A short book, missing from the Bible

This morning, in the wake of a US supreme court decision mandating gay marriage across the biggest nation in the Anglosphere, there was, serendipitously, a Pride march in London. I was making my way along the ragged boundary between Tower Hamlets and the City of London, where I chanced upon another kind of demonstration. Quite apart from the technicolour spectacle of a Pride march, these wore black encrusted around their white frames, carried white flags crossed with red and one large placard emblazoned “Not Racist, Not Violent, No Longer Silent”. All three were claims which I had immediate cause to doubt, coy as the group on such a sunny and momentous day.

Still, emollient though they may have been, I crossed the road in short order to avoid them. In doing so, I stepped off the kerb and onto a rat — or rather, angled my leg in an inelegant direction to avoid stepping on a rat — came down awkwardly on my ankle and spilled my falafel in the street. This was a source of immense pleasure for all the vermin in the vicinity, the rat most of all. And while the rat, in all likelihood, regarded the Supreme Court judgement with an assured disinterest, the protesters were in greater need of a pick-me-up.

The marchers’ protest was implicitly predicated on the inviolable principle that heterosexuality is sacrosanct.

Ella was a tall, thin, angular, pretty woman who smelled of a Pret-a-Manger fruit salad in which a rushed City worker has stubbed out a Gauloise. We matched on Tinder, subsequently we met for a drink at a conceited little microbrewery in Bethnal Green and later retired to her home. Time went by and we did the same again, then on a third occasion, after I dragged myself to a park to entertain her, we stopped off at a bar a few minutes’ walk from her flat at around 11 in the evening. I returned from the bathroom to find her in conversation with a man clad fully in denim, putting a number into her phone.

At every opportunity then on, she checked her phone and tapped in a hasty reply. I went to buy another drink for us two and she used the opportunity to make conversation with the man in denim. She went for a smoke and made clear I was not invited. Plain as day she returned inside, alongside the man in denim. She came over and told me, between kisses, that I should go home: “fuck off”, I believe she said, though sweetly, affectionately…I was not to walk her home. She would see me on Sunday.

I left and took out my phone to find a map of the way home (I had never been to her house sober) and she walked past, away from her house and down an alleyway with the man in denim.

Ella assures me that I am mistaken about what happened that night, but the sanctity of the heterosexual mode of romance remains lost on me.



My mate Alan, he’s weird. I was sitting there thinking: Alan is weird. And you know Alan Irving? He’s weird too. My teacher, Mr Allen, was pretty weird. I wonder if all Alans are weird? I’m weird…am I Alan?”


Callum held up the soggy joint in his left hand, ash pointing to the greying sky.

“So I think it’s time for you to hear about Alan.”


Callum looked at Neil, who dropped a smile and quickly picked it back up again. He looked me in the eyes as though he was measuring the worth of my soul. He turned back to Callum and nodded.

I belatedly took hold of the joint with my left hand as it passed across our bodies from Callum’s right. I quickly took a chaste drag while Callum adopted an open stance.

“OK so our pal Alan has been a tragic figure. Very quiet, could go a whole night without saying a word. Since we left school, he hasn’t had a job – five years. He’s not in uni or college or anything, hasn’t done an apprenticeship. He’s a true NEET.”

“That’s ‘not in employment, education or training’ in case you didn’t know,” Neil chips in laconically, punctuating with fact the reality of Alan’s situation.

“So we’ve been worried about him.”

“I have been anyway, I used to think he’d kill himself.”

“Like Neil is in a band with him and that’s like the only thing Alan does.”

“Yep, he more or less said that to me. In which case you’d think he’d be a better drummer.”

“At any rate, that was the only way he left the house. He lives with his parents, we kept trying to help him get a job but…nae luck. He stopped going to collect his dole money, so we really did think he was about to kill himself.So there you go there’s his background. To you, Neil.”

“OK so we were on tour with the band and we were in a sex shop in Birmingham. Loads of really heavy stuff. So Gordon turns to us and is like ‘what’s that about?’, gesturing over at the CBT stuff. For the uninitiated, that’s cock and ball torture. We kind of laugh along with him, except Alan, who’s like ‘yeah, no, I get it’.”

“So here’s Alan,” Callum interjects, “giving it all you need to know about cock and ball torture.”

“‘Yeah…I get that. I’m into that.’ Like Alan has had plenty of time to ‘experiment with his body’. He certainly hasn’t been spending the time on anything else. And he gets into his butt plugs, like does he just wear them to wank? No, he’s been to see his grandparents with it in. Been to ASDA to buy some ham. Wore it all day on Christmas – as a gift from Alan to Alan.”

“His next goal, at the time, was to get one with more flange, for reasons of safely stimulating his prostate. To my mind, that is high ambition for Alan. Bear in mind, I’ve known him for ten years, this is the most I’ve heard him speak. Maybe a third of the conversation I’ve had with him, cumulatively, has been about his wanking.

“OK so the gif,” Neil jumped in.

“Yeah, yeah the gif. Amid all this, Alan claimed he could suck his own dick. And we were all saying, you know, no waaay! But…you know…” he trailed off coyly.

“Alan has a massive dick.”

“So you know. Could be true. And so he got out his phone and showed us a perfectly looping gif of him just going down on himself.”

“He was sucking his own dick right enough. Like Ouroboros he was devouring himself.”

“Impressive. But there you go, so here begins the tale of true love.” He pauses and lets the potential hang in the air.

“So the other band that Alan and Gordon are in, not the one I’m in but the other, they were on tour and they played a gig in London. They were going to stay that night in an abandoned school, but the guy they had been talking to who had the keys wasn’t answering his phone. So they rang around, texted everyone they knew, put out pleas on Facebook, Twitter, anything you could think of. And getting towards the time of the gig, finally Alan pipes up. He’s like, ‘I know someone we can stay with’.”

“Now bear in mind, Alan doesn’t know anybody. He’s never been out of Livingston except touring with his two bands.”

“Yeah so they were like…meaning no disrespect Alan, but apart from Callum and Neil, everyone you know is here. Who the fuck do you know in London?”

“Yeah and it turns out…have you heard of IRC? Like it’s this kind of nerdy thing, like MSN messenger but really old and it’s only really for big nerds….bigger nerds than me, and I’m definitely the biggest nerd here,” bragged Callum in an uninformed fashion, “Yeah he had gone on one of those IRC sites and posted the GIF, and some girl LOVED it. She was taken by his unique skillset, and aimed to make use of it.”

“So what happened then, Alan? So he told us about how they Skype and call each other, and he just sucks his own dick and she loves it. So after the gig at 1am, with nowhere else to stay, they were like fuck it – he hadn’t pushed them into it, he seemed really keen. So they went to Whitechapel, where she lived in a grand tradition of psychopathy. They’re walking along the street and they see this haggard bird. The best descriptions we have of her at this point is that she has a red chin and was wearing cargo shorts. Gordon jokes that hey, imagine it was her? And of course, no sooner had he said it, that Alan went up and hugged her.”

“I think that tells you enough, really.”

“Hm. So they go in and crash, and all night long they hear them. From the first ‘oh my god – it’s huge, to the sound of his own cargo shorts slithering to the ground. Then they start beating each other, and it goes on from there. It’s beautiful, really.”

“So if we fast forward a few months, Alan is starting to get pretty flush with cash. He’s moving down to London to be with her. He has no job, no dole, Neil knows he makes fuck all from the band and doesn’t deal drugs. And it’s known that the woman has inherited a fair amount. Not to say these facts are related, but they certainly seem to be. And we can’t find any evidence that he’s been profligate with his intellectual property – Gordon assures me that there is no sign of the gif or a video on the self-suck network. So it looks like he’s found a way in life.”

“But this story has a moral, lest we forget.”


If you get deep enough inside yourself,
you will find true love

Beat Prose

Other Brick Lane Coffee Shops Are Available
Other Brick Lane Coffee Shops Are Available

In Brick Lane there is a plain coffee shop staffed by well-travelled and attractive young adults in harem pants and t-shirts regardless of weather, I was served on one occasion by a handsome woman with close-cropped pixie hair and striking, youthful eyebrows.

I ventured to compliment her shirt and to ask where she came by it — the answer came there: Brazil, she had bought it for 10 real, 12 years ago, when she had travelled around South America between school and university.

If pressed, I would describe this woman of at least thirty as  beautiful. She produced a loyalty card that said “FUCK” in stage-whisper lettering at the top, and stabbed with a sharp knife the box next to “this”, underneath it. After much contemplation, she handed it to me. I took my Japanese soup, Parisien sandwich on hard white bread, and smooth Rwandan coffee to the front decking to sit in the sun and contemplate my mortality.

When will I first be described as “middle-aged”? I’ve thought about it before: I don’t include jokes, sarcasm, insults. These, in any case, are the currency of the young. I mean, when will the day come that someone casually, uncontroversially, calls me middle-aged? An entirely practical description, useful logistically, for easy identification.

Next month, I will be 25. You might then immediately dismiss my worry, but I may be in the middle third of my count of heartbeats, today. And what do I do that can only be done by the young? Cocaine worries me when it smells too much like a building site, I have mobile phone insurance, I trust some people over thirty. I roll up my trousers in puddles and take into account the next morning when I drink.

It is coming to us all, to many of us it has come and to some more it has gone. Clapped-out, blacked-out conversations with your friends, now with heads surrounded by a desperate lapsed halo of disappearing hair, and children. The jokes you shared aren’t funny any more. Fading strength and the sure knowledge that you will be less tomorrow than you were yesterday. Not only does that Pink Floyd song make sense to you now, but a Pink Floyd song is making sense to you now.

The sun was behind the clouds and the wind was sharper than before. I would have gone back inside, but the music in the coffee shop was too loud and it was about time to get  back to work.

Depositioning Knowledge

I spent the day in training with the PR arm of my employer. I now appreciate the pressing need for global socialism.

In the early days of my current job, an email was circulated in which we were implored to attend a training session on creativity. The wiser heads in the office contrived to miss the session and carry on their work in the morally malleable world of drug development, so I alone undertook the schlep up to the glass office on the top floor, overlooking the City of London.

In here we meet our cast: the principal character and chief antagonist is “Ruth”. She begins by casually alluding to her previous engagements with de Beers, the diamond merchants, and the Israeli and Russian governments, the white phosphorous merchants. This passes without reaction; I take this to mean that this woman has a background in “detoxification”, which impresses some people in the room. After all, there is a more urgent requirement for an active and effective PR operation in an organisation that is committed to war crimes as an integral part of their business model.

Time drips on and I sense that we are fellow travellers in this beardly-ironic, transparent spaceship. It is not for us to question the morality of a business: we are mercenaries as those who buy us are mercenaries and the journalists whose stories we will write in lieu of news are mercenaries. Ethics is someone else’s lookout.

At first it strikes me that the three men behind Ruth couldn’t construct a personality between them and little happens afterwards to disabuse me of that notion. These are called Ben, Andrew and something else.

“Always be thinking of the bottom line,” says Ben or Andrew, and for a time I believed I was in Glengarry Glenross but Ben Affleck had fluffed his lines. “How we can be engaging with the consumer and driving the conversation.” A statement, phrased like a question in the imagined present continuous tense: the lingua franca of the industry. Cool, yeah, brilliant.

He brings up an ugly Powerpoint slide which details how many Twitter hits his Mastercard campaign has achieved. It’s probably a good number: it features myriad digits. In the interests of brevity: the point of the campaign is that a company wants to “deposition” (that is a made-up word meaning “to move into a bad position” or “to confer a bad reputation upon”) cash. They achieve this by making gifs about people receiving bad presents — the logic that bridges the difference between the aims of the programme and the tactics it employs are obviously tortured. I shan’t bore you with them: but ask yourself, is the thought of a crap gift going to stop you using cash? Are these people worth hundreds of pounds an hour? Anyway…

The lack of useful and productive talent is surprising and shocking. For example, in a room full of paid communicators, I present the case of a man who said “antithesis” when he meant pinnacle (I suggest he may have taken a wrong turn when intending to misuse apotheosis only slightly) to interested and thoughtful nodding from around the room. Or Ruth, who chided a marketeer for his unclear language and encouraged us to use plain English by telling us: “communicate as granularly as possible”.

On a system level, these people are not only allowed to exist in our society: they are, on an economic and therefore political level, valued. In addition, they save journalists time and effort by giving them adverts dressed as stories, and in doing so they set the agenda. The fingerprints of PR are all over the national papers, as much as nepotism and provincial small-mindedness is in the Helensburgh Advertiser or the Tain and Dornoch Picture Post, and the more popular the newspaper the more obvious it is.  They run lowest common denominator “viral media” sites, set trends by decree and get snapped up by the political spin machine. All of this in spite of the fact they are clearly intellectual cretins, but that is beside the point — I would rather principled idiots than intelligent, amoral automata, but these are neither. They hijack anything that is genuine or authentic and bend it towards their clients’ goals, often cack-handedly, always cynically.

These people, these people described above, are, tragically, the ones who prop up the establishment under cover of being free and creative spirits. Should this behaviour and these attitudes be rewarded? This is the foundation upon which our grey matter economy is built. This, dear readers, is the area in which we lead the world and will continue to lead the world, the edifice onto which we carve the chiselled face of the wealth-creator.

Pay by cash.

Hold a little titre

I wrote this some years ago as a way of dealing with a minor personal drama by way of undermining serious themes with the kind of jokes I liked when I was 15. The inspiration, or at least the soundtrack to writing this, was “4am forever” by lostprophets. A little awkward, with hindsight, but I bet you still like at least one of Woody Allen’s films.


Icy, grey December water rose above her knees as she waded across the dark shadow cast by the mouth of the cave. The prickling of her nerve endings and the blunt pain of the cold in her calves scarcely crossed her mind as she forced herself each step to lift her sodden boots from the ground and scrape across the top of the rough rock beneath her. Why she had come alone and told no one, she did not know — none of what she had done today made any sense to her. Keep going. Keep calm and carry on, as the poster above her bed read. When you’re going through Hell, keep going. Stiff upper lip, don’t trouble people with your trifling, trivial problems. Keep going, past the mouth of the cave and around the dark corner.

It was strange from the first moment, the letter Alex had left for her to read on her return from the town. From the first time they had met, drunk and directionless, he was so needlessly eloquent. An edge would be a precipice; a chill a paroxysm. Reserved but descriptive, quiet in his behaviour but in his words forthcoming and emotional.


In the letter: the simplest words. No joy in mastery of language, no playful pretension. Nothing of Alex:

I am bored with everything. Not with you but with everything. I do not want to cause a public scene, I will be found in the cave where we went diving last summer.


Direct, like a scientist, or a lesser Hemingway. The man shot the dog. Alex shot me, or himself which is the same thing.

She continued around the corner and before she reached the point where the high tide can block the entrance, she was struck by a pungent smell: ferrous and decaying, wasteful. She feared what she knew was coming and thought back over her week at the cabin with him. She saw his face when she thought he was happy, a convincing façade to cover over what he must know would destroy her. Surely…not this easily, not as sudden, it must be wrong…can there be a surprise party at the end of a dank cave? There must be.

She imagined his intentions as he sat down to write the letter, how he must have struggled against it, and she felt suddenly sick.


It could have been the smell that made her drop to her wet knees and allow the weight of her head to force hot tears out of her eyes. She crawled on a few feet and forced herself to look up and see a shadow of what was surely Alex. Her quivering fingers lit up her phone, which she raised to see his face — eyes closed and swollen, his face unchanged but jowly above the thin, coarse rope.

Among the living, she was alone in the cave. She crawled to where the floor was at its highest point and clutched her legs with her weakened arms as she watched the tide rise up so that it almost reached his waist. She never opened her eyes again — for it was perfect symmetry that the last time she saw him, he was balls deep.

I got angry at the Lib Dems again

Don’t read this unless you are an idiot, this mostly exists for my purposes. If you start to read it, you surrender your right to point out that it is self-aggrandising onanism — I don’t care that it is.

The policies reviewed are taken from BMJ 2015;350:h2031


Ticketty-tum, here they come, Tory
Ticketty-tum, here they come, Tory

Money — Of course, everyone is going to claim they will increase spending. Anything else by any party would be suicide: you can see that from the rest of the parties’ pledges and I promise you now that the DUP, UUP, SDLP, the MRLP and the National Liberal Coupon share the policy of putting more money into the NHS per year, at least nominally. From now on, I will not comment on any broad claims to “increase spending” because they are pointless.

More interestingly (though outwith the scope of this post) is the shared focus between the right-wing parties of government on home ownership, which even reaches into health policy. There is no pledge which guarantees you will never have to go without food or miss rent payments in order to afford care, which makes me think that this policy is not about social care, it’s about home ownership.

In all, the Conservative Party have no differentiating healthcare funding policies.

Organisation — There isn’t much here to see here. There is no point, in a piece which is implicitly comparing policies, in reviewing policies on which everyone agrees (see the “Money” section above) and I’d be very surprised if any party doesn’t support the integration of health and social care. I would also be very shocked if there was a party which doesn’t support cost-effective drugs and “innovative” health services.

What interests me about this section — and I am throwing around the concept of “interest” with liberal abandon — is that the manifesto mentions the government’s own dry and uninspired MedTech review, but not the ABPI’s recommendations on stratified medicines. While the latter report is imperfect and inevitably plagued by an undercurrent of self-interest, it is no less an interesting document which could positively influence future practice. Either the people behind this manifesto haven’t done their reading or, far more likely, the Conservatives don’t want to be seen to take their lead from industry. This is greatly to their detriment.

Again, from what is actually written, there is little to say.

Staffing — Aiming to train more GPs (and to train GPs better) is a pledge that implies a good understanding of the problems facing the health service. I have read in various that the UK is short 8000 GPs and the start of any cogent discussion would have to be a promise in the manifesto to increase GP numbers, surely.

However, this oft-repeated pledge is not in the Conservative manifesto. Therefore I give it equal weighting to other ex-manifesto pronouncements from the Tory party, such as “I’m too busy to take my kids to the GP, so I go to A&E” and “homeopathy works”, both from our current health secretary.

This section of the manifesto gets no points either.

Access and Targets — Anyone who grew up under New Labour will be aware that targets, least of all uncosted ones, are not always the most precise way to improve outcomes. For that reason it is perhaps troubling that this is the only section which seems to have been written with deliberation in the health segment of the document. However, targets listed in a manifesto at least indicate the direction that a party aims for — or claims to aim for, let us not forget 2010 — and I’ll judge them on that basis. After all, what other basis can you have?

GP access: good. Prioritising mental health: good. Supporting carers: good. Six out of ten, a convincing facsimile of a party that doesn’t mind if the vulnerable die, with a non-gratuitous bias in favour of the Tory-voting old.

Improve standards in all area of care: not a policy.

Use of private sector — This section is conspicuous by its absence. One can assume that this means that no change is intended, which is disappointing but not surprising.

Public health — This section of the programme is adequately do-gooding. However, it’s hard to be anything but positive in public health policy, if you care to include anything about it at all. Credit to the party for acknowledging the need, but the content is minimal. The one area of special focus is diabetes, which is an important problem, but no more so than heart disease. There is no insight to be found here and I would not be surprised to hear that one of the people who wrote this manifesto has diabetes in the family.

On a harsh reading: 4/10

*NB a rapid response to the BMJ article to which I refer is very critical of the policy (not listed under health) of removing benefits from patients who fail to attend counselling of whatever kind for mental health problems, obesity or addiction. This not only undermines the good work done to destigmatise mental health but also violates several overlapping codes of ethics in regard to coercion in medical treatment. The lesson here is that not all of a party’s intentions for vulnerable patients can be captured in the health section of their manifesto.


red tory
Diet Dr Tory with Cherry

Money — In the current times of straitened political manoeuvring, you have to commend any party that makes an attempt to cost their investments. 20 years ago Labour could argue that public spending was an investment, but those days are passed now and the necessary phrasing of this policy is positive, considering contemporary constraints. The name “Time to Care” is the worst kind of meaningless PR spin-tank nonsense, but if you rename it “recruitment fund” in your head and change nothing else then you must realise it is harmless.

I have no comment on the proportion of the mental health fund spent on children. Neither adult nor child mental health is enough of a priority, so proclaiming on this issue is all deckchairs and Titanics. Uninspired but leaning towards positive.

Organisation — The health and social care pledge is an obvious one, but phrased in such a way to suggest that the person who wrote it understands the need and has at least one suggestion to achieve it. The desire for a single doctor in charge of a complex care pathway is an almost constantly articulated desire in patients. Any steps towards this are admirable. While the likelihood of delivery-as-promised is slim, especially as the Labour party do not oppose compartmentalisation and semi-privatisation of the health service, any mention of this concept must necessarily be commended.

Other pledges take a broad and long-term view, at least compared to the standard Labour model for policy-making (think, for example, of the energy price-freeze) and the pledge to repeal the massively unpopular, ineffective and ideologically-driven Health and Social Care Act is a sitting duck for the Labour Party.

This section is the most impressive section of the most impressive section of the Labour Party’s manifesto, which is to say it’s not bad.

Staffing — At this point in the life of the NHS, more GPs and more nurses is certainly a cost-effective investment. Obstetrics is not particularly my area, so there is a possibility that this pledge is mostly populist (based on the theory that people like midwives and enjoy revelling in the mental image of a world where there were many more midwives) but I’d be reluctant to deduct points for a policy that aims to increase provision of productive employment in the caring professions.

While the goal of increasing the number of midwives is open to question, the need for mental health training as a staffing priority is not and this is a vital policy.

Targets and access — Ah, home! We set our feet for the first time on predictable New Labour territory. Most of this is not worth taking seriously for the reasons outlined in the Tory section. I have a slight preference for the Labour over the Tory here, because mental health and the concept of prevention (both forward-looking areas for study) have been imposed on the innately short-termist world of targets.

Use of private sector — I dream of the day when this section is unnecessary. Labour here reach the minimum standards required in 2015 by aiming to make the NHS the preferred provider of healthcare services. The cap on profits is fatuous nonsense and is directly contradictory to supporting the principles behind TTIP (please, please Google this if you don’t already know about it).

One tiny scrap of positivity is that Labour want to exempt the NHS from TTIP. Fair enough, it would be totally politically tin-eared for any party not to, though it’s very strange to agree with something on principle apart from where it is popular not to.

Public health — This is at least as bad as the Conservative public health policy and in some ways substantively worse. Micromanagement of free choices in nutrition is a total non-starter in a world where your party and others are unwilling to regulate these things wholesale. “Sin taxes” disproportionately hit the less well-off and reduce productive economic activity because the kind of people who spend all or most of their money can buy fewer things. In this instance it isn’t even a tax and won’t fund public services. Worst of all, this kind of policy forces me to talk like an economist. I am not impressed by any Labour Party policies on public health, except the policy which is about energy and transport rather than health and as such is not in my purview.



Liberal Democrat

I promise to enact every policy that no one likes or cares about
I promise to enact every policy that no one likes or cares about

I’d like first to point out that this section is substantially longer than the previous two put together, and provides significantly less than half the motivation to read it. In fact, if you put together all six of the mini-festoes here listed, the Lib Dems account for well over a third (closer to a half) of all the words written. Clearly this is a tactical decision: the party often boasts that it has achieved a large proportion of its manifesto pledges. Rarely do you hear (from the party, at least) that these pledges include minute re-organisations in some technocratic minutiae and exclude the headline manifesto pledges.

I shan’t be writing proportionately more to account for the number of obscure pledges.

Money — The first is a very disappointing pledge. They aim to match Tory spending, yes, and it attempts explain how it will be paid for, which is advantageous as previously described, but there is an ideological failure at the core of it. The strong implication is that if the deficit is not paid off, the NHS will suffer: it follows that public spending is a black hole, the NHS in particular, and that it is not a priority on the same level as central debt management. This is irresponsible and ideological, it puts the NHS in danger. There is no recognition that failing to fund the NHS in order to manage central government debt will lead to greater debt being incurred on behalf of NHS trusts; nor that central debt is cheaper to manage than NHS trust debt; nor that inability to hire salaried clinical staff will mean that more is spent on agency staff who are less committed to the trust and will add exponentially to the debt — to say nothing of the savings to the public purse from a strong health service. This is an ideological hatchet-job disguised as prudent fiscal management. I’d expect no less from the Orange Book liberals.

The rest is a curious mix and seems to me to support the famous right-wing adage that governments should not be in the business of picking winners. Aside from mental health (which the Lib Dems deserve credit for introducing into mainstream discourse, but now that it’s widely recognised as a priority they seem no further ahead with implementation than the rest) it’s a scattershot list of priorities. This is not to say that dementia is not important, it’s just strange to mark it out as the most important condition when there’s loads of other things that suck the life out of people at a much younger age.

The pupil…patient premium is an offensive attempt to bring cross-platform branding into a manifesto and the home-owner care guarantee is a bad policy for the same reasons as it was when the Tories came up with it first.

This section raises more questions than it answers. I intend not to be sucked in again by the sheer volume of asinine nonsense in the next few, but we shall see how we go.

Organisation — I had to go out and buy some maple syrup in order to swallow all of this waffle.

What’s the point in talking about “joined-up care” when you support the provisions of the 2012 Health and Social Care Act, which aims for cooperation to be subsumed by competition and targets? What is the point of talking about “[getting] the best out of innovative drugs” or “[ensuring] patient safety” at all? What do they mean by an integrated outcomes framework?

How does one transform pregnancy care? Is it a function of wishing it transformed, or are there tactics in mind? If so, where can they be found? Is this part of the mental health strategy? What does any of this mean?

All the reviews and reorganisations are very worthy, but they don’t amount to a bold vision. Taken together, this is gibberish: it all has the air of a business pitch for a client that you don’t know much about.

Staffing — There is, finally, something of value to be found in the yellow swamp. Training professionals in mental health awareness is the first true preventative measure mentioned and it should be welcomed, as should the recognition of the relationship between mental health and physical health. An emphasis on rights for carers is also a worthy aim: it’s a priority that has long been recognised, but has never been given much attention in terms of funding. Loneliness in later life isn’t a priority in terms of its economic value, but it is important if government aims to improve the lives of people and society. This is a long-sighted and humanitarian policy, as such it is a pleasant surprise to see it in a Liberal Democrat manifesto. Though I have my reservations about the care navigator idea (wouldn’t Labour’s idea of a clinician in charge of care be more simple and more popular with patients?) it is along the right lines in that it is likely to help patients manage a complex and often alienating system.

However, this short section (otherwise so good and so concise that I suspect someone other than the general author of this manifesto is responsible for it) is let down by the condescending talk about promoting the use of pharmacists. The Lib Dems, who haven’t bothered touching the health portfolio in government, should not be proclaiming on the subject of triage when they’re supporting a government where the health secretary is in favour of the middle classes sharp-elbowing their way into A&E. The recognition of triage as a policy priority is one thing, if you intend to do anything about it, but this is nothing.

Postscript note for the editorial team: you cannot better utilise things. Insofar as the word utilise has a unique meaning, it means “best use”. Failing all else, communicate in English.

Access and new targets — This section was either written by someone who isn’t aware of current developments in medicine or by someone who is hoping that their audience is not aware of current developments in medicine. Some of the targets imposed here are already existing and realistic targets imposed by the Department of Health, and the target to introduce targets is possibly the first known sighting of a meta-policy. Still, set the bar low enough and you’re sure to clear it.

The clinical trials register policy is more or less credible, but implies a bewildering lack of understanding of the problems behind clinical trial registration: the bodies that are duplicitously or negligently failing to publish negative trials are rarely reliant on substantial public funding. The better invocation of the same policy, simply stated, is from Plaid Cymru, from whom the Lib Dems could learn a lot.

Points should be given for mentioning generics, but I feel as though it’s an obvious point to make and the other parties won’t have mentioned it because it’s condescending to imply that doctors don’t know to prescribe cheaper versions of the same drug. These points can’t be considered to be substantial nor informed without even alluding to NICE reform.

Use of the private sector — I’m not sure about the organisational wisdom of repealing parts of the Health and Social Care Act that make the NHS vulnerable to EU competition laws, rather than the whole thing, and it is a bit half-arsed and populist to protect only the NHS from those laws, but there is a suggestion of further expansion. I would also have some reservations about the radical pro-public sector crusading of a coalition party.

Otherwise we here have a rare example of policy-making for the public good. If the rest of the agenda reflected the posturing here, this review would be much different.

Public health — The first lesson in public health is that you should not send complicated messages, nor demand onerous changes to lifestyle that are liable to change. That final point is salient: health education should be national and unified. Insofar as there is a specific policy in this section, it is the wrong one.

The general thrust of the other ideas have the right priorities in mind, though the same criticisms apply here as applied to Labour’s micromanagement of health priorities. Considering the sheer number of policies, it is disheartening to see no plans to reinforce advice in support of fresh green vegetables for example, instead opting to extend the reductionist and limited traffic light system.

3/10 – so all-over-the-place that it makes a mockery of giving a single score to the whole thing. Individual sections range from 0-9.


Scottish National Party

class war
Full communism for Scotland

The BMJ doesn’t list manifesto policies for the SNP, so this will necessarily be perfunctory. Health, in any case, is a devolved matter, so the SNP’s Westminster manifesto in regards to health is a matter of little consequence to anyone.

Money — Ending austerity in terms of the NHS and increasing funding to the NHS are technocratically valid policies. The both are unimaginative but wise in that they recognise the value of fiscal multiplication as it applies to health. It is also good to stop people staying in beds when they are healthy, it is also a profitable way to spend money. Free prescriptions are popular and inexpensive.

As uninspiring and competent as Scottish people have come to expect from their new party. It might well bewilder the commentariat that this kind of policy inspires pre-war level political participation, but I can only assume it’s a movable comment on the state of their opposition.

Organisation — So bland, vague and inoffensive that it could belatedly win John Major back ‘round. This pair of policies was last seen splitting a butter sandwich and discussing Deal or No Deal.

Staffing — This popular pledge could be carried out well or badly and is hardly a priority per se (although, the fact that there is no manifesto makes it grotesquely unfair to criticise policy omissions — this does not mean I am likely to stop).

Access and new targets — With the above caveats in force and with the best will North of the wall, there are no policies here, only aspirations.

Use of private sector — The only two correct opinions — that the NHS should not be privatised and that we should not agree to any EU treaty that forces privatisation and prioritises a company’s right to profit over a government’s right to care for its charges — are expressed here.

Public health — Right enough, reducing smoking is a laudable health goal, though not a policy. Minimum alcohol pricing is a sticking plaster on a deeper wound and while I have no doubt that sticking plasters stop people bleeding on the carpet, this is not enough, never has been and won’t be after the 7th. Greater ambition is needed, though I commend the setting of simple goals.

It would be unfair to rate this for several reasons given above.

Plaid Cymru

Full communism for…Wales?

The same provisos apply to PC as did to SNP.

Money — These are surprisingly bad policies, free prescriptions aside.

Encouraging innovation and attracting more research funding is a game in which successive UK governments have found themselves failing. Luckily the country remains a centre for biomedical education and the production of loquacious smartarses, which has made a drastic decline unlikely, but recent policies targeted at stimulating research and development spending (such as plans to cut tax on patents to zero for companies headquartered in the UK) have not had the desired effect. Recently Pfizer, the world’s biggest pharmaceutical company (and one which has emphatically not contributed proportionally to “innovation”) tried to buy AstraZeneca, a UK-headquartered pharmaceutical company. Historically, Pfizer and others like it have bought companies, fired tens of thousands of employees to achieve “synergies” and made their profits that way rather than by developing drugs to make patients’ lives better. As well as the stagnation and the massive loss of skilled, well-paying jobs, these processes have slowed the flow of drugs to market and reduced competition. This is because, if both companies have a similar drug in development, one will be shelved so as not to cut into the other’s profit, making things more expensive for the NHS and patients in general.

A late appeal to British nationalism saved AstraZeneca, the treasury, the NHS and the nation from that specific mess, but the underlying problems with incentivising big pharma to relocate to the British isles remain.

Additionally, the new medicines fund mentioned undermines NICE and the systematic model that the NHS uses for approving and recommending drugs, in favour of a system which privileges popular and glamorous diseases and treatments over those which are most cost-effective and useful. Typically, these diseases are the ones that “patient advocacy groups” do the best job of promoting. Which patient advocacy groups have the most money and are best able to promote their drug publicly? Well, in part it’s drugs for diseases that affect rich people, but mostly it’s groups that are put together, organised and funded by the pharmaceutical industry!

It is perhaps unfair that this rant has found itself in the Plaid Cymru section, but unless they have any more creative ideas for supporting research then they are equally culpable for propagating the myth and language of “innovation”.

Organisation — Someone, in one of the parties, is aware of clinical trial registers! Full marks to PC here and plaudits as well for giving priority to telemedicine. The importance of a medical accountability bill would depend entirely on its contents, though I’m not sure about a duty of candour. It seems to me to be a blunt instrument where perhaps it would be better to support the implementation of shared decision-making training more broadly, but it absolutely depends on the content, phrasing and binding clauses of such a bill. So who knows?

Staffing — Assuming that the 1000 extra doctors PC aim to recruit covers only Wales, that is a fair policy. Recruitment is especially a problem in Wales (presumably because people do not want to live there and I can understand that) so it is a good priority to have. However, this does not represent a costed and practical plan.

Access and targets — Why is there such a fixation on cancer in every party? The conspiracy theorist in me refers back to the patient advocacy groups mentioned before: cancer is a fantastic area for profit and has mysteriously picked up a reputation as the disease that must be eradicated, in front of autoimmune diseases, mental illnesses and metabolic disorders, all of which claim far more lives prematurely. Still, it would be churlish to disagree with the implementation of a national cancer plan, though nothing in the manifesto details whether the plan would be any good.

Otherwise, a focus on addiction and mental health services is to be welcomed.

Use of private sector — Again, the only two valid opinions that can be held on privatisation are held by this party.

Public health — Regressive taxation, regulation of small things and policies that are about the environment rather than health abounds here. No worse than the rest.

6/10 — I had high hopes, but clearly no one with any insight has been involved with this manifesto


Green Party

u tellin me we cant afford free social care, i fuckin swallow you hole fucker im, fuck
u tellin me we cant afford free social care, i fuckin swallow you hole fucker im, fuck

Money  — I disagree with the Green Party plenty but this is a really good start. Of course, the consensus is that we can’t afford the NHS and that it’s comically bloated and inefficient, despite recently being rated by a US-based non-partisan thinktank as the most efficient, the most fair and the best overall healthcare system in the world. Often the people who say this wish to compare it to the German or French system, which cost 11.3 and 11.9% of GDP respectively. If the pie-in-the-sky Greens got their way, we would be spending an astronomical…10.6% of GDP on health. Even if you include the 5bn set aside to pay off PFI contracts — which, to the uninitiated, would mean paying down the NHS’s own deficit much faster and more profitably than paying down the national deficit — we’d still be well below the OECD average for the year in which we did it. This all is to say nothing of the left-wing basket case that is the United States: to bring our public health spending per capita into line with theirs, we’d have to raise our investment by £171 billion per year.

I can’t speak of the costing of nationalising chiropody and dentistry, frankly I don’t know to what extent they are currently privatised, but the thrust here (a fully funded NHS which can make decisions in the long-term) is not just right: it’s financially sound.

Organisation — I know nothing about the effect of mixed sex accommodation or the cost of ending it. I suspect that if the funding is there then it should be done if desired. The emphasis on the reduction of market forces in the NHS is admirable and the high principles of the document are a positive sign.

A little more detail would be nice, but its lack is acceptable in a party that will not have a majority in the near future.

Staffing — In a country which has accepted into its discourse the mantra that you must pay the best to get the best, paying clinical staff well seems like an obvious choice. Not so with successive governments who agree that paying nurses in line with inflation is a luxury we can’t afford.

Access and targets — As ever, points for identifying mental health as a priority. Addiction, too, is a good thing to prioritise, but very vague on how to achieve better cancer outcomes to the point that their cancer targets are among the least inspiring in the whole political constellation.

Use of private sector — Buying out PFI contracts is a prudent investment, avoiding further PFI contracts will save the country billions that can go towards better things. The interest on PFI is far greater than the interest on government bonds: this policy is genuinely like using a 1% interest loan to pay off a payday lender who’s sitting on your doorstep waiting to kneecap you. The rest is ideologically solid while providing nothing for the banks to worry about in regards to our public finances, though a conspiracy theorist might disagree.

Public health — Copy and paste previous criticisms about micromanagement and regressive taxes. Treating addiction as a health problem rather than a crime is a positive development and assumed organ donation and dignified dying legislation is perhaps unpopular to the general public and certainly fodder for the tabloids, but I would wager keeps a good number of ethicists and doctors onside.

The climate change stuff is less health-related and more general “Green Party policy”, so I will not comment.

I would review UKIP’s policies but I don’t for a minute think they’re sincere, which is qualitatively different from being unachievable.