioned earlier, will definitely impact on the ability to retain and attract NHS staff. The proposals for a transition period during which many social care workers would only be allowed to come here for a limited time with no entitlement to bring dependants will, again, negatively impact on the ability to retain staff. When will this Government realise that immigration is good for our public services and good for our country, and that badly thought out policy in this area that impacts on the retention of NHS staff is wrong and nonsensical?

It’s nice to see him down as a Lib Dem in Hansard, too.

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12 June 2019 – the overnight press release

Missed waiting time targets put lives at risk

Responding to a report conducted by the Public Accounts Committee which concludes that the failure to meet waiting time targets is putting lives at risk, PAC member and Liberal Democrat MP Layla Moran said:

This report provides a vital contribution at a time when the Government is reviewing waiting time standards. The delays we are seeing not only put lives in danger, but extend the time patients and families are struggling with worry, stress and pain.

With waiting times being missed on this scale, the Conservative Government must not scrap waiting times, but ensure

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The NHS is not for sale

If you had still had any illusions that our NHS would survive Brexit, these will have been dispelled by the statement of Trump’s ambassador that, “The US will want business access to the NHS in any trade deal”. Indeed, some have speculated that access to the NHS, along with the rest of the economy, is the real reason behind Trump’s visit.

This should come as no surprise, for the “Stronger In” campaign always warned that the country could have Brexit or the NHS, but not both.

The NHS has long been admired by many Americans for its efficiency compared to their own expensive system, at the same time as our own politicians paradoxically sought to emulate the US model by introducing market forces and business practices.

The problem posed by copying Trump’s way of doing things is that we risk losing the close cooperation with Europe that has brought us so much success. A huge threat to both the staffing of the health service and Britain’s leading role in research, is the abolition of free movement. Free movement has been the catalyst for medical advance, enabling the sharing of experience and knowledge as researchers move seamlessly between countries. And on hospital wards all over the country, skilled nurses from many European countries have played a vital role.

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What would we do without the NHS?

Our family has used the NHS more this year than ever before – all five of us have seen consultants for a range of ailments.

Yesterday my husband saw the Haematology team to be told his cancer was in remission. We left the hospital grateful for the good prognosis, and thankful that we lived in a country with high-quality health care. Over the course of his treatment, from hospital stays to bone marrow biopsies, from chemotherapy to scans, we have been impressed with the professionals overseeing his care. We have not been made bankrupt through high medical bills and he had time off work for his recovery. It was horrendous and worrying, but the NHS was there for us.

However, lack of government funding means that not everyone is getting the same quality of care we have experienced. Recent stories in the papers highlight the shortfall now being experienced by many hospital trusts. There was a combined overspend of around £850 million by ten NHS hospital trusts in England in 2018. Funding per patient has been cut year by year since 2010.

The data is harrowing. Whilst my husband had a good experience with his cancer treatment, the statistics show many others do not.

Four of the cancer waiting-time standards were failed: two-week GP referral to first outpatient appointment; 14-day referral to first outpatient – breast symptoms; 62-day (urgent GP referral) waiting time target for first treatment; and 62-day screening from service referral.

These waiting times didn’t apply in the same way to us as my husband was hospitalised with a severe infection and in trying to figure out the cause of the infection, cancer was found. But for those being referred by GPs for outpatient appointments, the delay of treatment and the extended worry whilst waiting for an appointment adds even more stress to the uncertainty one experiences before receiving a diagnosis.

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Brexit: bad for doctors, worse for patients, but there is hope

The medical profession has always been staunchly opposed to Brexit. Even before the 2016 referendum the British Medical Journal predicted dire consequences, and whilst the pro-European tone was slightly subdued in the immediate aftermath, criticism has become more vehement as the process dragged on.

Last week the BMJ reported on a meeting of 150 doctors in Belfast who found “little to feel positive about”, not least the bizarre prospect of emergency ambulances being stopped when they crossed a hard border. A leading article (pictured) considered the plight of EU-qualified doctors who comprise …

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9-10 February 2019 – the weekend’s press releases

It may be that Parliament is at a bit of a loose end whilst the Government argue amongst themselves over Brexit, but that isn’t to say that there is much for Liberal Democrats to be stirred by…

  • Government ferry plan hits the rocks
  • UK citizens to be left without medical cover in event of no-deal Brexit
  • No specific funding for NHS in no deal scenario
  • Stone: Immigration rules for Commonwealth soldiers are outrageous
  • Cable: PM’s meaningful vote timeline irresponsible and insulting to parliament
  • UK must support Turkey’s stand on Uyghur crisis – Carmichael

Government ferry plan hits the rocks

Responding to news that the Government has scrapped its …

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20 November 2018 – today’s press releases

Another busy day, but I’m pleased to note that a bit more use is being made of our Spokespeople in the Lords. After all, there are rather more of them than in the Commons, and they’re a valuable asset when it comes to holding the Government to account…

  • Cable: Bank of England must conduct honest assessment of Brexit deal
  • Cable: Govt must block Interpol election of Alexander Prokopchuk
  • Tories to blame for missed NHS targets
  • Cable: Our priority is building the momentum for a People’s Vote
  • Vulnerable people put in homes not fit for human habitation
  • The licence fee is not the Government’s to spend

Cable:

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13 November 2018 – today’s press releases

We’ve had a deluge of press releases today, perhaps unsurprisingly, given events…

  • Moran: Isolation booths are a symbol of a broken education system
  • Davey: Brexodus already damaging NHS and social care
  • Lib Dems back move to defeat ‘craven’ Govt over FOBT delay
  • Brexit will derail the gravy train
  • Davey: Tory cuts make our borders less secure
  • Both Tories and Labour must be transparent about Brexit mess
  • Layla Moran: Botched Brexit can be stopped
  • Cable: Deal will be torn apart before ink is dry
  • MPs must now let people have final say on Brexit

Moran: Isolation booths are a symbol of a broken education system

Responding to a report by the BBC …

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A Basis for a National Health and Well-Being Policy?

The Frome Model of Enhanced Care is a GP focussed, community serving and using way of creating, assessing and delivering comprehensive health and well-being skills, services and attitudes, in, with and for a community, at a low to negative net cost. Its administration is remarkably inclusive, heterarchical or flat.

It is so attractive that it merits awareness, analysis, adoption and adaption to spread its remarkable and measured attributes.

It has delivered 5 years of medical care with social cohesion. It saves money and is more enjoyable! Somerset CCG reckons some £2 …

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Demand Better: Liberal Democrat Priorities for a Better Britain

For as long as I’ve been active in politics people have complained they don’t know what we stand for. We may have a reasonable profile for our position on Brexit, but the fact that we’re only the fourth party in terms of MPs makes it even more difficult than usual to gain media attention.

On top of that, the party has more than doubled in size over the last two and a half years, so we have a large number of new or newish members who aren’t as familiar as many of us with the details of party policy or our key priorities for action.

So over the last six months the Federal Policy Committee has worked to produce the paper Demand Better: Liberal Democrat Priorities for a Better Britain, which is available here and will be debated at our autumn conference at Brighton.

We’ve written the paper in close cooperation with the party’s campaigns and communications committees and staff, and we’re using the party’s new slogan as the paper’s title. Demand Better summarises the Liberal Democrat approach to politics in 2018 and highlights our key policy priorities. Should a general election take place in the next year or so, it will provide the core of the Liberal Democrat election manifesto.

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Vince Cable writes…We need to catch up with our European neighbours in fighting Cancer

Cancer is traumatising. It is universal, leaving no family untouched.

I saw this first-hand. Cancer took my first wife, Olympia, in 2001. To repeat what I wrote in my memoirs, that experience showed me that whatever may be said in criticism of the NHS, the capacity of the system to deliver high quality, sophisticated treatment to the acutely sick is so greatly appreciated by those who receive it.

Living with and caring for a cancer sufferer for 14 years led me to want to help others and to use my political position to do so. I campaigned subsequently for wider breast cancer screening, a screening programme for cervical cancer and the introduction of bowel cancer screening.

So many people work so hard to stop cancer: raising money with bake sales, running marathons, nagging our loved ones to eat better, drink less, stop smoking.

In the 2017/18 alone, there were donations of £192m to Cancer Research UK, a further £153m raised from events and charity shops.

But Cancer Research UK is marking the 70th anniversary of the NHS with a campaign to get the Government to commit to invest in training and employing more specialist staff to diagnose cancer early.

This is because, despite all we are doing, all the money we are raising, the UK is falling behind other European countries in the successful treatment of cancer. Olympia had diagnosis and  treatment that showed the NHS at its best. Others have been less fortunate – an IT glitch meant hundreds of thousands of women in England missed breast cancer screenings. 

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LibLink: Sal Brinton; The NHS can’t work without a sustainable social care system

As the NHS turned 70 this week, Sal Brinton looked back at the development of social care policy and outlined the Government’s failings:

… since 2015, the new Conservative Government has dithered and delayed, repeatedly promising that they would sort out the social care funding problem.

We still await the Green Paper promised in the Conservative 2017 Manifesto – with a side skirmish of the Dementia Tax, a form of inverse Dilnot, which so outraged voters it was dropped mid election.

Councils have faced massive cuts to all services, including making £6bn savings in adult social care since 2010. They are still being

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Help our MPs choose their Commons debate – last chance to have your say

Lib Dem MPs have a relatively rare opposition day debate this week. They are approaching it a bit differently by giving you a chance to decide the subject.

What’s particularly brilliant is that you get to vote preferentially too. That’ll be useful for next year’s Ashdown Prize organisers to note.

An email from Alistair Carmichael landed the other day:

On Tuesday 10th July, our MPs have an opposition day debate in Parliament.

This means that we can pick one topic and have MPs debate and vote on it in Westminster.

And we want to hear what you think MPs should be

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Happy Anniversary!

Embed from Getty Images

It’s hot, and our regular supply of posts from you, dear readers, seems to have melted away. But we can’t let today go by without acknowledging the 70th Anniversary of the NHS.

Of course, we can’t do it justice in a short piece, but we can be proud that, for all its faults, we do still have a system that is not only valued at home but also admired by other countries. Indeed, many nations now have systems of health care which are universal and free at the point of delivery, even if they differ in the methods used to achieve that.

Yes, of course there are anomalies in the NHS – dental care and prescriptions are often not free, social care is still not integrated properly with medical care, treatment is rationed by Clinical Commissioning Groups, too many services are outsourced.

But what has always astonished me is the fact that this blatantly socialist project, vilified by many at the time (including the majority of doctors), is now seen as an essential component of British life by people from across the political spectrum. And what saddens me is that the American right still don’t understand why we love it, and have dismantled the progressive systems that Obama carefully constructed.

The challenge over the last 70 years has been for the NHS to keep in step both with research and with societal changes, and that challenge will go with it into the future.

So it is appropriate that Vince Cable has chosen today to highlight quite a niche subject – access to fertility treatment for female couples.  He has written to Sir Andrew Dillon, the chief executive of the National Institute for Health and Care Excellence (NICE), and Health Secretary Jeremy Hunt, about ‘shared motherhood’. This is a treatment that involves one partner donating an egg which is then carried by the other partner, so that both women are physically involved. At the moment it is only available privately at a cost of £6000 per cycle.

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With more money coming to the NHS do we need to rethink how it’s spent?

While some of the major health think tanks such as The King’s Fund say the announced 3.4% increase in annual NHS spending is not enough – and I would agree with that – can we at least use the additional NHS funding more efficiently? I would say it might be worth looking at changing some long-established patterns of patient care.

Let’s start by looking at primary care. Currently it is estimated that around half of all GP appointments are for just two kinds of conditions – musculoskeletal (MSK) problems (accounting for a fifth of all GP appointments) and mental health problems …

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Gosport findings ‘shocking and devastating’

We have all be shocked by the revelations about the inappropriate treatment of elderly patients at Gosport War Memorial Hospital. Here is Norman Lamb talking about the way the NHS closed ranks when he was Health Minister, and how he called for the enquiry that has just been completed.

We also have some quotes from him:

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Theresa May shamelessly takes up discredited Leave campaign slogan

Most of my memories of the Leave campaign involve the blatant lies it told. 77 million Turks, we were told, would pretty much be here the day after we voted Remain, according to their literature. And the biggest lie of all was emblazoned on the side of a bus. £350 million a week for the NHS.

It was the thought of more money for our beleaguered NHS that prompted many people to vote Leave, something confirmed by Vote Leave’s director, Dominic Cummings.

Within hours of the referendum result, that pledge was in tatters. Nigel Farage distanced himself from

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We’re turning away skilled workers

6,000 skilled people were denied entry to the UK last year due to visa caps. The Campaign for Science and Engineering reported on a Freedom of Information request to the Home Office which showed that thousands of workers had been denied entry between December 2017 and March 2018.

The Government have refused over 6,000 applications for skilled overseas workers holding a job offer due to an arbitrary cap on visas, including engineers, tech professionals, doctors and teachers.

Many posts up and down the country are being left unfilled because overseas workers can’t get entry. …

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The Learning Disabilities Mortality Review Annual Report

The Learning Disabilities Mortality Review Annual Report was published recently by the Healthcare Quality Improvement Partnership. In it are harrowing statistics of people with learning disabilities dying far too young.

The report highlights the extraordinarily high incidences of preventable death. The Connor Sparrowhawk case has brought this to public attention recently: a young man with learning difficulties left in a bath unattended, he drowned whilst having an epileptic fit.

Between July 2016 and November 2017, 1311 deaths were put forward for review, often by a Learning Disability Nurse. Of those, 27% …

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New report out shows more paediatric consultants needed

As a mother of three, we have been to A & E more times than I would have liked and have had help from paediatricians and other consultants. The NHS is wonderful!

But sorely understaffed.

A report out today by the Royal College of Paediatrics and Child Health, “Facing the Future Audit 2017”, has recommended drastic increases in staff to meet need. Up to 752 more paediatric consultants are required across the UK: 520-554 in England; 84-110 in Scotland; 84–91 in Wales; and 30-31 in Northern Ireland.

There are clearly not enough paediatric consultants …

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LibLink: Sal Brinton: Ministers must protect our NHS against privatisation

This week, Sal Brinton and others argued in the House of Lords that action was needed to ensure that Brexit didn’t open the door to privatisation of the NHS.

She wrote about the issue for The House magazine:

If you asked most people what effect Brexit would have on our health service, regardless of how they voted in the Referendum, I suspect they will cite that large red bus from the Leave referendum campaign stating the EU costs the UK £350m per week, which on leaving could be invested in the NHS. Not only was this untrue, but there are now figures to show that the cost of leaving to our economy could be equal to £350m per week. And, at a time of unprecedented pressure on the NHS, it needs urgent and real investment to prevent it crumbling.

However, one of the lesser known pillars of protecting our NHS is also at risk with Brexit. With more and more parts of its services being put out to tender, the NHS has been protected by the EU Directive on Public Health Procurement. This directive governs the way in which public bodies purchase goods, service and works and seeks to guarantee equal access and fair competition for public contracts in the EU markets. It was approved in 2014 and includes protection for clinical services and more legal clarity on the application of procurement rules.

She also looked at some of the wider impacts on the Health Service that Brexit will have:

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The dire state of mental health services

The Parliamentary and Health Service Ombudsman’s recent report on mental health provision is damning.

Titled Maintaining momentum: driving improvements in mental health care, Rob Behrens’ analysis confirms what we already know: mental health services are in crisis and people are suffering and dying because of it.

The case studies are harrowing. Mr Behrens’ says:

The cases highlighted in this report starkly illustrate the human cost of service failures. These cases are not isolated examples. They are symptomatic of persistent problems we see time and again in our complaints casework and, moreover, they represent failings throughout the care pathway.

In the most severe cases,

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Growth in infant mortality highlights desperate pressures on the NHS

The annual statistics on stillbirths, infant deaths and childhood deaths in England and Wales were published yesterday by the government. The report also includes data on the causes of death and information on key risk factors.

This report evidences the first two-year increase in infant mortality rates in England and Wales for the last 30 years. Former Health Minister and Lib Dem MP Norman Lamb said:

Infant mortality has been in steep decline for over 30 years. However, this success cannot lead to complacency.

Figures released today show there is a trend towards increased infant mortality rates over the last two years. Losing a child is one of the most heart-breaking experiences imaginable. The government must urgently examine the cause and what might be driving this disturbing reversal of historic falls in infant mortality. The fact that the NHS is under such strain may well be contributing to this.

That is why the Liberal Democrats want to put a penny in the pound on income tax, to maintain and improve standards in the NHS.

At Spring Conference, a motion was passed celebrating the NHS at 70 and recognising the wonderful contribution of NHS staff.

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#TreatMeWell campaign launched today

Mencap has launched its Treat Me Well Campaign today, calling for those with Learning Disabilities to be given reasonable adjustments in hospitals.

The facts are shocking. Every year, 1200 people with a learning disability die avoidably in hospital care.

I blogged this morning on the disgraceful state of PIP and ESA assessments, many suffered by those with learning disability. This is another aspect of how people with learning disability are not listened to, are not enabled, and are sidelined in assessments. This video gives you a good idea of the issues:

I am on the Board of the Fragile X Society. Fragile X, a genetic condition, is the leading inherited cause of learning disability. Thousands of people with Fragile X will have had the experiences show in this video.

It is very easy to make modifications. Allow extra time for appointments. Use simple language. Break explanations down into smaller, understandable sentences. Allow time for mental processing. It’s what people with learning disabilities are asking for.

The Treat Me Well report is well worth a read. Mencap’s research showed (p.25)

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Clever question from Vince shows Brexit threat to NHS

Theresa May’s non-answer to Vince Cable’s question at PMQs today about whether a future trade deal with the US will safeguard the NHS could end up as being one of the turning points of the Brexit debate.

One of the huge advantages of the EU is that you have a lot more clout if you approach a protectionist like Trump with 27 of your mates rather than if you show up on your own.

Watch the exchange here:

The text is below:

Sir Vince Cable

The Prime Minister knows that one of the key objectives of American trade negotiators in any future deal after Brexit is to secure access for American companies to do business in the NHS. Will she give an absolute guarantee that the NHS will be excluded from the scope of those negotiations? Will she also confirm that she has made it absolutely clear to President Trump in her conversations with him that the NHS is not for sale?

The Prime Minister

We are starting the discussions with the American Administration, first of all looking at what we can already do to increase trade between the US and the United Kingdom—even before the possibility of any free trade agreement. The right hon. Gentleman does not know what the American Administration are going to say about their requirements for that free trade agreement. We will go into those negotiations to get the best possible deal for the United Kingdom.

The BBC’s Norman Smith felt that this would not be the end of the matter.

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Our NHS needs money!

Vince has been talking about how we can properly fund the NHS in England and Wales.

 

The full LIb Dem plan is here. It includes five steps for rescuing health and social care services, with the long-term goal being to integrate health and social care into one seamless service with pooled budgets.

  1. An immediate 1p rise on the basic, higher and additional rates of Income Tax to raise £6 billion additional revenue which would be ringfenced to be spent only on NHS and social care services.
  2. Direct this additional investment to the

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  • User AvatarIan Sanderson (RM3) 19th Oct - 8:43am
    @Ruth Coleman-Taylor 'We have all canvassed people who told us that they were not going to vote ......' And also, as a teller, witnessed the...
  • User AvatarPaul Walter 19th Oct - 8:43am
    The Letwin amendment (there always seems to be a “Letwin amendment”) looks as though it will pass and allow the bill to be properly scrutinise...
  • User Avatarfrankie 19th Oct - 8:26am
    And yet Caron enough scared Labour MP's will vote for it coupled with a couple of mad and bad Labour MP's it will probably get...
  • User AvatarRoss McLean 19th Oct - 2:10am
    Yep. This is excellent. Well done Daisy. I hope Norman Lamb reads it. Norman is being reported in the Guardian to be considering voting for...
  • User AvatarRoland 18th Oct - 11:46pm
    @frankie Norway+ is not on offer, at best it is Canada- and if the ERG get their way it is WTO. Actually, if the ERG...
  • User Avatarfrankie 18th Oct - 10:50pm
    I'm afraid John there are too many frightened Labour MP's along with some very mad ones, that coupled with Jeremey tacit support is likely to...