"An Empty Populist Pledge", by Clive Peedell and Louise Irvine

Reaction to David Cameron's pledge of 7 day a week GP access from National Health Action Party co-leader Dr Clive Peedell and London GP, Dr Louise Irvine.

NHA co-leader, Dr Clive Peedell said:

"This announcement illustrates the chaos within the Coalition. The PM says he wants to tackle the causes of ill health yet his Chancellor announces cuts to the incomes of the working poor creating greater poverty the leading cause for ill health.

The PM supported the Health & Social Care Act which divested the Secretary of State for Health the responsibility for providing a health service yet here we have politicians deciding where scarce resources are best spent without any economic analysis in the public domain.

The announcement he should have made was to abolish the NHS market and reinvest the billions currently wasted on bureaucracy in frontline services whilst simultaneously tackling the determinants of ill health."

NHA's Dr Louise Irvine, London GP and prospective parliamentary candidate for SW Surrey, the seat of Jeremy Hunt said:

"This is utter nonsense. It is an empty populist pledge. Many of the pilot schemes that he claims have been a success haven't even got off the ground, so where's the evidence that they are effective?​

£100 million cannot even begin to make up for the loss of funding to maintain existing GP services never mind extending them to 7 days.

£100 million is about £2/person/year. For an average GP practice of 6000 patients that means an extra £12000 a year. For that the practice would have to be open 60% longer than currently (from 52.5 hours to 84 hours a week) and pay doctors, nurses and admin staff to be there. That would be approximately 1500 extra hours a year - £8 for every extra hour opened. That would not even pay for a receptionist for the surgery never mind the medical staff to provide the service.

This is a bad joke and shows how disdainful the Tories are of ordinary people and their health services. Instead of recognising and tackling the real crisis in general practice - not enough GPs, £1 billion of funding cuts to GP services over past 5 years and a recruitment crisis where young doctors are not choosing general practice and older ones are retiring early - Cameron is pretending that if you give a measly £100 million that will somehow sort the problems in general practice.

The real issues that people are concerned about are not 7 day opening but actually being able to see a GP in a reasonable time, and for the GP to have long enough to really deal with their problems properly.

Indeed, with the rate of practice closures and threatened closures, for What is needed is a reversal of the decline in percentage of NHS funding spent on general practice, bringing it back up to 11%, and the resources should be invested in more GPs with smaller patient lists so they have more time with their patients. Increasing average appointment time from 10 to 15 minutes would make a great improvement to the patient experience and quality of care.

That is the kind of proposal that would make a real difference, not Cameron's populist posturing. But that would take real money - and Cameron would rather give tax cuts to the rich than invest in our NHS."

After the Scottish Referendum, by David Lindsay

There is no West Lothian Question. The Parliament of the United Kingdom reserves the right to legislate supremely in any policy area for any part of the country. It never need do so and the point would still stand, since what matters is purely that it has that power in principle, which no one disputes that it has.

If an English Parliament, or “English votes for English laws”, would be so popular, then put it to a referendum of the people of England. It would pass in the South East, although I only suspect that, just as I only suspect that it would pass by far less in East Anglia and perhaps also in those parts of the South West that were not too far south and west.

Whereas I know with absolute certainty, as do you, that it would not obtain one third of the vote anywhere else, that it would not manage one quarter anywhere beyond the Mersey or the Humber (or, I expect, in Devon or Cornwall, either), and that it would not scrape one fifth in the North East, or in Cumbria, or, again, in Cornwall. If anyone doubts this, then bring on that referendum.

As for Labour’s needing Scottish MPs in order to win an overall majority, certain grandees of the commentariat need to be pensioned off, or at the very least to have their copy subjected to the most basic fact-checking by editorial staff.

In 1964, fully 50 years ago, MPs from Scotland delivered a Labour overall majority of four when there would otherwise have been a Conservative overall majority of one that would not have lasted a year.

In October 1974, MPs from Scotland turned what would have been a hung Parliament with Labour as the largest party into a Labour overall majority so tiny that it was lost in the course of that Parliament.

In 2010, MPs from Scotland turned what would have been a small Conservative overall majority into a hung Parliament with the Conservatives as the largest party and with David Cameron as Prime Minister, anyway.

On no other occasion since the War, if ever, have MPs from Scotland, as such, influenced the outcome of a General Election. In any case, with the Government committed to the Barnett Formula, there cannot be any such thing as exclusively English legislation, since it all has knock-on effects in Scotland and Wales. What “English laws”?

The grievance of England, and especially of Northern and Western England, concerns cold, hard cash. What, then, of those who bellow for an English Parliament to bartenders who cannot follow everyone else and leave the room? They fall into two categories. There are the Home Counties Home Rulers. And there are those wishing to live under the Raj of the Home Counties Home Rulers.

On the one hand are those from the South East, Essex, Hertfordshire and Bedfordshire. Their definition of England is the South East, Essex, Hertfordshire and Bedfordshire, or at least a certain idea of that area. Give them something for that, and they would be perfectly happy, at least until the votes started to be tallied up. Everyone gets a vote. Even the people whom they have bawled out.

On the other hand are those from everywhere else. Their definition of England is also the South East, Essex, Hertfordshire and Bedfordshire, or at least a certain idea of that area. Although they are often professionally “local” to elsewhere, especially in Yorkshire but also in pockets of other parts of the country, the basis of their political position has always been that they were a cut above their neighbours.

That made them Conservatives until recently, and it increasingly makes them UKIP supporters. That is who the UKIP supporters in the North and elsewhere are. They were never Labour. That is also the context for the fact that there has been a UKIP MEP in Wales for some years and that there is now a UKIP MEP in Scotland, too.

They may never have elected an MP or even a councillor in their lives, or they may live in the only ward or constituency for miles around where their votes ever elected anyone. But enough MPs were returned from elsewhere to make Margaret Thatcher Prime Minister. That suited them down to the ground.

Quite wrongly, since it would be run by Labour as often as not, they see an English Parliament in the same terms. Their more numerous and concentrated brethren elsewhere would deliver them from the rule of their neighbours. It is very funny indeed that those brethren think that they are those neighbours.

In 1993, 66 Labour MPs voted against Maastricht, far more than the number of Conservatives who did so. Yet there were far more Conservative than Labour MPs at the time. Of those 66, at least three campaigned for a Yes vote in the Scottish independence referendum, including that campaign’s chairman, Dennis Canavan.

While it is true that several of those from Wales went on to be among the strongest opponents of devolution, the 66 also included the late John McWilliam, one of the first campaigners for a North East regional assembly.

So much for the dissolution of the United Kingdom as some kind of EU plot, and I write as an inveterate social democratic Eurosceptic and Unionist. If anything, the pressure for that dissolution is a reaction against the effects of Thatcher’s Single European Act, of Maastricht, and of the Stability Pact to which we are pretty much adhering despite not being in the euro. The Transatlantic Trade and Investment Partnership looms large.

If there is one group of people to be avoided at all costs, then it is the ones who go on about some EU map with England divided into regions. If anyone had paid any attention to them, then the toothless and Tyneside-dominated regional assembly would have been set up in the North East, purely and understandably in order to spite them.

City regions are what used to be called metropolitan counties, which Thatcher abolished because she did not like Ken Livingstone. No, that never did make any sense. But that was what she did. Similarly, many unitary authorities bear more than a passing resemblance to county boroughs. These things have to keep going around and coming around, in order to justify the salaries of the people who write the research papers.

But since city regions are now to be revived under that name, whatever powers are proposed for them must also extend to a body covering each of those 40 English ceremonial counties which are neither Greater London, nor the City of London, nor any of the former metropolitan counties.

In many cases, the obvious body already exists. Where it no longer does, then that raises the question of why it no longer does. And where, as here in County Durham, the legacy of the last Government is such as would leave that body unbalanced, with existing local government responsibilities for part but not quite all of its area, then that, too, would be called into question. Leading to the restoration of the former district councils.

This promise of significant devolution to rural communities might go some way to making up the support that Labour has been too lazy to build up during this Parliament by properly opposing cuts in those communities’ services, and by selecting strong local campaigning candidates, with or without prior party allegiance.

Whatever the conurbations are getting, as well they might, then so must the counties. The loyally Labour old coal and steel belts of County Durham, South Yorkshire, Nottinghamshire and Derbyshire are among the places that will need to be convinced that our, as often as not Conservative or Lib Dem, urban neighbours quite deserved all of this city regions carry on.

At the very least, we are not having the powers of our own local authorities transferred to them. In fact, since we are fairly populous, we may reasonably demand that whatever they got, then so should we. At least that money and those powers would always be under the control of members of Ed Miliband’s own party.

Will Devo Max really be opposed only by implacable Tory ultras? What about implacable Labour ultras? Or implacable Lib Dem ultras? Labour MPs for Scotland hold the Scottish Parliament in extremely low regard, and they did so even before it fell under the control of the SNP, as it did quite some time ago now.

Labour MPs for the North of England have spent an electoral generation voting powers to Scotland and to Europe, to Wales and to London, to Northern Ireland and to the judiciary, to everyone but themselves or their constituents. It is not as if Scotland has proved loyal to Labour in the way that the North very largely has.

All these years after devolution, Lib Dem MPs see that the Highlands and Islands are the only part of Scotland among the 11 parts of the United Kingdom that are poorer than Poland. Although Cornwall and Devon are both also on that list, as well as both being among those nine out of the 10 poorest parts of Northern Europe which are in this country.

Bringing us to the Barnett Formula, which has been elevated to the status of an article of the Constitution, but which in fact has never had any force of law. Lord Barnett has long been on record that it was only ever supposed to last for one year. It is an outrage against social democracy and even against basic justice, being not remotely needs-based.

The canonisation of the Barnett Formula imperils the Union by raising serious questions among the Welsh about why they should bother with a State that treated them so shabbily. Heaven knows, it does no good to the poorest people in Scotland. Their condition is as abject under Alex Salmond and Nicola Sturgeon as is that of their counterparts under David Cameron and Iain Duncan Smith.

Labour MPs for Wales and the North of England need to band together with Lib Dems for Wales and the West Country, and indeed for the North of Scotland, so that, perhaps even joined by Plaid Cymru and undoubtedly alongside all parties from Northern Ireland, they might propose a long-overdue replacement, based on need and organised through direct funding to localities without reference to the Nationalist nomenklatura in Scotland.

The areas of Scotland that would benefit most from such a new approach are those which suffer most as a result of the old one. Outside the rural Lib Dem strongholds, those are mostly the areas that return devosceptical Labour MPs to Westminster. As much as anything else, this offers the possibility of taking Holyrood seats from the SNP, by correctly presenting it as the party that hordes money away from the communities that need it.

Devo Max will pass. In order to force these concessions in the course of that Bill’s parliamentary progress, there should be 200 votes against it at Second Reading, perhaps even 250, and possibly even 300. There ought to be. But will there be? If not, why not?

The parts of the United Kingdom that are listed as one or both of poorer than Poland and among the 10 poorest places in Northern Europe are West Wales and the Welsh Valleys, Devon, Cornwall, Durham and the Tees Valley, Lincolnshire, South Yorkshire, Shropshire and Staffordshire, Lancashire, Northern Ireland, East Yorkshire and North Lincolnshire, the Highlands and Islands, and Merseyside. There are of course many other very poor places in this country.

All MPs for those areas should vote against any legislation that would give the force of law to the Barnett Formula. Likewise, all MPs from the 40 shire counties of England, but perhaps especially from the old coal and steel belts, should vote against any extension of the powers of the Scottish Parliament without devolution not only to English MPs en bloc or to city regions, but also directly to those county areas.

On Possibly Coming Round to Votes at 16, by David Lindsay

I am still not convinced about lowering the voting age. We are being bounced into it because 16 and 17-year-olds have voted in the Scottish referendum. But my mind is no longer entirely closed to that change itself.

I remember what it was like to be a politically active Sixth Former. It is not an experience that I shall ever forget. No one who was one could ever imagine that it was, is, or will ever be normal.

Even a superbly well-educated 16-year-old is still a 16-year-old. Lowering the voting age even further might pose a very serious threat to democracy, since no one seriously imagines that the opinion of a 16-year-old matters as much as that of his Head Teacher, or his doctor, or his mother. Why, then, should each of them have only as many votes as he had? Thus might the process start.

Harold Wilson probably thought that he might gain some advantage from lowering the voting age. But the Sixties Swingers hated him (that is largely forgotten now, but it is true), and they handed the 1970 Election to Ted Heath instead.

If there had been a General Election, as was once widely expected, in the spring of 1996, then, having been born in September 1977, I would have been able to vote in that Election, even though I would still have had a couple of months of school left to go.

But by then I had been free for more than two years to walk out any time I liked. I would have been so free even if the school-leaving age had been raised to 18, as is now going to happen.

Lowering the voting age to two years below the school-leaving age would literally be giving the vote to children: to people whom we, as a society, had decided were not yet capable of deciding for themselves whether or not they wished to leave full-time education.

It is still well within living memory that most people left school, and went straight into taxpaying work, a full seven years before they were entitled to vote. Now, we propose that people should have the vote two years before they were able to leave school.

If anyone doubts quite how monolithically middle-class our political culture has become, then consider that it has almost certainly never occurred to the proponents of lowering the voting age that even 21 was ever attained before leaving full-time education, never mind a third of one’s life to that date after having done so.

And yet, and yet, and yet.

With the introduction of individual registration, I suspect that the proportion of the extremely elderly that remained on the electoral register would be hardly, if at all, higher than the proportion of those all the way up to the age of about 25.

Of those registered, if 16 and 17-year-olds were able to be so, then I strongly suspect that a higher proportion of them would actually exercise the franchise than of the over-90s, who are also a very small cohort overall.

I have seen the way in which candidates press the flesh in nursing homes when there is an election coming up. Some of the residents know exactly what is going on. Others are decidedly confused. Others again hardly know Christmas from Tuesday. 16 and 17-year-olds would be very much the same.

(By the way, I am wholly unshocked by the practice of activists filling in postal voting forms on behalf of the institutionalised elderly who ask them to vote for those activists’ candidates. If that did not happen, then those electors' clearly expressed preference would go uncounted.)

Like a lot of my vintage, I see one third of bus passes used to commute, for much of the year from and to homes heated by the Winter Fuel Allowance. But then I consider that there will be none of those things for us, even though the people now coming into them no more fought in the War. They were no more on this earth than we were while the War was being fought by anyone.

In my more mean-spirited moments, I ponder that people who “worked all their lives” were paid to do so, and ought not to have spent it all, as of course many of them did not, with the result that they are now loaded.

Or I ponder that they have not in fact “worked all their lives” if they have retired a mere two thirds of the way through the probable length of their lives.

I make no apology for seeing no War-like debt to be repaid to those whose formative experiences were sex, drugs, rock’n’roll, full employment, cheap housing, student grants, public ownership, municipal services, the explosion of mass consumer affluence, and the felt need to demonstrate against another country’s war because this country was not waging one.

However, I believe in full employment, cheap housing, student grants, public ownership, municipal services, and opposition to American wars of liberal intervention. I am by no means averse to the finer things in life. I fully recognise that few are those who could really manage without their bus passes or their Winter Fuel Allowances. I support the principle of universality to the very marrow of my bones.

No, the question is one of balance, plus the perfectly simple writing into the legislation of a ban on jurors aged under 18 or 21, as there is already a ban on jurors aged over 75.

Balancing generational interests is as important as balancing class interests, or regional interests, or urban and rural interests, and so on. Only social democracy can do those. Only social democracy can do this.

The sheer size of the ageing Baby Boom is such that the democracy in social democracy might require a modest reduction in the voting age. While that case has not yet been made sufficiently convincingly to justify the change, I am less and less decided that it simply never will or could be.