Are you proud of your country? If not, why not?

Given that I very infrequently go out of the house or meet people, due to a profound depression due to a recent bereavement, I listen to phone-ins on local radio. A popular topic has been, ‘are you proud of your country?’

I must admit that I am totally bored to death of this discussion. In the blue corner, there is a lot of attacking of the ‘Leftwaffe’ (yes, remember that when you have to resort to insults you have lost the argument?) that the Left is ‘unpatriotic’ and ‘always doing the country down’. In the red corner, people are well and truly fed up; sick of stressful utility bills, sewage being pumped into local beaches, criminal barristers and posties on strike, railway workers sick of the way they have been treated, and so on.

Nostalgia meant that people enjoyed referring to the 1970s when the UK was ‘the sick man of Europe’. I remember looking up the inflation rate yesterday, having been aghast that a serious political commentator asked how we could “stop” inflation (revealing a complete misunderstanding of how inflation works). Apart from Lithuania and one or two countries in the European Union, we are well ahead. It is hard to escape from the conclusion that this is something to do with the Ukrainian war, but it clearly is something to do with the delays in processing due to Brexit. How awful is it must be to go back to the 1970s when shareholders were not fleecing the system, local libraries existed, it didn’t take hours to call an ambulance, social care wasn’t totally on its knees?

My late mother warned me that when you tell a lie you are forced to tell another lie and another and another. Listening to Nigel Farage argue that the Conservative Party has failed to use Brexit to stop the dinghy influx was totally laughable. It’s been explained to him that this problem has been caused by Brexit, in that we don’t have good relations with France – there is no obligation on France, for example, for them to return dinghies. One person in the audience in the Liz Truss GB News “people’s debate” even suggested quite randomly sending the refugees, contrary to international law, to Kenya. People talk about asking the Royal Navy to send the dinghies back to France, but this has been definitely rules out as an option.

The lie over Brexit is getting larger and larger. So confused I was about the arguments for why people might support the exit of the European Union, a position Mick Lynch holds, is that I followed Mick Lynch’s advise – to go back to the original arguments of the 1970s, such as Peter Shore. Tony Benn and Peter Shore both refer to the weakening of democracy. I, like Roy Jenkins, find this a rather dubious argument for a number of reasons. For example, people in France and Germany do not spend all of their time being ‘resentful’ that they are being ‘governed from Brussels’. Also, following 2016, the UK has taken back control, so that catastrophic decisions made by Liz Truss and others, regarding the Environmental Agency and other aspects, have led to raw sewage making the UK being surrounded by a moat of hot sewage. The legal aid cuts which Truss also delivered tells us what sort of ‘small state’ the Tories have in mind, meaning that the criminal law is now on its knees. Criminal barristers, some of whom are being paid less than the national minimum wage, are simply sick of it. The public are sick of water companies with litres of water spewing out of burst pipes, hose pipe bans, and millions of bonuses and spent on dividends. There is clearly no ‘market’ in that I cannot ‘shop around’ for water. Nobody ever says, ‘I had great electricity this morning’.

I completely understand why Grace Blakeley are exhausted at explaining the failure of Thatcherite economics. These were near monopoly oligopolies, with no real competition. When they were privatised, they were still acting as monopolies. And the worst thing is – with no ownership or stake, we cannot intervene. As Thatcher liked to triumphantly used, ‘You can’t buck the market’. Who knew Corbyn was right too – you can’t buck a rigged market? The regulators have failed to intervene on behalf of the public too. The media for decades have defended this failed ideology, and this had held the country to ransom with the Tory government. Labour is going through a tough time, with the usual split between socialism and social democracy, with much personal hostility thrown in, but this has always been the case. Bevan was himself expelled from the Labour Party, and treated pretty appallingly like other contemporaneous leaders. The Bevan / Gaitskell rift was followed by the Benn / Foot / Healey rift, and so on. The problem is, as it’s always been, is that Labour will put so much energy into procedure, process, and fighting each other, that it will not devote itself to fighting Truss and Sunak who are clearly atrocious. Labour has previously been accused of being more concerned with party than country, but if it is seen to be clearly on the side of the country – given that the Tories are clearly not – it seriously has a fighting chance of forming a government. A stuck clock is right occasionally, or every dog has its day, or whatever your worst case scenario is.


‘Returning to practise’ for some medical doctors is not easy, but the issues are both predictable and solvable

After a period of unmanaged mental illness about twenty years ago, I was removed from the GMC medical register. After this life event, I entered a coma and indeed became physically disabled. I have for various reasons found it difficult to return to full time clinical practise. You may ask why I have decided to write an article on ‘return to practise’ when I literally haven’t been a full time junior doctor since 2003. Actually, I’ve been procrastinating about writing the piece.

My situation concerns doctors who take unanticipated leave, due to personal health issues, or problems with colleagues, not people who plan to leave the NHS for a bit in an intended way. One thing which really annoys me is how politicians do not seem to understand the NHS workforce crisis, nor indeed have any practical plans to deal with it. I don’t deny that there is a retention crisis due to the NHS pensions arrangements. I am not focused on that, in that my contributions will be insufficient to secure my pension anyway. I think the apathy in solving the workforce crisis is illustrated by the sheer numbers of people who’ve been charged with the problem, often at very senior level, generously remunerated, but have not been successful one jot. It is a career limiting process potentially, but it could be a career defining or enhancing one. Like many things in medicine, like dementia or stroke, you probably don’t imagine that unemployment from the NHS will happen to you, but when it does you’ll finally understand why the matter matters.

Post pandemic, facilitating more registered medical doctors to work matters. This is obvious, because, not only do we need people to do the acute work and the elective procedures, we need to do other things such as risk reduction for illnesses and helping people lead as full a life as possible given mental or physical complications. But there is another issue which has always shocked me. That is, by not having a fair number of boots on the ground, life becomes much tougher for those who are there. There’s a clear difference between doing a job comfortably, and being too stressed to go even to the toilet without feeling guilty – or even taking any time off without incurring yet another rota gap. But it’s not just post pandemic due to COVID. Due to years of decline, social care is in a desperate situation, we have cut ourselves off from freedom of movement with the European Union, and we have the known known of an ageing population with ever increasing number and complexity of health needs.

No. The reasons why I have found it so hard to return to clinical practise should not be taken as ‘criticism’ of anyone or any statutory bodies, but should be used as inspiration as how to fix a broken system. The NHS is not fully privatised yet, and so the idea of a national plan is easier for the NHS than if healthcare were entirely privately owned and fragmented. It is theoretically possible for a central government to make the NHS workforce crisis as they can coordinate their response with the NHS social care crisis, or the housing crisis, or the economic and hyperinflation crisis, and so on. Whilst at a population level we need to know the ‘scale’ of the problem, at a personal level, unemployed doctors who want to work would benefit from careers advise. Of course not every unemployed doctor wants to return to the workforce, because of the unaddressed problem of low morale exacerbated by the hostile media coverage, burnout and so on.

It is impossible to plan numbers of boots on the ground without knowing the overall shape of how the NHS interacts with social care in providing an entire healthcare system. In other words, you can’t plan for the numbers of doctors in hospitals without planning for the numbers of district nurses in the community, and so on. The insidious and somewhat secretive yet acknowledged death of NHS dentistry should be a warning, like the ignorance of ‘Brexit’ and other “non-woke” issues, that ignoring an issue doesn’t in itself make it go away. When planning any strategy, there are known unknowns, known as ‘bounded rationality’ – take for example Brexit, or retiring BAME doctors, or doctors taking early retirement due to over punitive pension arrangements. But the problems in long term forecasting might be mitigated by shorter real-time forecasting.

There is clearly a financial disadvantage to NHS trusts hiring people to hire doctors at short notice through locum agencies. These doctors are able to charge a much higher rate, and do not especially like the lack of security at the expense of flexibility. Whilst doctors cannot plan, NHS Trusts cannot plan adequately. Speciality specialists, including physicians or GPs, could be asked how many doctors they currently need, even at a granular level. How they are funded cannot be kicked down the road indefinitely. Public services have become relied upon for doing more and more for less and less resources, and the various worms have turned. If a locum agency can warn me to keep my immunisations up to date, or my mandatory training (e.g. child abuse, ‘county lines’, safeguarding), or keep my registration up to date with an active license to practise, why cannot anyone else then? The GMC holds a central database of people on their medical register with a license to practise. They have revalidation and continuing medical education commitments. I had to sit a revalidation assessment for the GMC in 2019 in Manchester. Somebody should be mentoring all people on the register to tell them to keep their knowledge and skills up to date, even if they cannot absorb behaviours and skills because they are not in a paid regular job. This is a waste of talent otherwise, and the assets of the NHS are not just furniture or tangible.

For as long as I can remember it the informal advise from the GMC is that ‘it is not an employment agency’. I of course get that, but it does have a powerful say who is on their register or what motivates them. The GMC still has some way to earn the trust of BAME doctors on the register following high profile decisions such as Dr Hadiza Bawa-Garba. The recent furore over a teabag as a gift from the NHS has further identified about how the NHS approaches wellbeing. Years on, people do not generally see mindfulness and resilience training as the answer, but good care from colleagues. I for example became burnt out, living on my own in London, with no social life, with no regular educational supervision or pastoral care at all. As Liz Truss might say, ‘this is a disgrace’. I still have the wounds of my 2 months in a coma due to meningitis in 2007, but in fairness to me I have a license to practise on the GMC register, with full MRCP(UK) or membership of the Royal College of Physicians, a medical education training in progress, a PhD, plenty of post doc work including peer-reviewed papers and books, and years of being an unpaid carer with loads of experience about integrated care.

I was stuck off in 2007, but restored in 2014. Time lost for both me and my late parents. I can’t turn back the clock, but the best thing which would improve my wellbeing would be to have a paid job, a feeling of contributing to society, and a tangible effect of knowledge and skills to help the care and research for others. I have never wanted simply to join a locum agency after years away from the frontline, despite full registration, knowing that if I made a mistake I would be thrown to the wolves through under support – and I would go under with the legal and regulatory stress. This is why I think the GMC has a duty to solve the workforce crisis together with Health Education England – because the GMC is not only responsible for standards in ‘trainees’ but in all doctors, including education and training, and there is no more important a statutory goal than section 1 (1) of the Medical Act 1983 than to promote patient safety. To return to work, I need to be as confident as I can be about patient safety, working in teams, keeping my skills up to date. I should not be thrown to the wolves. As I have always been disabled since 2007, I am deserving of a statutory return to work as a reasonable adjustment under the Equality Act (2010). I have never had an opportunity to talk about this ‘need’ of mine, anticipating how to contribute to the workforce. I need to be valued before I return, not at the moment the NHS are forced to have me. I need to be supported and valued before I return. I need to know what mentoring and support services, including occupational health, before I return – even if they are patchy. And they need to be funded fairly.

The present situation is the result of years of neglect, and people who should have known better not asking people like me about their lived experiences of being thrown on the scrapheap rather prematurely. Hopefully things will finally change now. I am not holding my breath. You will of course notice that I have not offered much in the way of solutions. I don’t deny this is a very difficult problem, and one which deserves funding and a workstream of people solving the problem not as a part-time 3rd job. I think an extended induction or return to work scheme would really help. I think also that ‘returners’ really are yearning for a sense of ‘belonging’. This is what Prof Michael West and others have identified as part of their compassionate leadership approach. I entirely agree. Autonomy is another issue – all returners want to be confident, autonomous, independent practitioners but who can seek help and work effectively as part of a team. Returners like me are a not a ‘quick fix’. We are a neglected and scarce resource. If the NHS disappears, this debate will disappear too.

The 2022 Conservative Leadership Election – what have we learnt?

For many of us, it sometimes feels like this – as articulated by Andy Burnham on Twitter,

Kemi Badenoch MP, one of the candidates currently for the Leader of the Conservatives and Unionist Party, has said that the division between “remainers” and “Brexiteers” no longer holds. I’ve never liked the term ‘Brexiteer’ as I think of it as a wilful projection that the people who voted Brexit were like Musketeers, courageous and brave. I think they’re brave in that they voted for a drastic geo-political change not knowing what sort of Brexit they would have. The Conservatives never asked us, and then imposed their own brand of Brexit. Nonetheless, in 2019, some people were so terrified of a Jeremy Corbyn government, this did not matter. The policies Labour offered, ranging from nationalising rail or improving utilities, better funding for the NHS, a national social care service, and so, on, were deemed irrelevant – and with Johnson, one could ‘get Brexit done’.

It is now palpably clear that Brexit has not been ‘done’ in any sense. For example, the Northern Ireland protocol, hailed by Liz Truss MP as one of the biggest achievements of her and Boris Johnson, is a mess and now subject to litigation from the European Union. A second time bomb waiting to detonate is the commitment of the equivalent of ‘net zero’ by 2050 as part of the Brexit agreement. Not all of the Tory candidates are behind this, which is somewhat irrelevant considering the 2019 manifesto details. None of the candidates for the Tory leadership have really offered the meat on the bones of the ‘post Brexit’ world. If there is indeed going to be greater regulatory divergence, to satisfy the need of some of the Tory Party to turn Britain into the “Singapore-on-Thames”, one should reasonably expect there to be some trade barriers from the European Union. If indeed “we hold all the cards“, of course, there should be nothing to worry about.

Also not done is the reconfiguration of social care. The Conservatives have literally had at least a decade to consult and legislate on this – and we have nothing. For some reason, Penny Mordaunt MP made some reference to the insurance industry as ‘preliminary work’ in social care reconfiguration – and of course that is a fear of many requiring open, transparent discussion. ‘Will of the people’ cannot only be a slogan, after all. So long as nobody ‘gets social care done’, care packages at discharge destinations such as at home or in residential care settings (care homes, nursing homes) cannot be successfully activated, meaning that patients are languishing in hospital beyond their will and desirability. While Rome burns, Johnson is partying at Chequers as if it is 1999.

This all leads me onto the veneer of the debates – that the membership of the Tory Party are voting for the person with the best policies. There are some red herrings, like Liz Truss MP channeling her inner Margaret Thatcher by wearing a floral blouse which they both presumably would have been proud of. Of course, the candidates want to lay ideological lines in the sand, like Mordaunt wishing to say she is learning from the financial industry primarily in learning about social care (not people like me who are academics and service users of the profession). Or it might have been Suella Braverman MP (and Dominic Raab) who don’t want to be fettered by the European Court of Human Rights, so being ‘unshackled; from the article relating to the right to be free from degrading treatment and torture might allow flights to go to Rwanda. Or Truss to be free from the international legal restraints of the Good Friday Agreement.

But …. if it takes ten minutes to get through to 999 Ambulance, and then takes 19 hours to get from the call to a hospital ward, the system is not working and people can blame the Government. If you have to wake up and ring on the dot of 8 am, and still fail to get an appointment with the GP, a brass necked Tabloid will want you to blame your GP, but you should really blame the Government. If you fail to get a NHS dentist, it must be the fault of the Government, like Kemi Badenoch MP (despite her family’s total income and access to private dentistry) being able to get an appointment for a chipped tooth. Or somebody being unable to get a passport, say for avoiding England in the peak of a heatwave. At the end of the day, the Conservatives are a successful fund raising machine, as evidenced by the successful events run by Johnson and Sunak despite the politics of their ‘falling out’. The Conservatives need to reflect the views of their individual and corporate investors, who will wish to see a return on investment (for example, through Johnson’s alleged personal favours, or official awards in the honours list). This could lead to policy decisions which are not easily directly evidenced as ‘will of the people’ – such as aboltion of the BBC or privatisation of Channel 4. The financial case for Brexit is debatable according to who you talk to, and of course can be ‘rubber stamped’ by a referendum if need be, despite the loss of some trade and some geopolitical soft influence. Opposition voters and members are right to be concerned about a ‘one party state’, where there is progressive privatisation of the NHS, however-so defined (such as increasing proportions of NHS delivery by private and public limited companies).

This is where the ‘quality‘ of the opposition does matter. It is striking that Labour have distanced themselves from the highly popular movement of the RMT in defending workers’ rights. Mick Lynch and Eddie Dempsey have become internet sensations in their own rights. For a long time, RMT has had no financial link to Labour. Likewise, Wes Streeting MP publicly declared this week on LBC that he would distance himself from striking union health workers over pay (despite the freeze in pay compared to the cost of living). This is because Labour wants to be seen to be distant from the Unions. This is problematic for voters also because it looks as if Labour has no influence on the Unions, and the Unions have no influence on Labour. The question then becomes – who does Labour work for? You can see by the U-turn on all of Keir Starmer’s pledges since he became leader of the Opposition, as elicited by Andrew Marr (see here for example on instagram), that this becomes a valid question. So ultimately – what on earth is the point of voting Labour anyway? The Tories then become in the unenviable position where people in England will vote for them even if strategically and operationally void of competence. Boris Johnson MP was not sacked as leader of the Conservative Party for incompetence, although arguably he should have been. He was in effect not even sacked for partygate and the allegation of lying to parliament. He was sacked by his party presumably for making them lie on his behalf in morning media rounds, and effectively for one of his team allegedly looking at pictures of dominatrix while sitting in parliament and one team member allegedly groping young men in the Carlton Club in a way that Ancient Greeks might only have been proud of.

Voting in of the Tory Party, and the invididual positioning of the Tory candidates, may therefore have little indeed to do with the ‘war on woke’. I don’t feel that the culture wars are as in the front of the mind of the Tory PLP as everyone would like to argue. For example, the online safety bill being taken through parliament, albeit now very slowly, arguably drives a ‘coach and horses’ through freedom of expression. It is also possible to triangulate on trans-sexual identity politics – it is possible to respect someone’s identity, whilst also not allowing ‘mixed’ hospital bays or prison cells, or sporting events. It could simply be ‘red meat’ for the ‘red wall’. Some localities have seen evidence of financial levelling up, ungraciously called ‘bungs’ by some. But this is another area where nobody cares about how slick an answer is in a leadership debate, but how good the Conservatives are for delivering adding benefit and value to certain voters.

So it may be plus ça change after all. I suspect the Tory Party will choose the least worst option – and a ‘safe pair of hands’, sort of, in Rishi Sunak MP who seems to have more of a clue on the big problem facing the nation – the risk of hyperinflation and stagflation – than the others. But there is a strong case for someone with the ability of Tom Tugendhat MP being in a senior foreign office rôle too. Kemi Badenoch MP’s right wing politics do not especially appear to suggest that the NHS is ‘safe in her hands’. Liz Truss MP has been accused of not being able to find the door, when ironically the Tories have been trying to show Boris Johnson the door for ages. Perhaps what we take from the leadership events is how nobody has a strategy plan for certain topics, such as ‘saving the NHS’, for example, or clearing up the mess in the administration of criminal law and justice. Penny Mordaunt MP appears to be broadly clueless on most policy briefs, confirming the ‘grave reservations’ view of Lord Frost who is hardly covered in glory himself over the details of the Brexit negotiation outcomes. We know that Rishi Sunak MP is the only man with made to measure suits, where the suits have been made to fit someone else other than Sunak.

The known unknowns are how much Scotland wants to vote SNP despite the record of the SNP in office to give a mandate for a second referendum for ‘independence’, or how successful LibDems will be in securing Tory seats, or how ‘popular’ Starmer is. A major problem for Starmer’s Labour is the animosity from the large section of the membership who feel that Jeremy Corbyn has been unfairly demonised, and how he has no clear policies despite being apparently ready for an election tomorrow. A way to end this endless deadlock in policy and politics would be for someone to bite the bullet, and to catalyse constitutional reform. Britain does face ‘crises’ such as inflation or the cost of living, and voters want immediate solutions. But I think voters also want a clear vision from leaders with competence in transformational leadership, and that’s where somebody with an interest in systems thinking and systems engineering, such as Badenoch, would be very helpful indeed.

Ultimately, it’s the same script, but with a different newsreader. The problem was that the newsreader lost credibility for some, whilst retaining his celebrity status for others. Whether the script is fit for purpose needs to be communicated to all, and this is where bad dancers cannot blame the floor any more.

Is Kemi Badenoch about to make politics great again?

Kemi Badenoch has not been on any reality TV show. Nor was she President of the Oxford Union.

The impression was that the next Conservative leader would come from nowhere, and might not possibly the most obvious suspect. Rishi Sunak, it seems, always has somewhat fancied himself as ‘man of the people’. Few can remember the viral video where he discusses his favourite soft drink. But he is associated in some people’s minds as being associated with fundamentally un-conservative, some might say socialist, principles. He also, as an output of Winchester College, Oxford and Goldmann Sachs, a somewhat dubious product of social mobility.

The knives are out. And worse than that, he is not Boris Johnson’s preferred candidate – even if he has the backing of sun lounger Dominic Raab. It is possibly Liz Truss’ time where every week was ‘rollover’ week – a new (but old) international trade deal. Truss is considered the safe pair of ‘establishment’ hands – a former ‘Remainer’ who has made good her Brexiteer credentials. In other words, nobody quite knows how she is going to tackle Brexit as part of Britain’s new global outward-facing rôle in the world. Truss is incredibly astute at avoiding difficult questions. For example, when confronted with ‘If Ukraine, why not Taiwan?’, Truss recoils into a state of clever word-play and keeping all options open.

Some were clearly bound to fall by the way-side. For example, Grant Shapps was not able to manage simultaneously a high-level industrial dispute and being a Prime Ministerial candidate. Some might say that he could not even manage the high-level industrial debate. It only took Mick Lynch a few days to make Shapps look utterly ineffective. Suella Braverman is still going strong, with the ERG seal of approval; but her stance on universal credit, as well as the threatened departure from the European Convention of Human Rights, promises to put off even the most mild-mannered and risk-averse Tory.

Kemi Badenoch MP doesn’t need to be an expert in every single subject. Her quest for the truth may seem somewhat evangelical, but it seems sincere. Despite Michael Gove finding her ‘phenomenal’, she seems to have captured the attention of many so early on in this hapless leadership contest. It is easy to find fault with her positions on gender recognition or critical race theory but you can’t fault her for articulating a clear reaction. Nor can she be faulted with her concerns about the online safety bill and the threats of censorship.

I find some of Badenoch’s intellectual positions a bit problematic – but so would anyone. The US difficulties with ‘culture wars’ range from gun control to abortion, or even freedom of speech. Whilst it is an easy knee jerk reaction to avoid discussion of all of these matters, known issues since the 1920s, citing that one should resist the Americanisation of politics, this gives the impression that these issues do not matter. Whilst unisex toilets for some may not ‘matter’ as such, the issue of identity politics reflects differences in beliefs held extremely important to some. They might have relevance to safety in a hospital or prison, or other spaces. Avoiding a debate altogether, and not even clearly stating various alternative positions, did not work for Brexit. They are strictly speaking not “minority debates”. So for Kemi Badenoch to be one of the eight candidates to confront these issues, whether or not you think these are ‘common sense issues’, is to her credit.

It is easy to find fault with her thesis on ‘culture wars’, but one assumes that a Badenoch administration would apply systems-thinking to the NHS, social care reconfiguration, or the ‘cost of living’ crisis. Badenoch seems to understand that you cannot have a race to the bottom for ‘low taxation’ without a discussion of the fundamentals of the economy. But in firing up the base, and in seeking the ‘truth’, she already has conceded that the solution does not just include efficiency savings. This, of course, was THE popular dogma in the NHS a decade ago. But she has already alluded to redefining what the public sector does. This is nothing very fundamentally new, but a welcome admission all the same.

Badenoch is obviously not arguing that ‘diversity’ or ‘equality’ are unimportant. We broadly agree that they are very important. What she is arguing, however, they have lost their way; this is already acknowledged in business management, where more effort is put into diversity marketing than the actual outcomes (such as recruitment or retention of non-White doctors in the NHS).

Badenoch is refreshing intellectually as she is also willing to turn to ‘off limits’ topics. Firstly, she is not opposed to University education, but does not want, for example, for a system which overproduces too many graduates in law to become ultimately unemployable. Presumably she would find the excessive salaries of some vice-chancellors in Universities unconscionable too. Secondly, she does not have a blanket contempt for environmental issues, but likewise wants a sensible debate on ‘net zero’. Whisper it quietly, but so would many of Keir Starmer’s potential voters too.

Furthermore, diversity is more about action rather than words. It is deeply racist to suggest that Badenoch or Sunak would not be welcome as leaders of the Conservative Party. And indeed that Party should be given credit that they have legitimately made the cut on their own merits, so far. If ever there was a time not to be ‘pale, male or stale’, this might be it. OK, Diane Abbott may not be the pin-up for diversity any more and not all of her critics were racist (but many were, some argue). But nobody can deny that a Labour opposition led by Starmer, who professes no positions and all positions simultaneously, would have immense difficulty with Badenoch. Also, given that Starmer voted 48 times to oppose Brexit, as we keep on being reminded, Starmer does not have a legitimate voice in the Brexit debate for many.

I have never voted Conservative. I don’t want to wait any longer for Starmer to reveal himself. And there’s a part of me which thinks that: if somebody tells you who he is, believe him.

Many traditionally on the ‘left’ will have a good feeling about Kemi Badenoch, and if it is not her right time now – it soon will be.

A browner shade of pale: the lack of diversity of thought should concern us all

When they tell you who they are, believe them.

For the vast majority who are not Tories, this is not an impressive line-up of candidates.

The transformation of the artist previously known as the Conservative Party to something resembling UKIP is ‘near complete’. Issues such as “women with penises” or “withdrawal from the European Union”, which were never in the 2019 Conservative manifesto, and therefore never agreed with the Electorate, are suddenly being campaigned on.

Even the promotional videos give a flavour of what this motley crew is like. For example, in his socially mobile video, Rishi Sunak doesn’t mention the foot up given by Winchester College, Oxford or Goldman Sachs. And Penny Mordaunt’s video was so problematic that it had to be edited and re-distributed due to several significant complaints.

It’s said that this Tory leadership contest ultimately has two major functions: firstly, to select somebody with the ‘beliefs and values’ of a Conservative, and, secondly, somebody who can lead a Party as the majority party in government. The mission creep of beliefs and values into something quite Trumpian is striking, and significant as it could with time emerge into a cabinet of a Tory government in due course. Take, for example, the approach taken to ‘critical race theory’. The word ‘critical’ is supposed to reflect a balanced critique of issues in race relations, deliberately avoiding blame. The incorrect criticism of ‘critical race theory’ has to impute sinister agendas of those who wish to hold a transparent debate on race, ethnicity, power and society. It has become co-opted by the far right so as to say that it deliberately frames non-Caucasian individuals as ‘victims of oppression’, and the mood music of random herrings such as Jolyom Maugham’s tweet certainly doesn’t help. Diversity is best done when you’re not talking about it – there have been 3 non-White-skin-colour Chancellors of the Exchequer, implying that it is not just the left who care about equality, diversity and justice. Maybe.

Critical race theory started out life as an cogent debate, drawing on a number of intellectual strands, on – well, race. It does not deserve to be ‘cancelled’ by the far right, “banned”, or evade “freedom of speech”. The word ‘freedom’ has been bastardised in a completely unorthodox Orwellian way, and it is clear in certain cases ‘freedom is not setting us free’.

Diversity, whisper it gently, is not measured by the PANTONE chart of ‘brown’ of Tory leadership candidates. The lack of diversity in policy, and lack of stakeholder involvement, is fundamentally more of a concern.

One of the candidates is advocating withdrawal from the European Convention of Human Rights, a panel to which we still send a Judge to, an instrument which protects us from the Tory government, and which we helped to found through arch wokist Winston Churchill. This has not been voted upon as it never appeared in the 2019 Tory manifesto. The mantra we know ‘will of the people’ is utter bollocks we know that because of the constitutional set up of the UK, including the legislature, executive and judiciary. But there is no ‘will of the people’ involved in withdrawal from the European Convention of Human Rights. There should be a general election to endorse this, though it is far from obvious whether Keir Starmer is fit enough to win given that his USP is ‘being not Boris Johnson’ – and BJ has now gone.

They really don’t want to talk about Brexit. Even Liz Truss cites Brexit as one of Johnson’s achievements. But Brexit is not “done” – the oven ready Northern Ireland protocol is even the subject of litigation between the UK and EU. The trade deficit is a mess. It’s not ‘done’. That was, shock horror, yet another Boris Johnson’s mega whoppers.

The lack of diversity means all topics endorse flights to Rwanda, at a cost of hundreds of thousands of pounds per asylum seeker (as well as a considerable moral outrage). There is also widespread agreement on various forms of cutting taxes – including corporation tax, including from day one. None of these are costed. There is even a hint that this will be paid for out of printing money, in other words, quantitative easing, which ABBA dance supremo Theresa May once referred to as ‘there is no magic money tree’. A measure of inflation is already predicted to be 15% later this month, so printing money would be a bit of a disaster. We know that that low taxes are not being funded out of the success of the Tory economy, as we are now predicted to be the worst performing economy in the G20 (predicted by OECD). There is no specification of where the spending cuts are going to fall, but this merits some answer as we already know that the performance of public services is already dangerously band to chronic underfunding. We know that the UK has a productivity problem, we know that tax burden is still one of the lowest in Europe, BUT that cutting corporation taxes does not clearly lead to better productivity or increased investment. More’s the point, public spending is necessary to maintain national income. More’s the point, killing off a large market on our doorstep, the single market, is a big contributor to the death of the UK economy.

There is no diversity of thought. We have not heard a peep about environmental issues, although some people have broken ranks on the Trumpian/UKIP proposal of scrapping ‘net zero’. It is as if COP 26 never happened. There is maintained attack on equality, diversity, inclusion, no acknowledgement of environmental issues – and no regard to record waiting lists in the NHS, or a social care system on its knees. All the leadership candidates are complicit in the disastrous government of Boris Johnson, and, although the court jester has been sacked, the brown-noising suitors are still dangerously lurking.

In an ideal world, the Conservative Party should be finished. But it has a remarkable habit of re-inventing itself to secure its no 1 aim: to be in office. And the poor performance of the Labour Party must concern anyone who believes in democratic challenge.


Every saint has a past and every sinner has a future

So in the end Boris Johnson, like Donald Trump, refused to go easily. So where now?

Episode 9, the interview between Andrew Neil and Stephen Kinnock, made me think.

Through the prism of ‘cancel culture’, most politicians probably would not fare well, whether due to a dodgy tweet from 2008, or a cached web history of sex toys, or the such like. A person who was previously opposed to Brexit might find it hard to convince a voter that he or she wants to make Brexit work.

I’ve always found the ‘it’s factored in that Boris is like that’ argument quite interesting from that point of view. He has a record of making gaffes, and being critical of. the European Union. But likewise ask the stereotyped Red Wall voter what he or she thinks of Starmer, the answer might be, ‘A bit boring. And he tried to overthrow Brexit.’

Johnson used to enjoy talking about Starmer’s ‘remoaner’ credentials in #pmqs. He is of course thrilled about ‘getting Brexit done’, which in a sense is true in that we are out of the European Union despite numerous obstacles. As far as single issue politics are concerned, this was considered to be a huge achievement, breaking the deadlock. It is possibly the fault of someone that this has overshadowed lack of policy progress in other areas, such as macroeconomic management or social care reform. But it is clear that Brexit is not ‘done’ ‘done’, in that the NI protocol is still up in the air. Starmer’s speech on Brexit to many was a bit boring. It didn’t really say anything one could strongly disagree with, but likewise it didn’t really say anything particularly noteworthy. It deliberately avoided specifics of particular sectors, and possibly was striking by its lack of action on the single market or free movement of people, despite the impact on the economy and society.

It is a genuine question what Starmer ‘believes in’, so increasingly one is slightly more disinterested in what he opposes. For example, I think he opposes nationalisation of utilities, or crossing picket lines. I suppose he is quite keen on the BBC, and would like to keep his counsel on what a woman is. So, given a choice between Suella Braverman MP and him, an anti-wokist probably would go for Braverman. With even Braverman as the new Conservative leader, it is possible that this could deprive Labour of an overall majority. The question then becomes whether Starmer has shown enough Remoaner leg for that to be a carrot for a Labour voter.

When Stephen Kinnock said something along the lines that Boris Johnson had ‘debased’ politics, my danger antenna went up. Integrity and probity are of course brand identities of Starmer, despite the Durham investigation. But this mission creeps into sanctimonious moralising, which became part of Nick Clegg’s downfall (coupled with his U-turn on tuition fees). So it is a genuine question whether a voter feels that he or she can ‘connect’ with Starmer. We know that people who supported Corbyn tend not to, because of the breaking of Starmer’s leadership pledges, and the ‘getting our house in order’ argument to disposing of Corbynism. Corbynism has been made to be perpetually toxic, ironically given today that today France’s PM has decided to nationalise electricity. Whatever your views on socialism, one can perhaps admire France’s attempt at mitigating the cost of living crisis. And yet the British electorate appears to have rejected Corbynism for a bit of groping and Brexit.

I am intrigued who the next Tory leader will be in August or September. I quite like Andrew Bridgen’s non commitment to it, in letting due process run its course. I quite like Steve Baker’s unemotional assessment that there are ‘two great parties’ and it will be either Tory or Labour/SNP. I am no Einstein, but it doesn’t take much to work out that if there is an early election, the Conservatives will go mega pro Union and do the ‘vote Labour get SNP line’. And for all I know that might be as effective as ‘Get Brexit done’ – and Starmer might be equally toxic to Brexiteers as Corbyn was for some voters in general.

I don’t feel Starmer can ‘reinvent’ himself especially if evidence against Brexit points increasingly in one direction. It’s mind blowing that the Conservatives still have a reputation for economic prudence, which might make Rachel Reeves’ plan for cut through on solving the hyperinflation crisis.

But at the end of the day I am amused by Andrew Neil’s approach of ‘given how dire Boris Johnson is, why isn’t Starmer much more ahead?’ We are told by constitutional experts that we don’t live in a presidential system, so people vote for parties not people. But whoever succeeds Johnson will be up against Starmer, and presumably he or she will have a future. It may be that the actual policies or facts don’t matter. Starmer might be fulfilling a Neil Kinnock rôle in recalibrating Labour away from the ‘far left’, and one last heave might turn Starmer into the new Tony Blair. Tony Blair however had policies, was ahead in the polls, and was popular. It is quite possible that Starmer turns out to be nothing like Blair or Neil Kinnock, but that might be irrelevant given a ‘time for a change’ Tory leader. I suspect actually that Starmer will be more like Michael Howard or Iain Duncan-Smith in longevity.

It’s insane to believe that Sir Keir Starmer is completing ‘phase 1’ of his election-winning strategy

Just watching David Miliband’s interview on the Andrew Neil Show, on his new series on channel 4, will tell you why many traditionally Labour voters feel an enormous sense of frustration. To a perfectly sensible question on how he would tackle the cross channel ‘dinghy crisis’, a matter on most Faragists’ lips, David Miliband concedes calmly that he wouldn’t have wanted to start from here. He talks about how Brexit leads to not being a signatory any more of the UK to something called the Treaty of Dublin, and works backwards to think about how a legal infrastructure might be rebuilt.

I don’t suppose David Miliband devotes much time to thinking about how he could re-enter parliament, become leader of the Labour Party, and then become Prime Minister. He seems more concerned about putting his family first, and running his increasingly successful NGO well. I actually remember voting for Ed Miliband to become party leader in about 2010. I remember when his leadership was announced in 2010 to much excitement at party conference, which I think was in Manchester. Or it might have been Liverpool. Not sure. I remember meeting the late Michael Meacher who told me he was ecstatic. And he looked it. He died five years later.

2015 was coincidentally when Ed Miliband failed to win a general election. I remember the ‘one last heave’ approach very well – which had embittered many of us, with the famous ‘immigration mugs’.

The rest of course is history – David Cameron was voted in in an endorsement of ‘competence’ over ‘chaos’, while regretfully he brought in a referendum with no clear plan of what to do on voting Brexit. Corbyn was blamed for a lack lustre ‘remain’ campaign, when it is clear that Alan Johnson and Lord Stuart Rose hardly covered themselves in glory either.

My perspective I don’t feel is unique to Corbynistas. The irony is that I am not a Corbynista at all. I had supported all Labour leaders during my time supporting the party between 1992 and 2019. I thought it was a good idea in 2019 to strengthen the NHS as a public service, introduce a national care service, produce a proper infrastructure for internet services, and so on.

Somebody on Question Time recently in the audience started laying into Mick Lynch why the teams from Victoria and Euston were separate. It was calmly explained to ‘Tory boy’ that it was not common either for staff at ASDA to help routinely staff at Sainsbury’s. It was also calmed explained to him that this problem wouldn’t arise if the railways had been nationalised. Lynch calmly explained how he could not explain the ‘compulsory job cuts’ when the railways were returning multi-million revenues. And so it went on.

But now when people are told, ‘remember the 1970s?’, people think the 1970s were not so bad. Harold Wilson or Jim Callaghan were not, to our knowledge, shagging multiple mistresses consecutively, nor holding parties in Downing Street, nor balls-ing up a major plank of policy which threatened our geopolitical or economy security. OK, they did not have to pretend to be Bennie Hill, with dandruff and shirt hanging out, or need to get their deputies to wink across the despatch box either.

When asked simply on the BBC Radio 4 programme yesterday what his programme for national government would be, Andy Burnham simply said social and constitutional reform. This is what he feels, apparently, is holding back Britain. This of course would be a sensible move for members of the Labour Left, who do not consider themselves ‘hard left’, to feel more part of a party which has chucked out somebody they supported and went door-knocking for years. It is indeed possible that proportional representation and the reform of the House of Lords are issues which need addressing much more than Brexit. It is still the case that not many individuals can point to a tangible benefit or beneficial outcome from Brexit apart from ‘sovereignty’. And even the ‘taking back control’ has gone pear-shaped with the ‘oven-ready’ deal – which turned out to be, who’d have thunk it, possibly yet another one of Johnson’s porkie pies. The NI protocol is such a mess, that the Government has had to introduce its own legislation which many to think to be unlawful under international law – leading to a Trumpian government to say ‘breaking the law is sometimes a necessity’ (which is not true at all).

Starmer cannot be blamed for being able to set out, now, in detail, his policy on a number of areas – but there could be a ‘snap election’, and everyone fails to know what he stands for ideologically (apart from U-turning on his own ‘pledges’ to become leader of the Party). He doesn’t seem to have any views on what to improve on Brexit. The comparison with Tony Blair is quite insulting to Tony Blair. Blair ahead of the 1997 general election was massively ahead in the polls, and had the skeleton of a clear programme for government. Look at today – the running of the NHS, ambulances, social care, passport offices and so on is a shambles. Inflation is at over 11% on one measure, and this cannot simply be put down to ‘international factors’ – I am no economist, but I am sure printing lots of money as has been a drug since Osborne had something to do with it. Ironically, Ed Miliband wanted to come in on a ticket to reform the energy ‘market’ – so how’s that going for you then?

Whisper it gently. Wakefield was hardly a massive endorsement for Labour, as their number of voters actually went down in a climate of the worst Tory Prime Minister (and government) in ‘living memory’. I am not alone. I also happen not to be that interested in culture wars or Brexit. If you’re looking for ‘security’, this Government is the pits – howeverso defined, economic, financial, or political, with the shambolic running of public services. But if you’re looking at ‘aspiration’, it’s pretty awful too. I can’t believe that many so-called entrepreneurs found Boris Johnson’s call to arms, ‘Fuck business!’, that inspiring.

It might be a case of ‘hold your nose and vote for Labour’, which is what I suspect might happen. Meanwhile, Scotland might get some momentum on its indy ref, and this might alter the landscape of the next Government of the UK. I think, however, it would be wrong to say that Starmer has successfully completed ‘phase 1’ of his election-winning strategy. If the aim was to rout out all the hard Left, he has also palpably annoyed many who supported the policies of the previous leader of the Labour Party. So as the ‘unity’ candidate, I have rarely seen the Labour Party so divided. With a possible ‘summer of discontent’, extending from railway workers to nurses, post office, fire brigade workers, the plight of the public sector who have sustained world-beating pay freezes will come under increased scrutiny. We know that Starmer has cancelled the 2019 manifesto, and it’s hard to say quite how popular/unpopular these policies were. Two things to say here, Starmer’s 2nd referendum didn’t help with Red Wall Brexiteers. Secondly, much of this policy has been assumed by a rather non-conservative Conservative Policy anyway.

Starmer’s problem is that he does not seem to be wooing as many from the ‘Centre’ as he has clearly lost from the Left. And he has – as yet – no clear view on inflation, Ukraine, or Brexit – even if he knows what a woman is. I am yet to be convinced he has completed ‘phase 1’ of his strategy – but assume for a moment that he has, what is his programme for government?

The problem with not having anything to positive to vote for

My late father used to remind me that I had a habit of ‘doing’ before ‘thinking’, which is why he repeatedly said to me shortly before he died in 2010: “The problem with you, Shibley, is that you always ‘do’ before you ‘think'”.

I began today, about eight hours ago, with a tweet which summed up how I felt on reading that David Lammy could not support striking action. Lammy is the one who effused about Jeremy Corbyn, before he shoved the boot in. Last election, there was plenty that I could vote for, in preference to a person who referred to Muslims as ‘letterboxes’ or gays as ‘tank-topped bumboys‘.

Clearly some racism is acceptable to the voting public – some isn’t.

I could’ve voted for policies such as: national care service, improving broadband, for example. I did vote Labour in 2019.. It was ridiculously apparent that the NI protocol was totally unworkable with a border down the middle of the sea. Johnson with an impeccable record of lying, and getting away with it, was clearly fraudulently telling the UK public, “Get Brexit done!”. He has literally lied for his livings, and treats his Party in the same way his former lovers, one can assume by telling them distorted versions of the truth, allegedly. We are all now suffering due to the lies told by him and others over Brexit, and it will all unwind massively once the European Union takes the UK to court.

I might suggest that this is all ‘ancient history‘, but Johnson says he got all the big calls right – I think what he meant was he got the big culls right, with pretty disastrous policies as would be expected after decimating public health as his Party had done so for a decade. He ‘got Brexit done’, in contrast to Gordon Brown’s much flogged image of ‘dithering’. Remember when the media had a frenzy about how Brown couldn’t decide whether to dunk his biscuits or not? Johnson and pals have been sitting on the reconfiguration of social care for a very long time, and the NHS is in tatters (frustratingly for the very talented people who work in it).

So riddle me this. RMT, the union, disaffiliated from Labour a long time ago. Mick Lynch and Eddie Dempsey from the RMT have made abundantly clear what the arguments are for organising collective action against lies from the Govt and other railway parties. When asked about the allegation of ‘resisting’ change, progress and innovation, Lynch points out that they’re not using Stephenson’s “Rocket” any more. When Lynch is compared to a ‘dinosaur’ by a swivel-eyed loon during Question Time, Lynch calmly points out the dinosaurs were around for 130 million years, from which he deduces that they had a ‘very good innings’. When Dempsey is then threatened with why he opposes ‘compulsory redundancies’, Dempsey politely points out, ‘If a worker has an old spanner, you don’t sack the worker, but you buy him a new spanner’. It is ludicrous that RMT is expected to take the revenues when certain organisations have made much profit: e.g.

“In 2021-22 Q1 passenger revenue was £999 million, higher than the £184 million in 2020-21 Q1 but still lower than before the pandemic (£2.8 billion in the same quarter two years ago (2019-20 Q1).”

The Government haven clearly colluding to shaft RMT members, and Starmer/Labour refuse to give RMT any support. More than that there is talk of ‘disciplining’ those picketing. An odd reaction given that the Unions founded the Labour Party to re present working people in parliament. David Lammy, as a future foreign secretary, he wishes, can’t wait to distance himself from the Unions defending workers’ rights, for example striking BA workers.

I think Sir Keir Starmer has been abysmal in pointing out last year that inflation would be a problem this year. He was pretty useless in saying where he could ‘improve’ Brexit – even Nigel Farage and other Brexiteers wish that Brexit were going better.

Hence my tweet, which provoked a huge reaction within 8 hours.

I consider myself left wing, as a lifelong Labour voter. I probably wouldn’t want to vote LibDem, as they oppose the strikes (and have a proud history of opposing Labour), despite my pro EU sympathy.

There is a sense of ‘plague on your houses’.

‘Femi’ played the line that it is people like me who are the real problem, more left wing than is possible. So, riddle me this, how come these are actual data? I don’t recall people voting for mega right-wing policies like we’re currently enduring.

The current Government is pretty awful, and so are their echo chamber allies obsessing with Pride “swastikas”, transsexual athletes, racism as an overblown issue, Starmer not being able to define a woman, and so forth.

In the absence of sensible policies, defence of workers and Labour values, and convincing leadership, it is pretty hard for me to vote Labour. As a matter of ‘necessity’, it has been argued that I should simply vote to ‘get the Conservatives out’ – and there is some truth in the notion that my plan not to vote for Lammy, Starmer or Labour is both unpragmatic and totally unhelpful – facilitating a Johnson government. Johnson has already made it clear he intends to go a full three terms, with his ruffled hair ‘virtue signalling’ that he will ignore the critics. He already has called his record ‘outstanding’.

Johnson is outstanding at being ‘full of shit’. I am clearly not the only one able to vote for Labour, and this could turn out to be a big problem if Starmer felt that obliterating the Left would secure him office.

Fads, pads and dose-set boxes

I received an email this morning from a large international dementia charity launching a latest ‘anti-stigma’ initiative. I became interested in the activities of dementia charities about ten years ago, but I became tired that certain issues were going around ‘on loop’ without much apparent progress.

I have discussed, as indeed many have discussed, the slogan, ‘living well with dementia’. A point of convergence of us is that it may be achievable for most people to live relatively well with dementia. At the time that it was launched, when it was very much a policy fad, a whole schema had build up around ‘living well with dementia’.

That was, individuals could ‘live well’, independently in the community. A cost-neutral way of effecting this, it was hypothesised, would be that entire communities could have aspects which are ‘dementia friendly’. This might range from libraries, to shopkeepers, to transport.

Like many things which go awry, we can perhaps suggest that a pandemic got in the way. This would of course have been a golden opportunity for the new armies of volunteers to kick into action, to help those more lonely members of our community with dementia, and so on.

I am prepared to concede that this was well intended from an oligopoly of charities. Lurking under the surface was the notion that there might be ways of dramatically slowing down the progress of dementia, although there was never any convincing evidence regarding that. That much was clear, people with the ‘best diets’ in the world developed dementia, and even the most educated.

I think the fad was to some extent supported by a small platoon of ‘dementia advocates’, who had been apparently diagnosed with dementia, although nobody requested nor anyone volunteered much proof of that. The most striking thing about them, however, was their relative lack of clinical progression even to the most untrained eye. Specialists in dementia, who tried to draw attention to the potential problem of such ambassadors having totally different experiences to exhausted burnt out carers, painting a picture of dementia which seemed like ‘magical thinking’.

Anyway, these ambassadors still continue to give talks and continue to be given invitations to international talks. I am confused still.

In English policy, the NHS ‘living well with dementia’ pathway did not even dare to mention ‘caring well’, subsuming it under ‘supporting well’. It was if social care did not exist. To all intents and purposes, social care was existing less and less due to drastic cuts over a prolonged period of time. Social care professsionals, especially during the pandemic, have worked extremely hard.

The plight of carers has become increasingly difficult recently not least due to the ‘cost of living’ crisis. But, overlaying this, in dementia care, are two further problems which are to do the environment, and the blame cannot be laid at the feet of those people living with dementia.

Incontinence commonly happens in dementia. Community services have been stripped to the bone, so there are literally patients put into pads who had never been incontinent before. They remain unreviewed on discharge. The pads are not being used primarily for continence care. They were used in a hospital admission as a form of physical restraint. Some patients with dementia were simply unable to use their ‘call buzzer’ (more of a hazard when carers are restricted from visiting) or some caring staff didn’t want to answer them in a busy shift. It seemed much easier to strip patients of their dignity, by putting them permanently in incontinence pads. The repercussions of this are huge, as it takes persons living with dementia to an altogether different level of perceived dependence. The ultimate level, prior to death, is transfer to a residential care setting, inappropriately termed ‘institutionalisation’.

Furthermore, one care provider has decided to offer no longer dose-set boxes or blister packs, where patients and carers can simply dispense of the medications morning and night on specified days. What happened to patient choice? Carers are exhausted as it is. 

On top of that, COVID cases are still going up, there are still paid carers off sick, and there are still giant rota gaps. If your loved one then gets really ill, it can be impossible to get an ambulance.

It is almost as if the pandemic gave people license to act badly, irresponsibly and unreasonably. In many ways, it has never been a worse time to be a ‘dementia carer’, paid or unpaid.

In the psychiatrists’ chair

I have an odd ‘lived experience’ as a learner which in part represents an intersectionality between race, age and disability.

Tomorrow, some members of the Royal College of Psychiatrists appear to be rushing through some proposals to improve diversity in their College. I don’t want to mis-convey the original plans, but a summary of them I believe is here.

This is of course entirely laudable as a goal, but clearly the ‘rush job’ raises alarm bells for anyone. As a member not of that parish, I do find their approach very odd – a sort of ‘command and control’ without much command or control. Unsurprisingly, it has been subject to Twitter debate, which is generally a bad idea until proven otherwise.

My first foray into stigma came by reading Scambler’s sociological work on stigma and otherwise. That’s when I decided that ‘otherness’ tended to be a bad tide, and separating people largely ended up being segregation not divisive. I always had problems with the term ‘living well with dementia’, because I kept on thinking about those unfortunate individuals (and carers) who weren’t living quite as well. Segregation lies on a slippery slope for me with prejudice and stigma. A new stream for ‘postnomials’ is a bit of a no no in this regard?

So it came as a surprise to me that the Royal College of Psychiatrists was having ‘labour pains’ over the issue of their International graduates and SAS doctors. This issue is not unique to them – all Royal Colleges have similar issues. The regulator, General Medical Council, and Medical Schools Council have made it clear that active inclusion is meant to be the ‘norm’, and indeed for accreditation for Advance HE and the Academy for Medical Educators inclusion is taken as red.

Strategic leadership is valued in healthcare education, and no less important than in mental health and psychiatry. It’s worth reminding ourselves of theme 2 of ‘Promoting excellence‘ from the GMC. The GMC is paid for, and serves, registered doctors in the UK, so will only in part apply here depending on the interpretations of RCPsych.

Inclusive and diverse learning environments result in a better education for medical students and doctors. They can also lead to patients receiving higher quality andcompassionate care. Inclusion in an educational context is the facilitation of learning through pedagogy which allows for the differences between all learners. Inclusive practices are felt to include typically recognising uniqueness and promoting belongingness. Diversity is a fundamental property of populations qnd not a “problem” to be fixed. Equity addresses ongoing injustices experienced by marginalised persons, and leads to the construct that improved equity leads to improved quality.

Inclusive spaces are co-creative, so it makes entirely sense to co-design and co-create new proposals with the international or SAS or other doctors concerned. A diverse population is better served by a diverse workforce that has had similar experiences and understands their needs. Patients often identify closely with medical professionals with lived experiences, who can offer insight and sensitivity about how a recent diagnosis and ongoing impairment can affect patients. It is now pretty widely accepted that such experience is invaluable to the medical profession as a whole, and illustrates the importance of attracting and retaining learners.

In any curriculum, there would be ideally ‘constructive alignment‘ between learning outcomes, teaching and learning activities, and assessment outcomes. I don’t see why this cannot be extended to a legitimate expectation that all professionally registered psychiatrists who meet professional values and milestones in postgraduate education can apply for Fellowship. I think exams are one way of assessing the meeting of learning outcomes, but by far not only the means.

The de-emphasis on ‘time based curriculum’, more towards a competency based curriculum, is at odds with the idea that doctors mature ‘after ten years’ as a strange kind of magic. It surely would be preferable if the application for Fellowship could be assessed by a mentor and the College on the basis of objective criteria,, such as contribution to leadership, QI or research for example. The award of fellowship ought to be meaningful. The Royal College of Physicians, for example, my College, has done sterling work here. It could be that the MRCPsych is a ticket through the turnstile for this (skills based) raffle, or not. This is where research on the membership exams as a barrier to a career progression might be quite interesting. We already know there is an attrition in numbers between junior and senior psychiatrists, and maybe the real #choosepsychiatry battle is here for retention of the skilled workforce, recognised for their abilities regardless of background. Milou Silkens’ paper, which I came across from running journal club in Nottingham for our masters students in medical education, made an impact for me here.

Finally, I do get the ‘thing’ about voting rights. I think they are important, not least because of ‘P’ in the ‘PANEL’ principles of human rights. See for example the Scottish Human Rights Commission documentation. Some of us know, from rather bitter experience, that racism exists in the NHS. Some of us, more than others. The data are overwhelming and uncontroversial – and compelling. See Roger Kline‘s pieces on this.