Really radical healthcare

I’ve just seen the letter from the Prime Minister and Deputy Prime Minister to public sector workers asking for how and where cuts should be made.
Focussing the media vocabulary on cuts is missing a trick.
It sounds as if the interest is solely budget deficit reduction.  But this is not the whole story – the solution should also deliver a good service for the public.

Today’s proposed reform to the NHS is not perfect but is long overdue.

While some things (like getting a consultant’s appointment within a fortnight, or a doctor’s appointment within two days, including after work and at the weekend) have been great, I’m still not clear how some of the targets made any sense.
Anything that resulted in patients being admitted to hospital for a few hours in order to avoid an A&E waiting time target being missed is a nonsense.
After all, if you’ve ever tried to get discharged from hospital (as we did with my baby son), it can take 12 hours and a lot of tears and turn into a Kafkaesque nightmare.
I’ve also never understood the Value for Money argument for the Primamry Care Trusts – as far as I have seen their job is to duplicate letters coming to patients from the GPs surgery and from the local hospital (an extra letter from the PCT each time I got one regarding smear test appointments, for example).

But the Private Sector Lite idea that has been proposed is really not that radical.  Look, if you truly want money to follow patient, it needs to mean a real market in the public healthcare system.
Scary rightwing idea?  Not at all.  The model here is France and Belgium.

In Belgium, an insurance-based system (with a decent fallback for those in need) is run by mutuals.
That means no expolitation by insurance companies trying to screw their own customers and avoid paying out a la USA.
While each mutal has a different “ethos” (I used Mutualite Socialiste the first time I lived there, Partena the second, and my husband Mutualite Chretienne) essentially they all do a similar job and don’t have shareholders getting rish off the good health of the scheme’s participants.

What makes the Beligan system seem so radical if you are a Brit is that any genuinely quality provider can sell services within public healthcare system.
The ground floor of most of the apartment blocks on the big boulevards in Brussels feature a number of brass plaques.
Each building offers one or two GPs, or a gynocolgist, a physiotherapist, a dermatologist, a sports therapist…

Reputation counts – GPs are not in control, offering their patient one or two choices of hospital-based appointments – they provide a referral for a specialist and the patient chooses who they want to see.  The mutual says up front how much of the treatment they will refund depending on how public/ private the specialist is – an appointment at a private hospital will be partially refunded (at say 60%) whereas one at a public hospital might be refunded at 85%.

Oh, and in Brussels, it is possible to self-refer if necessary.
The mutual might not refund the appointment, but the truly free market means that it is possible to find someone to see you if you can’tget a referral but are worried about something.

So ultimately members of the public determine where money goes.
Public health with a bigger role for the patient – now that’s radical…

They also serve… but don’t count?

Ladies and gentlemen, today’s blog is dedicated to those who cannot make a difference to the general election today.

I’m not talking about people that did not register (their fault). 
Nor those who choose not to use the vote that others fought and died for them to have (and this debt is particularly great for women – yes, I would have been a suffragette). 
I’m not even talking about those in safe seats (after all, if enough votes are there percentage-wise nationally then it should be impossible to claim a mandate that ignores popular support for voting reform). 
And I’m not going to write more than this sentence about the scandal of our service personnel overseas who accidentally found themselves disenfranchised while on active service.

Today’s post does concern people who are effectively serving the interests of their country, but who are also exercising their rights as citizens of this country.  Today there are thousands of British people abroad, in other Member States of the European Union, who, because they have been abroad for more than 5 years have lost their right to vote in UK general elections.

The official explanation is that after 5 years – and it used to be 10 years – they are not sufficiently connected to the situation in this country.  And if they are so attached to living elsewhere, they can always apply to be citizens of the country where they are resident instead.

I can see that there might be something in this argument if you have, say, moved your entire family from Luton to a small village in Pakistan (although there are of course villages there where you can spend pounds). To move back to the EU for a moment, I can see that this might apply if you are living it up in the Costa del wossit, speaking English loudly at the locals and reading the Daily Mail.

But if you are a Brit directly employed by the EU institutions, the idea that you are that disconnected is… just weird.
Don’t get me wrong – on my return from Brussels I seriously considered (for about 5 minutes) a mini-memoir on recovering from expat life to be called “saying merci to London bus drivers”.
But living in Brussels, I was still intimately connected to the UK.  I not only travelled home for work, and for family, I watched the BBC (proper British BBC channels, not BBC World and BBC Prime), listened to Radio 4 in the mornings, shopped at H&M and Zara – and some people even had Sky (shh!)
Nothing about my life there made me particularly want to stop being British to become a Belgian national.
But that’s also a very odd suggestion for people who are actually engaged in one level of the UK’s governance (note that’s governance, not government, euroconspiracy theorists), just as if they were a public servant in local government or civil servant. 
The irony is that nationals from other EU countries can actually work in the UK civil service (except the Foreign Office, where they can only really be locally engaged at post).  For them, most of their governments allow them to vote – so they are not disenfranchised by living here.
But while we pride ourselves on being the cradle of democracy it actually seems that our starting point is not being expansive with access to the vote. 
Add to this the vagueries of a First Past the Post and the lack of a written constitution (where, watching Channel 4 news last night it looks as if either Cabinet Office guidance or the visceral right wing press will decide the way in which we get a new Prime Minister in the case of a hung parliament) and you begin to understand why no politician seems to care about those being left out while undertaking a role in public service at one of the UK’s constitutional political levels. 
So many of us don’t understand our political set-up and the potential wider implications of disenfranchising the Brits within it in the EU institutions, which help give it legitimacy (because there are Brits, who know and understand the UK in each of the institutions). 
Ignoring them gives succour to the europhobic idea that such people are somehow in it for themselves or traitors.  And that sort of rubbish denies us our right to see the EU as ours, just as much as it is French, Dutch, Portuguese or Estonian.   

But don’t hold your breath for this to be resolved.  No government can be expected to be motivated to change legislation for just a few thousand people, and the fact that they work in the EU institutions is hardly likely to motivate a great degree of sympathy.  Unless those that would benefit from the re-enfranchisement of the Costa Blanca expats might change it to get that extra support.

If you can vote, I hope you did.  On the Voltaire principle of course.

Brussels mon amour

 photo from fab site http://bars.blogueur.info

Have just had a day working in Brussels for the first time since February 2007. 

The sun was shining, it was warm, I even managed to squeeze in a swift coffee in a street cafe (cheers Jon!) before dashing to the Eurostar that takes me practically door to door and just about got me back in time not to be fined by the nursery.

There are many things that annoyed me about Brussels when I lived there – from the randomness of the cobblestones which procluded heels on all but the most important occasions, to not being able to buy stamps anywhere but the post office which was never open when I was free to go, to the need to return to the UK to go “proper clothes shopping”,  the water supply being so cleaned with chlorine to meet water quality standards that it upset my skin (and my husband’s), to the weeks of delay to get cable TV fitted…

But I loved the restaurants, the people I met including some of my truest and best friends, the real sense of community in being an expat, the sort of apartments available on a reasonable budget when compared to London, the way that TVBrussel kind of made sense after midnight even though it broadcasts in a language I don’t speak, the sort of jobs I did when I lived there – which I’d find nigh on impossible to do these days when I work part-time.

Oh Brussels I’ve missed you. 
Even though your metro system got so messed up earlier that I almost missed my train.

I really enjoyed the meeting I was at too – a combination of Brussels residents and interlopers like me, but conducted in a proper Brussels Eurocrat manner, recognition of each other’s expertise, positivity, genuine seeking of a conciliation and compromise helping each as much as possible to get what they were looking for. 
It can be hard to explain sometimes why that is a good thing when to many people here in the UK compromise is a dirty word, and the word Brussels is itself anathema.

Life in the UK is good, familiar, I know (roughly) how to handle local bureaucracy (probles here tend to be less with public authorities, more with the private companies that – oh, I’ll post about Northern Rock another day…). 
But life in Brussels was fun, oddly exotic and dipping my toes in the EU politics pool again today just reminded me why I enjoyed it so much before.  Perhaps more so now, having had a break from it all.

A recurring theme of my personal reflection blog posts is that I have a life with a husband and a son and a house and a job and that these things are good and I would not have it otherwise.  Life in Brussels now would not be the same as it was for us before as we’re parents and the hard bits of life (which to be honest are mainly logistical!) would still be with us. 
And -as the second earner- the idea of upping sticks to Brussels because I might want to is just not realistic.

But today, just for a minute, I felt properly like EU me again. And I liked it.

I wonder whether our toddler would be good at Flemish?        

PS apologies for the stream of consciousness style, but the title should’ve been a warning :)