Size of government, continuity of care in the NHS and community power generation.

One of the recurring themes in political debate is the desirability, or otherwise, of large or small government. Generally speaking, the Conservatives claim to be the champions of small government and they imply that others favour the larger variety. I cannot recall hearing any politician making the case for larger government, at least not in those terms.
My suspicion is that the term small government is supposed to appeal to the electorate at large in rather the same way that law’n’order is bandied about in a policy-detail-free way when an election looms. There is political atavism at work here. The more these magic mantras are chanted, the greater the chance of election. It must be so, because this is the way we always do these things, they seem to be thinking.
This is a false dichotomy. There is no meaningful content to these claims and counterclaims. There are no definitions or preferred frames of reference. It’s simply window dressing of a particularly unthinking, lame and time-expired type.
Were the parties to take the trouble to ask the electorate what size government they desired or required I hope that the reply would be: ‘sufficient government’.
The electorate has certain basic expectations of any government, I believe. Peace, national solvency, economic stability, education, health, transport, defence, low crime levels, etc. etc. – the usual appurtenances of a civilised society, neither more nor less. Sufficient government is that which is required to deliver these essentials with the greatest efficiency and reliability. Given the exigencies of ‘events, dear boy’ imposed on governments, the required size of government will fluctuate naturally.
The proponents of small government will, if given any encouragement, reduce the establishment below the optimal level in their tax cutting zeal and, therefore, habitually overshoot and fail to permit the necessary recovery when necessary. This will lead to progressive failure to meet the electorate’s expectations and failure to have sufficient administrative reserve to face unanticipated developments.
Contrarily, we see too often the growth of Imperial scale bureaucracies headed by overpaid ideologues, quangos, ‘consultants’ and ‘special advisors’ under governments of all stripes at the expense of the legions of civil servants and others who form the more legitimate and accountable component of the government establishment. Cuts, which everyone seems to feel are inevitable in the months ahead, should occur amongst these very expensive arrivistes in government circles. A politically neutral civil service, employing the best of the best and observing the highest standards, is long overdue for resurrection.
Most people, most of the time, see their doctor or any healthcare professional infrequently. Generally speaking, it is those at the extremes of life and women in their child-bearing years who seek medical care most often. Men, especially from teenage years to retirement, tend to be infrequent attenders.
When you do see a doctor, especially with anything non-trivial, what do you expect? That you recognise each other perhaps? That the doctor has your complete history available, either in his/her memory or written or electronic? That the doctor is the doctor you chose to see?
If the problem that takes you to see a doctor is minor, you may be happy to see anyone who is available as soon as possible. If the problem is immediately life threatening, then any qualified person will usually suffice. Between these extremes falls the majority of medical care, it is the continuing care of long term problems that occupies most doctor’s time.
When you are seeing a doctor for something that is a persisting feature of your life, most people prefer to see someone familiar, who knows you and your problem(s) and your circumstances. Having to go through the whole story of your life and problem, every time you meet a new doctor is very time consuming. A doctor unfamiliar with you may struggle to grasp the whole picture at once, sometimes with unfortunate results.
Everyone is unique – physically, psychologically and socially. For anything other than the most minor or the most catastrophic complaints, it is important to have a degree of familiarity with the whole patient picture. Everything is connected – rarely is this truer than in medicine.
The continuity of care in both primary and secondary care fields is being destroyed by successive Conservative and Labour governments. This is having a deleterious effect already and the problems will only worsen. In my more optimistic moments, I believe that this course of events has been chosen in ignorance and with lack of proper consideration. The alternative, that the bond between patient and doctor is being ruptured as matter of deliberate policy, is almost too sinister to contemplate and the repercussions will be life changing for many and life ending for some.
When elected, I will be doing all I can to get the message across to government that continuity of care is the essence of effective care. Unfortunately, it is difficult to price and therefore, in these times when governments know the cost of everything but the value of nothing, there is a considerable hill to climb.
Communities all over the UK are looking into generating their own power. Several technologies are immediately available – wind, hydro, anaerobic digestion, gasification, solar – and in each category there are many options.
In Haydon Bridge, where I am Vice-Chair of the Development Trust, we are just starting out on the road to energy self sufficiency with the help of an organisation called CoRE from Berwick. They are able to offer assessment and advice on both domestic and community level projects.
Our geographical situation is such that all the technologies are, at least potentially, suitable. A factor that we had not anticipated, however, is that large scale anaerobic digestion plants create local employment.
Every community – rural, suburban and urban – should be given the utmost support in developing their own local energy strategy. The price of energy is going to rise punishingly in the years ahead and there is nothing that governments can do about that. Citizens, singly or in communities, on the other hand, can take matters into their own hands now and be ahead of the game in the future.
Advantageous VAT rates on goods and services connected with these sorts of development would help, as would direct grants and low or no interest loans from government. Lenient planning regulations can be introduced to limit delays. I will be pressing for such considerations when in Westminster.

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