Memo to the BMA

The headlines read: 'Doctors to ballot for pensions strike action'.

As with local authority and NHS or even Civil Service pensions, there is no way the country can sustain a scheme which does not take enough in contributions to meet the cost of the benefits. That said, current contributions are meeting the cost of those already retired, and are not in any way related to the cost of providing benefits to the contributor. That is what is wrong with the current system and arguing over who pays what today is fiddling while Rome burns.

I support the BMA'S approach to the Government's NHS reforms but on this you are out of step. The government has made an unreasonable set of proposals to try and prop up the system for a few more more years and you have tried to persuade them to water it down. This is another way of saying 'subsidise doctors pensions'.

None of this should be up for discussion. There should be no subsidy of anyone's pensions, and ideally everyone would have a good enough pension that the state pension would be nothing more than a safety net. This would save a fortune and help to rebalance the books of our country. It is one of the key recommendations of the Unofficial Big Society Green Paper (www.bigsocietygreenpaper.org)

It would be very good therefore if the BMA, and any other similarly-threatened bodies, could alter their opposition to changes to a more strategic stance. Let's not have a stand off over who chips in how much to the black hole, let's have an open discussion about how we ring-fence and the fund that black hole, and what better system we create going forwards. That would be something worth striking over and in that it would improve pensions for everyone it would gain widespread popular support. It could also galvanise a group of similar representative bodies and unions which might just be enough to get Dave to take notice. I am happy to help with the detail if you wish.

Memo to Dave

The City of London and assorted cronies are now about to evict Occupy LSX. I am not as wild about the OLSX movement's choice of location as some but I follow David Allen Green (http://www.newstatesman.com/blogs/david-allen-green/2012/02/city-cathedral-camp-occupy) in his thoughts that they have performed a valuable service in exposing the fragility of both capitalism and law.

The laws and legal argument that has been used for the eviction are tenuous to say the least, and as always one ends with the suspicion that the outcome was inevitable and the argument irrelevant. Chasing Occupy LSX from St Paul's will not end their movement however, nor will it make capitalism any stronger or better. The Occupy movement is just one of a growing number of voices who point out that capitalism has gone too far, has been too successful, and now drives capital too quickly to too few participants. Whilst Occupy have been peaceful, unlike last year's riots, they are both singing different verses of the same hymn. Discontent is rising, too few of us are paying in to the system and in our old age we will feel even more cheated as there will be less to take out.

The Unofficial Big Society Green Paper (www.bigsocietygreenpaper.org) suggested ways to get ahead of the curve on this and deliver a fair and sustainable society for all of us. The alternative is more occupations, more riots and more discontent generally. As more and more people see less point in contributing to society, whether through taxation or practical help, the burden on those who are trying to save it rises inexorably. The rapid decline and then death of national and even continental civilisations historically comes very quickly after they peak. Unless you take bold action it is quite possible that we will peak in the next 10-25 years, taking a 1000 year view. Please do not think of the removal of Occupy as a victory, think of it as an opportunity to do the right thing without overtly giving in to them and before the next, possibly louder, wave of discontent breaks on our shores.

Memo to Al Gore

There is a lot of sense in proposals that seek to encourage long term investment and share ownership, as in your latest crusade: http://www.economist.com/blogs/schumpeter/2012/02/sustainable-capitalism?fsrc=scn%2Ftw%2Fte%2Fbl%2Fbloodgoreandcapitalism This is a potentially useful tool in moderating the worst excesses of capitalism, but I sense that it will be of only temporary use. That is for two reasons. Firstly, capitalism has a history of reinventing itself. It can move jurisdiction if need me to avoid rules that it does not like and it can punish those that try to do the right thing by taking its capital elsewhere.

For these reasons we would need to exercise great caution in trying to introduce any type of ownership control. In the Unofficial Big Society Green Paper (www.bigsocietygreenpaper.org) it is suggested that what is needed is not control to slow capitalism but social and community competition to make it try harder, and to give it an imperative to willingly submit to rules such as those in your manifesto. I think we agree on many things but essentially our approaches are very different. I have no confidence that capitalism can be controlled by law or re-trained by coercion. My instinct is that the only thing that will change it is a pure commercial imperative. Do this to compete or lose the battle is the thrust of my approach. It is a 'ground up' system which restores flows of capital across society and deliberately leaves capitalism to work out its response, rather than any type of legislative attack on the capitalist system.

This I think has a much better chance of success and a much greater potential to establish a truly sustainable economy, which is fair to all participants.

Memo to Andrew Lansley - How to save the Health Bill without changing it

The response to mounting opposition to the NHS Bill is not yet meeting the required standard. The concerns are far deeper than either political manoeuvring or self-preservation by empire-builders, although there are obviously elements of both. Before doing anything further if you stop and analyse the resistance you will find a common thread. It is that no-one understands how the reforms will actually get the NHS to a better place, and it is therefore causing fear rather than excitement. In effect it appears to be the fiddling while Rome burns. I have spoken to several GPs involved in new clinical commissioning groups who can see the logic in some of the arrangements but fear the funding will not support the needs of their patients and alongside that existing NHS commissioners are saying that the changes will do nothing to re-position the service to cope in 10 or more years time, that will need hard cash.

The Unofficial Big Society Green Paper (www.bigsocietygreenpaper.org) has a full chapter on the NHS because of it's importance to us and your reforms may well drive efficiency but they have two glaring omissions. Firstly, they do not show how they are compatible with the future financial strains which demographics alone will place on healthcare and the funding of it. This leads GPs especially to be wary of being the gatekeepers of insufficient funding and as a result being the ones to tell patients that they will be left to die. Secondly, the reforms fail to demonstrate how they will protect the NHS against lowest common denominator services which will result from a totally free any willing provider system.

What is needed therefore is a sub-bill which enshrines the role of community-led social enterprise in the NHS and does so within a framework which ensures open competition whilst supporting the funding model through reinvestment of profit. Secondly, you need to address the whole system that funds health, pensions and social care from current day taxation. This system frightens the life out of me and will break at some point, leaving us like Greece. No amount of reform or doing more for less can save a system in which twice as many people need help as those paying for it and that is where we are headed.

The Green Paper talks at length about this issue but in a nutshell you can save the bill by two relatively simple actions, which it will be easy and beneficial for the coalition to support:

1. Commit to a system of competition in which all outputs are measured, not just the financial, and in which the state seeks a return of profit from providers. This will ensure that social enterprise becomes the main delivery vehicle for our healthcare and avoid the danger of back door privatisation.

2. Commit to a new system of funding, on a whole of life basis, which will guarantee that a standard set of treatments and social/pension benefits are available nationally to all those eligible. 

This will not only help financially, it will help voters to believe in your full support for the NHS and also help those inside it to believe that the reforms will not simply be used to squeeze the NHS to save cash. These are not nice to have bolt ons, they will save your Bill. They will underpin the modernisation of the NHS as well as transform the financial position of the country.