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Transferability – The Solution to Systemic Bottlenecks in the NHS

by John Brian Shannon

Unfortunately for large healthcare providers like the UK’s highly rated National Health Service (NHS) people don’t always get sick near their local hospital. Rather, people will become ill, get injured, or encounter long-term illness everywhere throughout the United Kingdom regardless of where hospitals are located. Which is why some UK hospitals are full to overflowing while others have spare capacity.

One way to improve healthcare outcomes in the NHS is to incorporate transferability of treatment to relieve bottlenecks in the system.

Patients who can’t be treated in their local hospital due to lack of available capacity could be transferred to other hospitals in the UK where some amount of spare capacity exists and receive their treatment sooner than waiting for treatment at their local hospital. And even accounting for airline or rail tickets, possibly an overnight stay in a reasonably priced hotel in cases where the airline vs. operating room schedules don’t match, and for other incidental patient costs the health service would be required to pay, it would save the NHS money and dramatically improve healthcare outcomes for patients.

Patients who desire an upgraded hotel room could pay the difference themselves between the (covered by the NHS) standard room rate and the upgraded room rate.

When a patient has cancer, heart problems or other serious health issues, nothing is gained by making the patient wait for a treatment date in a hospital close to their home, because almost 100 per cent of the time those conditions will worsen as the patient waits for treatment.

Delayed treatment significantly increases treatment costs — because during the days, weeks or months of delay, the patient’s disease is certain to worsen.

Even those with slipped discs or other musculoskeletal impairments find their condition worsens over the amount of time their treatment is delayed. To say nothing about the suffering of the individual and their families while the person remains in a precarious health situation.

But if patients with serious conditions receive treatment sooner, healthcare outcomes for patients will improve and NHS statistics would improve because the disease or condition won’t have progressed as far in the case of faster treatment vs. waiting extra weeks or months for treatment at a local hospital.


Increase in Productivity

Workers who can’t work, can’t contribute much to GDP.

What is also true is that with faster treatment workers can return to work sooner and contribute to their company and by extension to the GDP of the United Kingdom.

Unhealthy people cost the economy, while healthy people contribute more. It’s therefore in the best interests of the government to get everyone the treatment they need with the minimum of delay.


Little Room for Improvement in the NHS

For an idea of just how highly the NHS is ranked in the world, please view the following chart courtesy of The Commonwealth Fund, an organization which ranks global healthcare systems via a number of metrics.

UK NHS and 10 other countries, Health Care System Performance Rankings

Health Care System Performance Rankings for the UK and 10 other countries. Image courtesy of The Commonwealth Fund.

It’s easy to see there is little room for improvement within the NHS, but Access (the ability to access treatment within a reasonable timeframe) and Health Care Outcomes (the success rate of treatment — which is often related to waiting times associated with treatment) could be significantly improved.


Scotland, Here I Come!

Some amount of transferability of treatment exists within the NHS at present, however, those in England tend to be treated or wait for treatment within England only. Scottish patients may be transferred to other hospitals in Scotland, and Welsh patients may be transferred to other hospitals in Wales. It’s likely a similar situation exists within Northern Ireland.

What would work to decrease bottlenecks in the NHS and thereby improve healthcare access and healthcare outcomes would be treatment transferability for patients throughout the entire United Kingdom.

Doctors could provide their patients with options for treatment when full transferability becomes the norm; (Example) “You can wait 6 weeks for treatment at your local hospital, or we can fly you to Scotland tomorrow, put you up in a reasonable hotel overnight and your operation will be scheduled for 7:00am the following day, and we’ll fly you home a day or two after the attending surgeon approves you for travel.”

For patients in severe musculoskeletal pain, or experiencing rapid cancer growth, or increasing difficulty in breathing or experiencing other serious symptoms, the sooner they can obtain treatment the happier and healthier they’re likely to be. That’s a win for patients, for doctors, for under-booked operating rooms in far-flung regions, for NHS statistics, and even for UK productivity stats and GDP.

There are so many ways to win with treatment transferability throughout the entire United Kingdom. It’s really the only systemic improvement left for the NHS.

Building more hospitals is expensive (and necessary in any case) but directing patients to underutilized hospitals (now, and even after more hospitals are built) can help patients towards sooner and better health while improving Access and Health Care Outcomes statistics for the NHS.

Theresa May Women’s Suffrage speech: February 6, 2018


Full transcript of Theresa May’s Manchester speech (February 6, 2018) marking the centenary of women’s suffrage


“One hundred years ago today British democracy was transformed. With the passage of the Representation of the People Act on 6 February 1918, most women aged over 30 and the 40% of men who did not own property gained the right to vote in Parliamentary elections for the first time, and with it, a say in making the laws of the land.

It was a great expansion of democratic participation – tripling the size of the electorate and empowering voices and perspectives which for centuries had been excluded.

Gender equality at the ballot box was not achieved for another ten years, and I am proud to say under a Conservative government.

But with the 1918 Act, the die was cast.

And it is wonderful to be here in Manchester to mark its anniversary. This great city was one of the centres of activism for women’s suffrage. It was the birthplace and home of one of the icons of the movement, Emmeline Pankhurst. I heard about the campaign for women’s votes from my godmother, whose parents were active in the cause and knew the Pankhursts.

So I am delighted that this year, with funding from the government, a statue of Mrs Pankhurst will be erected in this city as a lasting monument to her courage and vision.

And as Leader of the Conservative Party, and the co-founder of Women2Win, which works to encourage more women to stand for public office, I am proud that Emmeline Pankhurst was one of our pioneers, being selected as the Conservative candidate for the Whitechapel and St Georges constituency in east London in 1928. And the simple fact is that we don’t have nearly enough monuments to the great women of our country’s past – and I am pleased that we are now starting to set that right.

Today we celebrate a huge and irreversible step towards creating a truly universal democracy, and the beginning of a representative public debate.

But I also want to take this opportunity to reflect on the nature of our public life today.

As we remember the heroic campaigners of the past, who fought to include the voices of all citizens in our public debate we should consider the values and principles that guide our conduct today, and how we can maintain a healthy public debate for the future.

For while there is much to celebrate, I worry that our public debate today is coarsening.

That for some it is becoming harder to disagree, without also demeaning opposing viewpoints in the process. I believe that all of us – individuals, governments, and media old and new – must accept our responsibility to help sustain a genuinely pluralistic public debate.

Freedom of speech in a democracy

In that task we build on the finest of traditions and the firmest of foundations. Britain’s liberal democracy has long been respected around the world for its tolerance and decency. It is defined by values which have a universal appeal. Freedom of thought and expression within laws which are democratically made. The competition of ideas leading to collective progress and improvement. Respect for those with different viewpoints.

These principles have been at the heart of the British tradition of liberty for generations. From John Milton at the height of the English Civil War arguing against censorship and in favour of the ‘free and open encounter’ of different opinions, to John Stuart Mill in the nineteenth century, advocating ‘searching for and discovering the truth’ by way of free speech and debate, a philosophy of freedom of expression in an atmosphere of mutual tolerance has been one of this country’s great intellectual gifts to the world.

In an open market-place of ideas in which different viewpoints can coexist and people are free to make the case for their own beliefs opinions can be changed, arguments won and progress achieved.

Votes for Women

Mill, working in collaboration with his wife Harriet Taylor, was a leading advocate of women’s rights. But the cause of women’s suffrage had to overcome entrenched opposition, just to be heard. As an early campaigner, Margaret Wynne Nevinson, wrote:

Sometimes, the hostility of the people was so great that the police were alarmed. Occasionally, we were taken to the police station and kept there for safety till far into the night.

Those who fought to establish their right – my right, every woman’s right – to vote in elections, to stand for office and to take their full and rightful place in public life did so in the face of fierce opposition.

They persevered in spite of all danger and discouragement because they knew their cause was right.

Eventually, through a free and open encounter with the opposing view, the truth of their arguments won the day. And we are all in their debt.

Progress to be proud of

A century on from the first votes for women, we can look back with pride on the enormous strides which we have taken as a society.

A century ago women were forbidden the franchise, could not sit on a jury or be admitted into the professions. Today, I am proud to serve as Britain’s second female prime minister in a Parliament with more female MPs than ever before.

In 2018, the United Kingdom’s most senior judge is a woman. The Commissioner of the Metropolitan Police is a woman. The Director of the National Crime Agency is a woman. Women serve as England’s Chief Fire Officer and Chief Medical Officer. The CBI and the TUC are both headed by women. At Holyrood, a female First Minister debates against a female opposition leader. In the National Assembly for Wales, a woman leads the third party. The two largest parties in Northern Ireland are led by women. And at Westminster, where suffragettes chained themselves to statues and hid in a broom cupboard on census night, the Leaders of the House of Commons and the House of Lords are women. Black Rod, whose predecessor ejected suffragettes from the palace precincts, is a woman. A century ago the Home Secretary and Director of Public Prosecutions were grappling with the direct action of suffragettes. Today, both those offices are held by women. And just like the movement for women’s votes, many other causes began as marginal and unpopular campaigns. They sent down their first roots into the stony ground of indifference and hostility.

They were championed by courageous people from all parties and none who braved abuse and ridicule, violence and persecution in a tireless quest for justice.

Sixty years ago, being gay was a crime and it was legal to discriminate on the basis of race.

Fifty years ago firms could advertise the same jobs with different salaries for men and women.

Thirty years ago, there was no legal compulsion to provide facilities for disabled people.

Today there are more openly gay people in prominent positions in public life than ever before.

More people from black, Asian, and minority ethnic backgrounds are in Parliament, in the media and business.

And disabled people play a more active role in our society than they ever have.

Real injustices still remain for women, for LGBT people, for black and minority ethnic Britons, for people from poorer families and for people with disabilities.

But if we cast our eyes back to well within living memory, we can see just how far we have come.

These improvements have been achieved through free and open debate leading to progressive, democratic change.

Collectively, they have helped to create an ideal as yet still not fully realised, but closer today than it has ever been of a public sphere where wealth, gender, sexuality, race, and disability present no barrier to full and active participation on a basis of equality.

A society where every voice counts. And when everyone has a say in the laws and policies of our country, everyone benefits. I have seen it in during my years in Parliament. As it has become a more diverse and representative place, it has better reflected the concerns of all sections of society. And in my experience, women often bring a different approach to politics than do men. For women, politics can be as much about listening and learning from others as it is about broadcasting your own views and opinions. And that is all to the good. Because when there isn’t just one way of doing things or one perspective on an issue, our understanding is enriched and we can achieve better outcomes.

The threat to our public debate

But today, the ideal of a truly plural and open public sphere where everyone can take part is in danger. A tone of bitterness and aggression has entered into our public debate. In public life, and increasingly in private conversations too, it is becoming harder and harder to conduct any political discussion, on any issue, without it descending into tribalism and rancour.

Participants in local and national public life – from candidates and elected representatives to campaigners, journalists and commentators – have to contend with regular and sustained abuse.

Often this takes the form of overt intimidation. Social media and digital communication – which in themselves can and should be forces for good in our democracy – are being exploited and abused, often anonymously.

British democracy has always been robust and oppositional. But a line is crossed when disagreement mutates into intimidation. When putting across your point of view becomes trying to exclude and intimidate those with whom you disagree.

Women in the nineteenth century had to contend with open hostility and abuse to win their right to vote in the twenty-first century it cannot be acceptable for any women – or any person – to have to face threats and intimidation simply because she or he has dared to express a political opinion.

Sadly, that has all too often become the case.

A hundred years after bringing all voices – male and female, rich and poor – within our Parliamentary democracy we now face the prospect of our country’s public debate becoming oppressively hostile and participation in it a risk which many are unprepared to run.

We can all see this change happening and I know that many share my concern about it.

Just last week, the Leader of Haringey council resigned, citing, ‘sexism, bullying, undemocratic behaviour and outright personal attacks’ which had left her ‘disappointed and disillusioned.’

It is a depressing coincidence that in the week we are celebrating the first inclusion of women in the democratic process, one of the most senior women in local government has in effect been hounded out of office. In our universities, which should be bastions of free thought and expression, we have seen the efforts of politicians and academics to engage in open debate frustrated by an aggressive and intolerant minority. It is time we asked ourselves seriously whether we really want it to be like this. Whether we are prepared to accept a permanent coarsening and toxifying of our public debate, or whether, together, we will take a stand for decency, tolerance and respect.

Whether we choose to be a society in which we define ourselves by our differences or whether we want to be members of a community of common interest.

Those of us – the vast majority of all political persuasions – who want a healthy and pluralist public debate, where civility and tolerance are the default setting and abuse and intimidation have no place where every voice counts and no one is bullied out of speaking their mind have a responsibility to stand up and help deliver it.

Action we will take

Last year I commissioned the Committee on Standards in Public Life to conduct an investigation into intimidation following last year’s general election.

Their report makes sobering reading.

In this centenary year of votes for women its finding that ‘candidates who are female, black and minority ethnic or LGBT are disproportionately targeted in terms of scale, intensity and vitriol’ is a cause of deep concern. Such abuse risks undermining the diverse democracy which we have built in this country over succeeding generations.

But the committee’s report also points the way forward.

It presents a credible plan of action to help build a more civil public debate and I welcome its recommendations. All of us in public life have a responsibility to challenge and report intimidating behaviour wherever it occurs.

We must all seek to uphold the highest standards of conduct.

We must set a tone in public discourse which is neither dehumanising nor derogatory and which recognises the rights of others to participate.

In word and in deed we should never engender hatred or hostility towards individuals because of their personal characteristics.

And we must not allow disagreements about policy or questions of professional competence to lead to vitriol and hostility.

These responsibilities fall on each of us as individuals, and collectively on the political parties.

My Party has already put in place a new code of conduct for all representatives which puts respect and decency at its core.

And we have proposed that the other political parties follow us in signing a respect pledge for all campaigning, and I hope that they will take us up on that suggestion.

For its part, the government will act on the Committee’s recommendations.

We will take action to make our electoral process more robust and offer greater protections for people taking part in elections.

While intimidation is already a crime, we will consult on making it an offence in electoral law to intimidate candidates and campaigners.

And because some candidates and their families have been targeted for abuse in their own homes, we will extend to candidates for local government the same protection which parliamentary candidates have to keep their home addresses secret.

I can also confirm that the National Police Chiefs Council and the College of Policing will implement each of the recommendations in the report which refer to them.

This includes ensuring a clear standard is set for the police when dealing with intimidation and online activity during an election.

And it is online where some of the most troubling behaviour now occurs.

Social media

Social media is one of the defining technologies of our age. For millions of people, particularly young people, it is the means by which they engage with the world, express opinions and communicate with family and friends. In many cases this is clearly a force for good. More voices can find clearer and wider expression. Campaigns can gain publicity and traction.

Through the ‘Me Too’ movement, victims of sexual harassment and assault have felt empowered to speak out using social media.

But as well as being places for empowering self-expression, online platforms can become places of intimidation and abuse.

This is true for children facing the daily misery of online bullying, where a smartphone allows their persecutors in effect to follow them home and continue to torment them even after school has finished. And it is also true for many adults. This squanders the opportunity new technology affords us to drive up political engagement, and can have the perverse effect of putting off participation from those who are not prepared to tolerate the levels of abuse which exist. The Committee on Standards in Public Life makes a number of recommendations for action which social media companies can take to address this problem.

It sets them a clear challenge to do much more to ‘prevent users of their platforms from being inundated with hostile messages on their platforms, and to support victims of this behaviour.’ The social media companies themselves must now step up and set out how they will respond positively to those recommendations So far, their response has been encouraging, and I hope they will continue in that spirit. For its part, the government will publish our Internet Safety Strategy in the spring. It will set out details of a comprehensive new social media code of practice. It will cover the full range of issues we considered in our green paper – from enforcing community guidelines, to preventing the misuse of services.

It will make it easier for people to report inappropriate, bullying and harmful content when they come across it and ensure that firms have clear policies for taking this content down.

We will also establish a new Annual Internet Safety Transparency Report, to provide UK-level data on what offensive online content is being reported, how social media companies are responding to complaints, and what material is removed.

And to ensure that the criminal law, which was drafted long before the creation of social media platforms, is appropriate to meet the challenges posed by this new technology, the Law Commission will conduct a review of the legislation relating to online offensive communications.

The Committee on Standards in Public Life also called for the government to legislate to shift the liability of illegal content online towards social media companies.

These platforms are clearly no longer just passive hosts of the opinions of others, so we will look at the legal liability that social media companies have for the content shared on their sites.

The issue is far from straightforward, so we will consider carefully what approach we should take.

We are already working closely with international partners and social media companies themselves, to understand how we can make the existing frameworks and definitions work better and assess whether there is a case for developing a new definition for these platforms.

Press sustainability

Changes in technology are also having a profound impact on one of the cornerstones of our public debate – our free press. Good quality journalism provides us with the information and analysis we need to inform our viewpoints and conduct a genuine discussion. It is a huge force for good.

But in recent years, especially in local journalism, we have seen falling circulations, a hollowing-out of local newsrooms and fears for the future sustainability of high-quality journalism. Over 200 local papers have closed since 2005.

Here in Greater Manchester, several local newspapers have closed, including the Salford Advertiser, the Trafford Advertiser and the Wilmslow Express.

This is dangerous for our democracy.

When trusted and credible news sources decline, we can become vulnerable to news which is untrustworthy.

So to address this challenge to our public debate, we will launch a review to examine the sustainability of our national and local press.

It will look at the different business models for high-quality journalism. And because digital advertising is now one of the essential sources of revenue for newspapers, the review will analyse how that supply chain operates. It will consider whether the creators of content are getting their fair share of advertisement revenue. And it will recommend whether industry or government-led solutions can help improve the sustainability of the sector for the future. A free press is one of the foundations on which our democracy is built and it must be preserved.

Tolerance and decency

But the action we need to take to secure our democracy goes far beyond rules and reviews. It goes to the heart of how we conceive of political differences and, more profoundly, how we treat each other. At its best, British public life is characterised by the values which we have traditionally been most proud of as a nation. Fierce rivalry, yes, but also common decency. A rejection of extremism and absolutism. We have seen that spirit most clearly at some of our darkest moments. We saw it during the Second World War, when Conservative and Labour politicians put their rivalries and political differences aside to unite in defence of our common values. And we saw that spirit again recently, when Tessa Jowell made her deeply moving speech in the House of Lords about her own experience of suffering from a brain tumour and what more we can do to help people live well with cancer. She held peers from all parties spellbound, and all responded to a speech of great courage with an acknowledgement of our shared humanity. Because while political differences may separate us, and while those differences may at times be profound, so much more unites us. When we forget that fact, when we harden our hearts against those with whom we disagree when we exaggerate differences, doubt motives, accuse others of bad faith we risk destroying genuine debate and we leave open the path to extremism and intolerance.

We were reminded of that truth so tragically in 2016, when a politically-motivated extremist murdered the MP Jo Cox. Following that outrage, some inspirational words from Jo’s maiden speech rightly entered into our common political lexicon. Describing her experiences as a candidate, the new MP for Batley and Spen, said:

While we celebrate our diversity, what surprises me time and time again as I travel around the constituency is that we are far more united and have far more in common than that which divides us.

It is a lesson which we must never forget.

Conclusion

That sentiment chimes much more closely with how the public feel about politics than do shrill and tribal insults. Most people don’t view politics through an ideological prism. They want politicians to work together to improve their lives and our country. They expect disagreements and debate about the best way forward. But they also want practical solutions which will improve people’s lives. As the famous suffragette battle cry put it – they want ‘deeds not words’.

And each day in Downing Street when I pass the framed portraits of my 53 predecessors, 52 of whom were men I focus not on what I can say but on what I can do to make our country a better place.

Negotiating a Brexit deal that respects the vote of the people and delivers a prosperous future for everyone.

Improving our schools, our colleges, and our universities, so every young person in this country, male or female, from every background, has the greatest chance to get on and do well in life.

Tackling the injustices which still hold too many people back.

And as the woman at the head of our country’s government, a century after my grandmothers were first given the right to vote, my mission is clear.

To build that better future for all our people, a country that works for everyone, and a democracy in which every voice is heard.”


Transcript courtesy of: Prime Minister’s Office, 10 Downing Street and The Rt Hon Theresa May MP

Published 6 February 2018


Theresa May + Customs Union = Conservative Coup?

by John Brian Shannon

While UK Prime Minister Theresa May continues to take the path of least resistance towards Brexit (all the while courting and fawning over EU politicians) Conservative backbenchers are said to be considering their chances of staging a coup against her leadership.

At this point, such a coup attempt would fail and leave Brexit forces in a much weaker position than they’re presently in. Considering they have the will of the people behind them and formalized via the June 2016 referendum result(!) Brexiteers haven’t begun to come close to working their movement to its full and proper potential.

But it’s not only May’s path of least resistance approach that’s raised the ire of the Tory caucus, it now appears PM May is trying to appease both Philip Hammond and the EU by suggesting Britain continue as a member of the existing customs union, or that it should become part of a new customs union.

All of which has conspired to convince Conservative backbenchers that Theresa May might be dithering on her promise of delivering a full Brexit.

“Brexit means Brexit” will have turned into “Brexit Means Half-a-Brexit” if Brexiteers can’t organize and morph into a cogent group with a clear leader — complete with a de facto shadow cabinet within the Conservative caucus ready (ostensibly) to take the reins of power at a moment’s notice.

And most importantly (seeing as Theresa May and Philip Hammond aren’t doing it) to speak out and to sell the many benefits of independence from the EU to people of all political stripes, ipso facto chiding the government for not doing so.


Do we have the wrong Prime Minister for Brexit? Is the task too big for her?

Or is it that Brexiteers, still at this late date, are a poorly organized group of patriots that haven’t gelled together to become a force majeur in British politics — and are therefore unable to take their rightful place as a powerful political bloc that truly represents the will of the people?

Every poll these days reports the collective will of the British people is to get a Brexit deal signed and get on with creating a better future for families, UK companies and the country as a whole. Even those who voted to Remain now agree that Brexit must be completed as soon as possible.

It’s universally agreed that political uncertainty is the enemy of economic progress and that industries need clear regulations in order to thrive. That truism is almost as important as ensuring the democratic will of the people is upheld by the government.


A Weak Brexit Lobby Will Cause a Weak Brexit

Brexiteers should stop blaming Theresa May for being a weak leader and become part of the solution instead of part of the problem!

After creating a nominal shadow cabinet within the Tory caucus, the Brexit faction should be hitting every talk show, every town hall meeting, every photo op and every possible event in order to showcase all that Britain can and should be post-Brexit because if it appears that Brexiteers aren’t enthused about Brexit, why should anyone else be enthused?

Let’s see some easy-to-grasp charts, let’s see some future projections based on best practices, let’s see some side-by-side GDP and per capita income comparisons between staying in the EU vs. leaving the EU. Let’s also see what the £8.6 billion (net) annual savings can do for the UK budget, for NHS funding, for transportation improvements, and so much more!

I strongly suspect that Theresa May is merely reflecting the views of the loudest faction within the Conservative Party (which at this point are the Remainers) and I further suspect that if there isn’t a cogent, united and highly visible faction within the Conservative Party supporting the Brexit viewpoint, Britons are on track for a weak and wobbly EU exit.

My heartfelt advice to all Brexiteers, especially MP’s and MEP’s is to ‘use it or lose it’ because if they don’t, Britons will receive a Brexit in name only.

The ball is in your court, Brexiteers!