Thoughts on the Liberal Democrat Spring Conference 2018

The stringency of the austerity measures....Brexit.......The Housing Crisis.....issues that are discussed by people on a daily basis at the moment, whether explicitly or implicitly. Half the time it can feel like the structural problems connected with our society: inequality of opportunity, wage stagnation, low productivity, a growing demand for public services can seem insurmountable. Disengagement with politics remains an issue, particularly for Millennials and Generation Z (16-35). Hope for a brighter, more equal future flickers rather than burns brightly, which is why it's more important than ever to be engaging with voters and non-voters through the dissemination of an inclusive, ambitious and progressive vision for the country that will try to address our structural challenges head-on. I believe the party that can best articulate such a vision at a grassroots local and national level will have a real chance of winning a majority at the next General Election. The question is, whether there is a party out there who can listen to the electorate AND non-electorate, build political engagement and articulate a vision, in the shadow of disruptive Brexit negotiations.

This Mothering Sunday afternoon I decided to tune into Sir Vince Cable's (the leader of the Liberal Democrats) closing speech to Spring Conference delegates in Southport, which was streamed live via Periscope and also simultaneously disseminated via YouTube and Facebook live. I was probably only one of a couple thousand viewers who made such a decision but I didn't feel it was an entirely wasted activity. Cable came across as clearly passionate about campaigning for an #ExitFromBrexit (i.e. a referendum on the terms of the Brexit deal with an option to Remain in the EU) and well-informed about current domestic issues and the need for pragmatic, wide-ranging solutions. Yet I did wonder whether he was already preaching to the converted, although it is important to empower them to go out campaigning in constituencies across the UK in all kinds of places (including care homes, Mr Cable!!) I also thought his comments RE Leave voters were a little hap-hazard: trying to reduce the reasons why older voters backed Brexit down to one reason: nostalgia for a less diverse Britain isn't founded entirely on evidence- a minority of voters may have done so but they are exactly that, a minority. Hmm...Anyways onto the policy announcements...

Education:

The Lib Dems certainly have a number of policies that I believe would appeal to the electorate at large: protecting per pupil funding in real terms for all pupils including in Further Education, protecting the Pupil Premium, increasing the Early Years Pupil Premium by £700 to £1000 a year, requiring teachers in state schools to have QTS (Qualified Teaching Status) or working towards it and providing at least 50 hours of Continuing Professional Development per year for teachers. In addition to these, the Lib Dems are proposing quite radical changes: abolishing Key Stage 1 and 2 SATs with moderated teacher assessments and a standardisation test, abolishing Regional Schools Commissioners, making local authorities responsible for planning, exclusions and admissions and replacing Ofsted with a new inspection system, looking at emotional wellbeing of teachers and students in addition to test scores. I'm also glad to see SEND pupils' needs mentioned, with a desire to reduce the number of SEND pupils being excluded from mainstream school, and to see the proposal for a named person (a pastoral team lead preferably) who is responsible for craft whole school policies and approaches towards mental health.

I agree with the idea behind “Every Child Empowered”, ensuring that children and young people in constituencies across the country, including in deprived wards and rural villages and hamlets get access to the skills they need to prepare them fully for adult life: who can argue against providing First Aid training in schools and colleges if it means it reduces the amount of unnecessary GP appointments, A&E admissions and calls to NHS helplines? Who can argue with introducing comprehensive LGBTQIA+ Relationships and Sex Education if it helps to reduce instances of sexual assault, abuse, under-age pregnancies or misinformation about gender identities? Who can argue against teaching children about budgeting and debt management if it allows them to make informed decisions about borrowing and reduces the number of people resorting to loan sharks? Financial literacy, First Aid and RSE should all be on the National Curriculum, as part of the PSHE and Citizenship programmes of study and there should be funding given by Government directly to schools to allow for external providers to deliver sessions, taking the pressure off teachers who may not have the time to be researching such topics in depth with students. Such a broad curriculum, a “Curriculum for Life” should be required to be taught in academy and free schools and public schools should be encouraged to reform their curriculum offer.

There's also talk of introducing Personal Education Accounts, one for 16-18 year olds and one specifically for adult learners to help pay for training and skills courses delivered online, at local FE colleges and in community centres and libraries will help people access quality courses and aid their career development. Cable announced in his speech that a Commission on Life Long Learning will be set up to explore this policy idea further.

There's a lot of detailed recommendations and I'd refer those interested in finding out more to check out the policy document here: https://d3n8a8pro7vhmx.cloudfront.net/libdems/pages/42359/attachments/original/1518080686/Every_Child_Empowered_-_Policy_Paper.pdf?1518080686

NHS, Social Care and Mental Health:

Our NHS remains greatly under-pressure and little practical action has been taken by the Tory Government to try and alleviate such pressures. The Tories may claim that health spending is at record levels but it has not been enough given the rise in demand for services. They and previous governments have failed to prepare adequately for the ageing of our population. A&E waiting times are now the highest they have ever been: only 85% of patients in England were seen under 4 hours. The United Lincolnshire Hospitals Trust missed its waiting time target by 25% and has missed every target for A&E and cancer care for every year since 2014. For Lincolnshire residents, this is extremely concerning. The Lib Dems F18: The NHS at 70 motion recognises the pressure that NHS Trusts are under and are calling on the Tory Government to provide £4bn that the NHS will need for 2018/19 financial year, with an addition £2bn of funding given to local authorities to fund social care. Additionally, the Lib Dems want to see the introduction of a special NHS passport to allow 59,000 NHS professionals from the EU an automatic guaranteed right to remain following Brexit and for bursaries for student nurses to be reintroducted to encourage more British people to decide to train to be a nurse and thereby reduce the nursing shortage in hospitals and care homes across the country.

Mental Health care has not improved satisfactory under this Tory Government. Waiting times for referral remain far too long, demand for Child and Adolescent Mental Health Services has increased, with 1 in 5 children who have been referred to local CAMHS services being rejected for treatment :that's a total of 39,652 children (https://www.nspcc.org.uk/what-we-do/news-opinion/1-in-five-5-children-referred-to-local-mental-health-services-are-rejected-for-treatment/). This is concerning given that 1 in 10 children in England between the ages of 5 and 16 suffer from a mental health condition and up to 20% of children will experience a mental health condition in any given year. NHS CAMHS are currently only funded to meet 25% of cases but that is expected to increase to 33% by 2021. The Government has committed to recruiting 1,700 more therapists and supervisors and to ensure that an extra 70,000 children and young people are able to access CAMHS but it is unclear whether such targets will be achieved.

Norman Lamb has been a passionate campaigner for better Mental Health service provision and thus I'm not surprised to see some concrete policy suggestions being offered in F18: the earmarked £1.3bn of spending being brought forward to improve mental health service provision, ending out-of-area placements, very important for people living in rural areas such as Metheringham and the protection and promotion of community pharmacies. Perhaps the most radical suggestion, and one that has been made by Lamb for years, is the creation of a cross-party committee to look at funding the NHS and Social Care system long term. Raising the level of income tax by 1p in the £1 to fund social care short-term would help alleviate funding pressures but there has to be a sustainable long-term solution found and it's in the political interests of all parties concerned to find such a solution. Let's see if that happens anytime soon. I'm not holding my breath.

Housing:

Britain needs a housing revolution in order to ensure that every person has a suitable and safe roof over their head regardless of their socio-economic circumstances. It's ridiculous to think that the peak of house building in the UK was 1968 and that in 2018 we face a situation where 125,000 children are classed as homeless and rough sleepers are dying out on our streets, despite the best efforts of compassionate individuals and organisations such as The Nomad Trust, LEAP and Lincolnshire YMCA to help them. Access to decent housing should be viewed as a human right. A house should be a place to call home, not an investment to feel obligated to upkeep with no families living in it to bring the place to life. Yet the Government (when in coalition with the Lib Dems between 2010 and 2015 and afterwards) more than halved the state housing development budget for local councils and housing associations from £11bn in 2010 to £5.3bn last year. The Local Government Association revealed that local councils and their communities had granted nearly twice as many planning permissions (321,000) as the number of new homes that had been completed (183,000) last year. The issue is not with planning permission being granted, it's with housebuilders not building enough homes once they have planning permission granted.

It's good to see the Lib Dems reaffirm their commitment to building 300,000 houses a year in England by 2022 and to scrapping the draconian housing borrowing cap. I agree with the Lib Dems that local authorities must be able to access loans to build and invest in quality affordable and social housing, including “borrowing from the Public Works Loan board to buy land for housing and build affordable and social housing on the same terms they are currently borrowing to purchase commercial property” (https://www.libdems.org.uk/spring-18-f4-local-government-housing). I also believe local authorities should be given the right to scrap Right To Buy in their area, when assessments of local need have been carried out. Any proceeds from the sale of council houses by local authorities should be used to find new social housing for homeless families and I'd argue also to acquire adapted social housing for disabled residents who have been on the council house waiting list for more than 2 years. Councils should also have powers to monitor housing developments, to ensure that “poor door” practices are abandoned. Redevelopment of housing estates must not lead to a decrease in social housing: one of the best ways to prevent this from happening would be to introduce a (I believe legal) “right of return for all residents on the same terms as their pre-regeneration tenancy” (https://www.libdems.org.uk/spring-18-f4-local-government-housing). Such policies would benefit residents first and foremost and help to ensure community cohesion is maintained post the end of regeneration projects. I'd only add that PM May's suggestion of changing the use of empty retail properties in inner city areas would be beneficial to adopt and that the EDMO legislation strengthening should allow local authorities the opportunity to compulsory purchase empty retail property for the expressed purpose of creating social housing for the homeless and low income families with children. Landbanking is also an issue that needs to be resolved: it's not right that developers can be allowed to purchase land for the specific purpose of building new homes and then not start to build them within a 2 year period. Perhaps there needs to be compulsory purchases made if landbanking continued beyond a 2 year slot.

Rural Affairs:

I have spoken to numerous rural voters who do feel the issues that they raise are being ignored by the current Conservative government. In Lincolnshire, we have had streetlights turned off in villages and hamlets across the county and it has made some residents feel too scared to walk to the pub or to visit their friends at night for fear of being mugged, assaulted or worse. The safety of our county's residents has to trump ideologically driven efficiency savings but our Conservative controlled County Council has failed to listen to concerns and reverse the policy in full. I've spoken to rural residents in the Sleaford and North Hykeham constituency worried about the continued closure of Grantham A&E at night and wondering whether it will eventually be downgraded or closed through the implementation of Lincolnshire's Sustainability and Transformation Plans, forcing them to travel for an hour just to get medical attention at Lincoln County Hospital's already under-pressure A&E. I'm pleased to see the adoption of motion F8: A Rural Future: Time To Act by conference delegates, which includes a specific commitment to “increasing the availability of affordable housing” through the reduction of second home ownership (allowing local authorities to increase tax on second homes through a stamp duty surcharge or an increase in council tax rate). The installation of Superfast broadband which is defined as being “over 30 Mbps download speeds and 6 Mbps upload speeds” should continue to be a priority, so businesses and households in Chapel St Leonards have an ability to access the internet at the same speed as those based in Lincoln.

I would like to see the introduction of a Young Person's Bus Discount Card, for all young people aged 16-21 living in rural areas which provides then with 2/3 discount on bus fares. This will allow young people to be able to afford to travel across Lincolnshire, visiting friends, joining community youth clubs and attending training sessions, which will help reduce their sense of rural isolation. I agree with the notion of creating more community centre hubs providing a multitude of services to residents but would like to see investment come from central Government in order to facilitate such creation. Local authorities are overstretched and do not have the financial resources spare to shoulder the majority of the financial burden for these projects.

I agree with proposals to increase Common Agricultural Policy (CAP) payments to help maintain woodlands and forests, reduce soil erosion and uphold animal rights. Investment in flood prevention in rural constituencies and launching a National Fund for Coastal Change are also sentient policy ideas which clearly demonstrate eco-friendly credentials.

Voter Engagement and Equality and Diversity:

Cable talked of the need to improve diversity within the Lib Dem party in his speech, a comment which I respect him for making and one which I hope will be taken on board. The Lib Dems are doing well in local council by-elections across the country at the country at the moment, with residents listening to key policy ideas and buying into their vision for an open, tolerant and inclusive society. Credit for this success has to go to local campaigners, councillors and candidates who engage with voters and current non-voters on the doorstep, listening to their concerns and not immediately judging them their Brexit vote. This work needs to continue to grow in order to increase the number of MPs at the next General Election. Increasing awareness of the policy platform is half the battle. I'd argue that Lib Dems should set up more central meetings, held at village halls and community centres, liaising with local third sector organisations and allowing people to be honest, open and frank about their views. Organising meetings in care homes would be innovative and demonstrate that the party cares about all voters: after all, Brexit may lead to a reduction in sustainability staffing levels which will then affect them directly.

It was great to see a renewed commitment to advocating for electoral reform, making the case for the introduction of a right to vote for 16 and 17 year olds and supporting the private members bill put forward by Labour MP Peter Kyle. There's also a campaign being run to raise awareness that EU citizens can vote in local elections. More campaigning should be done on the need for House of Lords reform to build support for the creation of an elected House of Lords (or change of name...e.g. to a Senate or something similar). Supporting devolution of powers to local authorities (including those on housing proposed under F4) should be a priority too and may win over more skeptical voters.

It was amazing to see via Twitter and by watching some of the Spring Conference via YouTube the wealth of speakers who had been invited to talk about their personal experiences and ideas for the future. A motion put forward by Jess Insall, a member of LGBT+ Lib Dems on gender neutral school uniforms, arguing that schools should present uniform options that can be worn by pupils of all genders was praised and passed by delegates for being inclusive and feminist. There was no mainstream platforming of transphobic views masquerading as real feminism by trans exclusionary radical feminists. The party can build on their record for inclusion through further engagement with working class rural people, especially in constituencies such as Sleaford and North Hykeham, Gainsborough, Grantham and Stamford, Boston and Skegness and Louth and Horncastle. Engagement with habitual Conservative voters through promotion of rural policies and building up a reputation for economic credibility will also prove fruitful, as will engagement with suburban voters particularly with a number of young, passionate and thoughtful candidates standing in this year's local elections.

Back Away from the Brexit:

Of all the policy suggestions and motions passed at this year's Spring Conference, perhaps the one which will garner the most attention from ordinary people and the mainstream leader is the Lib Dem's commitment to an Exit From Brexit. I've spoken to voters and non-voters across Lincolnshire over the past few months about their views towards Brexit and it's clear there is still a lot of passion emanating from Remain and Leave voters, with no overall consensus as to the best way forward. Non- referendum voters feel that the debate hasn't moved on since June 2016 and a number are concerned about the potential economic and cultural effects Brexit may have on Lincoln and Lincolnshire. Even the most ardent of Leave voters I have spoken to have occasionally expressed their concerns. I remember talking to a very forthright retired plasterer, who believed in the need to take back control of sovereignty from Brussels but worried about whether his pension contributions could decrease if the Tory government did not secure “ more beneficial” free trade agreements with the US Trump administration or Commonwealth member states. A young lady, who works at a care home in Lincoln and voted Leave in 2016 told me that she was worried her workload may increase if the home couldn't replace the carers who had decided to leave the UK or were thinking of leaving the UK once Brexit happens afters March 2019. A young guy who is a very committed Conservative didn't like the fact that food prices may rise following a No-Deal situation, where the UK will have to rely on World Trade Organisation (WTO) rules in order to keep our economy alive. For certain elements of the mainstream media and Tory Brexiteers to deny such levels of anxiety about the potential consequences of Brexit exist, even in Leave voting areas such as Lincoln, is to deny the reality of the situation. It is inevitable that some voters will decide to change their mind, and would vote Remain in another referendum. More importantly though it is vital that the main political parties have strategic plans in place that will help mitigate any potential negative economic and cultural effects of Brexit. The Tories never talk of such plans, only making passing references to their Impact War Chest and hoping that a deal can be secured that allows them to maintain a veneer of economic competence. The Lib Dems have spelled out some policies but I personally feel more work needs to be done to craft policies that can be enacted in the event Brexit does happen. Better to be prepared and hope that Brexit doesn't happen in a No Deal form or even better, doesn't happen, than to fail to prepare for the No Deal Brexit. Perhaps such policies will be formulated and announced once a draft trade deal has been secured by Double D et al. But don't hold your breath that they can secure a trade deal, let alone a good one.

Whichever way Brexit is spun, whether it's a “take back control” or a “jobs first” type, it looks like it is going to lead to a contraction of the economy and potentially further cuts to our public services. As Mr Cable made clear in his speech, such measures would hurt the most vulnerable in our society who rely on effective public service provision for support. Jeremy Corbyn has pretty much committed the Labour Party to leaving the Single Market, remains very cagey about what a Customs Union that's not the current EU Customs Union would look like and has dismissed out of hand calls for a referendum on the Brexit deal. I don't know whether the Labour position will evolve as we get closer to the day of Brexit but one positive advantage for the Lib Dems is that they have a very clear Brexit position and are not afraid to stick to it.

Conclusion:

The Lib Dems have a lot of work to do if they are to regain seats at the next General Election. The Survation poll currently puts them at 9%, whilst Labour have seen a surge in support, placing them at 44% (http://uk.businessinsider.com/survation-labour-popularity-surge-7-point-lead-poll-conservatives-2018-3). Such poll numbers may be optimistic in both cases and may change upwards or downwards as the nature of the Brexit deal becomes clear. The motions passed at the Lib Dem Spring Conference, and the passion for a liberal future expressed by speakers, including Mr Cable may go some way towards changing voters' minds. It'll be interesting to see what new policies are developed in time for the Autumn Conference....unless a General Election happens before then. Who knows in our currently unpredictable political climate?

A Labour Remain Voter's Conundrum

Hello folks! It's been a wee while since I last blogged but I've spent the last month buried deep in thought on a whole host of topics and can't wait to start discussing them further!

What's happened since the start of the year is that there have been a number of reports brought out that make for despairing reading: figures in report after report released by third sector organisations, charities and think-tanks have shown the appalling effect that austerity measures, imposed by a Government far too occupied with sucking up to Donnie Drumpf and his “merry” band of “I want to go back to the 50's when we didn't know about pop music and Oreos” Trumpians and placating our own nostalgia loving elements of the electorate (who will never be satisfied until the gates are firmly shut to anyone who doesn't have “Dr” as a prefix or a few bob in their pockets).

Our NHS has been struggling to cope with this year's flu season, given the addition of the Aussie flu strain into the mix. More than 50,000 non-urgent operations have been postponed on the advice of NHS England this winter (https://www.newstatesman.com/politics/health/2018/01/towards-eternal-winter-can-nhs-survive) yet PM Theresa May boasted that the NHS had been prepared for winter, stating “there were 3,000 more beds in use and 2.9m more people using A&E since 2010” at PMQs last Wednesday. As Corbyn pointed out when he retorted her point, “14,000 beds in wards have been lost since 2010 and 100,000 patients have waited longer than 30 minutes for an emergency ambulance”. Let's not forget that 17,000 were left waiting in the back of ambulance to get admitted to A&E in the last week of December (https://www.theguardian.com/politics/2018/jan/10/pmqs-verdict-may-holds-up-better-against-corbyns-nhs-attack). More nurses are now leaving the NHS than joining it (more than 33,000 nurses walked away in 2017, a rise of 20% since 2012-13), perhaps because the working conditions are stressful, the pay is not enough given the amount of work nurses are being asked to do, EU nurses face xenophobic language being thrown at that and nursing bursaries, which trainees relied on, have been unfairly scrapped. According to Shadow Health Secretary, Jon Ashworth, “there are 100,000 vacancies in the NHS as of this month” (http://www.huffingtonpost.co.uk/entry/jonathan-ashworth-jeremey-corbyn-end-to-carillion-style-outsourcing-in-nhs-and-emergency-5bn-budget-plan-trickett_uk_5a6631c4e4b00228300577d6). Some hospitals are facing an equipment shortage, including a lack of ventilators and oxygen cylinders (https://www.theguardian.com/society/2018/jan/25/nhs-hospitals-serious-shortages-vital-equipment).

At a more local level, Lincoln's highly rated Walk-In Centre will be shutting its doors at the end of February due to short-sighted decision making by Lincs West Clinical Commissioning Group, leaving Lincolnshire residents and voters feeling concerned about where they can go to be seen for low-level medical conditions without having to wait for hours at an already busy Lincoln County Hospital A&E. 94% of people who responded to the consultation made it clear they did not want the facility to close (I was one of them) and yet Lincs West CCG chose to ignore us but perhaps if the CCG wasn't dealing with the consequences of chronic underfunding from central Government, they wouldn't have had to close it. Our NHS is facing its greatest crisis since the 1990's and it's time the Tories living it up in Westminster faced up to it.

Labour have announced a number of measures that may reduce pressures on the NHS and improve the situation for staff and patients; for example Labour Peer Baroness Chakrabarti stated that Labour would bring “life and death services” like hospital cleaning back into public ownership. Labour would halt the introduction of Sustainability and Transformation Plans “which devolve the national service into local ‘footprints’ with reduced accountability and the potential for marked reductions in healthcare provision, commercial control of both the public estate and the commissioning function” (https://www.opendemocracy.net/ournhs/stewart-player/taking-politics-out-of-nhs-or-constructing-elitist-consensus). Labour have also announced they will provide free car parking for patients, staff and visitors, funded by increasing the private medical premium tax. Labour would also scrap the public sector pay cap on nurses pay, reinstate nursing bursaries and guarantee the rights of EU workers to stay in the UK and continue doing their amazing work. All of which I believe would be broadly welcomed by voters like me.

Another issue that has been discussed in some depth this month has been the increasing number of children living in poverty in English cities. Figures released by the End Child Poverty campaign just this past week state that 4 million children in the UK are now classed as living in poverty, a truly embarrassing and unacceptable statistic when you are reminded of the fact that the UK is the 6^th largest economy globally. There are 4 constituencies in the UK where children are now “more likely than not to grow up poor” with over 50% of children living in poverty: Bethnal Green and Bow, Poplar and Limehouse (where the 1950s and 60's themed Call the Midwife is set), Birmingham Ladywood and Birmingham Hodge Hill.

The situation for children in Lincolnshire makes for less glum reading but still there should be pause for thought: 5,907 children are classed as living in poverty in Lincoln (which is defined in the report as a household having an annual income below 60% of the average); this means that 26.7% of children living within the constituency boundary are living in poverty. Louth and Horncastle has the highest percentage of children living in poverty for a Lincolnshire constituency (29%), followed by Boston and Skegness (28.6%). Data from Lincoln electoral wards (Jul-Sept 2017) shows that the percentage of children defined as living in poverty when housing costs are taken into account is highest in Glebe (34.13%) followed by Birchwood (34.12%). Birchwood happens to be the ward I live in (my parents have had a lovely house here since the Eurodance days of 1992) so to hear that 788 children in my ward are living in households where getting adequate food and clothing is disappointing to say the least.

Benefit freezes imposed by the Tory Government since 2016 (and expected to last another 2 years) have done everything to exacerbate the situation. The Child Action Poverty Group have stated recently that universal credit changes will push 1 million more children into poverty and I fear what will happen to Lincoln residents when the changes are brought in from March. The “Poverty Premium”, which is where low-income families pay as much as £1,700 more per year than wealthy families to buy essential goods and services needs to be tackled but there is very little desire from the Tory party to address the gap; instead they reiterate the tired party line that “employment is the best route out of poverty, and they have cited unemployment statistics which show that there are now 600,000 less children in workless households than in 2010. The problem with their assumption is that having a part-time minimum wage is not going to significantly improve a person's living standards, especially considering the cost of renting flats in the private sector in cities across England (how can someone earning £7.50 an hour for 20 hours a week afford a flat costing £400-£500 a month for themselves and their child??) and the potential price rises which may come as a result of the UK leaving the EU (clothing tariffs on items made in Turkey may increase by 12% from zero for example: https://www.theguardian.com/politics/2017/dec/26/warnings-of-post-brexit-price-rises-unless-uk-can-copy-eu-trade-deals). Doing well at school/university is also no longer a guarantee of future economic stability. Even when a graduate has manged to secure a position or a young person who has left school secures their first job, they may still find themselves living in poverty.

The End Child Poverty figures just add to what we already know about the effect child poverty is having in Lincoln. The number of emergency food parcels (which are designed to last 3 days) delivered by The Trussell Trust funded Lincoln foodback between April 1^st 2016 and March 31^st 2017 was 2,447, up from 2,233 the year before (an increase of 9.58%). The number of food parcels received by children increased by 17% from 813 to 952 (http://thelincolnite.co.uk/2017/04/foodbank-charity-reveals-staggering-rise-in-foodbank-referrals-in-lincoln/). Kate Taylor, in her excellent piece for The Lincolnite back in November 2017 highlighted the Institute for Fiscal Studies projections which predicted that “relative child poverty will increase from 30% to 37% by 2021” (http://thelincolnite.co.uk/2017/11/kate-taylor-poverty-in-lincoln-and-beyond-why-are-so-many-in-financial-insecurity/). I agree with Ms Taylor that there needs to be less time spent on “crucifying people for not being in work and more time helping them out of abject poverty” and that means focusing on more than just funding employability schemes.

I appreciate the situation in Lincoln could have been much worse, were it not for the Labour-led City of Lincoln Council's Anti-Poverty Strategy, which has been in place since 2014. The Strategy has a number of objectives, including “increasing money management skills and confidence, supporting families to feed and clothe their children and helping those facing poverty due to illness” (https://democratic.lincoln.gov.uk/documents/s26370/Lincoln%20Anti-Poverty%20Strategy%20-%20Appendix%201.pdf). Campaigns that have been run by Lincoln Against Poverty, the organisation overseeing the implementation of the strategy include The Living Wage Campaign (encouraging employers in Lincoln to pay their employees and workers at least the Living Wage, with employers being recognised and recommended by the City Council for doing this) and the Helping Hand Campaign, which is designed to get debt and budgeting information and advice to residents who need it (http://www.lincolnagainstpoverty.co.uk/us/). Projects delivered by the City Council included running 5 “Survive the School Holiday” sessions which provided adults in wards such as Birchwood and St Giles with information about debt, welfare and jobs and a pilot voucher scheme in Bracebridge Heath helping 119 children from low-income families get access to groceries over the summer holidays (6 weeks) during Summer 2016. Details of 2017/18 projects will be discussed at the next Lincoln Against Poverty Conference, which I'd love to attend later in the year.

Labour are very well placed to devise policies that appeal to swing voters on the issue of reducing Child Poverty. In the last election general manifesto, for example, Labour proposed spending £250m a year on the creation and implementation of a Child Health fund, with funding being made available to support the running of Child and Adolescent Mental Health Services (CAMHS) in schools, boosting the number of school nurses so there are more than 1 visit to a school (as seems to be the norm currently) and creating an Index of Child Health, measuring progress on tackling obesity, poor dental health, poor healthcare for under-5s and poor mental health (http://www.independent.co.uk/news/uk/politics/labour-junk-food-adverts-ads-ban-x-factor-hollyoaks-primetime-corbyn-election-manifesto-a7722926.html). For those asking where the money would have come from, Labour would have sought to half NHS Management consultancy fees by half (estimated to cost £538 a year): I don't think many voters outside of the private sector management consultancy sector would have disapproved of that.

On policies and strategies for the NHS, on policies to reduce homelessness, Labour have the upper hand. Corbyn's most recent announcement of buying 8,000 homes for homeless families as soon as his party wins the next General Election paints him as a compassionate figure in tune with the needs of the most vulnerable members of our society. With the rate of homelessness having increased by a shameful 169% since 2010, the number of rough sleepers up by 15% during 2017 (4,751 people bedded outside) and the number of people in sheltered temporary accommodation rising by 60% between 2011 and 2017, I don't think that the Tories can deny the seriousness of the problem any longer, particularly with regards to street homelessness in our inner cities. The heralded Homelessness Reduction Bill should help to alleviate the situation but if the Government had really wanted to address the issue, they could have provided ring-fenced funding for Local Authorities to prevent families becoming homeless in the first place (by paying outstanding rent arrears). As Zoe Williams so succinctly puts it:“Local government officials are now in a situation so impossible-statutory duty on one side, insufficient resources to meet it on the other-that they have to conceive the homelessness problem as a set of practical tasks to execute, rather than a series of human interactions” (https://www.theguardian.com/society/2018/jan/24/why-are-councils-so-creative-in-making-life-unbearable-for-homeless-people). We have people who are forced to endure night after night sleeping on cold doorsteps, getting little to no treatment for their mental health issues and we have amazing people, who work for organisations such as LEAP and the Nomad Trust who want to do far more but feel their hands are tied by a lack of funding (again a failure of the Tory Government to provide adequate investment for our Outreach services).

With such a bleak picture painted of a Britain struggling under the grip of Austerity loving Tories, it should make sense to a centre-left equal opportunities voter like me to turn to Labour once again and give them a chance to improve the lives of the most vulnerable people. But one aspect of the Labour leadership's view (and I am guessing the ongoing policy platform) is troubling me: that is the approach towards Brexit. When I voted for Labour back in June 2017, I did so with my eyes wide open; I knew that the likelihood of the Brexit vote being quashed entirely was next to zero and I knew at that time that support for a 2^nd referendum, or even a referendum on the terms of the Brexit deal was insufficient to encourage the leadership to consider altering their mindset towards Brexit. I had read the manifesto section which stated quite clearly that “Freedom of movement will end when we leave the EU” but I questioned in my mind whether we'd get to the point where we actually left the EU (naïve maybe?) What I did think may happen was in any clarification of Labour's position, Mr Corbyn would decide that membership of the Single Market, along EFTA(European Free Trade Association) lines, would be the best possible deal for the UK given the limited amount of options on the table. I'm glad that Labour has, along with the Lib Dems, the Greens, Plaid Cymru and the Scottish National Party seemingly managed to convince PM May to change tact and agree that a transition deal was needed and had to be one where the UK retained membership of both the Single Market and the Customs Union. But I can't say that I'm not worried about the future of the UK outside the Single Market. I'm disappointed in Corbyn's claim that the EU cannot be reformed (ask the Nordic Greens and ALDE whether EU reforms are impossible and they'd rebuff Corbyn straight out of hand) and I am equally frowning at his blanket dismissal of the possibility of a 2^nd referendum or even a referendum on the terms of the deal. That being said, Corbyn favours “some kind of Customs Union” but not the current version. Corbyn also doesn't want to be a member of EFTA either but wants to work with EFTA countries such as Norway (http://www.theneweuropean.co.uk/top-stories/jeremy-corbyn-second-referendum-1-5372112). There's been some references made as to what immigration policy will be like after Brexit but Sir Keir Starmer was the latest to comment, back in December, when he said “the end of free movement doesn't mean no movement. Of course we would want people to come from the EU to work here, we would want people who are here to go to work in the EU” (https://www.channel4.com/news/factcheck/what-is-labour-policy-on-brexit). Confusing policy remains the order of the day, you betcha!

I guess I should be grateful for any kind of clarity being offered by Corbyn on the party's official position but I do feel that crucial votes may end up being lost as a result of a lukewarm approach towards the EU. Take the most recent poll on Brexit support. The YouGov poll conducted back in December 2017 for The Guardian and Best For Britain campaign found that voters intending to vote Labour at the next election still are unsure as to what Labour's overall Brexit position happens to be: 23% believe Labour is “completely against Brexit” and 10% “didn't know”. The most recent Guardian/ICM poll, with over 5,000 respondents, shows that 39% of Labour leavers are now in favour of a second referendum with 65% of Labour backers overall wanting voters to have the final say on a Brexit deal (only 19% now oppose it). That being said, in the Midlands region (including Lincolnshire), 52% of voters polled would still vote to Leave the EU and that is despite 45% of voters thinking the decision will have a negative effect on the economy (https://www.theguardian.com/politics/2018/jan/26/labour-brexit-rethink-second-referendum-guardian-icm-poll). Students are also increasingly likely to vote for Remain (74%..up 16% since 2016...although the rise comes from those who could not vote in 2016) and women are more likely to vote to Remain in another referendum (53% to 47%). What may give any future Remain campaign a win is the fact that 51% of voters aged 38-64 would now vote to Remain.

Other results from the poll make for interesting reading. For example, when asked what impact Brexit will have on their personal finances, 36% of respondents said negative and that includes 50% of Labour voters. This stands in stark contrast to Tory voters, with only 18% stating that Brexit will have a negative impact on their finances. When it comes to asking about the impact of Brexit on culture, 42% of DE voters (unskilled and unemployed) said that it would be positive, compared to only 34% of AB (managerial and professional) voters. 57% of Labour voters stated that Brexit will have a negative impact on British culture, compared with 20% of Tory voters. There is clearly a sharp divide socially and politically here, although it would also come as no surprise to learn that 54% of voters aged over 75 believe leaving the EU will have a positive impact on the UK whereas only 24% of 18-24 year olds and 29% of 25-34 year olds agreed with them. What these figures reveal is the difficulty every political party has in adopting a unifying approach policy wise; there will be a significant section of the population worried about the social and cultural as well as economic effects of Brexit and they may feel politically homeless if the Labour party decides to align themselves with a harder form of Brexit. Nonetheless, the ruling out of a referendum on the terms of the final deal seems to be a foolish decision by Corbyn, given that 77% of potential Labour voters and 58% of overall respondents want to have that chance. Hmm.

Corbyn is set on gambling on the idea that Brexit voters in the North, in constituencies where Labour lost their seat, such as Mansfield (which went from having a 5,315 majority for Labour to just a 1,057 majority for the Tories) and Stoke-on-Trent South (which went from having a 2,539 majority to Labour to a 663 majority for the Tories) will be so convinced by Corbyn's commitment to Brexit that they will back him and vote Labour at the next election and that their votes would offset any votes lost with liberal pro-EU voters like myself choosing another party to vote for (e.g. Liberal Democrats) in marginal seats. It's certainly an interesting assumption. If you look at the figures from the poll for Northern voters especially, 54% would now vote Remain, 60% want a say on the final deal and 52% of voters think Brexit will have a negative effect on the economy. Who would have predicted that back in June? Anyways time will tell whether Corbyn is right to gamble Brexit policy wise and we shall see the effects at the next election.

Perhaps what is giving Labour the edge in polling at the moment is a desire to enact social change to help improve the lives of the most vulnerable. After years of policies favouring individualism and consumerism, there's a sense that voters are now realising the need to look after our public services after years of lack of proper investment in them. The lowering of taxes may have helped boost the economy but wage growth has stagnated and voters are increasingly fearful of the prospect of being homeless; most of us have next to no savings, which means we are often only one or two paydays away from finding ourselves on the street. That realisation should make us more compassionate towards those who have found themselves in dire straits. We should not be living in a country where more families have to make a choice between heating their home for a week or buying healthy meals for a few days. We should not be asking parents to fork out for expensive bits of clothing just because they have to have the right style of school logo on them. We should not expect single parents and parents who have found themselves with a reduced income as a result of illness or long-term disability to have to routinely deny their children access to leisure activities because they can't afford the bus fare or the petrol to take them. How can the Government continue to justify their approach and squeeze funding for Local Authorities to the point where they cannot afford to fund schemes that could reduce child poverty and empower young people from disadvantaged backgrounds to aspire to be in their dream jobs?

The question now is whether Labour leaning Remain voters put aside their concerns over Corbyn's muddled policy platform and trust in Labour's overall vision or whether they look for a party that showcases the referendum on the final deal as a central policy? 

Lincoln Walk-In Centre Consultation: My Thoughts

I'm concerned by the proposal put forward by Lincolnshire West Clinical Commissioning Group (CCG) to close Lincoln's only Walk-In Centre located on Monks Road. Not only is the centre used by central Lincoln residents and Lincoln College, Bishop Grosseteste University and University of Lincoln students, there are a number of patients who have travelled to the Walk-In Centre from villages such as Skellingthorpe, Waddington and towns such as Gainsborough because they are seeking immediate medical advice and treatment which they are currently unable to access through their local GP surgery. Lincoln's Walk-In Centre, which is part of the Lincolnshire Community Health Services NHS Trust (LCHS) opened in April 2009 and has a dedicated team of 15 which is nurse-led. The Centre is open from 8am to 8pm 7 days a week (except on Christmas Day and Easter Sunday) and aims to see patients within 30 minutes of being booked in at the reception. The team provides a range of minor treatments, including treating minor scalds and burns, insect bites and stings, minor skin infections and offering health screening advice. They can't deal with drug overdoses or severe allergic reactions so those patients are encouraged to make a GP appointment or attend A&E if they need emergency treatment. The Walk-In Centre staff can't issue doctors certificates or repeat prescriptions and patients are usually advised to contact their GP surgery to arrange these but there's no doubt that the Walk-In Centre is providing vital frontline treatment to patients; the team treated a total of 34,470 patients during the last financial year, with the centre costing just over £1m to operate. Lincs West CCG currently have a budget of £380m, so the centre's operating costs are an extremely small proportion of the budget.  The Walk-In Centre was built in order to help reduce Lincoln County Hospital A&E admissions and to allow patients to access medical advice and treatment regardless of whether they are registered with a local GP surgery or not. Lincs West CCG now argue that because of service improvements (the introduction of NHS 111 service for example), patients no longer need to access the Walk-In Centre to receive primary care. They say they need to close the Walk-In Centre to reduce "duplication of services" and improve efficiency. It seems to me that there is such a drive towards efficiency in the NHS and all of our public services these days but it must not come at the expense of patient care and safety.

Reading the Consultation document: 

To help inform the decision making process of patients, healthcare professionals and representatives from local organisations who have decided to respond to the proposal put forward by Lincs West CCG (through filling in surveys, attending drop-in centre meetings and conversing and emailing our newly elected Labour MP, Karen Lee (500 people talked to her about the proposals in Lincoln on Sat 1st July 2017 alone), a consultation document has been provided to give basic information: (http://www.lincolnshirewestccg.nhs.uk/wp-content/uploads/2017/06/Lincoln-Walk-in-Centre-Consultation-Document.pdf). 

The document gives 4 reasons as to why the Walk-In Centre needs to close, which are: 

1. the centre is not being appropriately used
2. the type of care that needs to be provided can be provided outside of the Walk-In Centre
3. the Walk-In Centre is a waste of budgetary resources
4. the Walk-In Centre has contributed to health inequity in Lincolnshire.

Let me address the fourth reason because I believe it's the most ludicrous. Lincs West CCG claims that maintaining the Walk-In Centre has led to "an inequity in service" provision in the area because the majority of patients who use the centre are registered with a GP and are resident in Central Lincoln wards but they provide no empirical data in the consultation document to back this claim up. It also begs the question whether GP provision in Lincoln wards such as Abbey are appropriate to meet the needs of residents. It's rather rude to suggest that patients who are registered with GPs are somehow enjoying a more privileged service when all they want is to be able to see a health professional to discuss their health condition and get some reassurance face-to-face. Blaming patients for using the Walk-In Centre service that was established because there was (and still seems to be) a need in Lincoln is not good enough and besides, as I've already mentioned above, the operating costs of the Walk-In Centre are miniscule compared to the overall budget and the Lincs West CCG have not provided evidence to show how they are going to improve equity of service across the Lincs West CCG area. 

With regards to "wasting budgetary resources", I fail to see how a service that has been regularly described as "fantastic" and has a 95% approval rating on the NHS website could be seen as "wasteful"; if patients are being provided with the advice, guidance and treatment needed to help them recover, especially if they have sustained a minor injury, then I believe the service cannot be categorised as wasteful. Lincs West CCG say they need to reduce "overlapping of services" in order to increase efficiency but does the plan that they have proposed do that without reducing the accessibility (and perhaps quality) of patient care?

The key component of the plan put forward by Lincs West CCG to accommodate the needs of those patients whose access to medical advice and treatment may become restricted due to the closure of the Walk-In Centre (because of their shift patterns or they feel they need to see a health professional for advice and reassurance) is to rely on GP surgeries around Lincoln extending their opening hours and ensuring the Lincs West CCG area has some form of accessible service for medical advice, guidance and minor treatment available 7 days a week, through a hub of several GP practices who will offer such a service. There would also be an increase in Skype consultations available for students who'd be happy to receive medical advice and guidance online and convenient access to GP services in surgeries near the University of Lincoln and Lincoln College. That's positive news for students but what about other service users?

Increasing "capacity" in GP surgeries so that patients can access appointments, including ensuring that children under 12 have access to an appointment on a same-day basis is a great idea in theory but of course I am naturally sceptical. My family's experience of obtaining appointments with our local GP surgery, Birchwood Medical Practice has generally been positive; in the past I've been able to ring the reception up when I've had ear complaints and I've been seen on a same-day or next-day basis (I've never been left more than a week to have an appointment with a GP). When I wanted to see my GP to take the baseline tests needed to start the application process for the Gender Identity Clinic in Nottingham, I was able to get an appointment slot that was available the week after I phoned reception. My Dad has been slightly less lucky but still he has been seen by his GP within the 2 week waiting period, even for flu advice. However, I've read of patients who have regularly waited over 2 weeks to see a GP to discuss issues related to stress and/or anxiety and some patients have even been advised by their GP surgery to attend the Walk-In Centre so they can be seen quicker. Same-day appointments are avaliable at my local GP surgery but you have to phone up at around 8am and ensure you have time during the day to go to the surgery and those appointments often are during office working hours. That's not always possible if you have an employer who is not flexible and won't give you time off to attend the appointment; very few people want to take a day off unpaid at short-notice to attend if they can help it. Attending the Walk-In Centre before the start of the working day is convenient for parents who want to get some urgent reassurance about their child's earache or women who need emergency contraceptive advice. The suggestion in the report to have walk-in centres in GP surgeries and extended opening hours would go some way towards providing an element of convenience provided that GP surgeries across the Lincs West CCG area are prepared to provide those services. If they do not, then there really will be an inequity in service provision.

Another aspect of the Lincs West CCG plan outlined in the consultation document is to try and get more patients to self-care through accessing information online and asking pharmacists for basic advice and guidance. Pharmacists are trained to give advice on a number of medical conditions including hay fever, athlete's foot and indigestion (see more here: http://www.nhs.uk/Livewell/Pharmacy/Pages/Commonconditions.aspx). Now a stat has been
bandied about by Lincs West CCG in the consultation document which states that "95% of patients who attend the Lincoln Walk-In-Centre do not require treatment".  50% of those 95% of patients "received advice and guidance only" and the consultation document suggests that those patients "would benefit from access to self-care support initiatives". I'm all for public health initiatives wherever appropriate but the consultation document does not specifically suggest whether such initiatives are being planned currently for the Lincs West CCG area, which areas those initiatives would focus on addressing and how much it would cost to create and then roll-out those initiatives. The survey document does talk about the various ways that Lincs West CCG may disseminate information; I believe that all of the methods suggested are appropriate, especially use of social media, newspaper articles and bus adverts.

I personally think it would be an excellent idea for LCHS and Lincs West CCG to look at creating an initiative that raises awareness of the role in pharmacies in helping to offer basic medical advice and guidance to help patients with their self-care treatment but I've never seen any initiatives at a national level either in newspapers, on the TV or on social media that have encouraged patients to ask them for advice and guidance. Also, it's relevant to mention that there have been plans to cut to pharmacist funding (through the Drug Tariff) of 6% - that's been worked out as approximately £14,500 per pharmacy. This could mean community pharmacists having to make cuts to overheads and that may include reducing staff. If there are less staff in pharmacies across our area, it means there are less staff who have the time available to properly advise patients; sometimes a 2 minute slot isn't enough to allay the concerns of a patient and given that the NHS should be a patient-driven service, it may be unrealistic to expect pharmacists to entirely take over the advisory role from community health nurses and GPs. I'd feel uncomfortable as a dyspraxic patient with only being given basic information if I had a recurrence of my recent kidney stone within a 2 minute time slot; it took a 15 minute slot with a GP at the Out-Of-Hours Service at Lincoln County Hospital A&E earlier this year to allay my fears and allow me to ask the questions and take-in the information I needed to help fight the pain and pass the stone naturally. Patients with complex learning differences and/or complex health needs may require longer. Capacity must remain in place within our local NHS trusts, including LCHS to facilitate appropriate time-slots with nurses and GPs to provide an advice and guidance service to patients with complex health needs.

The consultation document also highlights the importance of the NHS 111 service to providing advice and guidance to patients and argues that increasing the capacity within the 111 service (i.e. more call handlers) will help to bridge any potential gap that would be left with the closure of the Walk-In Centre.  I've read numerous comments about the 111 service online from Lincoln residents and I have to say that not many of them are particularly complimentary. It appears that there is a problem with consistency; the quality of advice and guidance given by call handlers on the general 111 service can be quite patchy. I've been fortunate to benefit from the 111 service when I was suffering from severe kidney pain that I later found out in hospital was the result of a kidney stone (I've had them twice since 2013). The nurse that I spoke to was extremely polite, encouraged me to keep calm and eventually suggested I attend Lincoln County A&E directly to get access to specialist pain relief (I needed morphine because the level of pain was so bad ibuprofen and paracetamol combined couldn't touch it). However, I realise that the nurse on the phone may have been able to help me specifically because I was able to describe my symptoms in some detail (despite being in agony) and I had told him about my visit to the GP surgery a few days before, complaining with pain on my right hand side. Yet a patient who's not able or is uncomfortable with describing symptoms to a stranger over the phone will not have been able to access the specific advice and guidance that I received. The 111 service call handlers haven't always been able to gage the seriousness of a medical condition over the phone and that means that patients are having to resort to going to the A&E or the Walk-In Centre in order to ease symptoms and get the reassurance they need.Equally homeless patients and patients who are being subjected to sustained domestic violence and abuse by a controlling partner may be unable to have access to a mobile phone to ring the NHS 111 service and thus rely on being able to walk-in anonymously to receive medical advice and treatment.

What's important to note is that in Lincs, the NHS 111 service call handlers can now pass patients onto a Clinical Assessment Service (CAS) staffed by healthcare professionals who have specialist knowledge of Lincs and have access to patient records. The CAS was established in 2016 to provide patients with appropriate advice and guidance and signpost them to other NHS services wherever appropriate. Or that's how the service is meant to work in theory. My friend who had severe pain in his neck for more than a week was told by a CAS professional that he should just take some paracetamol and rest until the pain went away; the paracetamol did not touch the pain and he eventually collapsed in the evening and was taken to A&E in an ambulance. Deeply worrying given that the NHS website suggests that someone with a stiff neck for more than a week should see their GP or be given advice to see their GP. An example of patchy guidance that needs to be ironed out in the future.

Another problem with Lincs West CCG's plan that immediately springs to mind is that it doesn't reflect the fact that the types of patients who visit the Walk-In Centre aren't necessarily ones who are registered with Lincoln based GPs in the first place (despite the fact that Lincs West CCG claim that the majority of patients are registered with GPs (no percentage given) and from central Lincoln). We need to know what would happen to those patients when the Walk-In Centre closes. How can we deliver quality healthcare to homeless patients, who may need urgent access to treatment, especially if they develop symptoms of flu or fever overnight when the temperatures dip below 0C during the winter months? How do we deliver healthcare to those patients who travel in from surrounding villages and towns who are unable to get into a GP surgery because they have no spaces available? What about tourists coming into Lincoln for events such as Lincoln Pride and the Christmas Market? Will they be able to access a GP appointment at short notice or will they be forced to attend an an already incredibly busy A&E department at Lincoln County Hospital where a 5 hour wait is currently the norm? I'd like to see specific figures published by Lincs West CCG detailing the number of non GP registered patients who attended the Lincoln Walk-In Centre who were homeless or tourists and I'd like to see evidence in their plans that definitively prove that the closure of the Walk-In Centre will not detrimentally impact on the health care of our homeless population and tourists (from the EU and outside the EU).

Further Questions: The Lincolnite Interview: 

Representatives from the Lincs West CCG Governing Body, Dr Sunil Hindocha, Chief Clinical Officer and Chief Operating Officer Sarah-Jane Mills  had a recent interview with The Lincolnite (http://thelincolnite.co.uk/2017/06/closing-lincolns-walk-in-centre-is-the-right-thing-to-do-say-ccg-bosses/) which discussed the reasons why they felt that they needed to close the Walk-In Centre. A number of claims were made during the interview which made me think further about the proposal:

• Dr Hindocha claims that 2/3 of patients who attend the Walk-In Centre do not receive any treatment at all; that directly contradicts the stats given in the consultation document. Confusing? 
• Dr Hindocha says that a number of patients who used the walk-in-centre then had an appointment with him on the same day; was that because they'd manage to get a very rare same-day appointment after being advised by a walk-in-centre professional to see their GP or were advised by the Walk-In Centre to contact their GP to gain access to repeat prescriptions or doctor's notes, which cannot be provided by the Centre? 
• According to Sarah-Jane Mills, over 20% of the patients attending the Walk-In Centre are University students (not sure whether they are from the University of Lincoln only or also from Bishop Grosseteste University...he doesn't provide that level of detail); does that mean GP surgeries located near the University of Lincoln need to have extended opening hours or offer more walk-in services or does there need to be another GP surgery established in the area? 
• Dr Hindocha argues that numbers of Lincoln Walk-In Centre attendees are falling because of online services....where's the objective empirical evidence to back that claim up? It's not in the consultation document! 
• A number of GP surgeries have a walk-in service but: 
• where are these GP surgeries located (are there some outside of the City of Lincoln boundaries)? 
• which of those GP surgeries have a walk-in service that doesn't require prior booking (i.e. do not need to telephone the receptionist in advance)? 
• is the walk-in-service only available at certain times of the day (usually in the morning)? 
• why aren't GP walk-in services being properly advertised so that patients in the local area are AWARE that those services exist?
• Reference is made by Sarah-Jane Morris to "different types of GP surgery appointments" being made available to patients; how many extra on average will be made available to patients needing to see a GP, how many extra on average will be made available to patients who only need to seen a Nurse Practitioner? 
• Dr Hindocha says there is "no evidence" in the dataset he has seen to show that more patients would attend A&E if the Walk-In Centre is closed because they'd go to pharmacists to receive "limited self-care information" - where's the empirical evidence from objective studies carried out in other areas of the UK where Walk-In Centres have been closed to back this claim up?
• Dr Hindocha states the obvious that the Walk-In Centre was not designed with A&E patients primarily in mind but there may be patients who will attend A&E if they cannot get a GP appointment when the Walk-In Centre is no longer in Lincoln. 
• There will be same-day appointments available (including for non registered patients) but only if patients "clinically require it" (only guaranteed to children under 12).  Where will patients be signposted to if they are deemed "fit enough" to receive advice and guidance elsewhere? Pharmacists or online services? Will there be differentiation in signposting according to individual patient needs? 
• Currently a shortage of GPs in Lincolnshire but Sarah-Jane Morris states that Lincs West CCG are the "leading recruiter of international GPs" in England and have managed to get 27 to join; this is excellent news but will this number be sufficient to fulfill demand for extended GP surgery opening hours and a GP surgery walk-in service?
• Dr Hindocha claims that in the 4-5 busiest GP practices in Lincoln, 2-3 additional appointments will be necessary to fulfill demand; is this on a daily basis? 
• What specific improvements need to be made to the NHS 111 service so that more patients that require specific advice and guidance get the specific support they need? 
• Conversations about service provision have been ongoing and all NHS trusts based in the Lincs West CCG area have had a chance to have their say on the proposal to close the Walk-In Centre including the risks involved with primary patient care; I wonder what they have said about facilitating the health care provision required for homeless patients and tourists?
• One of the risks identified concerns the flow of information to patients about alternative NHS services; how are Lincs West CCG going to help local NHS trusts to disseminate that information if the Walk-In Centre is closed (we'll hopefully find out after the Consultation process has been concluded!) 
• What would happen if there was a major incident in Lincoln and there was no Walk-In-Centre to take the overspill of patients who have minor ailments who were not involved in the incident?
• There is also the question of where the money (£1m a year) saved from axing the Walk-In Centre will be directed to within the Lincs West CCG budget:
• Would it be used towards the recruitment of GPs to alleviate pressure on surgeries and fill remaining vacancies?
• Would it be used to recruit more GP surgery nurses or community health nurses?
• Would it be used to improve the quality of the 111 service?
• Would it be used to put in place specialist health services for the homeless in Lincoln?
• Or has the money already been reallocated to the GP streaming service planned for outside the A&E department in the car park area at Lincoln County Hospital as has been alleged by a NHS Whistleblower (read The Lincolnite article here and judge for yourself: http://thelincolnite.co.uk/2017/06/lincoln-walk-centre-closure-consultation-lie-says-whistleblower/).
• Dr Hindocha states that closing the Walk-In Centre is not about saving money but streamlining services to "move to a new model of care" with an emphasis on utilising new technology to deliver service and relying on self-care initiatives. Not every patient is going to want to have a Skype consultation though, as I've highlighted earlier.
• Sarah-Jane Morris seemed to suggest that even a large number of responses against the closure of the Walk-In Centre may not change the mind of Lincs West CCG because they believe they are acting in the best interests of patients. Hmm! Hopefully the consultation process does help Lincs West CCG understand the needs of the local population but also those who may be visiting the area too! 

From hearing the interview and reading the consultation document, it seems apparent that there is an expectation from Lincs West CCG that walk-in services  may become the norm at most, if not all GP surgeries across the Lincs West CCG area. Of course GP surgeries will be mandated to offer a 7 day routine service for patients but it appears that it may not be established straight away (it has to happen within 3 years though) and that the service may be delivered through hubs as opposed to at every GP surgery. I think patients would on the whole welcome a move towards a more convenient and accessible local service, especially if they are based in towns such as Gainsborough or registered at 1 of the 4 or 5 busy GPs referred to be Dr Hindocha but I don't believe the Walk-In Centre should be closed until the provision is in place and the quality of service provision has been tested to see whether patient satisfaction levels match that recorded on the NHS website for the Walk-In Centre.  

Overall Thoughts: 

I believe that Lincs West CCG, working in conjunction with other Lincs based NHS trusts including LCHS must ensure that NHS services are available and accessible to all patients that happen to be in Lincoln at the time they have a medical complaint. There's nothing wrong in theory about extending GP surgery hours (I think they should be extended to 7 days a week for ALL GP surgeries in the Lincs West CCG area and not just be delegated to hubs) but there must be also be some form of walk-in service available in GP surgeries that allows non-registered patients access to medical advice and guidance and minor treatment without them having to resort to using the A&E department at Lincs County Hospital; that includes treating homeless patients and tourists. I agree that the Out-Of Hours GP service (currently based at Lincs County Hospital) should be maintained as it helps to ease A&E pressures overnight. There needs to be more public awareness campaigns at a local and national level that encourage patients to have the confidence to call the NHS 111 service because of the CAS tie-in we now have in Lincs and a national campaign aimed at promoting pharmacy services (I only hope funding will be restored to community pharmacies in the near future). Self-Care awareness can only be increased through national and local campaigning and I'd like to see Lincs West CCG work with local NHS trusts to come up with more innovative social media campaigns so that patients are aware of what they can do to alleviate symptoms of conditions and when they should seek advice in as clear and concise a way as possible.I also understand that Skype consultations may be appropriate for some University of Lincoln, Bishop Grosseteste University and Lincoln College students who are tech savvy but ease of access to services must remain in place for students who'd rather get reassurance face-to-face.

I still feel that closing a NHS service that has received a number of excellent reviews on the NHS Choices website (95% of patients have recommended the service) and is described as ""an asset to Lincoln" that ""provides vital and essential care for the local community" is a great shame. I don't believe the Walk-In Centre should close until at least ALL GP surgeries have extended opening hours and a walk-in service in the majority of those GP surgeries is guaranteed. I also want to have some indication as to where the money that has been saved from closing the Walk-In Centre will be redirected to. I've also heard no specific plans that would be put in place to ensure tourists gain access to minor treatment and prescriptions without having to attend A&E and to offer healthcare directly to homeless patients on the streets of Central Lincoln. With all this in mind, I cannot personally support the Lincs West CCG plans in their current form. I have already signed the petition to keep the Walk-In Centre open (like 4,547 others; patients based in the Lincs West CCG area can sign it here:   https://www.change.org/p/save-lincoln-s-only-gp-walk-in-centre-from-closure?utm_source=embedded_petition_view) and I support the right of Lincolnshire residents and patients to continue to protest against Lincs West CCG for their plan; there's already been a protest that was organised by UNISON outside Lincoln County Hospital on Wednesday 5th July and another was held on the 12th July at 10am outside the Lincs County Council offices. Labour's group on Lincs County Council have also made it crystal clear that they do not support the plans and brought a motion to try and oppose the proposed closure of the Walk-In Centre but I hope that the health scrutiny committee at Lincs County Council will properly look at the plans when they meet on July 19th.

I urge anyone interested in the future of healthcare provision in Lincoln to respond to the consultation and fill in the survey; you can do so here: https://www.surveymonkey.co.uk/r/wic-consultation. You now have until August 18th to respond. 

General Election Result 2017: How could it affect LGBTQIA+ Rights in the UK?

It looks like we're going to have a Conservative minority government in place backed up by an openly anti LGBTQIA+ rights party (the Democratic Unionists) for the next few months at least and I for one am wondering what this will mean for LGBTQIA+ people, especially trans, non-binary, gender-fluid, genderqueer, intersex and asexual people in the UK. As I have mentioned on my blog (http://sassysvensknorsk.blogspot.co.uk/2017/06/exploring-ge2017-manifestos-lgbtqia.html) the Conservative manifesto itself was very short on ideas, with the only direct mentions of LGBTQIA+ being a commitment to tackle hate crime on the basis of "transgender identity" (why not gender identity and include non-binary, gender-fluid, genderqueer and agender people in this promise?) and expanding the UK's global efforts to "tackle the perpetuation of violence against people because of their faith, gender or sexuality."

Prime Minister May was making promises here there and everywhere during her Pink News interview to try and entice LGBTQIA+ voters to back the Tory party at the polls, including supporting a "thorough and independent investigation" to examine human rights abuses against LGBT people in Chechnya (after I suspect being pressured into it by other party leaders and MPs; for example, Sarah Champion, the Shadow Secretary of State for Women and Equalities wrote to PM May on 21st April 2017 to call for an urgent UN investigation). It remains to be seen as to whether a Tory minority government held to ransom by an openly anti-LGBTQIA+ rights DUP would push ahead with such calls, let alone look at a comprehensive review of the Gender Recognition Act (GRA) 2004. I remain deeply sceptical as to whether any progress will be made at all to improve LGBTQIA+ rights on the two policy elements included in the Tory manifesto, let alone on the pledges that PM May made in the Pink News interview. Can we really trust PM May when she says that a review into the effectiveness of the GRA could lead to the scrapping of the need for medical diagnosis? Conservative MPs in the main rarely show support for such a policy because it doesn't register highly on the list of priorities. Tory activists keep telling us trans and non-binary people that we should be thankful for the progress that's already been made, as if all we cared about was the legalisation of same-sex marriage or the pardoning of LGB people. I voted for a progressive vision for the UK, not one that stands still and wallows in a sea of utra smug complacency. If the vote tells MPs anything, it should be that young people especially do not believe that there is much for the Tory government to be complacent about. Change is required and it needs to take place sharpish.

The DUP is certainly anti-LGBTQIA+ rights and they have never voted for any legislation to improve LGBTQIA+ rights. There are the well-documented comments of Ian Paisley Junior, who said that he was "repulsed by gay and lesbianism" back in 2007 as well as the party's involvement in the despicable "Save Ulster from Sodomy" movement but there are certain aspects of their and there are certain aspects of their policy platform that should alarm LGBTQIA+ people; for example they  have unashamedly backed a "conscience clause"  which would guarantee any religious conservative legal protection from openly discriminating against LGBT people in a public environment, which is completely against the provisions of our own Equality Act (EA) 2010. I will never support any attempt to bring in legislation that will allow employers to discriminate because their conscience tells them to treat applicants differently on the basis of their gender identity or sexual orientation. There's likely to be very little movement  blood donation ban for men who have sex with men either whilst the Conservatives remain dependent on the DUP (they want to retain the blood ban). I want to see the Advisory Committee on the Safety of Blood, Tissues and Organs conduct a review so that the case can be made to remove the blood ban in its entirety in the near future but I doubt the Conservatives are brave enough to conduct that review. Shame.

Gender Recognition Act 2004 and Equality Act 2010:
There's no doubt that the Gender Recognition Act needs urgent reform; in the last Parliamentary term the Conservative government announced that there would be a review into the GRA, with Nicky Morgan, the Secretary of State for Women and Equalities way back in July 2016 stating that she understood that disclosing "traumatic details of past surgery" was distressing and that trans people were being treated "as if they had a mental illness." The review that has been proposed is meant to be looking into ways of moving the GRA process from "medicalised questions" to "self declaration". I've not heard more on this since July 2016 and there's been no progress on other promises that were made by Nicky Morgan before the current Secretary for Women and Equalities, Justine Greening took over. I argue that there must be a firm commitment to at least reviewing the Spousal Veto with a view to removing it; there is no need for it to exist in law and there should be a review of rights so that couples with a trans or non-binary partner have the same access to pension rights and the custody of any children in the event of bereavement as the Lib Dems suggested in their manifesto.

Non-binary and intersex people should not need to prove their status to gain access to neutral gender markers for all appropriate legal documentation, including passports. Legislating for this isn't going to lead to the direct erosion of other people's' gender identities or human rights. So I really do not get why the Tories will not take a progressive stance and implement legislative reform now. I think that unnecessary requests for gender information should also be reduced on official documentation wherever possible.

We also need to see positive action with regards to amending the Equality Act. I can no longer see any logical reason to delay the substitution of the protected characteristic "gender reassignment surgery" for "gender identity", especially given the fact that the Government plans to amend the EA to include protection for those with mental health conditions anyways. I'd also like to see intersex people be specifically protected under the EA with the protected characteristic "intersex" being added to the list. There must be a commitment to banning unnecessary sex assignment surgery on an infant or a young child (i.e. when it is not done for health reasons) and in fact I agree with the Green Party's LGBTQIA+ manifesto suggestion that conducting such surgery should be made a criminal offence. Young intersex people should have the right to determine their own sex and engage in surgery if they have given their explicit consent. There definitely needs to be more training given to NHS professionals to help them support intersex patients and encourage intersex activists to work with healthcare professionals and be part of patient groups to help formulate training materials to help facilitate discussion. Extending legal protection against discrimination to non-binary, gender-fluid, genderqueer and intersex people is essential and reforming the EA will lay the groundwork for this. I hope the Conservatives are brave enough to commit to at least some of the suggestions outlined above.

The Tories did commit to conducting a study to "measure the size of the UK's population" in July 2016 but I wonder what the direct benefits of capturing this data would be; would it convince them that they need to expand gender neutral bathroom and changing room facilities, for example? There's also the question of whether a government obsessed with Brexit will be interested in analysing the results of the study to help them improve their policies. Labour on the other hand may take on board the results of the survey and add policies in as appropriate; if they want to increase their vote share amongst younger voters I'd say that it would benefit them greatly if they bring in more nuanced policies that can deliver equality for trans, non-binary, gender-fluid, genderqueer and agender people.

NHS: 
I still believe it is essential to boost funding for sexual health services in England, especially to continue fighting HIV stigma. Sexual health clinics (Genito-urinary medicine services) need to receive funding so that specific advice and guidance can continue to be offered to young people embarking on same-sex experiences for the first time. According to an article "What do cuts in sexual health mean for patients?" written by Ruth Robertson from The Kings Fund in April 2017 (https://www.kingsfund.org.uk/blog/2017/03/what-do-cuts-sexual-health-services-mean-patients), funding for sexual health clinics through the public health grant given to local authorities fell by 6.7% during 2015/16 and cuts have been planned up to 2020/21. However demand has been increasing (new attendance rates increased from 1.6m in 2011 to 2.1m in 2015) and there was a survey conducted by the Kings Fund which found that patients who have symptoms related to a Sexually Transmitted Infection were waiting more than 48 hours to be seen by a professional. The current expectation is that the public health budget ringfence will be removed by 2019/20, meaning that local authorities could face tough choices regarding GUM funding; whilst a comprehensive STI testing and treatment service needs to be in place (thanks to a mandatory law from 1916), other services such as family planning or the provision of free contraceptives may be reduced dramatically.

With regards to Pre-Exposure Prophylaxis (PrEP) provision, it appears that there has been no progress in England. Caroline Lucas, Co-Leader of the Green Party and MP for Brighton Pavilion has highlighted the fact that despite NHS England announcing that a PrEP trial would be set up 6 months ago, no such trial has materialised. The Tories have set £10m aside for the trial to take place over the next 3 years and claim that they will wait for the results of the trial before making any decision RE PrEP availability on the NHS but this may not happen until near the end of a full-term Conservative minority government, if at all.

There's been no open discussion about how to improve NHS training for GPs so they have a framework of best practice to help them better support trans patients and there's certainly no plans under a Conservative government to review trans healthcare provision more generally. We need more Gender Identity Clinics to respond to increased demand and help reduce waiting times and we need more specialist sexologists and nurses to staff those new GICs. There's also no plans to review how non-binary, gender-fluid and genderqueer people are treated by NHS staff, which is rather disappointing. There should also be an attempt to safeguard trans patient hospital rights so they can be treated in the ward which corresponds to their acquired gender whenever possible (another great Lib Dem manifesto suggestions).

Finally I believe there has to be a commitment from the Tories to ensure that mental health services are properly funded and accessible to LGBTQIA+ service users. Labour and the Lib Dems both promised in their manifestos to fully fund mental health but the Conservatives haven't made such commitment. We need to recruit more mental health nurses (6,600 have gone since 2010) and I hope the Tory manifesto commitment to recruit 10,000 more NHS mental health professionals by 2020 will be met but a huge reduction in applications from EU nurses of  96% since the Brexit vote and the refusal of the Tories to remove the 1% NHS pay cap isn't going to help increase staffing levels and the removal of training bursaries for UK nursing applicants won't entice students to consider a career in nursing.

Education: 
Sex and Relationships Education will be delivered in schools during this parliamentary term but I wonder how LGBTQIA+ inclusive it will be. The Conservatives agreed with Labour that guidance needs to be issued to schools to help them prepare lesson materials on LGBT+ relationships but there is no indication as to whether there will be any lessons that address intersex or asexual people. When would discussion of trans and non-binary, genderfluid or genderqueer people start? Key Stage 3 or Key Stage 4? Will there be lessons on domestic violence and domestic abuse in addition to consent and  will those lessons include LGBTQIA+ focussed discussions? Will SRE be taught in faith schools? I hope that trans, non-binary, gender-fluid, genderqueer, agender, intersex and asexual activists will be involved in the creation of materials and be encouraged to go into schools to talk to students about more than just homophobic, biphobic and transphobic bullying as has been the case in the past. I believe discussions about asexuality is important because no student should ever feel that asexual people are weird because they have no sexual desire or prefer to show affection through hugging rather than through penetrative sex. Humanity is far more interesting than gender and sexuality stereotypes portray and that should be reflected in SRE lessons in an age-appropriate but engaging way.  74% of 11-15 year olds when asked in a YouGov poll conducted by Barnardo's believe that they would feel safer if they were taught about sex and relationships in schools with 94% stating it was important for them to understand the risks and dangers of being online (including accessing gay chatrooms). The Terrence Higgins Trust and National Student Pride survey also found that 72% of students would have had a better first sexual experience if they had received LGBT+ inclusive SRE. These figures demonstrate to me that LGBTQIA+ activists should back the implementation of SRE and get involved with the creation of teaching materials.

We need more LGBTQIA+ teachers and teaching assistants in classrooms to provide positive role-models for our students and I believe there should be a national recruitment campaign designed to encourage more openly LGBTQIA+ graduates to apply for a PGCE course with a range of LGBTQIA+ rights organisations involved, including Stonewall. Ensuring that students are taught about how to be tolerant of people who may have a different gender identity or sexuality is imperative and I've had enough of sticky-plaster policies that tend to only address bullying and harassment after it has occurred. Let's make sure that teachers and headteachers who have pastoral care duties have the knowledge and skills needed to fully support LGBTQIA+ identifying students; building an awareness programme into the PGCE course and into Continuing Professional Development, led by trainers who come from the LGBTQIA+ community will help no end.

LGBTQIA+ asylum rights: 
LGBTQIA+ rights for refugees and asylum seekers in the UK may unfortunately not improve under a Conservative minority government. PM May doesn't have a good track record in this area after all; as Home Secretary she allowed LGBTQIA+ refugees to be humiliated, forcing lesbian, gay and bisexual refugees to have sex to prove that they were LGB...a totally barbaric and anti-human rights approach. The Green Party's LGBTQIA+ manifesto and the Lib Dem's manifesto both convinced me that far needs to be done to protect LGBTQIA+ refugees and asylum seekers from discrimination, including ensuring that no LGBTQIA+ asylum seekers are deported back to their home country if they are in danger of facing persecution on the basis of gender identity or sexual orientation. In fact the Green Party has called for a moratorium on the deportation of LGBTQIA+ asylum seekers until a review of the asylum process takes place with a view to making the process more efficient and quicker. Border agents do need to have equality and diversity training so they understand that asking sexually-explicit questions is wrong (especially if LGBTQIA+ asylum seekers have been subjected to rape before or during their journey to the UK). I believe that detention limits should be set at 28 days and asylum seekers should be allowed to look for work if they have been waiting for their asylum claim to be processed for more than 6 weeks. Accommodation should be habitable and trans and non-binary asylum seekers should be treated with respect, with professionals using their pronoun preferences wherever possible. Asylum seekers also need to have access to counselling to help them deal with the trauma they have faced whilst being persecuted in their home country. There's no indication at the moment as to whether the Conservatives are bothered to carry out any of these reforms.

Homelessness:
PM May said in her Pink News interview that homeless charities such as The Albert Kennedy Trust should be "encouraged to help end LGBT youth homelessness in the UK". The problem is that the actions taken by the Tory government have as of yet done very little to address the problem. Charities cannot fund young people aged between 18 and 21 who have lost mandatory access to Housing Benefit. Research carried out by The Albert Kennedy Trust found that nearly a 1/4 of LGBT young people are homeless in the UK and their projects rely on Housing Benefit funding to run properly; for example, according to a Financial Times article from March 2017 (https://www.ft.com/content/1414f788-30e8-11e7-9555-23ef563ecf9a) the Purple Door Project run by The Albert Kennedy Trust in London and Newcastle guarantees housing for 6 months but requires residents to pay £105 a week - £95 of which comes from Housing Benefit. The Conservatives need to absolutely guarantee homeless young people aged 18-21, whether LGBTQIA+ or not access to Housing Benefit. That includes those young people who may be currently sofa-surfing. Young people want to build a better life for themselves and a compassionate government should do everything they can to help, especially those who have had a traumatic start to their lives.

Brexit:
Brexit means Brexit, or so the old sage Theresa May's maxim goes. I've always wondered how Brexit will affect LGBTQIA+ people specifically. There is concern about the right of LGBTQIA+ EU nationals to remain in the UK post-Brexit and I think it was a mistake of PM May not to guarantee the right outright before Article 50 was triggered. It sent out the wrong signal to our EU neighbours that the UK may be prepared to openly discriminate against their citizens. EU nationals pay tax into our system to help fund our public services and some even work in the public sector, including in hospitals and GP surgeries. We now have a situation where applications from EU nurses are down 96% since the Brexit vote and we're not training enough UK nurses to fill the demand, so we need to have a change of tone as well as policy from PM May and her Brexit team.

There's been hardly any discussion about how Brexit will improve the lives of LGBTQIA+ people. Will the money that is meant to be saved from the EU budget contributions go partly towards improving trans health services or towards the construction of gender-neutral bathroom facilities? Doesn't sound like it. Will the money fund more training programmes for frontline NHS professionals to help them better support LGBTQIA+ patients? Why aren't the Tories doing that anyways? Will the money be used to help expand GICs? More chance of seeing a pot of leprechaun gold on the front seat of Bojo's personalised imaginary red NHS £350m bus. Will leaving the EU truly lead to more jobs for trans people? Unless we change the attitude of employers, especially small and medium business owners in rural constituencies, we're not going to see more openly trans and non-binary people employed in long-term, sustainable employment. I still contend that Brexit will not make any progressive difference to LGBTQIA+ rights in this country and that's why I still remain opposed to it. Plus I don't want to see the UK leave the European Convention on Human Rights or water down the Human Rights Act 1998, both of which may still happen under a Tory minority government.

Conclusion:
Overall, I am feeling pretty concerned about the possible state of LGBTQIA+ rights under a Tory minority government. Whilst I accept that LGBT Tories want voters like me to feel reassured about the promises elicited by Ruth Davidson, Justine Greening et al that LGBT rights will not be weakened by any DUP "confidence and supply" arrangement, it does probably mean that we will see little to no progress on improving NHS services for LGBTQIA+ service users or any improvement in the rights of intersex and asexual people in the UK. SRE may or may not become LGBT inclusive, let alone LGBTQIA+. I can't see a nervous Tory government asking for a review on the blood donation ban or amend the GRA or EA significantly whilst relying on DUP votes. As for PrEP becoming available on the NHS in England before 2022 (or whenever the next election happens to be), we have more chance of Andrea "I'm a mother" Leadsom becoming PM in the next year. However, that doesn't mean that LGBTQIA+ activists are going to sit back and let this parliamentary term take its course. We need to continue campaigning for truly LGBTQIA+ inclusive SRE and to improve health services for trans, non-binary, gender-fluid, genderqueer and intersex people. We need to encourage PM May to continue to take a firm stance against Chechnya and if possible, allow Chechen LGBTQIA+ people to claim asylum in the UK.  We need to stand up and be counted. If we stay strong, a progressive vision for LGBTQIA+ rights can be achieved. It's just going to take a little bit longer to achieve!