Noble or what?

The Department for International Development (DfID) is the only Government Department that has not had its budget cut, in the latest round of cost-cutting measures. There is always a furious debate over the subject of International Aid, with some questioning why we should spend billions of pounds on others, when our own country is being asked to make so many personal sacrifices.

I don't have too much problem with the principle of International Aid, as I don't think that we should be parochial over this and ignore the depth of need across the world. I agree with the International Development Secretary, Andrew Mitchell when he says that such aid is 'morally right' and shows 'compassion' for others. However, I sometimes have to question whether we are often just providing a sticking plaster to a problem, rather than dealing with the cause of the wound.

Over the last few months, the DfID has been examining how best to spend its £7.8 billion budget (which is set to increase by around 37% over the next four years). They have decided to stop direct aid to sixteen countries, two of which are Russia and China - it came as a bit of a surprise to me to see that we sent aid there anyway. Aid to India will stay at the current level (around £295 million); this is in spite of major questions being asked as to why we support a country whose economy is growing at nearly 10% a year. Substantial increases in aid will be given to Pakistan, Ethiopia, Bangladesh, Nigeria and the Democratic Republic of Congo.

Orla Guerin, BBC News says that "UK aid to Pakistan could more than double, reaching £446 million a year under plans announced by Andrew Mitchell". The UK has ambitious plans for education in Pakistan. It aims to supply 6 million text books, train 90,000 teachers, and get an extra 4 million children into school over the next four years (currently over 40% of children under 9 don't go to school). In addition, the aim is to save the lives of 110,000 children by expanding community health services; prevent 3,600 mothers dying in childbirth, and get another 2 million people to vote in the next general election. I applaud these targets, but they are down as UK aims; where is the Pakistan Government in all of this? Are they on board for the long haul, or are they just letting the UK get on with it? It's all very well having a plan for the next four years, but what about in 10 or 20 years time? By all means train 90,000 teachers, but will the country's infrastructure be able to pay them, and to train the succeeding generations? By all means expand the community health services, but will Pakistan carry on with these services when UK funding comes to an end? Short term solutions make great headlines, and undoubtedly achieves success, but what of the long term view? Or perhaps in political terms that doesn't matter, as it will be somebody else's problem. And what I say for Pakistan can be said for every other country that is a recipient of UK International Aid. Let me repeat, I'm for aid, but it has to be part of a bigger, longer term picture.

Still on the subject of International Aid, it was announced two days ago that Countries as well as the Bill & Melinda Gates Foundation have pledged £2.6 billion to help vaccinate children against preventable diseases.

This included £814 million from the UK, on top of the £680 million already committed, and about £617 million from the Gates Foundation. At the conference to discuss the way forward, David Cameron said, "Today we come together because we have the chance to save another four million lives". He said that the idea of children dying from pneumonia and diarrhoea should be 'unthinkable' in 2011. Two million under-fives die from pneumonia alone each year despite the existence of a vaccine to protect them. It is estimated that three times as many children aged under five die from pneumonia and diarrhoea than from malaria and HIV/Aids combined, despite new vaccines being available, that unfortunately many developing countries cannot afford. Bill Gates said, "For the first time in history, children in developing countries will receive the same vaccines against diarrhoea and pneumonia as children in rich countries".

Now, all this sounds like noble philanthropic work, so what possible problem can I have with it. Look, no one will be happier than me if four million lives are saved, but my problem is still with the longer term.

Leaving aside Bill Gates' alleged views on vaccines and population control (which I may return to in another Blog, after I've consulted my lawyer), there are two areas that should be questioned.

One is the historic role of drugs companies. Following the vaccine programme conference, major drugs companies have agreed to sell a vaccine for diarrhoea disease at cost price. But there has been concerns over the years about the content of some vaccines, particularly those sold to the developing world. Now, I'm no pharmacist, so I can only read reports and try and make up my own mind. F. William Engdahl, wrote a study on 'vaccines to reduce population', where he researched in depth the effects of certain vaccines on children and adults. He said, "The pharmaceutical vaccine makers do not speak about the enormous health damage from infant vaccination, including autism and numerous neuro-muscular deformities that have been traced back to the toxic adjuvants and preservatives used in most vaccines. Many vaccines, especially multi-dose vaccines that are more cheaply made for sale to the Third World, contain something called Thimerosal, a compound containing some 50% mercury, used as a preservative". To be balanced, many others disagree about one possible effect being autism.

The American Academy of Pediatrics, and the Centres for Disease Control and Prevention, alerted the public about the possible health effects associated with thimerosal-containing vaccines. Any medical journal will tell you of the dangers arising from the cumulative effects of ingesting mercury. How can we be sure what is in a vaccine? And in the rush to get mass vaccination programmes started, how can we be sure that vaccines given or sold to the developing world have been fully tested, authorised and are safe? I'm still convinced that we take too much on blind faith, and that more reassurance is needed that Governments, the World Health Organisation and pharmaceutical companies are not dumping toxins on the Third World. I know that I may sound like a conspiracy theorist, but there are genuine questions that need to be asked.

The last question I have is this. Vaccinating four million children safely is laudable, and there is no sane argument against it. But, those children will still go out to drink feces-polluted river water, and the generation to follow will do the same. How is there general heath improvement in that?

I know that there are non-governmental organisations working across the world to dig wells to produce clean drinking water, but they are scratching the surface of need, no matter how hard they try.

Having looked at the cost of digging wells in Africa, it seems that one dug up to 200 feet deep, that could meet the needs of hundreds people costs just over £3,000. Larger wells, up to 900 feet deep, and meeting the needs of around 3000 people, will cost just over £18,000 - from that depth they need to be electric driven. One well in a small village will meet their clean water needs now, and into the future, so preventing the catching of diseases that kill. Clean drinking water will ensure that millions of vaccines are unnecessary. Why can't Governments and philanthropists put more money into wells than vaccines? Surely it can't be that it will take that much longer for results to be seen, and therefore credit to be given.

If you look at the extra money that the UK Government has promised for the vaccine programme, and you divide that by the average cost of sinking a well to provide clean water, you can provide around 300,000 wells. Surely, it's not unreasonable to expect that if we are going to spend large amounts of money on vaccines for preventable diseases, that we concentrate on providing minimal sanitary, water and sewage systems, that can make a major difference to health now, and into the future.

Health and Social Care Botch-Up

Friends or Foes?

The much heralded reform of the NHS was published on the 27th January 2011, and I made my views known in a blog on the 29th March. But the reforms have not taken place; instead the Coalition Government have decided to "pause for reflection", and engage in a "listening exercise". If they had done this at the start, they perhaps would not be in the embarrassing position they are in today. For instead of "reflection" and "listening", we seem to be witnessing a full-blown, carefully orchestrated retreat. We are being presented with the message that Nick Clegg and the Lib Dems are now unhappy with the Reform Bill, and that theirs is the moderating voice safeguarding this great institution. However, it was the Lib Dem's who proposed the wholesale abolition of primary care, and not a single Lib Dem MP voted against the legislation at the second reading of the Bill.

The cynic in me comes to the fore when I wonder why this change of heart within Lib Dem ranks within the space of a few months. Could it have anything to do with the electoral mauling that they took at the start of last month, and the defeat of the AV proposal?

This new assertiveness by the Lib Dems is seen by some Tories as "cynical sabotage", and comes at a time when some Lib Dems are fearing that their identity is vanishing altogether. They are threatening to withhold support for the plans set out by Andrew Lansley unless drastic changes are made.

I'm questioning the sincerity of the Lib Dems current approach, as why not advocate this position months ago when there was an opportunity to do so? Whatever, the mess we are now in is due in part to badly prepared and presented legislation. Cameron, Clegg and Lansley failed to recognise what Francis Fukuyama in his book, 'The Origins of Political Order' says about institutional reconstruction, that it "is not like building a hydroelectric dam or a road network. It requires a great deal of hard work to persuade people that institutional change is needed in the first place". It seems to me that no such strategy for the NHS reforms was put in place, or at least not in time.

Nick Clegg has said that "arbitrary deadlines are no good to anyone", which is effectively saying that the plan to abolish Primary Care Trusts, and introduce GP Consortia by 2013 has been scrapped. In fact his view is that GP consortia should be introduced when GP's are ready for it, rather than to be imposed upon them. He also confirmed that the Bill would go back to the Commons for scrutiny. Oliver Wright, in the Independent on Sunday says, "The decision (to go back to the Commons) means the reforms are likely to be delayed by at least six months as the Health Committee will be unable to complete its consideration of the altered Bill until after the long summer recess".

Re-opening the Bill will enable some important safeguards to be put in place, but slowing it down poses problems to. David Cameron faces a painful choice, as the Editorial in today's Observer says, "To abandon the Bill would be a humiliating U-turn. The right wing of his party would be outraged and seek bloody vengeance against the Lib Dems. But if he presses on, the likely result will be a mangled, incoherent Bill, unrecognisable to its author, disliked by doctors and barely understood by voters. The health service will face years of instability with little prospect of immediate improvements in service".

Andrew Lansley

In all of this, where does it leave the Health Secretary, Andrew Lansley? Friends are reported as saying that he is ready to resign if too many concessions are made to the Lib Dems.

In a long and detailed article about "Why Cameron is giving Clegg the high ground on the NHS", Matthew d'Ancona says, "As for Lansley, he has good reason to feel aggrieved and betrayed. His life's work is being dismantled before his very eyes. Support that was promised is being withdrawn. He is being deserted in the most ruthless fashion. Number 10 accepts that he may well resign. Whether or not he does so, the final insult is the unambiguous signal he has already been sent by his most senior colleagues: that his departure, however regrettable, is a price worth paying. Anything - anything - to make this political horror-show go away".

Now, let's be honest here. I was implacably opposed to the introduction of the Health and Social Care Bill 2011, so I am happy that it is going to be looked at again, and probably will bring about some major changes. However, this current botch-up has lost sight of one thing, and problematically caused another.

What has been lost sight of in all this mayhem, and I hardly hear mentioned, is the report by David Nicholson, Chief Executive of the NHS, who has made it clear that, because of rising demand for health care, the NHS must find efficiency savings of £20 billion by 2015 merely to provide the same level of care as it does at present. That's an average of £5 billion a year for the next four years. No wonder that the Independent on Sunday says that "A great deal of energy is being expended on an institutional overhaul when the real challenge is a simple one: cut costs". Whatever the political persuasion, or ideological outlook, this has to be addressed.

The fluffed presentation of the Bill, and its current hiatus has caused major problems. For a start, the running down of Primary Care Trusts has already begun, but GP consortia that is supposed to replace them has been put on hold. If Primary Care Trusts have been dismantled by 2013, and GP consortia are not in place, who will commission care for patients? What will happen to these patients not covered by PCT's or GP's needs to be answered - and soon, after all, it's only just over two years away.

The current situation has brought loss of jobs to highly skilled and experienced health professionals; PCT's are finding it difficult to recruit, because who wants to join an organisation that may soon be abolished; there has developed a climate of uncertainty and unrest, with morale being, understandably affected. There is no doubt that a lot of political in-fighting will be going on at the moment, but in respect to NHS reform, I hope that the words of Nick Clegg will not be forgotten (particularly by him),

"The right kind of reform starts from the patients' point of view. Not bureaucrats, not unions, not ministers, not political parties - patients".