Jo Coburn is joined by Dr Clare Gerada, former chair of the Royal College of GPs, to discuss NHS funding.
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Hello and welcome to
the Daily Politics,
where MPs are getting ready to begin
a marathon series of debates
over Brexit that could
last until Christmas.
The EU Withdrawal Bill is intended
to copy EU rules into British law,
but the government's opponents,
including a number of
are threatening guerilla warfare
in the Commons
with hundreds of amendments.
We'll bring you up to speed.
The chancellor Philip Hammond
is still beavering away
on next week's Budget,
so will he welcome some
friendly advice from
backbencher Jacob Rees Mogg?
We'll speak to him about his
alternative Budget for Brexit.
It's been claimed that vital NHS
operations and treatments
are increasingly being rationed
in England but is there a good case
for restricting treatment
for smokers or the overweight?
And there's plenty for Theresa May's
cabinet to chew over when they meet
this morning amid reports
that they're not exactly
getting along swimmingly.
We'll ask a member of
John Major's cabinet for some
tips on restoring harmony.
All that in the next hour on another
busy day here at Westminster,
and with us for the whole
of the programme today,
it's the former head
of the Royal College
of GPs Clare Gerada.
She is still a GP and she also
campaigned with the Liberal
Democrats at the last election.
Welcome to the show.
First today, the monthly inflation
figures for the UK have been
released this morning,
that's the consumer price index
which measures the rate of increase
in the prices of goods and services.
And according to the Office
for National Statistics it has
remained at its five-year high
of 3%, which means there is no let
up in the cost of living squeeze
hitting UK households,
although the rate has not
risen higher as predicted
by some economists.
Well let's talk now to our economics
editor Kamal Ahmed
who can tell us what that means.
Has it peaked, inflation? Well,
certainly, there seems to be some
evidence that the foot has come off
the inflation accelerates a full.
First of all, the sterling effect,
so, the decline in the value of
sterling after the referendum meant
that the goods and services we
imported into the UK became more
expensive, that pushed up inflation.
Inflation is a comparative number,
compared with what is happening this
time a year ago, that inflation
effect starts to fall out of the
data, Stirling, although it is low,
is staying at the same low rate.
That inflation effect seems to
dissipate a bit. Well prices are not
rising as fast as they were this
time last year. The big question, as
you suggest, does it mean we have
hit a peak? We are seeing the top of
the upward curve, certainly, the
Bank of England believes the peak
will be reached by the end of the
year. There are still some in
inflationary pressures, food prices
are the highest they have been since
2013, unrest in the Middle East,
global growth, increasing demand,
has meant oil prices are starting to
push up again. Although, yes, for
the moment, inflation has eased,
whether or not... It is not the
peak, it will increase a little bit
more. The overall trajectory is
starting to come down.
Let's pick up
on two of those things, food prices,
your supermarket shop is still more
expensive than it has been in recent
times and wages are still not
keeping pace with prices.
household income increases are
around 2.2%. If you look at food
inflation, running at 4.2%. Exactly
as you say, that squeeze on living
standards continues, food is the
largest proportion of our weekly
expenditure, and certainly for
poorer households, it is more
significant than for richer
households, the issue you are
starting to see is this big increase
in input inflation into the food
system, into supermarkets, they have
suddenly had to pay a lot more for
the food imported from the European
continent, in particular and
elsewhere, because of the weakness
of sterling. Those prices are
starting to be pushed through the
system, coming out the other end, in
food inflation. That means it is
tougher, when looking at the
Christmas spend on food. Again,
because of the sterling effect,
those effects may start dissipating
over time. But, that fuel price
increase, some suggestions that fuel
prices will start rising again by
the end of the year, that will push
up the inflation numbers.
briefly, what about reaction from
the Bank of England, we saw interest
rates double from a very low bar,
but I have seen this strange phrase,
the Bank of England will stretch out
the horizon over which it plans to
rein in inflation. Does that mean it
will not take further action for the
For the foreseeable future
that is absolutely correct, many
economists say there will not be
another interest rate rise until the
end of next year, and the interest
rate rise, that very small number,
0.25%, once again. The Bank of
England is not just concerned with
inflation, where the pressure seems
to be coming off slightly, but also
concerned with economic growth, and
the real problems are in economic
growth, not in inflation. This will
encourage those dovish members of
the monetary policy committee, to
say, we need to hold off any further
interest rate rises, and weaken the
hand of the Hawks who think there
should be more interest rate rises
to control inflation. Today's
figure, I think, means any interest
rate rise, when it comes, is a long
way off and will be very small.
In the public sector, when you look
at the NHS, talk about busting the
1% pay freeze, which would be
welcomed, but with inflation at 3%,
it is not as much of a rise, in real
terms, it is still a cut all stop it
is still a cut but more importantly.
-- it is still a cut.
-- it is still
a cut but more importantly,
medicines I prescribed are from
overseas, China, America, I wonder
how much we see the health inflation
impact if we do not have sensible
trade deals post "Brexit", I know
that we will be discussing it later
on in the show but for me, the big
one is the health inflation costs
and what that means. That will feed
into the overall economy, because we
have medicines, we take them for
granted but they are very expensive
and if they are going to cost more
because we do not get proper deals,
then inflation will rise more. I'm
not an economist, just a simple
punter, but I see and read the
newspapers and think, we are in a
very precarious position.
return to this when we talk about
Brexit in more detail.
Now it's time for our daily quiz.
The question for today
is which political relative
is heading to the jungle
for the new series of ITV's
I'm A Celebrity, Get Me Out Of Here?
A) Samantha Cameron, wife of David.
b) Philip May, husband of Theresa.
c) Piers Corbyn, brother of Jeremy.
or d) Stanley Johnson,
father of Boris.
At the end of the show Clare
will give us the correct answer.
Let's turn to the story
that's going to dominate
here at Westminster for the next few
and frankly for
the following months and years,
as MPs brace themselves for up
to eight hours of debate
on the EU Withdrawal Bill
in the Commons today.
It's a crucial piece of the Brexit
designed to copy
across EU rules into domestic UK law
to ensure a smooth transition
on the day after we leave.
And it looks like storm clouds
could be gathering over Parliament
as MPs begin to thrash out
the details of the bill.
Labour and a number of Conservative
have already expressed anger
at Theresa May's announcement
that the date we actually leave
the EU will be put into the bill
and fixed at the 29th March 2019.
Mrs May wrote in the Telegraph
that her government would not
tolerate attempts from any quarter
to use amendments to the bill
to slow down or stop our
departure from the EU.
However, nearly 400 amendments have
and although only
a number will be voted on,
they could cause real problems
for a government with a slim
majority in the Commons.
The amendments include calls to curb
the so-called "Henry VIII powers"
that would allow ministers to change
laws without much Parliamentary
scrutiny and a demand that we don't
actually leave the European Union
until a new treaty establishing
a future relationship between the UK
and EU has been agreed by MPs.
Jeremy Corbyn wants to keep
the European Court of Justice's
oversight over us during any
and Remain-supporting Conservatives
could join with Labour
and rebel on the issue
of giving parliament a so-called
"meaningful vote" once
the deal has been done.
Yesterday Brexit secretary
appeared to give
ground on that issue,
promising a final
I can now confirm that once we have
reached an agreement,
we will bring forward a specific
piece of primary legislation
to implement that agreement.
This will be known as the Withdrawal
Agreement and Implementation Bill.
This confirms that the major policy
set out in the withdrawal agreement
will be directly implemented into UK
law by primary legislation,
not by secondary legislation
in the Withdrawal Bill.
This also means that Parliament
will be given time to debate,
scrutinise and vote on the final
agreement we strike
with the European Union.
This agreement will only hold
if Parliament approves.
That was David Davis speaking
but was that concession
enough for Conservatives
who might be thinking about voting
against the government?
Well, Dominic Grieve is a Tory MP
who has tabled 19 amendments
to the bill and has signed more.
He's in central lobby
of the Houses of Parliament.
The government is promising to
enshrine the "Brexit" deal in
primary legislation which means MPs
will be able to make amendments to
the deal, does that give Parliament
a meaningful vote that you will
It is a very significant
change and I greatly welcome it,
that said, it remains the case that
the Secretary of State, in
explaining it, also highlighted that
he thought the powers to do this by
statutory incident could not be
removed. Feels like it might be
necessary to use them and can only
have debate on the statute after we
have actually left. That is clearly
a very unsatisfactory state of
affairs, the government may have a
point on this but we will need to
explore it during the course of the
passage of the legislation and see
how we can try to make sure that in
virtue all circumstances Parliament
will have two reacts to the statue,
which in my view will have to be
necessary in order to leave the EU.
At this stage, we are not saying you
will vote against the government or
push ahead with an amendment for
this so-called meaningful vote?
yes, I should say, that is exact
what I am saying, the amendments
table, series amendment, the
government has come back with an
important concession, at the same
time, that concession has been
qualified, and we need to look at
the terms of the qualification. This
is part of the process of what
looking at a committee is all about.
I keep what optimism that we will
resolve many of the issues on which
I have taken amendments by
consenting between the government
and myself. -- consensus.
Conservative colleagues who were at
a meeting with the Chief Whip
yesterday, and there was some anger
expressed at that time, were you at
I was present at the
meeting with the Chief Whip
How bad was the
feeling between yourself and the
I will not discuss the meeting
but there was considerable anger
among sections of the Conservative
MPs, the government having tabled
the amendment, accompanied by a sort
of pronouncement that there would be
fixed on the face of the bill a date
of exit, March 2019 I could not
understand why they were doing this
and it made no sense to me at all
except as a placatory offering to
those of my colleagues who really
want to take us out of the EU
without any deal at all. I
subsequently discovered this morning
that the government tabled another
amendment, which they did not talk
about on Friday, which, if passed by
the house, entirely negates the
effect of their first Amendment. I
have to say, this is all a bit
regrettable, I think the government
should be treating Parliament as
grown-ups and we should not have
games going on which are likely to
make people irritated.
Why do you
think they are playing games, they
obviously want to have people like
yourself on site for this important
piece of Brexit legislation, you say
there was a lot of anger expressed
at the time but what is essentially
wrong with having an end state on
the face of the bill?
And end date
on the face of the bill, which is
obligatory, is a crazy thing to do.
We do not know exactly how the
negotiations will and, it could lead
to a situation where we leave the EU
in chaos, whereas just by extending
the period of membership by one
week, for example, we would have
been able to get the deal the
government is seeking. It is a
completely pointless amendment and
should never have been introduced to
the statute books. What the Prime
Minister said that we will not
tolerate attempts from any quarter
to allow amendments to block the
democratic will of the people.
talking about you.
I don't know if
she's talking about me or not, my
task as a parliamentarian is to
listen to the consequences of the
referendum, I have always said this,
and I have been consistent in not
trying to obstruct Brexit taking
place but that is not removed my
responsibility as a parliamentarian
to scrutinise legislation and ensure
that every stage, people, the public
generally, understand what we are
doing and the consequences of what
we are doing, and that is what I
intend to do as this legislation
goes through. I'm confident that as
we go through this, we will end up
with better legislation at the end.
Are you prepared to vote against the
government if you don't think this
legislation is fit for purpose in
I said at second reading if the
legislation was not improved, it was
questionable as to whether it was
fit for purpose. We believe that as
a hypothetical question.
as if you are prepared to vote
against the government. Are you
prepared to consider what will
happen if you vote against the
government, it could lead to a vote
of no-confidence the government
could fall? You have taken that into
I have taken everything
into account, but if the legislation
is not fit for purpose, it will not
deliver what the public want, a
Are you prepared to
bring the government down for that?
That is an entirely hypothetical
question. I am a supporter of the
government and my task is to ensure
the government succeeds.
join forces with Labour on a number
of these amendments to improve the
The question is not a question
of joining forces, as a
parliamentarian I express a view on
the floor of the house as to what I
think could improve the bill. If
there are other members across the
house to share my views, they were
expressed that as well.
If you do
vote with Labour colleagues, are you
a collaborator as your Tory
colleague Bill Cash suggests?
will say to Bill Cash is that he has
probably rebelled against the
Conservative government more often
than any single other colleague on
the Conservative benches in the
course of his career. I think with
one exception over HS2, I do not
think I have ever rebelled against
the government after 20 years in
Was it helpful that will
cash did that?
I was not around, but
he thought it was the right thing to
do with his conscience and decided
to support the government at the
time despite disagreeing with them.
So a deal is agreed on mice the 29th
at 3pm in the afternoon and it comes
to Parliament and you do not like
the deal. What we do because it will
be eight hours before the EU leaves
We will make an assessment
of the situation as it stands at the
time. The only option open to
Parliament is either to accept the
deal or reject the deal and face a
chaotic exit without any agreement
to move into any transitional
arrangement. That is a problem for
Parliament and indeed the public
which they will have to face up to
at the end of this risky and complex
If you reject it at that
point, there will be no time to go
back to the EU to undo the bill?
That is right unless the EU is
prepared to re-negotiate.
course it is not at the moment.
Which of course it
is not at the moment.
Well, to discuss this further we're
joined by former Conservative
cabinet minister Theresa Villiers,
who campaigned for Brexit,
and by Labour's Chris Leslie
who is a member of the pro-EU
campaign group Open Britain.
Welcome to both of you. Chris
Leslie, are you pleased that David
Davis has now promised a meaningful
vote to Parliament?
He has tried to
polish it up as though it is a
meaningful vote, but within the
space of 15 minutes all of those
impressions quickly fell away and I
think most parliamentarians,
including Dominic and others, are
now saying, hang on a minute, what
is the point of offering an act of
Parliament, a bill that will become
an act of Parliament, after the
withdrawal agreement has been signed
and sealed by ministers? The whole
point of parliamentary democracy is
you can shape events, you can steer
what happens. If you have that Bill
before the withdrawal agreement is
signed, so it is a draft withdrawal
agreement, that would be a
is a sham. When do you want it to
be? Surely the same situation will
stand if it is a month or two months
before we leave the EU? There still
will not be time to redo the bill
before we go back to Brussels.
Because this is the most important
change in a generation we should not
box ourselves into an artificial
timetable. We have to get it right.
When a draft, is from the European
Commission, from ministers of the
Crown, Parliament can look at it and
decide if it is good enough. Does it
protect businesses and jobs? Is it
making sure that European medicines
can flow, that we can have tariff
free trade? Or is it going to really
harm this country significantly? I
think we have got to be serious and
growing up about it and deal with
that before the withdrawal treaty is
Explain to our viewers why
does offer from David Davis is a
It is a very important
compromise the government has made,
signalling it wants to work across
parties with people with different
views on these matters. It will give
Parliament the opportunity to
scrutinise in detail the withdrawal
agreement. I think it is a sensible
move and it does demonstrate that
the government wants to work across
parties to make a success and
deliver a smooth exit from the
Or it is worried
about defeat because there could be
enough Conservative rebels that they
might actually lose the vote. You
say there will be time and it will
be meaningful, but if the deal goes
to the wire, we are talking about
the last moment which David Davis
has discussed, the vote could happen
afterwards, could it not?
wants to get an agreement before the
deadline. But we have to bear in
mind that he meaningful vote took
place in the referendum and when MPs
decided to invoke Article 50. Once
we did that, the question is we get
another vote on the deal, but if we
reject that deal we leave under
Article 50 without an agreement.
There were lots of things not on the
ballot paper and that were not part
of the vote in Article 50, for
example the market, the customs
union, should we be a member of all
these various agencies? The aviation
situation, the fishery system. If
Parliament cannot deal with all of
these, what on earth is the point of
having Parliament there at all?
Because you want to stuff it, you
want to thwart the decision that was
taken at the time of the referendum
and enacted by Article 50 which the
Labour Party voted for.
There is no
static, democratic snapshot. The
situation is evolving all the time.
Yes, I am personally very sceptical
about Brexit, but in the House of
Commons there may be a consensus
which says maybe we need to stay in
the single market, maybe we want a
proper transition more than the deep
deal that the government are doing.
How can Parliament secure that if
the deal is already done and dusted?
That is the point. You campaign so
hard to give Parliament sovereignty
in this case, but it will not have
any meaning. You just said yourself
in terms of the deal it could well
be a take it or leave it.
the way Article 50 works.
So it is a
sham. This offer from David Davis is
not a meaningful vote.
invoke Article 50, you say you are
leaving the European Union and that
is what will take place on March the
We know the Prime Minister
has probably had some legal advice
because she is refusing to say if
she has had legal advice and the
government policy is that we leave
on March the 20 night in 2019, but
the government is backed into a
corner, the clock has ticked down,
we have not got a good deal and
Parliament might have to revoke
Article 50. It is far better if we
get into a situation where
Parliament is taken along and not
treated as an afterthought.
revealing. At the heart of it you
want to use amendments to overturn
it, to block it from going along?
want to ensure prosperity and jobs
for this country rather than take an
ideological view that somehow going
over a cliff edge into a hard Brexit
is great for Britain.
We all want to
ensure jobs and prosperity and the
way to do that is by working
together across parties to deliver a
successful end result.
If that is
the case, let's do it in Parliament
before the treaty is signed, surely
that is the most grown-up and
sensitive way to do it.
about working cross party because
your amendments do not have Tory
support apart from MPs like Dominic
Grieve, so they will not go
anywhere, will they?
We are joined
up with Ken Clarke and in the
Florence speech, where Theresa May
said she wanted a transitional
arrangement, we want to put that
into the bill.
And how much support
has Theresa May got from other MPs?
Those votes will come on days six
and seven and eight, so we are only
at the foothills of this particular
bill's committee states so far.
you need remain Tories on side
otherwise your amendments do not go
How much talking is
Lots of discussion is
going on across all parties. I have
a very strong opinion about the
dangers of Brexit and others are
saying they want Brexit do happen in
a gentle way with the transition. I
will get the best possible outcome I
can do and work with colleagues to
do that. But if we stick to
ideological, party political
tramlines, we will not do much right
for the public.
Is that what Bill
Cash is doing when he describes them
as Tory collaborators when they join
the Labour Party?
I urge my
colleagues not to vote against the
government, but I recognise they
have strong views on these issues.
As Dominic Grieve said we need to
work to scrutinise this bill
carefully and make sure nothing goes
through which would jeopardise
implementation of the result of the
Would they be
collaborators if they joined forces
with the turncoat Labour Party?
would not describe them like that,
but I would urge them not to do
anything which would undermine
respect for the 17.5 million votes
in this country.
Why was it
important for Theresa May to put the
date in the bill? Does it not tied
the government's and by having a
hard buffer their in March?
country has made its decision. MPs
ratify that when they invoked
Article 50, that means we are
leaving on the 29th of March. It
makes sense to include that date in
It is the stupidity of
boxing ourselves into a poor
negotiating hand so that the other
side of the negotiating table can
wait for the clock to come down and
we get more and more desperate for a
deal as time goes by. There was
nothing on the ballot paper about
the 29th of March, 2019. All of this
should be for Parliament to decide.
Do not be so rigid, getting the best
deal is what we want.
I can agree on
the need for an implementation
period. Right across the House of
Commons we agree on that. That will
enable us to prepare for Brexit.
Which is why some of the amendments
today are really crucial. Do not
forget the Prime Minister herself
said in the Florence speech that win
might need the ECJ to continue in
order to get existing institutions
in the transition. The bill as it
stands stops all of that and throws
it out on exit today, so the bill is
not consistent with the
implementation position that even
the Prime Minister has talked about.
How likely is no deal scenario now?
We have got this hard buffer of a
date which the government would like
to put on the bill and the clock is
ticking. Do you think no deal is now
the more likely option?
No, I remain
optimistic we will get a deal. One
question is the mechanics of the
exit deal and the second is the
trade agreement. Delivering the
trade agreement will be more
difficult in the time available, but
it is in the interests of both sides
that we do that and I remain
optimistic we can do both.
doctor and working in the NHS, how
important is it for you to get that
You want to remain. I sit here
aghast and known as the majority of
the public do I suspect. If I was
offering you a major operation and
told you nothing about it until your
guts were spilling out and you are
on the table and told you nothing
about the side-effects and what it
would cost and what it would mean
further down the line and then you
have little choice, you would strike
me off and refer me to the General
Medical Council. There are real
people frightened about this, real
people leaving this country and real
people suffering and yet we are
playing party politics. For me in
the NHS, the NHS relies on overseas
people not just for service
delivery, but for innovation and yet
we are entering this process, if I
can finish, I understand people who
want to leave because they were told
more lives than a used car salesman.
Did the other side not tell lies?
They did not tell lies. Project fear
was considered lies. It was not, but
they were too arrogant and two
expert to say it does not work.
Theresa Villiers comeback in terms
of reassuring people. You talk about
the majority of people. There is no
evidence to say the majority of
people are worried. The polls are
shifting. We do not have that
evidence. Reassure her if she thinks
people are literally terrified about
what is happening.
This is a period
of uncertainty and one of the
reasons we need this withdrawal bill
to go through is to ensure we have
as much certainty as possible for
businesses and individuals. I take
issue with you in terms of the
reasons why people voted to leave.
It is legitimate to say that we
should take back control of making
our own laws in our own Parliament.
That is why people voted to leave
the European Union.
We will have to
leave it there. Briefly, this
statutory instrument Dominic Grieve
topped the back that he says is in
the bill which would allow the
government to extend the data beyond
the 29th of March, does that worry
you? does that worry you?
I have not
seen the details, I think it was
That is the detail, that
they can extend the date by using a
statutory instrument, it could go
further into the future, are you
It would be good to have an
exit date, if there is flexibility
that the government also puts
forward, I will certainly consider
that carefully, it is not worry me,
from what you have told me about it.
Chance of Philip Hammond is not
short of advice, including from some
within his own party, believe
supporting MP Jake Jacob Reece Mark
has today been delivering his own
budget for Brexit.
The leave supporting MP
Jacob Rees Mogg has this morning
been delivering his own
"budget for Brexit".
He predicts there will be
a £135 billion windfall
to the Treasury between 2020-2025
as the financial benefits
from leaving the EU are felt.
We'll speak to him in a moment,
but first let's have
a listen to the speech.
The key to economic success and the
ability to pay for public services
is our ability to exercise economic
freedom and simultaneously minimise
protectionism. The results of these
ideas will be an intensification of
competition in the UK economy which
will improve the UK's productive
performance. I confidently believe
therefore that over the medium-term,
the fiscal prospects are much
better, than those that will be
revealed to you by the Obie's
short-term projections. It does it
reputable, but on the basis of full
assumptions, supplied to it by the
I apologise for the
picture quality, we were hoping to
speak with him directly, but I think
there are technical issues which
prevent us from doing so, so
We like to introduce
you to new words on this show,
think of us as a political
version of Ccountdown, but
without dictionary corner
or the loyal fanbase.
Some recently coined terms include
"fake news", "gig economy",
or how about "gender fluid"?
Well, the philosopher
Roger Scruton has brought
one to our attention,
Oikophobes, he says,
"define their goals and ideals
against some cherished form
of membership against anything that
makes a claim, however
justified, on their loyalty".
Well, Roger Scruton talks
about "oikohphobia" in his new book,
it's called Where We Are,
The State of Britain Now,
and he joins us now.
You refer to this term oikohphobia
but is a deep cynicism needed to
make institutions work for everyone?
Certain measure of cynicism is
always a good thing, but a deep in a
system, which bases its self
entirely on mediation, that is not a
very helpful thing to the thing that
We all of us in my view have a need
to belong, we all define belonging
in slightly different ways but there
are certain fundamental things that
we must share. A place, which is
ours, whether or not we agree about
how it should be governed, this is
the place we are talking about, a
system of law, political process
which is ours. In defining that
term, I was really trying to come to
terms with the growing current of
rejection that runs especially
through the intellectual world, in
which people try to define
themselves not in terms of where
they belong but in terms of what
they would not belong to if they
were not rejecting it!
Where do you
fit in, in this, are you an
you are fundamentally
correct, we all have a fundamental
need to belong to a group. All have
groups, there is a great move at the
moment not to belong to something,
we have not to belong to a gender at
the moment, and the confusion that
What about the belief of
being part of the country, the land.
Absolutely, as a foreigner, I feel I
belong to this country, this country
is very dear to me, gave me and my
family a home and work and gave me
my future and I belong to the United
Kingdom, does not mean that when I
go abroad to where I actually come
from I do not feel some loyalty, but
I belong here. The rejection of
belonging is a perverse and
pervasive part of our society, as
You talk about it being
part of the intellectual is...
do you mean? My colleagues in
universities on the whole, as George
Orwell pointed out a long time ago,
they cannot utter words like
England, Britain and so on without a
certain smear. It is always, we are
not to be identified like that, that
is what our grandparents fought for,
but we are in the business of
establishing our identity completely
apart from all the ordinary forms of
Do you agree with that?
Universities were criticised for
negativity towards Brexit, is that a
form of elitism that should be
Not at all,
universities were critical of Brexit
because of what people do to
innovation and academic and
universities that is part of it, I
den think it is part of not
belonging to Britain. If one were to
ask. -- I don't think. I'm European,
that is why I feel strongly about
Brexit. I was born on one continent
and I live in another, we are all
from all over the place, very few of
us are one bit, if we check DNA. I
belong here, my loyalties, we have
just celebrated Remembrance Day, I
was not born there, it is not part
of my culture in many ways but I
feel it through me.
sympathise with Roger's point that
there is a smear about Englishness
Yes, if you went to
yes, absolutely, again, interesting
point, by being in favour of
Scottish nationalism, someone can
use that to enhance his rejection of
England, that is one of the reasons
why we do not find a great
intellectual movement to smear
Scottish nationalism. While we do
find a great movement to smear
Do you see the support
of the the EU, the remain
credentials Claire inhabits, do you
see that as being disloyal?
course not, not in itself, best to
say. It is quite possible to be a
committed citizen of one country and
also have wider loyalty to other
things. I am very much a British
patriot, also, an English patriot,
and I am also European. But I also
think that in the end, one's basic
political identity is wrapped up
with the people who govern you.
Where are we governed from, by whom?
That is why I am in favour of Brexit
because I am in favour of national
sovereignty. But it does not stop me
being European or thinking that I
have a wider loyalty to the
continent and the civilisation that
I agree with you
with most of what you said except
for the last bit.
I know that you
Quirkiness, that the
English do not promote themselves, I
love that, the English bemoan
criticise Jeremy Corbyn as being a
radical oikohphobe but you seem to
agree with him on globalisation, for
instance, one of the issues you
highlight is damaging the nation.
Yes, that is true, but he would join
in this fundamentally anti-English
sentiment, I think.
Why would he do
He believes that ours is a
class society, which has to be
turned upside down, we have two
repudiates all kinds of institutions
and ways of doing things for the
sake of a more egalitarian border,
which is not defined.
institutions are not working for
large portions of society, as Jeremy
Corbyn and Theresa May have said,
isn't it right that they are
Up to a point, yes, but
it depends upon which institutions,
not the political process under the
common law, that we have inherited
about which Jeremy Corbyn has almost
nothing to say.
Do you think it is
right to challenge in the tuition is
to lead to a more egalitarian
Who could possibly disagree
with that, of course I do, but what
institutions? The NHS is the most
egalitarian in the juice and we have
in this country, it is classless. --
institution. If we put more money
into education we would then have...
I disagree, if we put less money
into it, it would get much better.
Tell that to the teachers.
know, but at the moment, two
bureaucrats for every teacher in the
state education system, that money
is being squandered partly because
people are not taking seriously the
crucial encounter, that between the
teacher and the pupil.
when you have schools having to ask
parents for substitute Harry on
teaching, when teachers are taking
in equipment in order to teach, and
where you know that bureaucracy is
management, you need to run an
organisation, you cannot run it on a
wing and a prayer.
I don't see why
not, you see, if we privatise the
entire educational system, people
all over the country would be taking
these initiatives and running things
on a wing and a prayer. I have
believed that all my life.
you go, talking about the European
Union, you are in favour of leaving
it, do you access that it could lead
to worse consequences, of
globalisation, bargain bucket
economy, race to the bottom in
regulation, a Singapore style
economy, very successful however in
Singapore but which may not work
Anything might happen, none of
us are a profits, and I am even less
of a profit than Jeremy Corbyn
because I have no power, he can
influence things. But it has ever
been so, all political decisions are
made largely in a void. And all you
have to rely upon is your own sense
of the past and obligations and
loyalties. -- none of us are
prophets. That is what should take
Thank you very much.
Is it right for patients to be
prevented from having
certain types of treatment
unless they quit
smoking or lose weight?
Well, health trusts argue this
is often the best way to improve
results of non-emergency operations,
but critics claim it's also a way
of dealing with the pressure on NHS
budgets in England and Wales
by rationing care.
Emma Vardy's been to Hertfordshire
where some new rules
have caused controversy.
Here, some NHS patients
are given an ultimatum.
Under new rules, some smokers
will only be referred
for certain operations
they quit smoking.
Those who are obese may be
restricted from having non-urgent
surgery until they lose weight.
Clinical commissioning groups,
these are the GP-led organisations
that plan local care,
they are facing tough
decisions this year about how
to balance their budgets.
The Hertfordshire case is not
a one-off, the majority
of CCGs are having
to consider different ways
to restrict access to patient care
in order to balance budgets.
I think we can expect to see more
and more of these cases of CCGs
taking tough decisions about how
to meet financial targets.
The NHS is under huge financial
because the demand for care is going
up much faster than funding.
It means like Hertfordshire,
many areas are taking more
but is that fair?
I don't think it should be
a blank "we cannot treat
you because you smoke."
I think they should have to say,
you need this, but we want to see
that you are stopping smoking
in the meantime.
Never smoked in my life,
and I do feel that it should be
considered absolutely, yes.
if you've been paying into
a national health all your life...
Then you should get the treatment.
The Royal College of surgeons has
become increasingly concerned
about the rationing of surgery
in the NHS.
It commissioned a report which last
year showed that now nearly one
third of clinical commissioning
groups in England and one health
board in Wales now have policies
which require patients either
to lose weight or stop smoking
before they can be referred
for routine surgery.
It fears some patients are becoming
soft targets for NHS savings.
The Royal College of GPs is also
worried, saying trying
to force patients to change
will not always work.
knows smoking is bad
for us, drinking excessively is bad
for we also all know that eating too
much red meat is bad for us
and living sedentary lifestyles.
But it doesn't mean that we all
live by those rules,
and so there is a difference
between encouraging people
to make the right choices,
making it easy to live good,
healthy lifestyles, but then also
enforcing rules upon them
that they were not expecting
and in a situation where
they haven't got much control.
That is tough.
Hertfordshire clinical commissioning
group says its policies
are not about saving money,
but to improve patient safety
during nonurgent surgery.
Some argue that these strategies
are destroying the fundamental
principles of our NHS.
We're joined now
by Alastair Dickson.
He's a GP and former clinical health
adviser to Parliament.
Welcome to the programme. Just
before I come to you, the CCT in
Hertfordshire says it is not about
saving money and it is not about
rationing. If the surgery outweighs
the outcome, the patient will have
You have to separate
obesity and smoking. Smoking is a
childhood disease. I was a smoker. I
used to pick up my Father's dog ends
when I was an eight-year-old and it
took me 40 years to finally stop.
Restricting smokers and where it is
very dubious whether the risk
outweighs the benefits I think is
If someone is asked to give
up smoking and they give up smoking
and it will impact positively the
outcome, is that not the right thing
Fantastic. But as an ex
smoker myself it took me the best
part of 40 years to give up smoking.
If it was that simple, we would have
all stopped a long time ago.
Alistair, Hertfordshire says that
before being referred to surgery you
will be referred to Weight Watchers
and slimming world. Is that a good
use of NHS money?
It is in the most
circumstances. We all know that as
the film showed we should do things
to build up our own health and look
after ourselves. That should be in
the overall promotion anyway. If you
are talking about everybody and not
targeting, then one cannot question
it. But if you are looking at
someone who is struggling and they
are getting problems with arthritis
in the knees and their hips, we know
from guidelines that this should be
part of a package of care. It should
not be just thrown in at the end.
What we should be doing is working
proactively to do this. When we are
looking at surgery we should be
saying, look, it is important for
you to lose weight. We know you will
have a better chance with your knees
particularly of actually having a
safe and fulfilling operation with
good outcomes afterwards with
minimising failure if you can get
your weight down.
Hips it is not so
obvious for. Is there not also an
aspect of saving money. If you can
defer these operators, it will
improve the outcome, but it saves
money and it is a form of rationing.
Everything is a form of rationing if
looked at in the right manner. But I
agree, it could be a way of saving
money, but I am not interested in
saving money, I am interested in
patient outcomes. If we look at the
triage for primary care developed in
the North East and other parts of
the UK, we have shown that 80% or
more of people who were referred for
surgery did not need surgery and
benefited from things which were
better, including weight loss. When
you asked them, they said they did
not want surgery.
Alistair is right
around obesity and we have a
population disaster going on and we
need to tackle it at individual and
That could result
in a lot of people being denied
What Alistair is saying
is right. Your risk of dying if you
have a BMI of 37-42 is quite high,
therefore a routine operation you
are better off postponing it and
going to evidence -based treatment
and going to Weight Watchers,
absolutely 100%. My issue is with
smokers. Where do you end with
lifestyle? If I go skiing in
January, should I be denied
treatment because it is a dangerous
activity. All of these things become
insidiously put in. You are a GP and
I trust you to make the right
decision, but as time goes on and
Is it more important than you can
show that they have low carbon
monoxide in their blood, on the day
of the operation, when it does
require you to reduce significantly
the amount of cigarettes you are
taking in 448 hours before the
Doctors make decisions on
whether to refer people to surgery
every day. Doctors make those
-- for 48 hours.
have been making assessments about
weight and lifestyle forever.
now have referral management.
Doctors make that decision. There is
an additional barrier, that will
increasingly be managers who then
decide, whether or not that person
will go on to the operation.
disagree, actually, we are looking
at the need for specialist teams.
I as a GP will be referring you to
surgery, but often you need a
Will there be a
case of deserving and non-deserving
There has to be a clinical
need for patience and they will be
patients who are winners and losers
in the system. The Oregon experiment
clearly showed that in the 1990s.
There will be deserving and
non-deserving and whilst I think
there are some rationing decisions
that have to be made on clinical
grounds, it is wrong to make these
decisions purely on lifestyle.
The cabinet has been meeting this
morning for the first
time in a few weeks,
and rather a lot has happened
since they last got together.
Not only have two cabinet ministers,
Michael Fallon and Priti Patel,
been forced to leave,
but there have been fresh signs that
not everyone left behind is exactly
singing from the same hymn sheet.
Oh, to be a fly on the wall.
So are the tensions in cabinet any
worse than this lot?
# I stay out too late...
Sir Geoffrey Howe has
announced his resignation
from the government.
How do you feel this evening?
Fine, how are you?
# But I can't make him stay,
at least that's what people say.
If he wished to change his
Chancellor, it was surely right that
I should leave the Cabinet.
# Can't stop, won't
stop moving, it's like
# I've got this music in my mind
saying it's going to be all right.
It is not often the
Chancellor gets something.
At least I don't have
to worry about her
running off with
the bloke next door.
# Shake it all, shake it all...
The whole point is we had a great
agreement and the cabinet works very
If you think there is a time to go,
there is a time to go
and I want a break.
Is the coalition still working?
# Shake it all, shake it all #.
Well, to discuss how to restore
cabinet unity we're joined now
by Jonny Gifford, he's a specialist
in mediation from the
of Professional Development.
And by someone who sat
in John Major's cabinet,
which wasn't always exactly united,
the former minister David Mellor.
Welcome to both of you. David
Mellor, none of us are in the
Cabinet and none of us were dead
this morning when they met and they
are divided on a number of issues,
but that is not unusual. How would
you assess the state of Theresa
I think appalling.
I have been in politics for 50 years
and have been actively involved in
it for most of that time and have
never been so depressed about the
state of it. There is grandeur when
candidates get angry with people in
These people are pygmies.
But the fallout is the same. If we
look back at previous governments,
you mentioned Margaret thatcher and
Michael Heseltine, there were sleaze
allegations against politicians and
back to basics was ridiculed.
really any worse? It is worse today
because lots of good work was being
done by John Major. He had two good
chancellors. Norman Lamont was
unfortunate with the ERM and the
exchange rate mechanism and was
brought down by it. Ken Clarke was
an excellent Chancellor and the
British economy was handed over in
good shape to Tony Blair. I think
there was a great deal of common
effort. Whereas this lot cannot help
but squabble. They are not big
beasts and there is no discipline.
Under Mrs Thatcher if you went out
and said what you thought about
things, Bernard Ingham would descend
on you like a tonne of bricks. Even
if you thought she was wrong, you
had to keep your opinion to yourself
as I had to do on a number of
occasions. But this is anarchy,
anything goes. The cat does not have
to be away before the mice connect
to play, the cat can be around and
the mice are not afraid of it.
Imagine you were given the case that
David Miller says exists at the top
of government, what would you do?
is not an uncommon phenomenon.
sorry to hear that.
From our own
work we can see that one in four of
UK employees would identify that
they have had some kind of
interpersonal conflict given a 12
month period and that can involve
any sort of behaviours ranging from
lack of respect due to refusing to
work together or verbal abuse,
shouting, right through to threats
of actual physical abuse which are
much rare but which can still happen
in one in 100 UK workplaces.
you had Boris Johnson and Philip
Hammond call you up?
How would you bring them together?
David talked about working together,
lack of unity. I think one of the
common things in any kind of
conflict is recognising that there
are interests that prevail over
positions, so getting people to
think about what do they actually
want from a scenario rather than why
I can't work with that person, why I
cannot trust that person. And then
getting them to recognise there are
certain parameters within which we
have got to work. There are some
givens in any workplace relationship
that is going wrong.
What you have
to remember, David, is she is
looking after Brexit and Brexit is
an enormous task, is it not that
that is making it difficult?
part of it. It is the classic
hospital pass. It is appalling.
Think of our previous Prime Minister
David Cameron chill axing with lots
of money telling people not to be
Prime Minister whilst the chaos
continues. But it is the breakdown
of discipline that is the problem.
Is she up to dealing with the
I do not think she can.
Look at that lot, there are 30 of
them around the table. I was looking
at the photo. In the good old days,
permit me to say that, it was not
like that, only secretaries of State
sat in the Cabinet. Now you get
ministers of state, and all manners
of odds and bits sitting at the
table and of course they will
squabble. But they will not squabble
with any grandiloquence. When you
get people like Boris, he is
untameable unless you sack him. Can
she sack him? I do not think so. She
was going to sack Philip Hammond if
she won a majority at the election.
And she did not win a majority and
that hampers her ability to impose
It makes it impossible
for her. The trouble is that Theresa
May became Prime Minister but she
was not one of the above and there
were no real qualities she had to be
Prime Minister. Those of the above
are even less qualified now than
I am not sure she will be
calling you in to help bring the two
There's just time before we go
to find out the answer to our quiz.
The question for today
was which political relative
is headed to the jungle
for the new series of ITV's
I'm A Celebrity,
Get Me Out Of Here?
Was it a) Samantha Cameron.
b) Philip May.
c) Piers Corbyn.
or d) Stanley Johnson.
So Clare what's the correct answer?
I would imagine it is Stanley
And you are right, it is
Boris's father who is heading to the
jungle and I can imagine he will I
jungle and I can imagine
he will I get there.
That's all for today.
Thanks to our guests.
Jo Coburn is joined by Dr Clare Gerada, former chair of the Royal College of GPs, to discuss NHS funding, and ahead of parliamentary debate over the EU Withdrawal Bill, she talks Brexit with Labour's Chris Leslie and former Conservative cabinet minister Theresa Villiers.