24 Hour GP Access

The announcement that Teresa May has today demanded that GPs in England remain open from 8am until 8pm follows on from David Cameron's aspiration to achieve seven days per week GP access by 2020. It will achieve many outcomes, some good, some not so good.

In the first instance, prospective medical students and junior doctors toying with a career in primary care will now have second thoughts. Under the existing system, a career in primary care has traditionally attracted those who wish to put family life first and enjoy a role at the centre of their local community. The idea of working Monday to Friday from 8.00 until 6.00 has traditionally been deemed conducive to a stable family life. It seems as though those days are now numbered and many would argue that this is long overdue.

Oh that it was that simple. Primary care is currently facing two huge problems. On the one had, it is being swamped with patients as never before and on the other hand, there is a national recruitment crisis. Planning to stretch the existing GPs to seven day working will inevitably make some think seriously about early retirement - and many already have.

This presents two huge challenges for primary care. In the first instance, they need to start addressing why it is that so many medical students continue to look upon a career in primary care as a last resort. Speaking from my own experience, too many doctors in hospital medicine continue to express ill informed comments about GPs. The medical students very quickly start to believe these judgments and become reluctant to even consider a career in primary care for fear of the perceived stigma. But as medical students, the medical schools themselves should be doing more to present a more balanced view of the available career options. During my time, I could have been forgiven for thinking that hospital medicine was the only option - that is a huge problem.

The second massive challenge for the next government is how to address the insurmountable numbers currently presenting to their GPs. It is well documented that up to 30% of those presenting do so with either no identifiable ailment or a condition for which there is no justifiable treatment. Just addressing this alone would have a huge impact on the working practice of our GPs. Another inescapable problem is that we are currently failing to make best use of the IT which is now at the fingertips of just about everyone. Anyone with a smartphone will probably have a camera on their phone. This means that many more consultations can be done utilising existing technology currently at the fingertips of most people. This will reduce patient travelling times while still giving the doctor the opportunity to assess the severity of the clinical picture in front of him or her. Although I would be the first to bemoan the impersonal nature of such an approach, it remains a viable, pragmatic solution. Given the recent news headlines relating to the detrimental effect of excess diesel emissions on our health, any solution which will reduce this can only be a good thing.

There is also the question of women doctors. Primary care is currently attracting women doctors on an unprecedented scale. There is nothing wrong with this except that many women doctors understandably wish to start a family and work reduced hours. Although this is a welcome development from the standpoint of obstetrics and gynaecology because many women understandably prefer to be seen by a female doctor, the part-time working hours can then exert even more strain on the finite numbers of GPs out there able to come in and fill that gap. This is another reason why seven day access needs to be thought through very carefully. If they get it wrong, they will just drive even more medical students and junior doctors towards hospital medicine. This will make the current crisis in GP recruitment even worse. But where do patients go when they can't get a GP appointment? Accident and emergency! And A&E departments up and down the country are at breaking point now!

But why is primary care so important? Put simply, if we don't get primary care right, hospital medicine won't stand a chance and we can kiss our NHS goodbye in it's current format ie. free at the point of access for every man, woman and child. It is an established fact that those countries which invest the most in primary care enjoy the best health outcomes. The only way we can begin to address the huge numbers in our hospital beds is to have more GPs to better manage them in their homes and in their communities. This is an inescapable fact. The current state of affairs is now futile. We have to do something different and while I welcome seven day opening in principle, I would warn strongly against the short and long term consequences for primary care in the UK. The current system of GP out of hours services works really well but I suspect that many people (through no fault of their own) are not always aware of how to access it.

If seven day access to full GP services is important, the same must also apply to hospital medicine. At present, hospital medicine continues to run a skeleton service at weekends. I suspect the real issue underpinning this debate is that doctors across primary and secondary care must accept that they will now have to work rota systems seven days per week. If these proposals are to work, they must be applied equally to primary and secondary care because the current divisions between the two are bad enough.

In a recent article in the Spectator, Rod Liddle wrote an interesting piece on this subject. Essentially, he was writing about our consumerist approach. But it is not just in healthcare that we have adopted this approach. "Black Friday" is necessarily a new concept driven by the ever greedy marketing men whose very existence depends on us all buying in to their carefully crafted strategies. This week, it was announced that the people of Britain continue to throw away tonnes of uneaten food but at the same time we read constantly about the growth of food banks for those facing destitution. When I looked out of my window on the day of the post-Christmas refuse collections, it was mind-boggling to see the endless rubbish waiting to be "taken away". Out of sight, out of mind...

Of course, the lay man or woman might be reading all of this and reflecting on the healthy salaries being enjoyed by their doctors. It is true that doctors get paid well but it is also true that they carry huge amounts of responsibility. It is also true that they study for years to get to that position and, in truth, in this post-Harold Shipman world, they never actually stop studying. That is not a moan - that is merely a fact. So if Teresa May is truly serious about healthcare in the UK, I suggest she takes a much closer look at the whole concept of primary care before increasing the workload of weary GPs. Rather than make knee-jerk responses to the current challenges, she would do better to explore why these challenges are there in the first place. 

Double Blow for Scotland

Looking back on the events of the last few weeks and months which culminated in this morning's rejection of independence in Scotland, it is hard not to be impressed on so many levels.

As a resident of Wales, I was consciously aware that a Yes vote would have serious implications for the Principality. To compare Wales to Scotland though would be more than a little optimistic. The last time the Welsh went to the polls over devolution, near half of the population couldn't even be bothered to vote. Last night, a staggering 85% of Scots voted. By any measure, that is an absolutely extraordinary statistic. I sincerely doubt whether I shall ever see anything approaching that again during my lifetime.

Although campaigning on social media did manage to spill over in to acrimony and ill feeling, it was heartening to witness such a passionate debate being fought in such graceful manner by so many people of so many ages. It is also hard to ignore the cynical tactics employed by various factions within the No campaign. There are many ways to win a fight but I don't feel they will necessarily look back on some of their tactics with a great deal of pride.

It is also hard not to feel absolute respect for the outgoing SNP leader, Alex Salmond. There can be little argument that he has been the outstanding politician of his generation. His achievements from a starting point very close to the floor have been incredible - and he very nearly pulled off one of the great political victories of all time.

Imagine if you will a boxing match. In one corner we had Alex Salmond as the sole proponent of independence. In the other corner stood just about every political party you can think of: Tories, Labour, Liberals, UKIP and even elements of Plaid Cymru. Given the inequality of the debate, it is amazing that the Yes vote still garnered nearly 45% of the vote in such a high turnout.

But the debate has been had and the chance has gone. With all of that, Scotland has also lost it's greatest leader. Salmond was the one man who could have made independence a reality. But he should hold his head up. He fought an honourable battle and did so with great dignity and grace. Now the arguments turn to the West Lothian question and the prospect of a profligate Labour government south of the border looms ever closer. If that is to be the real legacy of yesterday's vote, there will be many who rue the day they chose to vote No in Scotland. For certain though, nothing will be the same again after the events of the last few weeks. Rightly or wrongly, Alex Salmond may not have won the battle but he has certainly unleashed the cat among the pigeons at Westminster.

Behind the Painted Smile

Although it has been really sad to learn of the death from suicide of the actor and comedian Robin Williams, the greater sadness is the thousands of suicides which occur with little or no attention. In a reflection of the modern world which we occupy, it often now takes the death of a celebrity to bring a particular health issue in to sharper focus. The problem is that few people want to dwell for too long on negative health outcomes. For a variety of reasons, that is understandable. People still have their lives to lead and rightly so.

One aspect of the Robin Williams story is inescapable. It is arguably more straightforward to consider his alcohol and drug addiction than it is to consider his depression. Successive studies indicate that alcohol consumption continues to rise in Western populations with the spectre of addiction lurking not far away. Although the numbers taking illicit drugs are lower, the concept is still likely to be more palatable to the many. The stigma attached to all mental health remains as strong as ever.

If the passing of Robin Williams impacts even only slightly on the way people think about not just depression but mental health in general, that will be a great achievement. Only when whole societies start to consider it differently will the potential outcomes of people like him be improved. We will never save everyone from this fate but it is certain that whole societies can make a huge difference just through a change in attitude. The media in particular can make a massive difference by reflecting on the language they choose when reporting. We must all remember that negative language is just as powerful as positive language.

I went to fuel in my car recently and happened to glance down at the pump nozzle as the fuel went in. On the nozzle was a really powerful message and I salute whoever thought to put it there. It simply proclaimed the value of a "can do" message when talking about maths with our children. Clearly, the message is aimed at the parents who will be filling their fuel tanks but this is exactly the sort of subliminal education which is needed to effect meaningful change in our society for the better. That same strategy could be used to great effect to suggest to all of us the benefits of being open, honest and respectful when we talk about mental health.

I listened last night to a wonderful programme on the radio in which Sir Ken Robinson was being interviewed about education. The programme started with him revisiting his first school. As a child, like so many others at that time, he had developed polio. He described the primary school class as looking a bit like the bar in the Star Wars films. He was just being candid. The children at that school had a variety of physical problems but his point was that the children themselves only saw each other as people each with their own humour and so on. He went on to describe how he was taken out of the grammar school for which he had passed the 11 plus exam (to the enormous pride of his family) because the teachers felt that it was too much for him to get up five flights of stairs wearing his calipers. Nobody consulted him and he was indeed moved to another school. Had they consulted him (and there is a growing body of opinion that education should be about the child...), he would have reassured them that he was prefectly happy and loved being at that school. The crime is that nobody even bothered to engage with the lad with polio who would go on to become one of the most sought after speakers and thinkers on education in the world!

The subject of suicide is perhaps without parallel in generating very strong opinions. Some consider it selfish and others look upon it in a wider context. When we are blessed with the gift of life, it is up to each of us how we intend to use that gift. That people choose of their own volition to surrender that gift must rank as one of the most extraordinary acts imaginable. It is not about it being right or wrong because it is entirely a matter for the individual.

During his life, the singer and songwriter Nick Drake could barely sell a record. His songs were wistful, plaintiff and plucked at the very soul of those who dared to listen. Since his suicide in 1974, people can't get enough of his music. Although Robin Williams achieved his recognition, achievements and fame before his death, there are still a great many who never do and that is a real tragedy.

Local community: How would you define it?

Since the new year, I have become increasingly drawn to the concept of community with respect to the town of Denbigh where I live and in the wider sense. Many would stop reading at this point because the subject would be a matter of indifference to them.

I recently read an interesting piece written last year in the Guardian. Written by Rosie Niven, the article contrasts the concept of community of yesteryear with the modern day equivalent. Fifty years ago, the word community almost invariably referred to the place where you lived. Since then, the definition has become a little more flexible often alluding to a common area of interest, values, activities, hopes and fears shared by people irrespective of the place where they live. By implication, it thus follows that people living in Britain today can belong to several different communities be they real or virtual. Communities these days are also less static than their predecessors of fifty years ago.

Local activities are cited as promoting cultural integration. The town of Denbigh where I live has been notably active in this regard in the last couple of years. In a short space of time, my home town has re-introduced a town carnival which for many years had faded away. A variety of local communities have also been responsible for the introduction of a car boot sale, a St. David's Day festival and a midsummer festival to name but a few. All these events point strongly to a town which has decided to get back to basics. Enough local people have got together in a variety of separate communities to generate these projects with the shared intention of regenerating the concept of local people coming together to engage in meaningful community activity.

What has really warmed my heart about this is the obvious intention to do so without involvement of local government. This reaffirms the original modus operandi of the local community - people doing it for themselves. All too often in modern Britain, local government has become a bloated organisation too far detached from the real issues facing the people over whom they exert jurisidction. In truth, history informs us that local government had little to do with community activities such as those referred to. One of the factors which has driven the growth of local government is a greater propensity to depend upon it. Obviously there are those occasions where such dependency is justified if only for the sake of the amount we pay in council tax. Equally, our society has tended to become somewhat lazy expecting local government to provide the solutions in instances where we might have done more for ourselves. It is a rare sight where I live to see someone picking up litter in the vicinity of where they live and yet the majority of us are quite capable. It is also rare to see anyone sweeping the mess off a pavement yet most of us are more than capable.

Citing the examples of litter picking and sweeping up, I am really alluding to the sense of civic pride which was ubiquitous when I was growing up in the early 1970s. It is far less obvious now so I wonder whether my local town is on the verge of rediscovering it. Given that they have voluntarily reignited the sorts of event so much beloved of our forebears, does it follow that they will soon start to assume similar levels of civic pride? I certainly hope so and have every reason to remain optimistic. Rural towns such as this are dependent on a sense of community pride to remain vibrant.

Like many similar former market towns, Denbigh has seen it's high street eroded by a combination of factors which continue to impact so negatively the length and breadth of the land. More people now work outside the locality. More people now have access to a car and the greater access which this affords them. More local councils have sanctioned the introduction of supermarkets on the outskirts of the town which have now lured the consumer generation since the 1960s. All too often, the latter has been devastating for the erstwhile high streets.

In purely economic terms, most markets are subject to the whims of cycles in which peaks and troughs are reached with monotonous regularity. While my local high street may well have reached it's nadir in recent times, there are signs afoot to suggest that the ascent to former glories is now on track. Without the involvement of local people in their respective communities with their shared focus, such a change in fortune would have been unimaginable. For a long time, successive generations have looked longingly at the greener grass of the out of town retail centres. Having feasted on that grass now for many years, it seems as though the oldest truism of them all is finally being realised. The grass is becoming more attractive in our own field as indeed it always was.

In our own field, we know more about the local food we eat. We also get to know with forensic detail the people with whom we share that field, warts and all. Ultimately, we exist within a finely balanced ecosystem in which jobs in our local shops are taken by local people often selling the produce of local farmers and artisans. It is difficult to see what can be so unattractive about that particular flavour of grass.

  

Maybe the last time?

I have just one more day to attend at the medical school in Keele before I can drive away from ten years' study. Although I return on July 14th for my graduation ceremony, it is now that I can begin to reflect on the enormity of the last decade of my life.

It started with the death of my first wife from breast cancer. Having unexpectedly met my second wife later that year, I made the risky decision to pursue the long road to a career in medicine. I embarked on a first degree in Medical Biochemistry before being thwarted after just one semester due to kidney failure. Nine months on dialysis were rewarded with a successful kidney transplant. The birth of my daughter just after my original kidney failure shone a bright light on our lives but then the light went out when she succumbed to meningococcal septicaemia at just 15 months of age.

It was a hard decision to carry on with medicine after that but tomorrow will be the last day of my quest. Barring miracles, I will start the process of giving something back at the Wrexham Maelor hospital in early August. I have nothing but admiration for the students at my medical school all of whom have far more maturity than I ever did at their age. They are also infinitely more intelligent than I could ever hope to be. It is hard to adequately convey the extent of their dedication and focus. It has kept me on my my toes being surrounded by so many bright minds and taught me far more than I could ever teach them. They are an inspiring bunch with the world at their feet - and deservedly so.

When we begin our posts as junior doctors five weeks hence, I'm sure we will often look back on our time at medical school and the friends we made and the lessons we learned. Many of my colleagues are not yet 25 with the biggest hurdle safely negotiated. At the age of 45, I can only say that learning becomes more challenging with the passage of the years. I wish them all luck in their careers and look forward to my own. This has been a long journey which I could not hope to have achieved without the love and support of my amazing wife and family. I wish Dad could have been around to know that I had definitely made it but remain grateful for his enthusiasm and guidance.

When I was working in the coca cola factory in Wakefield in 1994, days like tomorrow seemed to belong to other people. I have stretched myself to the limits of my capacity and have savoured every moment. We really are never too old even though it sometimes might feel like it.

British Values

In recent weeks, a clearer picture has started to emerge of what current British values really are. As the politicians seek to take the moral high ground in their endless quests for power at all costs, I take the opportunity to reflect on what values we have in Britain.

We are obsessed by our relationship with Europe and are about to be dumped by the Scots as the Union begins it's inevitable demise. We have just returned to the economic levels we enjoyed before the financial crash even though the resurgence has largely been achieved by the same route which got us here in the first place. Levels of personal debt are being promoted by another cynical Government more concerned with it's own chances of re-election next May.

We have a worryingly high rate of teenage pregnancy. We have a bigger public sector than France. We have a health time bomb ticking underneath the very foundations of our allegedly beloved NHS in the form of booze, obesity, diabetes, smoking, lack of exercise and diets dripping in the high glycaemic index sugar procured from supermarkets who could scarcely do more to destroy whatever community spirit we might once have had. We obsessed with moaning about the quality of our free health service while the majority seem oblivious of their role in it's downfall.

We bemoan immigrants having their faith having long since discarded our own. As church congregations dwindle, mosques and temples continue their relentless spread. Where we do little to promote the benefits of faith to our young, immigrant families have the good sense to retain their faith. Go to the Law schools and Medical schools and see the students. Every picture tells a story.

British people have new Gods. We have gambled a fortune in recent days on England winning the football world cup. Football and money continue to attract the British although both remain bereft of real value. As I write, the England footballers who are paid morally indefensible sums of money for reasons I will never understand are being urged to try and sing the national anthem at the beginning of their forthcoming matches. Being urged to try?

At the recent European elections, an outcry was heard when it became obvious that the anti-European UKIP had won the day. British values dictate that in the centenary of the beginning of the Great War in which our forebears laid down their lives so that we could enjoy our freedom, only a third of us can even be bothered to exercise our right to vote.

A recent school trip to Barcelona made the headlines because of another set of British values. The teachers were so drunk, they started to fight with each other and thus the example was set for another generation. Where I live, the local council wants to close two of the last remaining faith schools in a cynical attempt to finish the secular job off.

The modern British value is to borrow as much we can in the vain hope we will ever be able to repay it thus guaranteeing a return to the previous recessions for the same reasons.  

A British value which has come to the fore in recent times is our ability to eat mountains of food of dubious nutritional content as food banks continue to prosper. We throw away as much food as we eat and the greedy supermarkets are equally culpable. And still the waste goes on less than fifty years after the end of the rationing which guaranteed such a good start in life for our grandparents. We still have the same number of legs as our grandparents but prefer the car even for short journeys.

We pertain to love and cherish our NHS and yet there is little evidence to support that view in the lifestyle choices of the many.

Our prisons are full at a time when our churches have never been so empty.

The British values to which Michael Gove refer are not clear to me but if he intends to teach the values to which I have referred, God help us all.

Amazing journey: The 400th and last blog from this series

I started this blog four years ago on the 8th April 2010 as a bit of fun but then it slowly developed in to something more involved. At the time of writing, these little essays have been read over 22,100 times by people from the UK and far beyond. The Americans have been my second biggest readers with Germany and Russia coming third and fourth respectively. I have been read in Papua New Guinea, all bar one of the South American countries, all the European countries and some countries whose location was not immediately obvious to me. I have enjoyed writing these pieces but have enjoyed the feedback far more. Some have been political, some local, some amusing and some reflective. I have enjoyed them all.

During my time as a medical student which is slowly drawing to it's close, I have found writing to be a great release from the endless learning. All work and no play makes Jack a dull boy! With qualification just around the corner, the time has come to bring "betweendenbighandkeele" to an end. It will be a great relief to be moving closer to home and bringing to an end my late flirtation with being a student. I have spent ten years now as a student having previously graduated in medical biochemistry. Aside from the obvious implication of achieving my objective, the most rewarding aspect of this last decade has been the way in which I have retrained my brain to deal with learning. When people suggest that we're never too old to learn, they are quite right.

This is the 400th and final piece in four years. I have learned that readers decide which posts they like. Many is the piece I have written which I felt would be widely read and strike a universal chord only to be sadly disappointed. By contrast, many of my most well read pieces have been written in no time with no great expectations. Last July, I wrote a piece entitled "A twitch upon the thread" which I consider to be my best. It only attracted the attention of 35 readers. By contrast, a rather tongue in cheek piece written about the managerial legacy of Alex Ferguson reached nearly 300 reads. It goes to show that the writer frequently predicts the reading habits of others at their peril.

Of the various communities with which I have become involved, the one which continues to inspire me is the "Health care in the UK" community so ably run by Dr John Cosgrove. It explores aspects of our current healthcare system as viewed by a variety of health care professionals. Although the GMC remains anxious to curb our forays in to social media, I remain in favour of it because it is such a potent vehicle for change because it also promotes healthy discussion and takes in to account views from both sides of the argument. At a time when the future of our health service has seldom come under more scrutiny, communities such as this one are vital for people to express their views. Better to seek their views than to suppress them.

Many of my pieces have focused on medical education and I have offered my own proposals for improvement based on my personal experiences. As a medical student, I have experienced the doctors who I would be proud to emulate and the ones who I would be ashamed to emulate. I am pleased to say that the former outnumber the latter but not by nearly enough.

Next week, I have my final exams after a decade of study and I approach them with a certain fear. Not a fear of the exams because we become normalised to them after such a long time in the system. The fear arises at the thought of passing them and all the responsibility which that will bring. Many of my friends have been reminding me to just think of the money. That is the last thing on my mind.

I have become increasingly concerned at the political direction of our country. In simple terms, there appears to be two distinct factions. Putting aside subjects such as the EU and immigration, the real divide in our country today seems to exist between the realists and the rest. At some stage in the near future, a UK government is going to have to address the size of our public sector and the way in which it is funded. That has to include pension provision which remains as unsustainable in 2014 as it was in 2010 when I started writing these pieces. Put simply, it is no longer a choice to ignore the reality and yet successive UK governments have shirked their responsibilities in this area. It is a sad fact that for many in the UK, a career in the public sector has become the aspiration. If that were more for altruistic reasons then fair enough. The fact is though that the public sector has become bloated and out of touch. It is a shadow of it's predecessor of fifty years ago. The need for a vibrant private sector being propelled by a new generation of skills based apprentices has never been greater and yet too little is being done in this regard.

The power of the UK supermarkets for the first time shows signs of weakening. It is difficult to know whether this is being driven by income or a public weary of yet another retail con. My instincts point me to the latter. Every recession serves to remind us all of what our priorities really are as opposed to what we would like them to be. Even if they are on the downward curve, the presence of these retail giants has had a devastating impact on many of our town centre high streets. This damage is going to take a long time to reverse and can only be helped by a growing private sector. At the heart of any such reversal must be the local communities which have been so badly battered in recent years following some misguided decisions by local government.

If the Scots decide to go their own way later on this year (and I still expect them to do so), the union will be gone after 300 years. This will be a good outcome for the Scots but a bad one for England, Wales and Northern Ireland. It will then only be a matter of time before Wales and Ulster want to follow suit. The writing is on the wall and there will be hard times ahead. That said, if the Scots do vote for independence, it will all but guarantee a Tory victory next year and with that we will be accorded our say on a straightforward in or out EU referendum. For many of my generation, we have waited a long time for this.

A new blog will doubtless emerge in due course but under a different moniker. In the mean time, I would like to thank everyone who has read these pieces and hope they have at the very least been entertaining.

Substance and Style

The pursuit of power seems to be dominating our headlines as never before as various factions of British society vie with each other for their taste of this precious commodity. I always thought tobacco, alcohol, sugar and drugs were addictive but it seems as though power is the most addictive of them all.

Last night saw the first of the televised debates between UKIP and the Liberal Party over our continued membership of the EU. I listened yesterday to a programme looking back at the first of these televised debates way back in 1960 during the US presidential campaign. That debate took place between the rising star of John F Kennedy and the establishment conservative Richard Nixon. In due course both would meet their fates in rather different ways. When the US public was asked for their opinion of the debates though, the results were rather surprising. For the few who watched them on the television, Kennedy came out on top. For the majority who listened to the debates on the radio, the rather less photogenic Nixon won the day. But that debate set the precedent for the X Factor formula now embraced by the marketing men to choose our next Government.

The clash between Farage and Clegg last night was little more than a side show in many ways but it did have huge relevance in other areas. The issue of Europe will not go away so it was refreshing to see a debate between the two opposite poles of the argument. Although neither has a hope in hell of securing a majority at the next election, this debate does need to happen. After the politicians have finished with their carefully choreographed posturing, it would be nice to think that after 39 years the rest of us might have a say but it appears that the power still rests firmly with the political classes.

In 1989, I was living in student accomodation in the Anfield area of Liverpool on the day of the Hillsborough tragedy. It is nothing short of a disgrace that as we approach the 25th anniversary of that appalling tragedy, we are still seeking the truth from the police. As I write, the parents of Stephen Lawrence are still seeking the whole truth in the matter of the murder of their late son. In both instances, the police have been shown to be culpable of hiding evidence which would not flatter them if it was in the public domain. The erstwhile Tory Chief Whip Andrew Mitchell is still trying to get to the whole truth in respect of allegations made against him which have effectively cost him his career. Once again, the police have been found wanting in the truth department. It is instructive to consider the role of the police and the people to whom they are ultimately accountable. Theirs is to serve the public trust with integrity and impartiality. It seems that power is preventing them from doing so unless there is another less obvious explanation.

The headlines have once more been dominated by revelations that the British are increasingly viewing obesity as the cultural norm. It would be difficult to contend with that assertion. The strains on our hospitals are also well documented which is not entirely surprising given the current lifestyle crisis. As if the hospitals didn't have enough of a challenge in trying to meet the extra demands being placed upon them, it is today revealed that the body charged with the allocation of the NHS budget has been found guilty of diverting funds for their own use. The hospital where you live receives it's funding from your local council.

In an article published in the British Medical Journal, a Freedom of Information request has revealed that 45 councils have been guilty of diverting local NHS funds for public services such as smoking cessation, substance misuse, sexual health and obesity. It was thought that the councils had a duty to ensure that the allocated health budget for their local area went to the local health service as intended. Instead, they have defended their actions citing housing and planning as being just as important as the public health services mentioned. Be that as it may, theirs is not to decide. They are taking it upon themselves to decide how to spend you local health budget. So the next time you hear a horror story pertaining to your local health service, remember that your local NHS is dependent upon the local council to allocate their funds as intended. That they are not choosing to do so is about as glaring an illustration of the power of local government as I have yet seen - and that really is saying something.

In Wales where I live, our local councils have paid out £32 million in "Gagging orders" over the last 10 years. It seems a bit rich then to consider that the local health services are helping to pay that price at a time when they have seldom been more stretched. If your local health budget was properly ring fenced as we are constantly promised, such deviation would not be possible. Only power makes it possible.

But back to Clegg and Farage. Neither will achieve power in their own right but both would do a deal to gain a share of the big prize. Clegg has already intimated his openness to form a future coalition with either Cameron or Miliband. Clegg's principles appear to be in retreat. Farage by contrast appears to be more realistic and pragmatic. Give him a vote on our membership of the EU and he will probably fade away in to the sunset. He could scarcely be more clear. The announcement by Miliband that he has no intention to offer such a vote will make a vote for Farage compelling for a lot of people at the next election in 2015.

The concept of democracy has been questioned many times in recent weeks. The 100% vote with which North Korea re-elected their leader was about as farcical as is humanly possible. That said, President Putin came a close second when he secured an impressive 97.5% of the vote in the Crimea recently. Clearly both elections were an utter nonsense and made a nonsense of democracy. To complete the rout of the dictator over the people, the Egyptian general Abdul Fattah al-Sissi has announced his intention to stand for the presidency. Having seen so many lives lost to dispense with the military man Mubarak, the Egyptians had a free vote and elected the Muslim Brotherhood. Had the latter complied with the requirements of the Egyptian army, they might have survived as puppets. The mad cycle of events is therefore about to enter it's latest chapter by appointing another version of Mubarak - and all in the name of power.

With Russia having taken the Crimea, the issue of power has once more come to the fore. Not power in the political sense (although that is now beyond question) but domestic power in terms of how we heat and light our homes. Although the UK is only marginally dependent on Russia for it's power, it has certainly sent shock waves through our energy markets. One of our Big Six energy companies yesterday pledged to freeze it's prices for 18 months. Theirs was the biggest price rise in the autumn and the wholesale price of energy has actually come down quite a lot over the same time period. Quite how impressive this "freeze" really is I don't know but I feel copious amounts of wool being pulled over our eyes as the powerful Big Six seek to continue their grip on power - quite literally.

So 12 months hence, you and I will have the opportunity to see Cameron, Miliband et al performing for the cameras in a last gasp attempt to secure our vote. For my part I will be concentrating on the facts. In the golden era of Yorkshire cricket when the county side was expected to win the championship every year, their choice of captain was as relevant to politics as it was to cricket. "Tha' picks a captain to laike (play) cricket - not make pretty speeches". My vote won't go to the prettiest speech either. Give me substance over style every time.  

Shut up and go! The mantra of local government?

In many of my recent posts, I have repeatedly questioned the accountability and worth of my local council. Not the locally elected councillors but rather the employees charged with running it. As with many other councils in the UK, my local council has undoubtedly been subjected to the same cuts as the rest of us as the Coalition seeks to balance the books which they inherited in 2010. The way in which they have approached this challenge has been cynical and underhand which does them little credit.

Just yesterday, new information came to my attention. Under normal circumstances, I would have been flabbergasted but there is now little they could do to surprise me. Following a link on a social media site, I learned of a Freedom of Information request which eventually revealed details of the "Gagging orders" paid out by my local council over the last four years. It's fair to say that this information has been released not because they wanted the public to know but because they have been legally forced to do so.

In 2009/10, 3 gagging orders were paid out by my local council at a cost of £131,962.12. In 2010/11, 2 orders were paid at a cost of £37,500. In 2011/12, 4 were paid out at a cost of £91,963.92 and in 2012/13, 8 were paid out at a total cost of £182,032.24. This means that my local council has paid out a whopping £443,188.28 in the last four years (obviously not including the current financial year!). During the last year, that same council has closed down Rhyl Sun Centre, Prestatyn Nova Centre, the North Wales Bowls Centre and Llanbedr primary school to name but a few. They also tried their very best to close St. Brigid's faith school in Denbigh and have stated their intention to do so by 2018.

A gagging order is issued when the council wants to terminate the employment of an employee and shut them up. To do so, they have to pay a price such that both parties are happy. Thus, rather than go through normal employment tribunals and grievance procedures, they can simply pay off any employee whose face doesn't fit. This is 2014 and this is our council. If this was 1934 in Stalinist Russia, it would be difficult to tell the difference. Put simply, the power has got out of control. It will continue to do so until such time as they are held to account. The £443,188.28 so profligately spent in the last four years was done at a time when Clwyd Leisure (the not-for-profit company charged with running Rhyl Sun Centre) were having their annual budget slashed by £50,000 per annum. You don't need to be a mathematician to see that Rhyl Sun Centre, the Nova Centre and the North Wales Bowls Centre should all still be open. Meanwhile, the current Chief Executive continues to earn more than the Prime Minister!

I feel genuine sympathy for the ordinary council employees who are just trying to do their jobs to the best of their ability with the resources they have. I do take issue though with the spending decisions being made by the more senior personnel. Any outsider looking in at Denbighshire would surely question this track record? It does not reflect well on the people making these poor decisions and it insults the thousands of council tax payers in the county who frankly deserve a lot better. If you pay for a service in your life, you normally expect to get what you pay for. For the people of Denbighshire, such an expectation has for too long been an aspiration instead of a reality. Shame!

In his 1864 novella Notes from Underground, Dostoyevsky referred to the "farce in Schleswig-Holstein". The Schleswig-Holstein question concerned the relationships of the Duchies of Schleswig and Holstein with the Danish crown and the German confederation. It was not an easy concept to try and understand and few people did. Famously, the British Statesman Lord Palmerston admitted that "only three people have ever really understood the Schleswig-Holstein business - the Prince Consort who is dead - a German Professor who has gone mad - and I who have forgotten all about it".

In Notes from Underground, Dostoyevsky rejects the concept of Utopian Socialism which would ironically come to dominate Russian life throughout much of the twentieth century. The novella portrays humans as they are which caused great upset among his contemporaries. He portrays humans as irrational, uncooperative and uncontrollable. It is perhaps easy to see why such assertions would cause discomfort. He also claims that human needs can never be satisfied. Many critics consider this novella to be the first example of existentialism in literature and no less a judge than Nietzsche called Dostoyevsky "the only philosopher from whom I had anything to learn".

But just how accurate were the assertions of Dostoyevsky? Are we irrational? Are we uncooperative? Are we uncontrollable? I've not yet met anyone who doesn't tick all three boxes. So why did he cause so much upset? Is it because we would rather not face the realities of our shortcomings or do we genuinely believe these claims don't apply to us?

Lord Browne resigned as Chief Executive of BP in 2007. Since his peerage, he has become active in Government and today highlights a culture which exemplifies the observations made in Notes from Underground. Referring to the civil servants in Whitehall, he expresses his exasperation at their culture. His background in the Private Sector meant that any mistake made was identified and dealt with such that chances of its repetition were negligible. I have worked in such a culture and can concur with him. Things get done. This is the culture of progress. Lord Browne highlights a culture in which mistakes are never admitted and where accountability is non-existent. It must be intensely frustrating for him to be faced with such a culture when he has spent his whole life in a proactive environment. He points to a prevailing culture of blame and denial which renders progress nigh on impossible. Several cases have emerged whereby ministers have recently found themselves having to micro manage a project for fear it won't get done if left to the Civil Servants. If this is true, it begs the worth of bureaucracy. This surely confirms what many have suspected for a long time. Bureaucracy stifles people and stifles progress. While it is intended to promote the most efficient way of completing a task, it all too often acts as a barrier. In short, they are complex, inefficient and inflexible - all the things against which Dostoyevsky warned. Trying to find out who is responsible is like trying to understand  the Schleswig-Holstein question. Even Lord Palmerston struggled with that one!

Power to the people?

In the first week of August last year, my local council in Denbighshire discussed ways in which they could seem closer to the communities they purport to serve. I read the minutes of that meeting with incredulity. That said, I was grateful to the council in one respect. At least their discussion was laid bare in the minutes of that meeting. We were thus given an insight in to some of the real issues which they consider to be important.

Since that meeting they have done a good deal to affect their popularity with the local population. I would imagine that the announced closures of the Sun Centre, Nova Centre, North Wales Bowls Centre and Llanbedr primary school (to name but a few) will have done little to enhance the public perception of them. The role of this or any other council though is surprisingly not as they seem to see it. It is not (and never has been) a popularity contest. As far as I'm aware, their role has historically been to augment and support what the local community is already doing for itself. During my life time, there appears to have been a different understanding of their role. When reading pieces in the local media and opinions on various media, I could be forgiven for thinking that the council are here to do everything for us. We only need to step back briefly to see the naievity of this proposition.

Another big change has occured during my life time. The council today is a lot bigger than it was in my childhood and I believe this will be true for you wherever you happen to live in the UK. With that growth in size has come a growth in power. It is palpable. What is surprising is that massive business decisions are being made by people with limited experience to make them. I'll qualify that. To be able to make key business decisions costing millions of pounds, logic alone dictates that a semblance of business experience is required.

When you're running your own business, you are only spending the money you have generated. Thus even for a comparatively small business, all spending decisions are questioned and analysed before they are executed. If that decision is a bad one, it can ultimately result in the end of that business as a viable concern. That is reality for millions of small and large business people every day in the private sector. But imagine if you were running a business charged with spending public money instead. When you're spending your own money, you tend to be rather more careful with it. When it's someone else's money, the dynamic changes.

Recent decisions executed by my local council are testament to that fact. If the decisions were being made with their own personal money in mind, those decisions would not be the same as those which they have made since last August. That is reality. That is why I believe more strongly than ever in trusting the local community to make decisions for themselves. Nobody will know their local community like they do and the extent to which they value their local community will dictate the wisdom of the financial choices they make. In other words, I believe the time has come for local government in the UK to be radically revised. Not for the sake of revision but for the sake of the real people who make up the communities.

I have watched recent events at Plas Madoc Leisure Centre with great interest. When the council announced their intention to close the facility, the local people soon got together to do something about it. They did so because they valued the facility in terms of their community. These are people with very little wealth but a robust sense of community. They knew that if they stuck together, they could get around the problem in spite of the council. Running the facility as a community trust independent of council involvement will free them from existing constraints and enable them to have a leisure centre which works most appropriately for their community which they know better than anyone else. Their action is not political per se. It just makes sense. Thay have recognised the worth of the leisure centre to their community on a variety of levels and are prepared to do what is necessary to make it work for them. It has been inspiring to see how they have set about their challenge. Their initial disappointment at being let down by their local council soon turned in to a focused group intent on overcoming the challenge. The £40,000 per annum being currently paid for the lease of a photocopier might be reviewed by the local community?

I don't know if there is such a thing as a measure of community but if there is, Plas Madoc in Wrexham would score very highly. In the end, it will always come down to people joining forces for those things which they hold ear within their own communities. Waiting for the council to come along and do it for you is a misapprehension which has somehow filtered in to our psyche. We need to let it filter out and remind ourselves of how powerful we can be as communities in our own right.

I have written a lot recently about town centre regeneration. Just like Plas Madoc leisure centre, the future of my town centre is entirely in the hands of the people. If they value it in terms of their local community like the people of Plas Madoc have with their leisure centre, they will do what it takes to support and grow it. The future of my high street and your high street comes down to personal choice. If it matters sufficiently in terms of the community where you live, you will support it and take pride in watching the growth not only of your local high street but also your local community. As the people of Plas Madoc have proved so admirably in recent weeks, all this can be achieved if people join forces and contrary to popular belief, it's ok to effect change for the better without council involvement. I've seen photos of Denbigh high street recently from my childhood and although much has changed since those days (there are more cars and more people work outside of the locality), people are still people. We can have that high street again if we want it bad enough. I feel my local high street is already on the up but I also feel it will go in to overdrive if more of the local population make the informed decision to get behind it. Surely it's a win-win situation?  

50 years since the US invasion

Next year, the UK will be all of a flutter about the forthcoming General Election. For the majority though, such matters continue to assume little or no relevance to their own lives. What many people do relate to strongly is music. Next year, we will be approaching a significant anniversary in the history of UK popular music.

On April 12th 1965 a little known band from the US shot to the top of the charts both sides of the Atlantic.
At that time, it had become more customary for bands from the UK to go Stateside and make a big impression. The band I refer to had embraced the songs of the man who for many came to epitomise the singer songwriter. That band was called the Byrds and it would be difficult to overstate their influence on the music which would follow. Like many other bands of such huge influence, they did not stay together for very long but long enough for everyone to be familiar with their unique style. They more than anyone brought the songs of Bob Dylan to our consciousness. Nearly fifty years later, it would be all but impossible to get the songs of Bob Dylan out of our consciousness.

The Byrds had emerged from various branches of the popular folk scene in the US whose epicentre was in Greenwich Village. When they started out, the power base of popular music in the US was firmly entrenched in New York. In time, these young troubadours headed out West and became the forerunners of the Hippy Generation and the Summer of Love. By the end of the decade, anyone who was anyone in the US music industry had relocated to Los Angeles. They have been there ever since.

As with many short lived groups of such lasting influence, the Byrds' members were a wide mix of characters whose collective egos limited any chances of lasting. For the time they were together they left us with some of the defining performances of the sixties. Their first hit was their rendition of the Dylan song "Mr Tambourine Man". From the opening chords, a new sound had been born, "Folk rock". The Rickenbacker guitar of singer Roger McGuinn along with the intricate harmonies of Gene Clark and David Crosby formed a unique, dynamic sound. A sound like theirs is ultimately judged in hindsight. I have the 45 single and can assure you that it still sounds really fresh - that is the ultimate measure.

By September of 1967, the other band members had grown tired of David Crosby in the aftermath of the now iconic Monterey festival. Crosby had become too political on stage for their liking and had also annoyed them by playing with Buffalo Springfield at the same festival.

Within a couple of years, Crosby had joined up with Springfield's Stephen Stills and the recently departed Hollies harmony man Graham Nash. The rest as they say is history. The first Crosby, Stills and Nash album came in the wake of their debut appearance at the Woodstock festival. By the time of their second album, they had become hot property and along with Led Zeppelin, were the jewels in the crown of the rapidly expanding Atlantic record label managed so skillfully by the late Ahmet Ertegun. For their second album, they realised that they would need to add to their personnel if only for the purpose of touring to promote the album. For studio recordings, Stephen Stills had played keyboards and lead guitar - clearly impossible on tour with live performances. They returned for another ex-Buffalo Springfield member. The addition of Neil Young created the iconic Deja Vu album which still stands as one of the great recordings from that golden era.

One of my Christmas presents this year was the latest solo album by David Crosby. This is his third release since his first solo effort "If I could only remember my name" in 1971. For a man who has overcome drug addiction and a liver transplant, this latest offering is a revelation. Crosby largely returns to his acoustic roots and those distinctive harmonies feature throughout the album.

This week, the UK lost one of it's greatest social activists with the passing of Tony Benn. While Crosby has never been a politician himself, his entire career has been notable for his political activity. Only recently, Crosby has been performing at Occupy Wall Street with long term harmony partner Graham Nash. Much of the "Hippy nonsense" being spouted by Crosby and his peers in the sixties have since been viewed in a different light. In the half century since those early days, the world is slowly coming around to the basic messages being espoused by the "Hippies". Crosby and his musical friends recognised much of what was going wrong with the world and questioned the madness of war and the extent to which we remained disengaged from the youth in our society. They warned against the ill effects of capitalism and have been proved right on just about every level. People like Crosby were arguably the musical equivalent of Tony Benn. Like him, they have remained true to their core beliefs and principles and continue to fight against the blatant injustices they see all around them. They were campaigning against US involvement in Vietnam in the late sixties. They were proved right. They have been proved right over every single war since then too. Their stance on the growing gulf between the haves and the have-nots is as loud today as it was then - long may it continue.

The Great Shop and Con Swindle

The story which I am about to share with you is particularly relevant to the town where I live. It also has relevance to the town where you live and I don't even know where you live. If you're living in the UK today, this piece really should interest you. If it doesn't, I fear for the future of the town where I live and the town where you live.

Over the past thirty years or so, the UK has become a monopoly state. There is a mountain of evidence to support this assertion but for brevity I will restrict myself to a couple of examples. How happy do you feel when you see the bill for your gas and electric? Opening our utility bill statement has made a visit to the dentist a veritable pleasure in recent times. Put simply, the big six suppliers who dictate our market have had it all their own way for a very long time. Some of the reasons given for the scale of the price rises are on a par with "the dog ate my homework!". As well as being unbelievable, they are all too often insulting to our intelligence.

For my second example of corporate greed, I turn my attention to the beloved supermarkets. Just today, Morrison's has released rather disappointing profit results for it's millions of shareholders. A profit of £879 million last year has translated in to a loss of £176 million this year. By any measure, that is a pretty spectacular fall from grace. But what has caused it? Some would contend that Morrison's has lost market share due to being behind in the online delivery market so cleverly exploited by their main rivals. This argument has limited worth though. The fact remains that their turnover fell by 2%. Coming from the food industry, I can assure you that a 2% drop in turnover is colossal - and particularly when your entire business model is based on continued growth.

But there is more to this story than meets the eye. The key to this story is not the performance of Morrison's per se. The real story here is the extent to which the gargantuan buying power of the big four supermarkets has held prices as high as possible in a desperate attempt to continue the growth upon which their expansion is based. Enough has been written about the credit crunch to reach the moon and back and we are all well aware of how much more difficult it has become to keep our heads above water. Throughout the UK, a succession of local councils have been gullible enough to support a relentless influx of supermarkets in to towns of all sizes.

The town where I live is arguably no different to any other. The planning consent was granted under the pretence that the supermarket (on the outskirts of the town) would somehow bring more people in to the high street in the town centre. As arguments go, it is pretty flimsy. With the benefit of hindsight, we can now all observe the worth of that assertion. In the North West where I live, the number of empty shops stands at a depressing 17%. That means that on average, one out of every six retail premises currently stands empty in the North West. Dare I tentatively suggest a link here?

On announcing their disappointing sales figures, Morrison's have revealed that they will have reduced profits in the next few years because they are having to slash their prices to try and compete with the "discounters" such as Aldi and Lidl. This tickles me. If Aldi and Lidl can both run viable, quality retail stores at their prices, how much over the odds have we all been paying at the big four these last thirty years or so? A recent survey illustrated that identical baskets of commonly used groceries at Tesco and Lidl respectively amounted to £27 and £17 respectively. I appreciate that a great many people have become accustomed to the "reward" of clubcard points, but that is a heck of a price to pay for them!

Morrison's are only going to reduce their prices because their hand has been forced. So goes the old saying, "You pay your money and you take your choice". Well, it seems as though more and more people are doing just that. In the town where I live, the High Street feels a bit more vibrant every time I go there and the local branch of Lidl goes from strength to strength. I'd prefer it if Lidl was a local company but have to seek value. Speaking of value, the High Street where I live offers great value at every given turn for those prepared to go there. This whole debate revolves around consumer choice.

For my part, I'm glad that the big four supermarkets are starting to take a hit because it's high time we fought to save our town centres. There remain several important reasons why we should choose to do so. Your local high street retailer is frequently independent with no share holders to worry about. That retailer will often have an impressive knowledge of the product you are buying. That product will be more likely to have been sourced locally. By supporting your local high street, more of the money you spend will stay local. That will support a local job and the local economy. Shopping in one of the big four supermarkets will support a local job too but it will cost several more and less of the money you spend will find it's way back to the local town where you live.

Maybe the time has come where we have seen through the great supermarket con. Maybe we'll all take a step back to the same high street upon which the communities of our parents and grandparents were built? It's all about choice. I've made mine - what about you?

What would Joseph Ablett think?

Fund raising has often been used to achieve the objectives of local communities. Such initiatives are frequently given their initial impetus by the generosity of altruistic benefactors. Such an example arose in my home county of Denbighshire in 1842. To fully understand why Joseph Ablett of Llanbedr Hall donated 20 acres of land in Denbigh towards the building of a mental asylum for North Wales, it is instructive to consider the events which led to the need for such an institution.

It would take too long to cover every aspect so I will stick to the more salient points. Prior to the North Wales Mental Hospital in Denbigh, any person in North Wales with an acute mental illness was sent to the nearest asylum in Gloucester. Most Welsh patients spoke no English and most English asylum staff spoke no Welsh. Hardly an ideal environment within which to achieve effective treatment.

That the North Wales Hospital was even built in the first place was little short of a miracle. The case of an emaciated Welsh woman living above the smithy in Llanrhaeadr-yng-nghinmeirch was cited in a speech in the House of Commons. The appalling details of Mary Jones were referred to by Lord Ashley in his Commons speech of 1844. He informed the house that "If they went to the Principality, they would find that the insane were too often treated as no man of feeling would treat his dog".

Following the generous donation of land by Joseph Ablett, the fund raising was given a further boost by financial input from both Queen Victoria and the Prince of Wales. The rest as they say is history. The eventual North Wales Hospital was nothing short of a cultural icon. It provided asylum for the mentally ill of Anglesey, Caernarfonshire, Meirionedd, Flintshire and Denbighshire. To the rest of the United Kingdom, the North Wales Hospital achieved legendary status often blazing the trail which others would follow. As with all institutions of it's era, it had it's fair share of bad practice but it also achieved so much good.

The decision which brought about it's closure are beginning to be judged with the hindsight of the intervening twenty years. It does not make for attractive reading. The way in which this once great building was allowed to disintegrate was a shocking indictment on those involved. The efforts which made that once impressive institution were cynically undone within a couple of decades. To end the sorry story, the vultures have finally descended. Hiding behind the comfort of a Compulsory Purchase Order (CPO), the present local council has announced it's plans to go ahead with re-developing the site.

In modern parlance, this means that they intend to cash in on the enormous value of the real estate. With the luxury of a CPO, they can do so unopposed and will doubtless do so. That they are getting involved in the site at all is only because they are being forced to do so. Had the original building not been made so unsafe by successive hoards of adventurers and looters, there would have been no legal need for the council to become involved. Once the roof had become a threat to health following the terrible fire, their hand was forced. It could scarcely have been forced more conveniently in the long history of the council. In having to spend £900,000 to make the roof safe, they now had their motive to pursue a CPO in essence to recover their costs. If the credentials of the buyers since 1995 had been properly scrutinised, things would never have come to this. It's all very well whinging that the holding company is based in the British Virgin Islands, but the current owner was made to wait four years when it applied for planning permission. How long will it take for the council to be granted planning consent following the inevitable CPO? Four years? I doubt that very much.

In my naivety, I had assumed that a CPO was only going to be granted if the original building was restores to it's original glory. Such an eventuality would of course be impossible anyway given that all items of historic value have long since been stolen and flogged. Such items are naturally irreplacable. The plans for the re-development (which will go ahead irrespective of what local people say) are soon to go on display. This charade will comply with the formal legal requirements. The former hospital building will become luxury apartments. Not for the mentally ill (the have-nots) but instead for those with the means to buy them (The haves). The land will sprout houses like mushrooms on a dewy September morning. So who will profit by all of this? Joseph Ablett? No, because his donation was altruistic for the benefit of the people of North Wales. The people of North Wales? No, because the majority won't have a hope in hell's chance of even being able to afford one of these houses. The people of Denbighshire? No, because any profits made out of this venture will rest with the council charged with providing for them. On the basis of recent evidence, I can confidently predict that the people of Denbighshire will not be the winners. The people of Denbigh? No, but doubtless the council will contend that the re-development will bring more trade to our local High Street just like when they sanctioned the building of the Safeway supermarket on the former Smithfield Market site. The council? Absolutely - every step of the way.

If Joseph Ablett came back to see these plans, I wonder what he would think? I wonder what he would say? The North Wales Hospital was so called because it served the people of North Wales. All of North Wales from Holyhead to Aberdovey to Bala to Chirk to Flint and everywhere in between. Even as I write, the vultures with money will be circling ready to make a fast buck out of the new homes. They will rent them for income or sit on them for a few years to make capital. From where I'm sitting, it doesn't read well and doesn't feel right. It is as though the founding principles and needs upon which the hospital was built count for nothing.

Acute bed space for the mentally ill in North Wales has seldom been more stretched. My family has known of acute cases where people with immediate needs have been placed on general medical wards. So how far have we come in the twenty years since it's closure? Has community care been the solution? Can anyone think of a more amazing monument of human endeavour so needlessly and wrecklessly abandoned in the name of progress? I've tried hard to think of one but I can't. I have though formed a clear view on the lack of principle underpinning a CPO. I am more opposed than ever to CPOs having seen them abused by so many councils in so many different places. I would struggle to think of a less democratic process if I tried.  

Lent: How do you do yours?

As I am working late this evening, my family enjoyed pancakes together last night. For me, the most important word in that first sentence was the word "together". Eating has huge social significance and binds us together with our family and friends. Of course, the religious connotations of Lent to the many are now superfluous. That said, a great many still see Lent as an opportunity to give something up or seek to effect some change in their lives. The aspect of self denial is one of the more ancient aspects of Lent observed religiously by our forebears over the centuries.

The pancake arose from a need to use up whatever rich foods were still left over to begin the fasting which would last until Easter. It would be very difficult to foresee that happening now if only for the simple reason that many of us would be physically sick if we really did consume all the rich food in our cupboards when we get home tonight. In some of the other great faiths, fasting is still widely observed so the concept is perhaps not such a big deal to to their followers.

In modern times as the Christian faith has become less well observed, many people use Lent as an opportunity to foresake one of their vices. Popular targets include alcohol and chocolate. If, like me, you live in a traditional market town, I am going to suggest a new target which may not entirely surprise regular readers of this blog.

I am going to make a radical proposal. I am going to suggest that every time you think "I must just pop in to Tesco/Sainsbury's/Morision's/Asda/Waitrose/Coop", step back and ask yourself one simple question. Could I get those goods (research suggests that those goods are often no more than a dozen items) on my local High Street? If the answer to that simple question is "Yes!", I am urging you for the next six weeks to support your local High Street. There is good reason for this idea.

A pound spent at a large multi-national retailer like one of the afore-mentioned, tends to leave the community where it is spent for good. A pound spent at a local independent retailer tends to stay in that community and tends to sustain a local job. The person in that local job can then spend their income locally thus supporting another person in a local job. Very simplistic but my point is made. Please give consideration to this idea and see if you can notice a difference on you High Street by Easter. This is what I will be doing and I hope you'll try and join me. Let's give local a chance for Lent and see what happens - we might even like what we see!

Lent has become associated with self denial but it is as much to do with changing habits and maybe we all need to re-evaluate some of our own choices and the legacy of those choices?

Your NHS data - confidential?

Much has been written recently regarding the decision to transfer millions of confidential patient files. In a move which will come back to haunt the Coalition, the decision had become something of a cloak and dagger affair. Had the Coalition explained properly the reasons for their decision, the resistance would not have been so great. Caveat emptor!

The current Health Secretary has just announced a halt to the scheme pending a full investigation in to how the details of millions of people were about to be sold to health insurance companies. The former head of the Royal College of General Practitioners, Dr. Clare Gerada, was recently on the Today programme trying to justify the transfer of patient information. In doing so, she cited the thalidomide tragedy of the early 1960s. She patiently explained that the thalidomide legacy might have been drastically reduced had the then Government been privy to such large amounts of patient data. Reasonable enough on the face of it but there is still the small question of informed consent. Minor details for a Government in a hurry I realise...

Jeremy Hunt is the current Health Secretary and has done reasonably well when compared to one of his more well known predecesors. All things are relative. In 1960, the Tory Health Secretary in the Macmillan Government visited a small market town in North Wales - not usually the sort of venue to attract much media attention. His name was Enoch Powell and the town he visited was my home town of Denbigh. That day, he announced in a famous speech his intention to see a radical overhaul in the provision of mental health services. He wanted an end to the institutional Victorian lunatic asylums in favour of community care to augment the existing hospitals.

As Health Secretary, Enoch Powell had been decidedly unsympathetic to the mothers of thalidomide babies and won few admirers as a result. He stood as a Tory leadership contender in 1965 and garnered just 15 votes as Ted Heath won the day. While Heath would go on to win the General Election in 1970, Powell would become synonymous with his outspoken views on immigration. If his views on immigration were controversial, history would suggest that his views on the provision of mental health services was more so.

Just last week, more warnings were issued regarding the crisis in acute mental health services for young adults in this country. This problem has been deteriorating steadily as a succession of Governments have failed to recognise the absolute importance of mental health. As a town, Denbigh became synonymous with mental health services. Until the closure of the North Wales Hospital in 1995, Denbigh had provided care for the mentally ill of North Wales since it's inception in 1848. The announcement of Enoch Powell ensured that mental health beds in North Wales went from 1700 beds to care in the community literally overnight. In the 20 years since the hospital closure, it is hard to see whether things are better for the mentally ill of North Wales - or anywhere else in the UK.

It is not that I seek to defend the regimes of the former asylums because my research has revealed much that was wrong with them. That said, they also got a good deal right. Not least was the fact that the availabilty of bed space seldom became an issue. Generations of the same families found employment at the North Wales Hospital and Denbigh became something of a centre of excellence in that arena. In several mental health placements as a medical student, it is clear that the name of Denbigh is well known throughout psychiatric circles and not for the wrong reasons.

Whether or not this or the next Government is justified in seeking to gain access to your medical records is open to debate. Bed space provision for acute cases of mental illness is open to debate though. Enoch Powell was no stranger to controversy in his life and although he currently remains more synonymous with immigration, it might not be too long before he becomes rather more well known as the man who made life more challenging for the mentally ill. That would be an infinitely worse legacy because all health begins with mental health. One day, a Government will emerge with an understanding of this crucial area. I can but hope.

The Proof of the Pudding..

Many of my recent pieces have focused on the town where I live. In seeking to highlight the good points and identify any areas where the town can improve, I have sought the opinions and input of the local community through a social media group. I have really enjoyed observing discussions unfold as people chew the fat over what is already good and what they feel is lacking. A recurrent theme which came up repeatedly was the need for the town centre to have a regular street market as indeed it used to when I was a child.

Sometimes people get together and work hard to make something happen only to be thwarted by circumstances beyond their control such as adverse weather. Today was St. David's Day and a huge amount of planning and preparation had been undertaken by Rhodd Dinbych. It was St. David's Day and it was the last Saturday of half term with our children returning to school on Monday. When I woke up this morning I was thrilled to see that the sun was shining with barely a cloud in the sky.

At 10.00 I took my son to see all the stalls and the entertainment. The variety and quality of the stalls was truly amazing and the efforts to which a great many people had gone were self evident. Crown Square has become notable of late for the Crown Hotel standing empty. Today, it didn't matter because there was too much going on for anyone to even notice. In front of the Crown Hotel was a falconer with a marvellous array of owls, hawks and buzzards. He more than made up for the Crown Hotel being empty and we had to wait about 10 minutes just to get near him due to the large numbers in front of us.

Live music was being played outside the town hall and I was particularly impressed by the playing of the Celtic harp. We sat with many others just taking in the atmosphere. Atmosphere is a strange commodity. You can't buy atmosphere and it was on tap in Denbigh today. Next stop was the market hall. I'm glad I only had one shopping bag with me or I would have been bankrupt. There was so much fantastic produce and crafts on show. Young or old, there really was something for everyone. Every time I looked around me, the crowd seemed to have doubled again. The mixture of local exhibitors and those who had come from far further afield was enticing. As ever, I succumbed to the olives which had come from Cyprus - literally. To be able to speak to the Cypriot man who had grown them was a privilege. At every stall, we were met with waves of friendly goodwill. This was Denbigh at it's very best.

Whatever your views of this great town, today proved one thing beyond debate. If the people get behind it, anything is possible. To the people who made today happen, all credit to you. I've read people recently pointing out that the supermarkets are convenient because you can get everything under one roof. Well, I beg to differ because I saw so many things on the street in Denbigh today which you would never find in a million years in a supermarket. I also experienced a warmth of atmosphere which the supermarkets can only dream of. But above all I saw what happens when a local community gets together and pools it's resources and I saw what happens when the town en masse comes out to support it's own. As an avowed proponent of localism, I only hope to see more days like this one in Denbigh. Well done to all concerned and please keep up the excellent work. Well done too to the people of Denbigh for getting behind the event and coming out in such large numbers to support it.

This was the impression it left on me. The impression it left on my six year old son is priceless because his is the generation with whom we need to engage. Today, Denbigh did that in spades. Llongyfarchiadau i bawb!

A Tale of Three Towns: What Denbigh can learn

In recent posts, I have chosen to focus on the current status of the high street where I live. I may be deluding myself, but the responses to the existing discussion strongly suggest that a core nucleus of people care passionately about our town. That is as good a starting point as any.

I received a really well worded response from someone this morning citing the strengths and weaknesses of the existing high street. The respondent made the point that high streets such as the one in Denbigh will ultimately become venues for local services such as cafes, hairdressers, nail salons, bookies etc. It was also pointed out how valuable it can be to have a local butcher. Instead of having to buy your meat pre-packed in the weight dictated by the large supermarket, the local butcher can supply your exact need. If you are part of a couple or living alone, this can be a massive difference. So, instead of buying 500g of minced beef in a plastic container, your local butcher can supply you with a lesser amount with far less packaging. In most of the arguments I've heard so far bemoaning the future of our high street, many people seem to overlook the mind boggling amount of plastic packaging foisted upon us by the large supermarkets. I detest it and also worry about it's impact on our environment. It takes up to a thousand years to degrade in some instances so sustaining such an approach is actually irresponsible.

Today, I intend to focus on two towns of comparable size to illustrate that the high street in Denbigh is faced with an opportunity rather than a threat. I will describe the first town to you. In 2001, it had a population of 9,458. This is very similar to that of Denbigh. It has a famous castle just like Denbigh. It has a well known supermarket on the periphery of the town centre just like Denbigh. It has limited car parking in the centre of the town just like Denbigh. It has a healthy quota of pubs just like Denbigh. It has a fair smattering of charity shops being run by a willing army of volunteers just like Denbigh. It has a small theatre just like Denbigh. It also has a predominance of independent shops which are extremely well supported by the local community. Like Denbigh it also has an area which has not had the rub of the green when it comes to jobs and opportunity. The town I refer to here is Ludlow.

On a recent placement which lasted for 15 weeks, I had the opportunity to observe Ludlow at close quarters. A number of aspects were immediately noteworthy. The first thing to note was the absence of empty shop premises on the main high street. The second was the large number of local shoppers on foot. They were enabled by large pedestrian areas in the town centre. It was very pleasing to see such a high ration of independent shops to multi national chains. There was no doubt that the former were in the ascendency in Ludlow. Aside form their impressive variety, their service to the public was wonderful to see. They did have a moderate sized Tesco but you always got the feeling that the Tesco remained secondary to the town centre. That was because planning for the Tesco was only granted with the town centre in mind. The local planners did not make life easy for the Tesco and have restricted the extent to which it can impact on their high street. They got the important bit right - they recognised the absolute importance of a vibrant high street with respect to the local economy which they serve. Their castle is of a similar age to the one in Denbigh but is utilised far more. It is the centre piece of most of their festivals and is situated right next to their highly prized daily street market which they have fought so hard to maintain. It is to their credit that they have done so because they now boast a thriving high street as a result. In other words, they have resisted too much change for the sake of change and sought to retain the character and strength of their high street.

Moving a little closer to home, the second town which I would like to highlight is also notable for it's thriving street market. At the time of writing, it too boasts a healthy high street with very few empty retail premises. Until recently, it has only allowed a moderate sized Tesco on the periphery in such a way as to maintain the integral strength of it's high street. Mold is down the road in Flintshire and the local council charged with the responsibility of sustaining the vibrant high street look as though they are now going to grant planning to a large Sainsburys as well. That aside, the town has held it's own even with the added threat of Tesco. The market is held twice weekly and is well supported and attended. As with Ludlow, the variety and quality of the independent shops is excellent even if the ratio of multi national chains is slightly higher.

It should not be too difficult for Denbigh to observe the towns I have highlighted and seek to emulate some of their more sensible strategies. Just because our high street has sported empty shops recently doesn't mean they can't be filled provided the will exists to support them and the shops themselves seek to offer all that is good about the independent sector; great quality and service. The re-introduction of a street market shouldn't even be open to debate in Denbigh and I would strongly advocate more pedestrian zones in the town centre. I would finally play the trump card all day long - Mold doesn't have a castle like Denbigh. Ludlow does and uses it for all it's worth. Denbigh should be doing likewise because many other towns would give anything to have such an obvious asset.

The forthcoming St. David's Day festival will be great for Denbigh and I'm really looking forward to going along to support the town. But the town needs this sort of event to be the norm - not the exception.

Lies, damn lies and statistics

The recent decision by my local Council to cease funding for Rhyl Sun Centre has provoked a great deal of criticism. How much of that is fair remains to be seen.

Seeking to defend their decision, the local Council cited the inability of the appointed (not for profit) management organisation to contend with a 2.8% reduction in it's subsidy. That amounted to £50,000 annually. It is open to conjecture how their proposed £10 million project for an Aquatic Centre now looks given the importance attached to £50,000.

Of course, the real reason for closure of the three sites in Rhyl and Prestatyn is perhaps as barn door obvious as it seems. The smoke screen speaks of ineffective management and infrastructure in need of repair and upgrade. Much has also been made of the "shelf life" of the sites in question. The latter tickles me because even a tent will last for decades if constructed and looked after properly. The former North Wales Hospital was built in 1848. Had it not been for a series of outrageous decisions since it's doors finally closed in 1995, I have no doubt it would be still be standing and ready for another century of public service. I was under the impression that building had progressed since the Victorian era but I stand corrected if that is not the case. Perhaps it is the decision making which has deteriorated since Victorian times rather than the actual construction?

Returning to the closures though, it is obvious that the real motive has been cost saving. For all the rubbish spun out regarding mismanagement and deterioration, closure of the three sites will immediately save the Council millions of pounds per annum when they are being asked to make savings - in common with just about every other council in the UK. To debate whether such cuts is right or wrong is fast becoming academic because they are clearly here to stay. What is not academic is to discuss the most appropriate areas for these cuts to take place. The management structure at my Local Council is mind boggling. When I worked in the Private Sector for the largest wholesale food supplier in the UK, the machine was meaner and infinitely leaner. Every penny spent had to be justified and accounted for and if cuts were made, they were invariably based on past performance. We had nowhere near the number of managers which the local Council employs. The same local Council has this week announced a £250,000 project aimed at attracting tourists to the town of Ruthin.

The same local Council also gave the thumbs up to Tesco a few years back and it's fair to say the effect on the local high street has been significant. So rather than pursuing the attentions of tourists who might only visit sporadically, would it not be more instructive to try and pursue the local residents who appear to have deserted their high street in droves? Or is this not the priority of the council? I can only comment on what I see in front of my eyes and the evidence to suggest that the local Council is serious about high street regeneration is currently a little thin on the ground.

In a mirror image of the situation unfolding in my County, the locals of Ruabon and Plas Madoc are fighting to try and overturn the decision to close Plas Madoc Leisure Centre. As in my home county, the story is depressingly familiar. Two perfectly adequate leisure facilities are being dropped in favour of a new centre. The rationale is doubtless the same - perceived cost savings. A good friend of mine has recently ascertained that the Council making that decision had been paying a staggering £40,000 per annum for the lease of a photocopying machine. That leisure site was being run by the Council - not an outside body. I'm no expert on photocopy machines, but I would suggest that I could buy a reasonably good one for a fraction of that amount!

When any of us seek to justify the money we are spending in our own lives, we usually have to think about the impact of those decisions on our families and loved ones. I would have thought the same principle would hold for the local council?

Time for new blood?

As the local council elections draw closer, I have taken time to reflect on where we are and where we might be five years hence. A cursory glance at the incumbent local councillors reveals one stark reminder as to how far we have to go. The most obvious feature of the current councillors where I live is their age.

While they all undoubtedly have experience of sorts from all walks of life, it is their age which is likely to be least attractive to the one sub section of voters most disenfranchised as I write. When local council elections were last held in Denbigh, just 591 of the 1,583 eligible to vote did so. Much criticism (justified in my opinion) was expressed when the new Police Commissioners were recently elected throughout the UK. The counter argument always follows that democracy is being played out irrespective of the turn out. I counter that it is not healthy to content ourselves with voter turn outs of one in three. Even with a half full glass and brimming with optimism, I know that this falls well short of our democratic aspirations. But why does it?

It does so because the current incumbents of public office have failed to engage with a significant proportion of the total electorate. Maybe people really have given up on the democratic process but maybe they haven't. Maybe it's time for younger candidates to come forward with a voice more sympathetic to the aspirations of their peer group. I would happily vote for a younger candidate if only to inject some balance for the existing cohort of councillors. Experience is a wonderful quality but it also comes with baggage. Experience warns us against risk. Experience urges us to play safe. Experience convinces us we have all the answers.

Youth comes with a different set of qualities. Failure is often something yet to be experienced. That is a massive advantage. Youth can see how something can work. Experience can see the pitfalls. Youth has the imagination to see beyond the obstacles. Experience can become too focused on the obstacles. I could go on but I hope my point is made.

If the forthcoming elections were to yield an influx of younger members, I'm sure the town would be the winner. In a recent group I set up exploring what it was that people would like to see on our high street to  make it more attractive and vibrant, I was overwhelmed with the number of responses. Sadly, those responses featured too few of the views and insights of our younger age groups. There is nothing I would love more than to see some of the under 30s become actively involved with THEIR town.

If the next elections are decided by the votes of three quarters of the electorate, we will have a better chance of being represented by a more age diverse subset of councillors. It is not that I have any misgivings about any of the current incumbents - I don't. I know how hard they all work often behind the scenes for little reward. I would just like to see a better spread of our community and witness the youth getting more involved. Those I've spoken to are brimming with fantastic ideas so let's try and engage them to take the next step. The energy of youth is a vital resource which I feel we are currently missing out on.

If we really want to see a vibrant high street in our local town, I feel passionately that we can only do so with the involvement of all age groups and we are currently missing out. In their seminal song "Teach your Children", Crosby, Stills and Nash recognised fully the symbiotic relationship between the old and the young. While the first part of the song urges parents to teach their children well, the second part provides the balance by urging the young to teach their parents well. It cuts both ways.

Hunger in a Civilised World

The decision by our most prominent Church leaders to write an open letter protesting at the growing numbers of people needing food is a long overdue debate. The growth of food banks has been well documented in recent times as many of us have continued to feel the after effects of the recession.

All recessions result in misery and it is sadly the poorest in society who inevitably fare the worst as jobs become more scarce. The debate this morning on the Today programme concentrated on how to solve this problem. While I applaud that approach, I would also urge people to engage in seeking the cause. If the cause is removed, the problem will be addressed more effectively.

As I write, we live in a purportedly civilised society. Food waste has never been so high. In equal measure, the general public and the all conquering supermarkets must both shoulder their share of the blame. I would struggle to think of a more immoral scenario than this one. On the one hand, we have increasing numbers of people going hungry (this is 2014) and increasing levels of food being thrown away. Yes, we have food banks and for some they have literally become a lifeline. As the welfare budget has been cut, those dependent upon it have become ever more squeezed.

Did the new Government in 2010 have the choice to maintain the welfare budget? Sadly, I don't think they did. They have introduced a new system which encourages people to work if they are able to do so but this is not a new system. This is the very system upon which Beveridge built the Welfare State after the war. One of the problems has been the way in which successive Governments have allowed the budget to rise. In so doing, they have perpetuated a culture of dependency upon it. The Welfare State was never designed for such an outcome. I have genuine sympathy for the disabled, carers and those genuinely unable to work. These are the very people for whom the Welfare State was designed. I was a carer for my first wife for over two years and received the princely sum of £11 per week for the privilege. It's not that I wasn't grateful for that money because I most certainly was. It's just that it was patently insufficient and in no way recognised the true worth of the millions of carers who continue to work for their loved ones every day. The money they save the NHS is incalculable.

When a new Government comes to power, it is faced with assessing the state of the nation's finances before it can start making promises about spending money and this Coalition was no different. We can argue about the speed of the cuts but we can't argue about the need to make them. Our country was in a financial mess and they have had the thankless task of addressing that. I do not profess political allegiance to the Coalition but I do recognise that they had to take the decision they took. Whether the deficit was caused by the outgoing Labour party or the Global recession or a combination of the two is frankly irrelevant now.

But the real question remains; why are people going hungry? In truth there are many reasons for this. I find it interesting that religious leaders have entered the fray at a time when religion has seldom seemed less relevant. They deserve great credit for initiating the debate. In the days when our churches were well attended, a man would not stand by and witness his fellow man suffer the indignity of hunger. I certainly wouldn't. The demise of our community spirit has contributed largely to this and has been brought about by a succession of ill advised policies.

I listened to the CEO of British Gas (Centrica ) this morning defending the prices being charged by his company. It is reported that 3% have left in the last year with many more expected to follow. That is one glimmer of good news in that the competition within the energy market is beginning to warm up. If we still had our coal industry, this problem need not be as bad as it is. Still, we are where we are so we must look forwards and not back. Looking forwards, we need to invest in strategies which will reduce the cruel levels of fuel poverty. Having to choose between heating or eating is a tough choice. It is all the more so when you are an elderly person living alone. Again, if our community was functioning as it once did (and as it still should), we would not stand by and tolerate such an outcome.

I have recently highlighted the need to support our local high streets. The main reason why I support this so passionately is that this constitutes the community hub. The church, the pub, the cafe, the grocer, the butcher, the cobbler. The list goes on but these services should be at the centre of our lives - not on the periphery. The supermarkets should be on the periphery but a succession of Governments both national and local have welcomed them with open arms. Had they stopped for one minute to consider the consequences, they might not have been so quick to do so. The effect on local jobs has been catastrophic but the effects on local community has been devastating. A vibrant high street correlates with a vibrant community spirit and if you don't believe me go to towns like Barnsley (overtly Labour), Ludlow (overtly Tory) and others. They demonstrate that you can have a healthy high street in spite of one of the supermarkets. Politics has little to do with it. This is all about people making community choices when they spend their money - if they want to live within a strong community. It is the role of our independent high street shops to be community orientated and distance themselves from the cynical marketing ploys of the share holder driven supermarkets. We pay our money and we take our choice...

I listened yesterday to an interesting programme exploring the recent trend which has seen the big four supermarkets see their takings stagnate while the discounters such as LIDL and Aldi have prospered. An expert was charged with buying the same basket of shopping fro LIDL and Tesco. They were not buying foie gras - just basic food such as bread, milk, eggs, vegetables, fruit, cereal etc. The basket from LIDL costed £17. The equivalent basket from Tesco costed £27. Even with a clubcard, that is an almighty difference for the many millions living on or near the bread line.

But how far have we sunk when supermarkets are throwing food in to skips at the rear of their premises and seeking to prosecute those trying to rescue some of that food for their consumption. How much food are we all throwing away and why are we doing that? What do food banks represent to us? Do we see them as solutions for the needy or do we see them as an indictment of our civilised society?