Private Healthcare: Better Value For Money?

Rather amusingly, we now have the think tank “Reform” advising the coalition government to push through their planned health bill regardless of the opposition, at the same time making it appear as though such advice is coming from a completely independent and non-aligned organisation that has no vested interest in the subject generally. Strange then that this same supposedly unconnected think tank (or should that really be lobby group?) continues to publicly refer to itself as independent and non-partisan, despite having been founded by Nick Herbert and Andrew Haldenby, both of whom are inextricably linked to the Conservative Party. Although they openly declare their mission to be the delivery of “better” public services through privatisation and de-regulation of such vital services, it is notable that their donors continue to include the likes of the General Healthcare Group, a “for profit” healthcare company and GlaxoSmithKline, a major commercial pharmaceuticals supplier, so quite how they have the nerve to declare themselves as independent or as non-aligned is a complete mystery to me?

There is no healthcare system on the planet that is perfect and I would challenge anyone to find one that delivers everything at minimal cost, largely because those two objectives are completely at odds with one another in terms of expectation and financial restraints. However, despite the proclamations of supposedly independent think tanks like “Reform”, the British National Health Service is still widely regarded as one of the better health models to follow and in terms of actual value for money certainly outperforms some of the more unproductive private systems that the coalition government would have us copy.

As part of their recent press release, or should that be public pronouncement, Reform was able to cite the case of one American healthcare company, Beacon Health Strategies, of Rhode Island, which managed to reduce costs and improve outcomes by concentrating certain operations and specialist services in a small number of “centres of excellence”. Well, “no shit Sherlock”, that’s brilliant!! Just give us a shout when they manage to do the same thing everywhere else in the US, instead of wasting trillions of dollars, as they do now.

Don’t you just get sick and tired of this rose-tinted view of the American healthcare model that proponents of the system keep raving about, but which when you look at it a bit more closely is little better than some of the world’s poorest banana republics. This will be the much vaunted private healthcare system that’s caused 51 million Americans to be without any sort of health insurance, about 17% of that country’s total population. This’ll be the private healthcare system that despite being the third highest expenditure in the world delivers some of the very worst outcomes; and regularly results in countless personal bankruptcies every single year. This is the private healthcare model that results in an increasing number of its citizens not being able to afford insurance, as year on year the costs of insuring themselves and their families gets higher and higher; and generally more unaffordable for the average man in the street.

Despite paying twice as much for healthcare as their modern day contemporaries elsewhere in the world, the US is reported to lag well behind other developed countries in terms of both infant mortality and whole life expectancy, conclusively exploding the myth that their particular private healthcare system is something that the rest of us should want, or even try to aspire to. Currently America is said to rank 42nd in the world in terms of life expectancy, even though it ranks highest both in terms of cost and responsiveness. In terms of overall performance, compared to any other developed country in the world, the US only ranks 37th, which is thought to contribute to the 18,000 unnecessary deaths that occur in America’s health service, each and every year. In a more recent study undertaken in the United States, it has been suggested that annually an estimated 45,000 Americans perish as a direct result of not having any sort of health insurance.

In comparison with of Europe’s leading economies, the United States is reported to spend twice as much of its total GDP on healthcare, 16% as opposed to the 8-9% spent in the likes of France, Spain and the UK, etc. However, because up to 70% of American health services are owned and operated by private companies (both for profit and non-profit organisations) there is a significant amount of waste and criminal fraud in the system that ensures less value for money in the US model than their European counterparts enjoy. According to some reports, in exceptional cases, healthcare costs in the United States can sometimes be billed to the private insurers at 10 times the basic cost of the medical procedures; such is the level of maladministration and fraud within the various systems. It has also been suggested that anything up to 50% of total health spending in America is accounted for by the top 5% of the population, indicating that healthcare there is rapidly becoming the province of the wealthiest members of society, with the poor and middle class increasingly disenfranchised by the commercially driven healthcare industries.

Interestingly, even though supporters and advocates of such wholly privatised health models point to the financial advantages that they are purported to bring, by way of efficiencies and savings, in actual fact a number of studies tend to suggest that even within these privatised systems there is extensive waste, with figures of up to 30% being quoted. Because commercial profit and/or future investment are deemed to be the driving forces behind such private healthcare services, typically monies made for providing such services tend to find their way into paying shareholder’s dividends, buying new equipment or buildings, improving staff salaries, or purchasing supplies, rather than directly into patient care itself. Notably, despite being one of the most expensive medical systems in the world, generally speaking American hospitals are thought to have fewer doctors and nurses per patient than does our often much maligned National Health Service, which delivers far better outcomes with much less financial investment.

Even both services are so different to one another and proponents of the American model would have our National Health Service privatised in a heartbeat, it is interesting to note the causes for the wholesale failure of the supposedly “superior” US system. Firstly, there is the endemic over-treatment of patients, resulting in vital resources being used to either carry out procedures that are not medically necessary, or that do not substantively add to medical outcomes (e.g. prolonging a terminal patient’s life for no good reason). Secondly, the system is undermined by a lack of co-ordinated care, where different health and social agencies fail to liaise with one another, thereby causing hold-ups within the system (e.g. bed blocking, etc). Thirdly, the American health system suffers from administrative complexity, where different departments and administrators lack the will, equipment, record-keeping, or systems to streamline a patient’s ongoing care and oversight. The fourth major hurdle to making the system efficient are rules that prevent agencies and healthcare personnel being able to communicate and interact with one another in the best interests of the individual patient. Finally, the fifth problem associated with the privatised American model is that of fraud. It is interesting to note that the first four problems identified within the US system are also appropriate to our own Health Service, with structures and systems being the underlying problem and therefore proving beyond doubt that the both public and private health models are almost inevitably beset by such issues, so private is no better or worse than our current system. The major difference arises when money comes into the equation; and bearing in mind that fraud is a major problem within the American system should be a warning to all of us that a potential pot of £60 billion per years will almost inevitably lead to criminality and corruption within a newly privatised or part privatised National Health Service, if it doesn’t do so already.

It is perhaps particularly ironic that while advocates of healthcare privatisation are trying to alter the basis and ethos of the British National Health Service, most independent health experts believe that the American models would do better to copy it. It has been estimated that the United States could offer every single one of its citizens comprehensive healthcare for far less than is currently being spent to cover just 80% of its population. Unfortunately, the private health lobby is so inextricably entwined with the offices of government and personal selfishness so deeply embedded within the national psyche’, most Americans would be aghast at the idea of implementing any sort of national service that might benefit anyone but themselves, so would rather pay “through the nose” for what is widely recognised as a “second rate” health service. So from that point of view I don’t think we need to take any lessons on healthcare from across the Atlantic.

Another healthcare system which is often suggested as a possible model for England is the part-privatised systems currently operating in the likes of France and the Netherlands. Once again both nations are reported to spend around 8% of their GDP on health, although both require that citizens pay particular amounts of money out of their own pockets, in addition to that which is taken through general taxation. From what I can understand the French model operates on the basis of doctors appointments, etc being paid for by individual patient, who then claims about 70% of that cost back from the state, which is all very well if you happen to have the money available in the first place. The Dutch model is slightly different again, being a mix of payments from the state (which is raised from general taxation), plus an obligatory (i.e. compulsory or mandatory) private health insurance policy that on average costs each Dutch citizen around 100 Euros per month. Although low income earners are largely exempt from having to have the compulsory private healthcare insurance, citizens earning in excess of that threshold are required to purchase their own private cover.

The Dutch healthcare system, introduced in 2006 combines two mandatory elements, the first being general taxation and the other compulsory health insurance, although according to a number of international studies does produce some of the best health outcomes in the world. However, a report in 2008, produced by Duke’s University, noted that despite its benefits such a system it also had a number of potential problems, most notably those of controlling costs and the almost inevitable problem of rising insurance premiums, which might potentially exclude certain, less well of, citizens from such a healthcare system as time passes. There was also thought to be an inherent danger with such a public/private healthcare model that costs would rise to such an extent that eventually such a system would not provide good value for money.

It is also worth pointing out that under the Dutch system, routine medical visits, such as a GP’s appointment, clinic appointments, etc are not free, as they are in the UK, but are paid for by the individual’s private healthcare insurance. Only Geriatric care, terminal illness and mental illness is covered entirely by the state, although given that many of these same future patients will have paid something into the mandatory insurance schemes anyway, it seems likely that costs may eventually be shared by both public and private schemes, as opposed to just the public purse. More positively though, most Dutch hospitals and health providers run their businesses on a not for profit basis, although as in the case with care homes and other such organisations in the UK, ultimately potential profits can be realised through conventional corporate loans, takeovers, buyouts, etc, so clearly the purpose of such businesses are not entirely altruistic.

Regardless of what purported independent think tanks like “Reform” might say regarding the future of our National Health Service, part or full privatisation is clearly not the answer to creating an efficient, cost effective or rational healthcare system. Nobody in their right mind would wish the highly expensive, discriminatory and inefficient American model on another country, not even their worst enemies. Even if you look at other alternative systems, such as the French, the Dutch, the Spanish, or anyone else’s, almost inevitably you’re going to find a healthcare system that has its own unique set of problems, simply because you’re not only managing people’s day to day health, but also more importantly their expectations.

The National Health Service of today is a far cry from that which was launched in 1947, when people had few expectations, other than to live as long as possible and in the best way possible. Today though, we have sections of society who expect to be molly-coddled from the cradle to the grave, but who choose to take no responsibility for their own personal health, safe in the knowledge that we have essentially created a safety net for all of their bad habits, be that smoking, drinking, living dangerously or eating excessively. The NHS is not broken, it doesn’t need breaking up and rebuilding, it is simply acting in the way any large organisation does, when it becomes unwieldy, over bureaucratic and poorly led, as has the American model. Perhaps if ministers used their time more effectively by figuring out how we can stop over-treating people, to help co-ordinate the various agencies that are supposed to work together, to cut down on the administrative complexity and to reduce the amount of legislation that currently binds our hospitals and care-givers, perhaps then the NHS might be able to be the affordable service that everyone wants.

NHS Reforms: Privatisation By Any Other Name

Quite why anyone should be surprised that the Tory’s and their Lib-Dem “lapdogs” are intent on privatising Britain’s last great industrial treasure, England’s National Health Service, is, quite frankly, beyond me. Having ravaged most of the nation’s industrial base, including mining, shipbuilding, utilities, transport and communications, the only great “cash cow” left for private commercial interests to pillage is Britain’s relatively cash rich health industry, which with the help of the Conservatives and their political allies, some of the bigger private health companies now believe is firmly within their grasp.

Rather than being at one with the British electorate over the NHS and the country’s future health needs, increasingly David Cameron, Nick Clegg and their Health Secretary, the chief architect of the planned reforms, Andrew Lansley, find themselves at odds with a majority of the general public, who along with the vast majority of health professionals, are all equally opposed to such sweeping changes in the way our health services are run. Even though the opposition Labour Party are making significant political capital out of the proposed reform, despite having allowed increased levels of commercial involvement in the NHS since 1997, their claim that anything up to 49% of NHS capacity and resources could be given over to the private sector, should be a wake-up call for anyone who believes that the NHS must remain free at the point of delivery for everyone, regardless of their means.

Even though most people recognise that the NHS could do better, the prospect of private healthcare companies being allowed to raid and plunder the vital resources of the English health service, for their shareholders benefit, fills most observers with dread; not least because of the real threat that such providers will not only seek to cherry pick the most profitable areas of the health services for their own corporate benefit, but will also use their newly acquired access to fatally undermine existing NHS institutions, thereby reducing choice to NHS patients. Of course supporters of the proposed health reforms defend the changes by claiming that a newly appointed regulator will be put in place to prevent any widespread “privatisation” or exploitation of health services, suggesting that it will operate in a similar fashion to the likes of OfGen, OfWat and OfCom. However, the only problem with such guarantees, is that although Britain’s electricity generators, water suppliers and telecommunication companies have undoubtedly improved the basic infrastructure of these industries since they were first privatised, all three have done so by imposing huge price increases on the British consumer. Sometimes bordering on being completely unaffordable for the poorest consumers, rampant price increases and excessive profit-taking have been allowed to thrive in these industries, simply because the various regulators don’t have the necessary powers to control these large private corporations, suggesting that any planned health regulator would fare little better, regardless of any government promises to the contrary.

Clearly with an annual budget in excess of £110 billion to spend on English health services, it is perhaps little wonder that numerous private healthcare companies are anxious to gain unlimited access to a market that is currently dominated by the publicly owned and fully accountable National Health Service. However, when one considers that the Cameron-Clegg coalition is currently looking to find savings of 20% from that headline figure then the real health budget figure is probably closer to £88 billion per year. An estimated 20% of that £88 billion is retained by the Department of Health for national services, meaning that the actual amount of money spent within the 150-odd Primary Care Trusts and Strategic Health Authorities is around £70 billion per year, of which an estimated 60% is reportedly spent on staff costs. A further 20% of the £70 billion is said to be spent on drugs and medical supplies, whilst the remaining 20% is thought to be used to cover the costs of buildings, equipment, training, catering, etc.

Interestingly, according to some commentators, the £20 billion worth of “savings” being demanded by the coalition is significant, in that there is a suggestion that this money is being deliberately withdrawn from the national health budget, in a cynical attempt to purposefully “under-resource” the NHS, thereby strengthening the coalition’s case for further private investment, much the same as the previous Tory government’s did in the case of Britain’s former heavy industries. By withholding this £20, 40 or 60 billion worth of “savings”, it has also been suggested that these monies will subsequently be returned to the NHS, but only after the private healthcare companies have begun to involve themselves in England’s seemingly impoverished health service. That way at least, the Conservative Party will be able to publicly repay their political paymasters by offering them access to a multi-billion health fund, which has in effect been stolen from the English taxpayer in the first place, through the much criticised budget cuts.

Remarkably, England’s National Health Service is reported to employ around 1.4 million people, making NHS (England) one of the world’s largest single employers; and similar in scale to the likes of the Walmart Supermarket Group in the United States, the Indian National Railways and the Chinese People’s Army in terms of manpower. In England alone, the health service is thought to employ some 410,000 qualified nurses, 150,000 scientific, therapeutic and technical staff, 52,000 doctors in training, 40,000 General Practitioners, 37,000 Hospital Consultants, 24,000 Midwives, and 375,000 other medical support staff, as well as a further 200,000 infrastructure staff, who include managers, administrators, secretaries, etc. A significant number of these health workers will be almost certainly be part-time employees, although taken all in all, it is reported that these 1.4 million personnel help to look after the health and welfare of England’s 52 million citizens, with one million patients being treated by the NHS every 36 hours..

One particularly interesting factor, when looking at the various figures relating to the running and associated costs of the English NHS, is to see exactly where the money for staff wages or salaries is being spent each year. Significantly, some of the most avid supporters of the coalition’s proposed health reforms are thought to be an assortment of GP “commissioning” groups from around the country, who are the very same people that under Andrew Lansley’s reforms would have direct control over their own share of the £80 billion health budget, which is currently allocated to the various PCT’s and SHA’s, that will all be abolished under the planned changes.

According to a number of sources, many of these same GP Partnerships (those running their own private practices within the NHS) currently earn an average of around £100,000 per year, for an average of a 44 hour week, only 60% of which is thought to involve direct patient contact. It has also been reported that many of these same doctors can and do undertake additional out-of-hours work (formerly part of their standard contractual obligations), sometimes at a rate of anything up to £200 per hour. Additionally, on BBC Panorama programme, screened on Monday 20th September 2010, it was widely reported that there were in excess of 6,500 GP’s, currently being paid more than, the £142,000 a year, David Cameron earns in his role as British Prime Minister. Panorama also discovered that at least one General Practitioner, reportedly employed by the Heart of Birmingham NHS Trust was said to be earning an annual income of £475,000, another one £375,000 per year, while two others General Practitioner’s were said to be earning around £325,000 per year from their NHS contracts. An OECD report also found that British GP’s are paid twice the salary of their French counterparts, even though both nations spend equivalent percentages of their GDP on health services, which perhaps in part explains the parlous state of the NHS finances in England. Surprisingly enough, this situation has little if anything to do with the present coalition government that we now find ourselves saddled with, but is entirely as a result of the previous Labour government’s renegotiation of GP’s contracts in 2004, which not only saw a 30% increase in most GP’s salaries, but also a significant reduction in their hours of work, notably the out-of-hours they had previously been obliged to undertake as part of their contracts.

Yet another piece of research undertaken by the BBC was said to have found that seven of NHS England’s highest paid employees, were in fact GP’s. Although many might argue that GP Partnerships are in a sense private businesses, in that they employ their own staff, manage their own costs, etc, when one considers that a salaried GP (a doctor not within one of these private commercial partnerships) works an average of 39.5 hours per week, but only receives a basic salary of £58,000 per year, it seems to put Partner GP’s seemingly outlandish remunerations into some sort of context. Also, the argument that GP Partnerships have the added expense of staff, buildings, etc. would undoubtedly be a major factor in the hugely different wage scales, were it not for the fact that in most cases such private partnerships often involve a number of GP’s sharing such overheads, so such expenses are often minimised for the individual doctor. The very fact that a small number of GP’s are managing to operate more than one practice at the same time, by using locums, agency staff and salaried GP’s to help maximise the particular “owner’s” income from the NHS might well give an indication of just what the coalition’s new reformed health service will begin to look like in the future. That said of course, the fact that GP’s are more likely to be the core voter for the Conservative or Lib-Dem parties might well suggest that as much as anything, Cameron, Clegg, Lansley, et al, are in fact playing to the gallery with regard to the proposed health changes, believing that personal avarice will allow them to gain support amongst the GP lobby, most of whom will undoubtedly benefit from the new so-called commissioning groups. On this point it is worth considering a recent report, which indicates that anything up to 2.5 million patients are registered as being on various GP’s panels, even though they don’t actually exist, despite the fact that each of these individual surgeries are thought to be receiving a fee of £65 for each of these non-existent patients, at a direct cost of millions of pounds to NHS England.

As an addendum to this, it is also worth considering that a hospital consultant can earn anything between £75,000 and £100,000 per year from the NHS, depending on their grade and specialisation, in addition to any fees that they can earn through their own private practices. These same Consultants are also reported to be able to earn awards or bonuses ranging from £3,000 to £30,000 per year, suggesting that top performing specialists might earn anything up to £130,000 per annum from the NHS, not including their private practice earnings.

Although you don’t need to be a genius, or indeed a Member of Parliament, to recognise that the modern day NHS is struggling to cope with an ageing population, instead of managing budgets, so that this vital resource can then be exploited by those commercial enterprises allied to the various political parties, perhaps governments, regardless of their ideology should be managing peoples and patients expectations. Bearing in mind that the average life expectancy in 1901, just over a century ago, was 45 years for men and 49 years for women, one begins to see the basis for our much reported ageing population, along with the financial difficulties that such changes inevitably create. The major factors in determining our modern day longevity are increased infant mortality, lifestyle, housing, elimination of disease and advances made in medicine generally. Unfortunately, along with living longer, society has begun to see the associated downsides of people living into their late 70’ and early 80’s, with dementia, cataracts, hip replacements, knee replacements being some of the most common health ailments suffered on an almost daily basis.

Our lifestyles too are putting an increasing amount of pressure on our country’s limited financial resources, with obesity, alcoholism and smoking all causing a multitude of associated diseases and symptoms, which at one time would simply have been regarded as a personal lifestyle choice that individuals chose to pursue; and die from, but which now the NHS increasingly finds itself burdened by. Even though it has been calculated that NHS England budgets around £1900 for each member of the population, in reality the vast majority of ordinary people cost our health services absolutely nothing, as they never visit their GP or indeed a hospital, from one year to the next. Instead, an increasing proportion of the country’s escalating health budget is now being spent on maintaining patients that 50 or 60 years ago would almost certainly have died from their conditions, be that a heart attack, obesity, smoking, drinking, etc, but whose lives society now seems duty bound to prolong, at a substantial cost to the national exchequer and to the health service particularly.

Ever since the National Health Service was first conceived, governments of all persuasions have promised to make the service clinically driven, putting doctors and nurses at the heart of medical provision, something that all have parties have singularly failed to do. Instead of more doctors, nurses, carers and hospital beds, successive political administrations have simply tinkered with its management, adding layer upon layer of bureaucracy, which has done little to improve clinical performance, yet at the same time managing to fragment what after all is supposed to be a “national” health service. For all of the thousands of managers, administrators, executives, secretaries and bureaucrats who populate the 150 plus health bodies, even today millions, if not billions of pounds is wasted, simply because it seems beyond their wit to establish and run a centralised supply system, which perhaps explains why the NHS works so badly on a day-to-day basis. Maybe if central government and the Department of Health were to make a start in addressing their own organisational disasters and mistakes, there would be far less need to begin looking for substantial savings at the clinical end of the organisation.

Unfortunately, for a coalition government marked by its own political and economic ineptitude, most commentators believe that Cameron, Clegg and Lansley have invested too much of their own personal reputations to admit that their planned health reforms will be catastrophic, not only to the health service itself, but also to their own long-term political futures. However, given that they owe some of their limited electoral success to the funds provided by many of the private healthcare companies, which even now are lining up to raid a reformed NHS, it seems highly unlikely that Cameron, Clegg and Lansley will put basic morality and a duty of care for the English electorate, before the indebtedness they feel towards their political paymasters. Perhaps instead of trying to convince the general public that they are proposing these changes for the good of the people, Cameron, Clegg and Co should just be honest and call this new Health and Social Care Bill exactly what it is, the Privatisation of the English National Health Service.

Good Idea, Let's Take Britain Back To The Past

It wasn’t until I watching part of the BBC’s Question Time the other night that I was reminded about the proposed elected regional assemblies in England, an idea that was raised as a possible answer to Scottish devolution and the increasing uneasiness regarding the almost gradual dismemberment of the UK by both major political parties. John Prescott having jogged my memory that the idea of these planned assemblies had been rejected by voters in the North East, I was surprised to learn that not only had the idea been flatly rejected by voters living in the region, but the response had been so negative that proposals for ballots elsewhere in the country were very quickly abandoned. Apparently, the North East of England was the area thought to be most likely to adopt these new assemblies, so the fact that the plans were rejected by more than three to one, sort of suggested that if the argument couldn’t be won there, then there was no chance of winning public approval elsewhere. According to figures on Wikipedia, some 696,000 people rejected the idea of a new elected assembly, as against the 197,000 who thought it would probably be a good thing.

For most of those who rejected the proposed assembly their biggest concern was that any such body would simply be an expensive talking shop that would achieve very little, apart from creating yet another layer of bureaucracy, which would inevitably lead to higher costs and therefore higher council tax bills. Of course for the Labour Party, it was hoped that the establishment of these new assemblies might go some way to offset the effects of their wider devolution experiment, under which the Scottish, Welsh and Northern Ireland assemblies have been created. For others though, the idea of regional assemblies smacked of a foreign system, where individual states, regions and provinces, operate independently, but still find themselves under the umbrella of a central federal government. At least one commentator noted that rather than moving the whole country forward, such regional bodies were simply a step backwards to the medieval period, when much of England was ruled by a series of appointed councils populated by the great and the good of the region, overseen by an antiquated feudal system that our country has quite rightly consigned to the history books. Likewise one might well make the argument that the forthcoming elected police commissioners and proposed professional mayors, such as Boris Johnson represents in London, are both in their turn throwbacks to the Sheriffs and Earls who dominated the towns of cities of England hundreds of years ago; and that have little place in our country today. Once again though, you could be forgiven for believing that these newly resurrected posts are simply populist imports from the United States and Europe, of which our current crop of governing politicians seem to be such huge fans.

One wonders just how far these experiments in regionalism, or localism will go before the entire project comes falling down around their individual architect’s ears, where people simply stop regarding themselves as British, or English, or Scottish, or Welsh, or Irish, but begin referring to themselves in territorial or regional terms, be that a Glaswegian, a Cumbrian, a Northumbrian, a Mancunian, etc. etc, etc. What chance for our country then, when we no longer have a national identity, where there is no commonality or link between the peoples of Portsmouth and London, between those living in Norwich and those who reside in Manchester, or between the populations of Birmingham and Glasgow? That master of disaster, Gordon Brown, bemoaned the fact that our country and its people no longer recognised or celebrated their “Britishness”, which shouldn’t really be any great surprise, given that successive generations of national politicians, including Gordon Brown, have worked so hard to undermine that national identity to begin with. After all, why should children growing up today celebrate a history, a culture and traditions that are largely unknown to them; and that are regularly attacked and vilified by politicians, commentators and educators alike? Why should anyone celebrate Britain, when the message seems to be that “Britishness” is bad; and that our country’s rich history is a blood-soaked one, marked by human exploitation, personal enrichment, divisiveness and cruelty to anyone that wasn’t British? Just who in their right mind would want to celebrate that sort of heritage anyway?

No-one should be surprised that the idea of “Britishness” or being British is a rapidly disappearing concept in the UK, or indeed that nationalism in Scotland, Wales and even to an extent in Northern Ireland is beginning to gain ground. In the face of increasing European-ism from the continent, championed by the likes of Clegg, Miliband, Blair, Brown and Cameron (yes, he of the proud Scottish heritage); and the recent antagonism caused by the apartheid messages of the SNP, it is perhaps little wonder that increasingly those that live in England now choose to refer to themselves in that way, as a way of reinforcing their pride in their nation. Quite whether national politicians are concerned about this slow but sure fragmentation of the UK is unclear, although purely from a electoral perspective it has been suggested that the Conservative Party (at one time a staunchly Unionist party) has much to gain from this political dismemberment of the country, because traditionally, Scotland and Wales tend to return more Labour Party representatives to Westminster than they do Tories. As a result, critics have implied that David Cameron’s Conservatives have much to gain from Scottish, Welsh and Irish nationalism, which offers their party overwhelming political control of England’s remaining parliamentary constituencies and therefore the Westminster Parliament itself. Even though Cameron and his deputy, the equally Europhile Lib-Dem leader, Nick Clegg, have both dismissed the suggestion of electoral advantage as a consideration in any negotiations regarding Scotland’s proposed independence, the fact that one or both parties would be likely to benefit from purely English elections, should make us all question both men’s commitment to actually holding the union together. The very fact that Cameron chose to try and “bribe” the Scottish electorate into delivering a “no” vote for full Scottish independence, by offering the promise of further devolved powers, might well suggest that his intention was to either deliver Alex Salmond a hefty majority in the forthcoming ballot (thereby guaranteeing an independent Scotland), or to offer the Scottish Parliament such new powers that they would in effect be independent in all but name. It may well be the Coalition’s intention to create a Federal Britain by stealth, first by creating a fully devolved Scotland, then Wales, then Northern Ireland and finally England itself, a creation that would seem to fit in with the federalist principles of the European Union, which believes that no individual state is bigger than the community itself, unless of course you happen to be one of the chief architects of the scheme, such as Germany or France.

If indeed it were the case that England, Scotland, Wales and Northern Ireland all became federal states, once again history would be repeating itself, restoring a situation that hasn’t existed for well over three hundred years, with England bordered by foreign nations to the north, south, east and west, states that have no cultural or national affiliation to us, save through sometimes tumultuous and antagonistically historic ties, as well as the offices of and the unelected officials from Brussels. One wonders just how accommodating the federal parliaments of a nominally independent Scotland, Wales or Northern Ireland would be, in the event that their own national interests conflicted with those of the one at Westminster, especially if the will or the wishes of the European Parliament was brought into play?

It has always been the intention of the European Community to create a “federal” Europe, a single political and economic entity made up of nominally independent states, but where a single body or a central government has control over the individual supposedly sovereign territories. Had former French President, Valerie D’Estaing, had his way, we would already be a member of a formally identified European Federation; and it was only because of British objections that the word Federation was replaced with Community, in what one can only assume was an attempt to deliberately hoodwink people. According to experts on the subject, the only difference between the current “union” and a fully fledged “federation”, is that member states continue to hold the power to change various treaties; and that the EU lacks a real tax and spend policy (something that will undoubtedly change in the very near future in light of the continuing Eurozone crisis)

Although the idea of Britain becoming increasingly fragmented and therefore less influential in the world may seem fanciful, consider this, like it or not, it is in Europe’s long term interest for Britain and her population to become less resistant to further European integration. As one of the world’s leading economies, major military forces and biggest consumer markets, a Britain outside of Europe is not only harmful to the whole European experiment, but might be deemed to be a major obstacle to the ongoing expansion of what is in all but name a federalist bloc, one that has been designed to compete with the likes of America, China, India and Russia. Is it so fanciful perhaps, given that we now have very little say or control over the masses of laws, statutes and legislation that affects every aspect of our everyday lives. So fanciful that our international policies are being dictated by unelected politicians and presidents in continental Europe. So fanciful that our Armed Forces are now in such a parlous state that we have the smallest standing army since Queen Victoria was sitting on the throne. So fanciful that despite being an island state, we have few effective ways of projecting our military power across long distances, assuming of course that we can’t find a willing ally to lend us their territory. So fanciful in fact, that we now have to consider sharing the cost and expertise of our future weaponry with a continental neighbour, who has not only been one of greatest military allies, but also one of our foremost political enemies, depending on which way the winds of opportunity have been blowing at any given time. Its worth remembering that although the Entente Cordiale binds France and England together, another agreement, the Auld Alliance, pre-dates that and having an independent and belligerent Scotland in the north, allied to an antagonistic France in the south, was yet another one of the reasons that eventually drove England to seek a permanent union with our northern cousins, so for all that to be undone, really would be taking us back to the past.

David Cameron: Today's Neville Chamberlain?

When describing Britain’s political leadership during the 1930’s Winston Churchill later stated that it was “a long, dismal, drawling tide of drift and surrender”, which ultimately resulted in millions of deaths, worldwide destruction and a national shame that even after the allied victory in 1945, continued to linger whenever the word appeasement was used. Despite Neville Chamberlain being a decent man, who devoted the latter part of his life to public service, during which he introduced national legislation that benefited the everyday lives of millions of his fellow countrymen, in the end it was his policy of appeasement towards foreign tyrants that has defined his historical and political legacy, rather than any of his other great national achievements.

The current Tory incumbent of 10 Downing Street, David Cameron, is a decent man, no doubt, but sadly also seems to share his now infamous predecessor’s willingness to meekly accommodate his opponents, rather than confront them, when the UK’s national interests are at stake. Rather than confront his coalition partners with the realistic threat of electoral annihilation, in the event that they choose to oppose government policy, he compromises and retreats. In the face of Tory backbench rebellions, he first bullies and harasses them, blames his coalition partners, then offers compromises that he has no intention of keeping. In Europe, like Chamberlain, Cameron returned with his own agreement, this time the mythical and much publicised veto; that was actually nothing of the sort, but was in fact yet another compromise of sorts, that at some point in time he’ll no doubt try and sneak past the British electorate when they’re not paying attention. More money for the IMF to rescue the failing Euro experiment will be yet another compromise to be added to the list, just as soon as he and Gideon can find a form of words that will allow the new loans to pass through the Commons unscathed. The best compromise to date though is that offered to the Scottish electorate yesterday. Where a determined and worthwhile British Prime Minister might have confronted First Minister Salmond with a “have your referendum and be damned”, or even arranged for a legally binding ballot to be held on the matter, sooner rather than later, Cameron sought to bribe the Scottish electorate, by offering the promise of “Devo-Max”, but only if they vote no to full independence!

Quite why anyone within the Tory Party imagined that David Cameron would make a good Prime Minister beggars belief, unless of course he was only chosen for his background in PR and the similarly slick characteristics he shares with Tony Blair. At least poor old Neville Chamberlain had the excuse of confronting the likes of Hitler and Mussolini, much more serious and threatening adversaries who both had large military armies to enforce their demands, whereas Cameron is faced by nothing more threatening than a bunch of unelected bureaucrats, third-rate political partners and a nationalist cause that suddenly senses weakness at the heart of central government. Even today, some 70-odd years after the event, Chamberlain is still derided as an appeaser, an apologist, a man prepared to compromise international reputations and sovereign territories in order to avoid making those hard and inevitable decisions that came as part of the biggest job in British politics, that of Prime Minister. Sadly, to date there is little sign that David Cameron is prepared to make those hard decisions either, which begs the question, will his term of office be as short, ignoble and disastrous as his unfortunate Tory predecessor?