privatisation

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Breaking: Anaesthetists United take GMC to court for pushing non-doctors in doctor roles

Published by Anonymous (not verified) on Tue, 04/06/2024 - 7:19pm in

General Medical Council changed rules to allow ‘associates’ to be exempt from national standards and trusts to set own local standards

A group of anaesthetists under the name of Anaesthetists United (AU) has announced today that it has engaged leading legal firm Bindmans to take the General Medical Council (GMC) to court for allowing unqualified ‘doctors’ – so called ‘physician associates’ (PAs) and ‘anaesthetist associates’ (AAs) whose role is used to extend NHS privatisation and help private medical providers – and the Royal College of Physicians – to make bigger profits, to be confused with doctors.

The roles have also been used to avoid national standards, allowing local health boards effectively to use the roles how they wish. At least two patients, who thought they were being treated by fully-qualified doctors, have died as a result of misdiagnoses by PAs that led to no treatment being given for dangerous conditions.

The government used a backdoor ‘statutory instrument’ to push through recent changes to widen and relax the use of PAs and AAs – opposed only by independent MP Claudia Webbe. Labour then colluded with the Tories to defeat an attempt by Green and independent peers to block the legislation in the House of Lords. Actual medical professionals are horrified at the threat to patients and AU is now taking action.

The group says that the GMC is abusing the term ‘medical professionals’ to include undertrained PAs and AAs as doctors. The legal action crowdfunder explains:

The General Medical Council was given powers under the Medical Act 1983 to regulate doctors and protect the public from those falsely claiming to be qualified when they are not. But instead, we have watched with dismay as doctors are quietly being replaced by ‘Associates’. Worse still, the GMC appears to be actively encouraging this. 

We’ve listened to empty reassurances from the establishment, as the lines between the two professions have been systematically blurred.

We think patients deserve better; they should be cared for by doctors when necessary, should know who is and is not a doctor, and there should be separate regulation underpinning this.

And we’re ready to take action.

What are Physician/Anaesthesia Associates?

Physician Associates and Anaesthesia Associates are a new profession. They are not doctors, they do not have the same training as doctors, but are being permitted to take on many of the roles doctors have traditionally fulfilled. The press have reported on troubling cases. And the General Medical Council, the body legally responsible for doctors’ regulation, has now been given the responsibility of regulating Physician/Anaesthesia Associates too.

(To make it more confusing, an “Associate Specialist” is an experienced doctor.)

So how have they blurred the distinction between Doctors and Associates

Parliament originally made it clear that Associates were to be kept entirely separate from doctors. There should never have been any ambiguity as to who or what a health worker is. But instead, the GMC has made the situation vague and indistinct.

The biggest worry is that the GMC have steadfastly refused to say what an Associate can, or cannot, do to support patients. The precise term for this is their ‘scope of practice’. The GMC have even refused to hold a consultation on it, despite a statutory requirement for them to do so.

So it is left entirely down to market forces to determine scope. This favours using Physician/Anaesthesia Associates as doctor replacements. There is no good reason for this ambiguity: in comparison, the General Dental Council has strict rules on the difference between dentists, hygienists, technicians and the other professions that they regulate.

Worse still, the GMC has confusingly started to use the term ‘Medical Professionals’ to encompass both doctors and Associates. It has even issued guidance on ‘Good Medical Practice’ for both doctors and Associates to share.

We believe the GMC is simply ignoring the law on professional regulation.

You can read our legal case in more detail here.

What are we trying to achieve?

  • Clear and enforceable guidance from the GMC on the ‘privileges of members’ admitted to Associate practice, defining what they can and cannot do (their Scope of Practice) and clear rules on levels of supervision. This can be delegated to the appropriately-empowered Medical College/Faculty.
  • The current ‘Good Medical Practice’ guidance replaced by two separate sets of guidance for the two separate professions, and
  • An end to the use of the ambiguous term ‘Medical Professionals’ used to describe two separate groups misleadingly.

What have we done so far?

On 26th March we wrote to the GMC setting out our case. In their reply they answered some of our points but completely failed to address others. We feel that the only route left open to us is a legal one, and we have had expressions of interest from some top lawyers in the field.

How much money do we need?

We have been quoted the sum of £15,000 to cover the initial costs of a brief and opinion. 

We are working with John Halford of Bindmans LLP, a public law solicitor with experience in the regulatory framework on protected titles, and Tom de la Mare KC of Blackstones. Both of these are highly regarded and respected in their expertise; we need to work with the best.

It is quite possible that a strongly-worded representations from top lawyers will be sufficiently forceful to push the GMC into accepting our proposals. But if not, then the next step is court action. We don’t yet know how much that will cost, although we do know that the GMC has a reputation for spending large sums of public money on defending themselves.

Who are we?

Anaesthetists United are a group of Anaesthetists of all grades. 

Anaesthetists have a reputation for getting things done. We are the group that convened the Extraordinary General Meeting of the Royal College of Anaesthetists, which led to a sea change in the way the medical profession, and the public, have looked at the whole issue of Associates. You can read more about us as a group, and details of our core members, here.

The GMC was set up so that the public could tell who was and was not a doctor. That aim is now being undermined. We urge doctors and patients to come together and fund a legal challenge to restore faith and ensure that patient safety is never compromised. 

Thank you.

If you wish to republish this post for non-commercial use, you are welcome to do so – see here for more.

Private water lobbyist who worked for Cooper claims she will be ‘change’ candidate

Published by Anonymous (not verified) on Mon, 03/06/2024 - 5:33am in

Jade Botterill’s employment history raises questions about her campaign claims and ‘about’ section

Jade Botterill, Keir Starmer’s candidate for the new Ossett and Denby Dale seat, has claimed in her ‘about me’ campaign page that,

Unlike many in politics… I haven’t spent a lot of time in the Halls of Westminster.

However, her Linkedin page reveals that she spent six years in Westminster – first as a parliamentary assistant to the Chair of the Home Affairs Select Committee (from 2016 Yvette Cooper) and then directly for Cooper as her parliamentary head of office:

Her ‘about me’ section also mentioned, according to The Daily Politik, that she worked in PR for petitions site ’38 Degrees’ for about 18 months – the mention now appears to have been removed. However, it makes no mention of her working as a spin doctor for Yorkshire Water, one of the worst sewage polluters of Britain’s waterways:

Instead Ms Bottrill claims, without mentioning her time with Yorkshire Water, that she now spends her working hours ‘holding water companies to account when they pollute our rivers and seas’:

Now, in my professional life, I work to support vital local and national campaigns, like holding water companies to account when they pollute our rivers and seas… These are all key issues facing us across Ossett and Denby Dale.

Ms Bottrill claims she represents ‘change’ and is unlike the usual Starmeroid/Blairite drones who get their selections after working for other Blairite MPs. Her employment history raises serious questions.

If you wish to republish this post for non-commercial use, you are welcome to do so – see here for more.

Starmer unveils ‘GB energy’ logo – a stock graphic for 57p that ‘looks like it’s farting’

Published by Anonymous (not verified) on Fri, 31/05/2024 - 8:43pm in

Great British Energy logo is a cheap stock graphic available for pennies

Keir Starmer has ‘unveiled’ the logo for his ‘Great British Energy’ scam – it won’t actually supply any energy – and it’s a shocker that suggests how little thought and seriousness is behind the whole project.

The logo drew derision from the moment of its publication, with pithy reactions:

Another wag observed that the logo,

looks like a lightbulb farting.

And there may be a reason it’s underwhelmed its viewers – Labour appears to have bought it as a stock ‘vector graphic’ logo for the princely sum of… as little as 57 pence:

The price may have been slightly higher if bought as a one-off.

Great British Energy is a PR con designed to create the impression of nationally owned energy while allowing corporations to make huge profits at the public’s expense. Shadow Business Secretary Jonathan Reynolds admitted as much when he told Utility Week in 2022 that it will not produce any energy, but its purpose would instead be the:

management of the investments, which we believe are essential to unlock these markets and opportunities.

Nothing to do with public energy provision to ensure that UK families do not continue to be ripped off and impoverished by greedy private energy companies making obscene profits, then – just more marketisation of an already broken sector that can only be repaired by full renationalisation.

And it seems that Labour can’t even be bothered to spend a bit of time and effort badging the thing in a credible way.

If you wish to republish this post for non-commercial use, you are welcome to do so – see here for more.

Claudia Webbe MP confirms standing for re-election: ‘people need independent voice for real change’

Published by Anonymous (not verified) on Fri, 24/05/2024 - 8:31pm in

Webbe has shown she will stand for actual change that neither Tories nor Starmer’s Labour are offering

Leicester East MP Claudia Webbe has today confirmed that she will stand for re-election as an independent left candidate.

Elected in 2019, she became the first female to take the seat and the firs Leicester-born MP – and the first Black female MP – ever to represent a constituency anywhere in the whole county region of Leicestershire. Webbe was born and raised in the city and remained there to the end of her university education. Her father worked, with his identical twin brother, as an engineer’s hand at the former Wadkin Factory on Green Lane Road, while her mother – in a city famous for its garment production – was a dress maker who ‘made clothes to last’, who worked for companies like the old Fenwick and Corah & Sons.

Claudia Webbe, left.

Webbe has distinguished herself in Parliament by her fearless campaigning on local and international issues, from dangerous sweat-shop garment factories in Leicester and abroad, domestic abuse and politically-driven cuts to services, to the genocide in Gaza and the oppression of Indian farmers. She was also the only MP to speak out against the government’s dangerous plan, unopposed by Labour, to replace medical doctors with ‘physician associates’ – part of the so-called privatisation drive pushed by both main parties that she has also been vocal in opposing – helping to draw attention to the cost-cutting plan and make it the national issue it has become. She has refused to back down on these and other issues despite a torrent of racist abuse from supporters of other parties and of the oppressors.

Ms Webbe said:

It has been an honour and privilege to serve the people of Leicester East as their MP, representing all communities with passion and integrity, and I will ask them to re-elect me so that I can continue to serve their interests.

My independence means I’ll listen to local people and put them first. I’ll place people and planet over profit and vote for humanity and never against. I will work for justice for Leicester East.

I have shown that I will not stand-by silent while division and damage is done to Leicester East and the needs of the people ignored or injustice is perpetrated elsewhere in our name. After so many years of cuts and cruelty in this country, and wars overseas, the needs of ordinary people in Leicester East have never been greater to have me as their MP, who will genuinely stand up for them and what they care about, and not serve narrow party agendas or corporate donors.

My track record as MP for Leicester East shows that I understand their concerns and that I will work for the issues they care about, from low pay and exploitation in the garment industry and the closure of local services, to protecting access to NHS doctors, to speaking out for justice in Palestine, calling for a lasting, permanent ceasefire in Gaza.

With the support of the people of Leicester East I will continue to campaign tirelessly for real change, real justice and a reversal of the inequality that has enriched a few while the many struggle”.

For more information, visit claudiawebbe.org. Skwawkbox understands that a campaign website will shortly be online and that Ms Webbe will welcome offers of campaign support. Her fundraising page is here.

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Clarke: 100 MP strategy to hold Starmer’s feet to fire

Published by Anonymous (not verified) on Fri, 24/05/2024 - 7:03am in

Left strategist targets key MP wins to resist Starmer when he takes us into war or when he privatises our NHS’

Left-wing strategist Eoin Clarke, who has been at the heart of left resistance and the victories of the Corbyn period before sabotage and smears brought down the then-Labour leader, is targeting a hundred wins in the coming general election for grassroots candidates with the integrity and vision absent from what passes for the Labour party under Keir Starmer.

Clarke has laid out the target, which he has been working on for two years in a project named ‘Wag the dog’, along with a breakdown by nation of what could be achieved ‘to hold Starmer’s feet to the fire’ and resist the Establishment automaton when he tries to take the UK to war or to privatise our National Health Service:

Working with Clarke, the Ordinary Left grassroots activist group will shortly be announcing the socialist candidates, whether independent or associated with an existing party, that it will be recommending to the movement for campaign support. With the widespread disgust with Starmer over Gaza and his breaking of every promise he made to con his way into the Labour leadership, and the recent local election results showing independents and Greens surging compared to Labour and the Tories, and suggesting a potential hung Parliament, achieving the target does not look beyond the realms of possibility.

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Liberalism Against Itself: Cold War Intellectuals and the Making of Our Times – review

Published by Anonymous (not verified) on Mon, 15/04/2024 - 8:53pm in

In Liberalism Against Itself: Cold War Intellectuals and the Making of Our Times, Samuel Moyn dissects intellectual battles within Cold War liberalism through six key figures: Judith Shklar, Isaiah Berlin, Karl Popper, Gertrude Himmelfarb, Hannah Arendt and Lionel Trilling. Teasing out their complex relationships with Enlightenment ideals, historicism, Freudianism and decolonisation, Moyn’s masterful group biography sheds light on the evolution of liberalism and the cause of the Red Scare, writes Atreyee Majumder.

Liberalism Against Itself: Cold War Intellectuals and the Making of Our Times. Samuel Moyn. Yale University Press. 2023. 

Liberalism against itselfIn his most recent book, Samuel Moyn provides a set of intertwined intellectual profiles of six scholars of the Cold War, especially post-WWII era: Judith Shklar, Isaiah Berlin, Karl Popper, Gertrude Himmelfarb, Hannah Arendt and Lionel Trilling. Before I read Liberalism Against Itself: Cold War Intellectuals and the Making of Our Times, I had never come across the term Cold War liberalism. As Moyn clarifies, the term was coined in the 1960s by enemies of liberal ideas (presumably from within the Free World) emerging at the time, blaming “domestic compromises and foreign policy mistakes”. Moyn offers an intriguing argument that liberalism arrived at its current iteration through its defenders in the Anglo-American region during the Cold War.

Moyn offers an intriguing argument that liberalism arrived at its current iteration through its defenders in the Anglo-American region during the Cold War.

Interestingly, all the scholars in Moyn’s study except for Karl Popper are Jewish intellectuals of the post-Holocaust era or are children of American Jewish immigrants. An Austrian émigré in England, Popper was born Jewish but later converted to Lutheranism. Moyn takes great care not to reduce their loyalty to a certain iteration of liberalism to their religious identity (111). He employs an interesting writing strategy whereby he establishes a grapevine of conversations among these six figures and their various compatriot liberals. For instance, Shklar appears as a sharp critic of Hannah Arendt in Chapter five, while Berlin provides a corrective to Shklar’s rejection and blaming of Rousseau for sowing the roots of the red spectre with which the free world was confronted with in the twentieth century.

The first two chapters elaborate on Shklar and Berlin who have divergent attitudes towards the Enlightenment, Romanticism and Rousseau. Both are critical of the Enlightenment to the extent that they find themselves amplifying liberalism’s state-limiting function over its dimension of emphasising creative agency of the individual. They differ on the extent to which the Enlightenment could be held responsible for the rise of the Red Scare. It is in the Karl Popper chapter (Chapter Three) that the plot thickens, as Popper rejects “historicism” by way of rejecting Hegel and his infusion of the idea of progress with Christian “inevitabilism” (77, 80). As Moyn narrates, Popper held that history, if embraced, would mean the inevitable progress as argued for Hegel and later, in Marx’s terms, would lead to a communist version of progress that would usurp liberalism’s dominance. This anxiety made Popper reject the category of history itself. In fact, Jacob Talmon, the “slavish follower” of Popper, described “the idolization of history” as a “nineteenth century novelty” (80).

It is through Hannah Arendt that we see the uncomfortable relationship the Cold War liberals had with the decolonisation movements outside the west

The book reaches a crescendo in the last two chapters on Hannah Arendt and Lionel Trilling, respectively. It is through Hannah Arendt that we see the uncomfortable relationship the Cold War liberals had with the decolonisation movements outside the west; those that claimed the word ”freedom” for colonised populations. As a reader from the postcolony, I found it instructive to read Moyn’s discussion of Arendt’s ambivalence about reconciling her liberalism with the growing liberalisms of the former colonies. In an insightful section at the end of the Arendt chapter (137-8), Moyn discusses how nationalisms of these fledgling nations were objects of suspicion for Arendt and the Cold War liberals while they were eager to embrace the cause of Israel’s nationalism. In the final chapter we witness Lionel Trilling’s strange embrace of Freud’s psychoanalysis, especially Freud’s late work Civilization and its Discontents (1930). Trilling wanted to render a reformed liberalism – one that wasn’t so naïve and shocked at crisis or evil in the world. Moyn writes of Trilling’s use of Freud in working out his own theory of liberty and liberalism (152):

“…..Freudianism affected the theory of liberty. It turns out that people are constrained in the control they can win from the passions, and therefore in the freedom they should have in their self-making. They must use what autonomy they can gain in pitiless struggle with their own proclivities in the service of self-control.”

Trilling’s own treatment of Cold War liberalism […] could have arisen from his repeated attempts to process what he witnessed in Europe in the 1930s as fascism took hold

Trilling’s own treatment of Cold War liberalism, Moyn speculates, could have arisen from his repeated attempts to process what he witnessed in Europe in the 1930s as fascism took hold; Moyn writes that “he rationalized out of it a new liberalism” (153) – a kind of “survivalist” one. Trilling’s move for a reformed and less idealistic liberalism marked liberalism’s slow shift towards the right.

Moyn has written a masterful interconnected intellectual biography of Cold War liberals, unpacking arguments within the liberal establishment about what actually brought about the Red Scare.

Moyn has written a masterful interconnected intellectual biography of Cold War liberals, unpacking arguments within the liberal establishment about what actually brought about the Red Scare. Moyn also makes clear that these figures are not particularly worried about the institutional arrangement that will bring about such actualisation of freedoms and hence, their version of liberalism. Moyn often uses the term neoliberal and I understand that his usage is quite different from the commonplace social science use of that word – which is a political form accompanying the condition of late capitalism. Hence, I would have liked Moyn to delineate his specific use of the term. Moyn does discuss, especially, in the chapter on Hannah Arendt (Chapter Five), the discomfiture of the Cold War liberals with the rise of new nations across the globe, claiming for themselves the political and social goods of liberalism through their own interpretation of what these might entail. He especially mentions, David Scott’s indictment of Arendt for her erasure of Haiti (138). A blind spot about the rest of the world seems to have existed among the Cold War liberals, which Moyn could have explored further. Finally, I was curious about whether Western Marxism – of the Althusser variety (I believe many of them are writing at the same time as Althusser in the 1960s) – were at all in the conversations that the Cold War liberals engaged in. If so, how would they respond to the Althusserian idea that “freedom” as ideology that hides actual class relations in the name of a pleasurable political ideal which thereafter encodes their worlds of desire? Nonetheless, Liberalism Against Itself is an illuminating and, at times, counterintuitive account of the intellectual wars internal to liberal establishment while it was under attack during the Cold War.

Note: This post gives the views of the author, and not the position of the LSE Review of Books blog, or of the London School of Economics and Political Science.

Image credit: DidemA on Shutterstock.

Leading medics publicly accuse RCP of misleading docs about non-doctor ‘associates’

Published by Anonymous (not verified) on Tue, 26/03/2024 - 10:58am in

Open letter to Royal College of Physicians officers cites false claims, failure to declare conflicts of interest and disregard for patient safety

Twenty-nine Fellows of the Royal College of Physicians (RCP) have accused the RCP’s leading officers of misleading doctors and hiding conflicts of interest in an attempt to persuade them and other RCP Fellows into voting down a key motion, tabled at last week’s RCP Extraordinary General Meeting (EGM), calling for a slow-down in the expansion of ‘physician associate’ (PA) roles pushed by the government, which ninety percent of doctors believe are endangering patients.

Last week, Skwawkbox covered the extraordinary scenes at, and outraged reaction to, the EGM and the conduct of the RCP panel as it refused to engage with doctors’ questions and misleadingly presented statistics to inflate support for the way in which the government is (ab)using PA roles, which do not have a medical degree, to replace fully-trained doctors – and to excuse the RCP’s continued support for the government’s programme. The RCP was exposed as having a huge financial interest in the programme.

The Fellows, senior doctors and medical professors, sent their letter to the RCP expressing concern at the ‘terrible harm’ the RCP leadership has done to the College’s reputation and detailing the issues with the way the EGM was run and data were presented by the RCP panel in the debate – and the way in which the College mishandled the need to come clean after the issues were exposed, failing to let doctors know before the close of the vote on the five motions that they had been misled. The motions, including the fifth one that the RCP board had urged doctors to reject, passed overwhelmingly:

STATEMENT OF CONCERN

The events of the last week have done terrible harm to the reputation of the College and the trust that its members and the wider public have in the leadership of the organisation.

Prior to the extraordinary general meeting (EGM) on 13th March 2024 to discuss issues around Physician Associates (PAs), members of the College who are not eligible to vote on the motions were surveyed. Their views were important to inform Fellows voting on the EGM motions about the impact of PAs on patient care and doctors’ training. It has become apparent that the Senior Officers of the College presented selected survey data at the EGM on 13th March, that in our opinion was manipulated in a way that can only have been intended to mislead fellows of the college.

Of note, the Deputy Registrar who presented the survey data, but who we understand did not prepare the slides, resigned from their post immediately after the EGM.

Following the EGM, multiple formal written requests were made to the CEO and Senior Officers to release the survey data. The CEO and Senior Officers refused for 5 days to release the survey results, only doing so after sustained public and direct pressure and multiple written requests. PRCP also cited the same misleading, manipulated survey data in an email to Members and Fellows of the College after the EGM.

The survey results were published on the RCP website at 9am on Monday 18th March, but no attempts were made during the voting period which ended on 20th March, to directly inform members or Fellows of the College that the data presented at the EGM were misleading, although PRCP emailed members on related matters.

During this time, Fellows voted on the 5 motions presented at the EGM, and they were doing so informed in part by the misleading information presented to them at that meeting.

The 5 motions presented at the EGM have been approved by a substantial majority of the Fellows of the College including Motion 5, which the Senior Officers had advised Fellows to vote against, despite the patient safety concerns raised in relation to PA scope and practice.

Discussions at the EGM and events leading up to and following the meeting raise serious concerns about the conduct, governance, and performance of the RCP, especially in relation to patient safety.

These concerns include but are not limited to a number of issues over several years:

  1. Apparent failure of the RCP to adequately monitor the role and scope of PAs since the College agreed to house the Faculty of PAs (FPA) in 2015
  2. Apparent failure to communicate clear parameters and scope for PAs from 2015 to March 2024, including failure to clearly communicate that PAs are not doctors and PAs must not replace doctors.
  3. Apparent failure to respond to the concerns of the RCP Training Committee in relation to PAs raised in 2015 and subsequently with regard to loss of training opportunities for doctors and patient safety.
  4. Apparent failure to respond to patient safety concerns raised by Fellows of the RCP with Senior Officers during 2023.
  5. Providing false assurance from 2015 onwards to Members and Fellows of RCP and the wider public that PAs were safely working in their intended scope of practice.
  6. Apparent failure to acknowledge that PAs in substantial numbers are and were working outside the intended scope despite being provided with evidence that this was the case.
  7. Apparent failure to acknowledge that PAs are and were working in place of doctors in General Practice, and that PA locum agencies were facilitating this using NHS ARSS funding despite being provided with evidence that this was the case.
  8. Apparent failure to acknowledge that PAs in substantial numbers are and were working in place of doctors on medical rotas in hospitals.
  9. Apparent failure to act on evidence ]Provided by DAUK and the BMA that PAs are and were systematically replacing doctors in General Practice and hospitals.
  10. Apparent failure to work collaboratively with NHS England, the FPA and GMC to ensure that PA Schools educate and communicate with PAs in line with their agreed scope, including but not limited to the principle that PAs are not doctors and must not replace doctors.
  11. Apparent failure to adequately monitor and analyse the performance of PAs in clinical practice to determine patient safety, performance, clinical outcomes and cost effectiveness.
  12. Apparent failure of Senior Officers to act on patient safety concerns raised by Members and Fellows and the wideir public because of the potential financial impact on the College.
  13. Apparent failure of the Senior Officers to fully declare their Conflicts of Interest.
  14. Apparent failure of the Senior Officers to adequately determine the Conflicts of Interest of the FPA leadership team.
  15. Apparent failure of the Senior Officers and CEO to act in accordance with the RCP Code of Conduct.
  16. Apparent failure of the Senior Officers to act in accordance with GMC Good Medical Practice.

This non-exhaustive list highlights that the Senior Officers and CEO have failed on multiple accounts to adhere to the RCP Code of Conduct.

Whilst, given the time pressures, there must be an immediate action plan to ensure that PAs are working within their scope of practice and not in place of doctors, there is a parallel urgent need for an independent review of the Senior Officers with a particular focus on governance and probity.

Dr Asif Qasim FRCP
Professor Alexander Ford FRCP
Professor Charlotte Bolton FRCP
Professor Trisha Greenhalgh OBE FRCP
Professor Martin McKee CBE FRCP
Dr Dagan Lonsdale FRCP
Professor Shah Ebrahim FRCP
Dr Taryn Youngstein FRCP
Professor Nick Hopkinson FRCP
Dr Vinoda Sharma FRCP
Dr Barry Monk FRCP
Dr John Stephens FRCP
Dr Arjun Ghosh FRCP
Dr Scot Garg FRCP
Dr Shrilla Banerjee FRCP
Professor Liz Lightstone FRCP
Professor Mamas Mamas FRCP
Professor Raanan Gillon FRCP
Dr David Nicholl FRCP
Dr Animesh Singh FRCP
Professor Jim Nolan FRCP
Dr Philip Pearson FRCP
Dr David Cohen FRCP
Professor Shahrad Taheri FRCP
Dr Rajiv Sankaranarayanan FRCP
Dr Nasser Khan FRCP
Dr Kevin O’Kane FRCP
Dr Zoe Wyrko FRCP
Dr Muhammad Ahsan FRCP

23rd March 2024

The use of PAs, which is considered by nine out of ten doctors to be dangerous to patients and confuses many patients, who do not realise that they have not been seen and treated by a fully-qualified medic, is being pushed by the government as a way of ‘downskilling’ the NHS, reducing costs and allowing increased profits for private providers, under the guise of the so-called ‘NHS Workforce Plan’ as part of the ‘Integrated Care Systems’ (ICS) project.

ICS, formerly called ‘Accountable Care Organisations’ (ACOs) after the US system it copied, were renamed after awareness began to spread that ACOs were a system for withholding care from patients and that care providers were incentivised to cut care because they receive a share of the ‘savings’. The system remained the same, but the rebranding disguised the reality.

The government used a ‘statutory instrument’ (SI) to pass these changes, avoiding proper parliamentary scrutiny, but both the Tories and Keir Starmer’s Labour support these and other measures to cheapen the NHS for private involvement and only independent MP Claudia Webbe spoke against them during the brief SI debate. Green peer Natalie Bennett’s motion in the House of Lords to attempt to kill the instrument was defeated by the Tories with the help of Labour peers.

Some of the signatories, such as Keele University Professor Mamas A Mamas, have added a demand for a full investigation into the actions of the RCP leadership – and ‘urgent action’ to prevent the government’s push for physician associates to operate beyond safe boundaries:

Despite the government’s attempt to keep this cost-cutting, care-degrading manoeuvre below the radar, it is rapidly becoming a major public issue – yet both Labour and the Tories are committed to continuing it, despite the avoidable deaths among patients that it has already caused.

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Industrial Policy in Turkey: Rise, Retreat and Return – review

Published by Anonymous (not verified) on Mon, 18/03/2024 - 11:03pm in

In Industrial Policy in Turkey: Rise, Retreat and ReturnMina Toksoz, Mustafa Kutlay and William Hale analyse Turkey’s industrial policy over the past century, highlighting the interplay of global paradigms, macroeconomic stability and domestic institutional contexts. The book offers a timely analyses of industrial policy’s past and possible future trajectories, though it stops short of interrogating exactly how cultural, social, political and economic factors shape state-business relations and bureaucracy, writes M Kerem Coban.

Industrial Policy in Turkey: Rise, Retreat and Return. Edinburgh University Press. 2023. 

Industrial Policy in Turkey book coverIs industrial policy back? The Biden administration’s Inflation Reduction Act and the CHIPS and Science Act, or the 2016 UK industrial policy are only two contemporary examples. These policies seek to address value chain bottlenecks, as well as the question of how to “take back control” in manufacturing and key sectors, along with concerns about gaining or sustaining economic edge and autonomy

In this context, the Turkish experience is illustrative for making sense of the trajectory of industrial policy in a major developing country. Mina Toksoz, Mustafa Kutlay and William Hale examine the evolution of industrial policy in Turkey. They present an accessible, detailed account of the trajectory and evolution of the policy since the establishment of the Republic, which argues that we had better study “the conditions under which state intervention works, rather than whether the state should intervene in the economy” (26, emphasis in original).

[The authors] suggest that effective industrial policy is the outcome of the interaction between global development policy paradigms, macroeconomic (in)stability, and the domestic institutional context.

The book is divided into five chapters. Chapter One discusses the political economy of industrial policy and sets out an analytical framework. The authors assert that analyses should go beyond dichotomies (eg, horizontal vs. vertical policies; export-led vs. import-substituting industrialisation) and that a broader understanding requires identifying the factors and conditions of effective industrial policy. They suggest that effective industrial policy is the outcome of the interaction between global development policy paradigms, macroeconomic (in)stability, and the domestic institutional context. Global development policy paradigms evolved from étatism of the 1930s, import-substituting industrialisation in the 1960s and the 1970s, neoliberalism of the 1980s, and the return of industrial policy after the 2008 Financial Crisis. Macroeconomic (in)stability drives (un)certainty regarding economic policies and instruments and the trajectory of economy, which, in turn, regulates investment decisions. Finally, the domestic institutional context concerns how state-society, or state-business, relations are structured, whether the state capacity is sufficient to resolve conflicts, discipline and coordinate actor behaviour, and whether bureaucracy has capabilities to formulate and implement policies. Figure 1 seeks to summarise the main argument of the book.

Industrial Policy in Turkey Figure 1Figure 1: Flow chart summarising the book’s main argument. Source: M Kerem Coban.

Chapter Two focuses on the longue durée between 1923 and 1980. From the ashes of incessant wars that ruined the already unsophisticated infrastructure and demographic challenge, the new Republic had to build a new nation. Yet the rise of the state interventionist era in the 1930s drove policymakers towards the first industrialisation plan and the opening of many industrial sites across the country. When the Democrat Party assumed power, the interventionist, planning-based industrial policy was scrutinised for liberalisation that even included state-owned enterprises to be released to set up their own prices (73).

At the same time, business was encouraged to invest. For example, the fruits of these included Otosan or BOSSA (75). Between 1960 and 1980, the authors underline the second planning period with the establishment of the State Planning Organisation (SPO). SPO boosted bureaucratic and planning capacity and capabilities for disciplined, systematic industrial policy during the era of import-substitution.

Between 1980 and 2000 […] Turkey shifted to export-led growth and liberalised trade and financial flows. These shifts had profound implications for bureaucracy

The third chapter examines demoted industrial policy between 1980 and 2000 when Turkey shifted to export-led growth and liberalised trade and financial flows. These shifts had profound implications for bureaucracy: SPO was sidelined, parallel bureaucratic networks of Ozal were implanted with the opening of new offices or agencies. Consequently, the role of state became less coherent, as political uncertainty driven by unstable coalitions eroded the market-shaping role of the state. The financial sector did not help industrial policy, since banks were dominantly financing chronic budget deficits during a period of high inflation (111). What is more, business, including Islamic conservative SMEs in Anatolia, reduced or ignored investments in manufacturing given the clientelist state-business relations that incentivised construction, real-estate development (115), emphasis in original). Finally, the external conditions were not disciplinary: accession to the Customs Union with the European Union and the World Trade Organization ruled out export support and import restricting measures, among other trade regulatory instruments.

The fourth chapter claims that industrial policy retreated between 2001 and 2009. The first years of this period was marked by political instability and a local systemic banking crisis and its resolution, and Justice and Development Party (AKP in Turkish) assumed power. During this period, industrial policy was dominated by institutionalisation of the regulatory state and  the privatisation of state-owned enterprises, the establishment of autonomous regulatory agencies and are structured banking sector. While the regulatory capacity of the state increased, privatisation and the regulation of the market were highly politicised. For example, “a major cycle of gas privatisation saw ‘politically connected persons’ winning fifteen out of nineteen metropolitan centres and serving 76 percent of the population” (161). In such a politically compromised setting, which was accompanied by the institutionalisation of the capital inflow-dependent credit-led growth model that prioritised “rent-thick” sectors, industrial policy could not flourish.

While the regulatory capacity of the state increased, privatisation and the regulation of the market were highly politicised.

The fifth chapter locates the policy within the global ideational and political economic context that marks the return of industrial policy in various forms. In line with policy documents such as the 11th Development Plan, horizontal measures, private and public R&D spending on high-tech initiatives, electric vehicle manufacturing attempt, and most notably the advancements in defence sector have constituted the revival of industrial policy. At the same time, the authors point to several challenges such as eroded academic research and quality and a lack of investment in ICT skills. Additionally, R&D subsidies or other industrial policy measures require thorough performance criteria and measurement to discipline actor behaviour and regulate the incentive structures.

Industrial Policy in Turkey is a timely contribution to the current debate. Its historical account and analysis of current policies, instruments, and the potential trajectory of industrial policy are its main strengths. Still, there are several caveats. First, the book’s framework is not systematic, which causes some confusion. For example, the book does not demonstrate a convincing link between the role and impact of autonomous agencies on industrial policy. Second, the book leaves the reader with more questions than answers, one of which relates to the effect of bureaucratic fragmentation in shaping industrial policy. Another is around the implications of state-business for bureaucracy, and consequently, industrial policy.

The book leaves the reader with more questions than answers, one of which relates to the effect of bureaucratic fragmentation in shaping industrial policy.

Third, the trajectory of industrial policy cannot be considered independently from the shifts in growth models. Yet the fact these shifts occur because the country depends on hard currency earnings for capital accumulation and to finance consumption and investments: Turkey either relies on capital flows or export earnings, in addition to tourism and (un)recorded (illicit) flows. Pendulums between these channels imply that the country cannot design and implement disciplined, systematic industrial policy. Put differently, there are macroeconomic and financial structural impediments against generating hard currency earnings. Industrial policy is one of the remedies, however, the macroeconomic and structural transformative consequences of the latest episode of emphasis on industrial policy and the export-driven growth experiment in Turkey are yet to be seen.

Finally, and perhaps most importantly, the book tends to relegate a core problem of coordination, long-term policy design and implementation to “governance issues”. Deeper cultural, social, political and economic factors determine the clientelist state-business relations and their effect on bureaucracy and bureaucratic autonomy. Such deeper ties have been masked by instrumentalised “democratisation reforms” or higher economic growth rates in the previous years. In this context, is the more critical problem the purposefully immobilised or challenged infrastructural power to coordinate societal actors? If that is true, then should we make interdisciplinary attempts to identify this problem’s core determinants?

Note: This interview gives the views of the author, and not the position of the LSE Review of Books blog, or of the London School of Economics and Political Science.

Image credit: Chongsiri Chaitongngam on Shutterstock.

Video: EGM leak reveals RCP ‘refusing to answer patient safety questions’ and more

Published by Anonymous (not verified) on Mon, 18/03/2024 - 10:56am in

Clips from 2-hour leaked extraordinary general meeting appear to show Royal College of Physicians avoiding scrutiny – but making damning admission of financial conflict of interests in government’s expansion of ‘non-doctor-doctor’ roles

A leaked video of the entire ‘extraordinary general meeting’ (EGM) of the Royal College of Physicians (RCP), called by doctors to try to force a slow-down in the roll-out of the government’s expansion of the use of non-medically-trained staff in ‘doctor’ roles, has revealed comments and obfuscation that have led medical professionals to call for the resignation of senior RCP officers. One has already resigned.

A number of patients have already died avoidably because of errors by ‘physician associates’ (PA), who have only two years’ training compared the seven-plus years completed by doctors. A Doctors’ Association UK survey has found ‘deeply disturbing’ abuse of the PA role in NHS trusts.

Keele University cardiology Professor Mamas A Mamas wrote of the leaked video:

The ‘PlatinumPizza’ Twitter/X account has posted a number of excerpts from the EGM video highlighting what it feels are the most noteworthy evasions and obfuscations. The first two reveal that, while the RCP claims that PAs must complete national exams, a freedom of information request revealed that this can be bypassed – and that the RCP, which criticised a far more comprehensive survey by the British Medical Association (BMA) as biased, in fact skews the results of its own small survey to present a falsely positive outlook:

Doctors participating in the EGM also raised the issue of the fact that PAs are paid more than the junior doctors who often have to supervise them (and can be held to blame if a PA screws up) – but the RCP said it was ‘not a union’ and not interested in getting involved in pay issues:

Next, the first of two posts about the RCP’s prioritisation of its finances above what nine out of ten doctors feels is a grave threat to patient safety:

And then the second, which shows the RCP’s treasurer admitting/warning that the RCP could stand to lose millions if the PA expansion is halted or even slowed down – and the RCP apparently disagreeing with the RCP of a short while below about being a ‘union’, at least when it comes to ensuring PAs have jobs:

And, adding farce to the ‘contempt’ of which doctors accused the RCP after the meeting, the panel refuses to say what additional benefit a PA brings to a ‘multi-disciplinary team’ that is not already present in the mix – rounded off by a clip of a doctor warning of the dangers of pressing ahead with the whole damaging system:

And in a clip not included in the thread but created by Skwawkbox, one of the movers of the motion for the expansion to be slowed down until it can be shown to be safe for patients explains why it is so important for voting members of the RCP to support it, despite the RCP management’s recommendation to reject it and plough on:

Other discussions during the meeting included the panel failing to explain how it was going to ‘hold the government to account’ for the safe functioning of the system, as it had claimed it would – and treating the mere inclusion of any extra doctors in the government’s ‘long-term workforce plan’ as an achievement by the RCP.

The use of PAs, which is considered by nine out of ten doctors to be dangerous to patients and confuses many patients, who do not realise that they have not been seen and treated by a fully-qualified medic, is being pushed by the government as a way of ‘downskilling’ the NHS, reducing costs and allowing increased profits for private providers, under the guise of the so-called ‘NHS Workforce Plan’ as part of the ‘Integrated Care Systems’ (ICS) project.

ICS, formerly called ‘Accountable Care Organisations’ (ACOs) after the US system it copied, were renamed after awareness began to spread that ACOs were a system for withholding care from patients and that care providers were incentivised to cut care because they receive a share of the ‘savings’. The system remained the same, but the rebranding disguised the reality.

The government used a ‘statutory instrument’ (SI) to pass these changes, avoiding proper parliamentary scrutiny, but both the Tories and Keir Starmer’s Labour support these and other measures to cheapen the NHS for private involvement and only independent MP Claudia Webbe spoke against them during the brief SI debate. Green peer Natalie Bennett’s motion in the House of Lords to attempt to kill the instrument was defeated by the Tories with the help of Labour peers.

Watch the full RCP meeting here.

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Doctors’ Association survey finds ‘deeply disturbing’ misuse of govt’s non-doctor roles

Published by Anonymous (not verified) on Sun, 17/03/2024 - 10:34am in

Danger to patients and conflicts of interest as government continues to push for expanded use of ‘associate’ roles – with help from the Royal College of Physicians

A survey by the Doctors’ Association UK (DAUK) has revealed ‘deeply disturbing’ ‘scope creep’ in which – as warned by the British Medical Association (BMA) and others – ‘physician associates’ (PAs), who are not qualified as physicians, are being used and acting as doctors.

A statement by the group warns that PA are not only overstepping the boundaries in which they are meant to operate, but also being used by NHS trusts and health companies to fill positions that require fully-qualified doctors:

PAs are overstepping boundaries, putting patient safety at risk, and impacting doctors’ training. This is shocking in itself, but made far worse by recent events at the Royal College of Physicians… Doctors at Torbay report PAs being used as “middle grades” – clear scope creep.

According to a doctor recruitment agency:

Doctors in speciality training programmes are known as Middle Grade doctors. Junior Middle Grade doctors are trainees who have completed their foundation training and are now in the early years of their speciality training. They are: ST1/ST2: ST stands for Specialty Training.

According to survey responses from doctors at Torbay and South Devon NHS Trust, as well as being used as ‘middle grade’ doctors and putting patients at risk by acting outside their competencies, PAs:

  • work without adequate supervision
  • consent inappropriately
  • participate in unsafe clinical activity
  • treated severe infective colitis with antibiotics and steroids simultaneously

According to NHS Scotland, steroids “shouldn’t be used if you have an ongoing widespread infection. This is because they could make it more severe.”

The DAUK also linked the survey results to this week’s fiasco at the Royal College of Physicians (RCP), where attendees of an extraordinary general meeting (EGM) regarding concerns about PAs linked the behaviour of the RCP’s panel, which was accused of ‘contempt’, shutting down discussion and even filibustering, to the RCP’s financial conflict of interest in the millions of pounds it reportedly makes from administering PA examinations.

The RCP is hiding their full survey data from FRCP and Council until after the EGM vote. This lack of transparency is unacceptable…

The RCP Registrar, who sets RCP professional standards, works at this Trust. (Important note: there is no indication she was involved in this case [of steroid/antibiotic administration].)

Doctors at Torbay report PAs being used as “middle grades” – clear scope creep. Yet the Registrar, whose job is to “create consensus” & uphold standards, has been involved in withholding critical data that potentially sways the EGM vote. This is not leadership.

The Registrar’s own job description emphasises “accountability for clinical and professional affairs” and “…setting and maintaining professional standards.” How can the Registrar fulfil these duties, ensuring patient safety and upholding standards, when those very standards are being violated in their own Trust? This is an untenable conflict of interest.

In our view, the Registrar has failed in their core responsibility for transparency and integrity of RCP decision-making. We call for their resignation to restore trust in the RCP. The RCP’s position on PAs is currently compromised.

The statement concludes with a call on all voting members of the RCP to vote to support all the motions tabled at the EGM calling for a rethink on the issue of PAs:

Lastly, we are asking that Fellows vote in favour of all five motions as presented, to ensure that a safe revaluation of the PA role can be conducted to ensure patient safety and to ensure continued viable training of the medical profession moving forward.

The use of PAs, which is considered by nine out of ten doctors to be dangerous to patients and confuses many patients, who do not realise that they have not been seen and treated by a fully-qualified medic, is being pushed by the government as a way of ‘downskilling’ the NHS, reducing costs and allowing increased profits for private providers, under the guise of the so-called ‘NHS Workforce Plan’ as part of the ‘Integrated Care Systems’ (ICS) project.

ICS, formerly called ‘Accountable Care Organisations’ (ACOs) after the US system it copied, were renamed after awareness began to spread that ACOs were a system for withholding care from patients and that care providers were incentivised to cut care because they receive a share of the ‘savings’. The system remained the same, but the rebranding disguised the reality.

The government used a ‘statutory instrument’ (SI) to pass these changes, avoiding proper parliamentary scrutiny, but both the Tories and Keir Starmer’s Labour support these and other measures to cheapen the NHS for private involvement and only independent MP Claudia Webbe spoke against them during the brief SI debate. Green peer Natalie Bennett’s motion in the House of Lords to attempt to kill the instrument was defeated by the Tories with the help of Labour peers.

At least two people have already died avoidably because of misdiagnosis by PAs. Emily Chesterton, 30, who didn’t realise she wasn’t seeing a doctor, was treated for a calf strain when she had a deep vein thrombosis that led to a lethal embolism. Ben Peters, 25, was sent home from A&E with a ‘panic attack’ that was really a serious heart condition. A doctor’s Twitter/X thread includes details of others said to have died because of issues around PAs.

If you wish to republish this post for non-commercial use, you are welcome to do so – see here for more.

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