Episode 15 The Big Questions

Today on The Big Questions - rationing on the NHS,

welfare reform, and doing good rather than doing God.

Good morning, I'm Nicky Campbell, welcome to The Big Questions.

Today we're live from Manor Church of England Academy in York.

Welcome, everybody, to The Big Questions.

This week, a leaked letter from the medical director

of the National Health Service in Yorkshire and the Humber

to Rotherham's Clinical Commissioning Group

It praised the GP-led commissioning group for what is dubbed

lifestyle rationing - in this case making dangerously

overweight patients and smokers to wait longer for hip

And it said that the NHS expected more commissioning

Around 20% of patients needing a hip or knee operation have been denied

surgery or had to wait much longer than other patients.

And very obese people in Yorkshire waiting for ?10,000 gastric band

operations or ?15,000 gastric bypasses have been put on hold, too.

Should the NHS ration according to lifestyle?

Doctor Raj, good morning. We have got a big problem on our hands here.

Absolutely. We are going to end up as a sick society. The NHS will

buckle on its knees very soon. Is there any excuse ever for putting

somebody to the back of the cute? If you give them advice on their

lifestyle and they do not heed it? Based on medical decision coming as.

I am a bariatric physician, one of very few in the country. Someone

comes to me and says they consume 40 units of alcohol week and they want

a gastric band surgery, we refuse them. The reason is as a doctor I

have to make sure he is safe and outcomes are good. Research shows if

someone consumes lots of alcohol then outcomes will be bad. They will

become alcohol addicts after the surgery so why would you subject a

patient to surgery when he will not do well. Can you see the point? I

can. If you say to a patient who was obese, you have got to lose a lot of

weight beforehand otherwise the operation will not work? Less, or

they will put the weight back on. It could be detrimental to them. They

could be alcoholics worse than they are so what is the point of pushing

someone closer to their deathbed by subjecting them to this complex

operation. Stephen, this was your situation as well, you were put to

the back of the queue. Tell us your story. What happened was I went on

to a boot camp in Sussex and I lost 11 stone in weight. In six months on

the boot camp. After that, I was promised surgery but at that

particular time I believed in exercise and diet. I always believed

in exercise and diet. The trouble is the NHS has too much weight on them

at the moment because there are lot of people who are obese going to the

NHS. It didn't work for you? You worked. I worked, I pay my national

insurance and I was a taxpayer. I went away and in six months I lost

11 stone. I got off my backside and got out there and did something. The

trouble now is I am asking someone to help me and I have been in the

media about it and they keep putting me to the back of the queue. I want

to get a job and do something, but the trouble is, every time I try and

do something, I cannot do it because people keep putting me in the queue

all the time. The trouble is, there is too much pressure going on the

NHS. The trouble is, when people read piece, -- when people are

obese, some people should get exercise and diet, and yes, some

people should get surgery. Do you get a lot of abuse from people? I

do. I travelled all the way from Plymouth yesterday. I had a lot of

beds to -- I had a lot of abuse from people. At the end of the day I know

I am doing something for myself. I know that I am a taxpayer, I could

do something and I am going to do it. I am not going to give up. That

is the point, isn't it? Let me come to, Alan Maynard. People have paid

their tax and then national insurance. People should be entitled

but there is rationing going on. The NHS will never have enough money,

will it? If people have paid their taxes and national insurance and

goodness knows what, in principle people should be treated when they

benefit from it and some people cannot benefit much from it. The

basic problem is the underfunding of the NHS. We have had parsimonious

funding since 2010 and the system is groaning and creaking and in a great

deal of difficulty. There will be a lot of cruelty in it. People will be

delayed for hips and other things. They will have to wait much longer.

That is what the government wants. It is government policy which is

leading to this rationing. Is there ever going to be enough money, ever?

Because of the ageing population and the increasing demand? The problem

with the NHS is there are finite resources and infinite demand and of

course, some of the demand comes from more complex expensive

operations which require more resources to be used. Part of the

reasons why some of these operations have been cut back is because the

money has been directed to other front-line A services and cancer

treatment. The real base issue is we will never have enough money to fund

everything for everyone. Where do we draw the line when it comes to

rationing? The problem where it comes to rationing, way to draw the

line? There are arguments that there are real medical dangers in some

places for to undergo operations. If lifestyle changes are requested,

people should go down that route. At what point do we say you had two

glasses of red wine, you cannot have an operation. I think there is a

danger in some point that we go too far and we say health fascism takes

over and we say we will not fund half the operations in this country.

On clearly defined objects, most people do believe that if your

lifestyle does lead you into a bad place, you ought to take some

responsibility for that. What Stephen was saying is sad and I

think it is ridiculous he has been refused surgery. The first thing is,

there is no standardisation in this country. The way he has been dealt

with is completely different than what I would deal with in Yorkshire.

I get references from all over the country. If someone has lost 11

stone in weight, that shows you are committed, you are engaged, so you

should be supported. So I cannot see any reason why you should not be

supported because you will cost the NHS more. I am not asking the NHS to

pay for my surgery, I am asking to pay some of it because I cannot

afford all of it. Absolutely. I really think it is madness. Where

else can this rationing fall? Some people are talking about the ageing

population, we should reduce treatment on old people. It is an

appalling thing. Some people say that. If you could argue that

someone like myself in my early 70s has had a fair innings and you begin

to divert resources away from people such as myself. There are whole lot

of ways in which you can ration. The other thing to be borne in mind, if

you ration as we are for hips and bariatric surgery, we will have idle

surgeons and idle nurses because they will not be able to use their

facilities. They will have to go home and do their knitting. It is a

most extraordinary situation that May has been created and it can only

be ameliorated by pouring more funds in. You are looking at me? Because

you made a funny face. You were grimacing. I think what Stephen has

done is very brave and come here and explain his own situation about the

methodology you are using and seems to be ridiculous that you are not

getting your operation given that you are undergoing the things you

are doing. But on the resource in point, I know what press have said,

but realistically, how much more money can we pouring? Is it 10

billion or 100 billion, seriously, how much more money is it? Kate? It

is a choice. Is it a bottomless pit? Does. No, it is not. If we want to

prioritise health, social care, public health and education, then we

will have a healthier, fitter society that it needs less acute

care and will save money in the long run. So investing in those things...

Need will not always outstrip resources given the ageing

population and the improved health treatments which means we are living

longer? We will need to spend more money with an ageing population. We

need to spend it on social care as well as health, so that we prevent

many of the problems that end up in our hospitals, with delayed

discharges and costing us more than they need to. I think the best way

to deal with this is through demand. You have a whole range of incentives

through the tax system have to try and reduce

demand for things which are doing people harm. You already have

significant taxes on cigarettes. We are debating the sugar tax right

now. If you saw it happen and it was effective, of course you would want

to roll it out. Should those funds be ring-fenced for the NHS? The

taxon fizzy drinks, for example. Working the tax on cigarettes to

make them more expensive, these are taxes on the poor, aren't they? They

do not need to be ring-fenced. You are improving people boss of health

later on, you are doing them a favour. Whether people necessarily

realise that! I think it is morally wrong to discriminate against people

on the basis of their lifestyle. We are talking about taxes. Smokers

contribute ?12 billion a year in tobacco taxation. That far outweighs

the alleged cost of treating smoking-related

diseases. And disproportionately people who smoke pay earlier say we

do not have to pay your pension is! That are statistically and actual

fact. The point is it is cruel not to give people operations. Many of

these operations have nothing to do with smoking. They are hip

replacements or knee replacements. People in massive physical pain.

Sometimes they cannot even move. To be told you cannot have an operation

unless you give up smoking is absolutely ridiculous. You deter

people waiting longer for operations overall. And the thing is while they

are waiting based on need medication and physiotherapy so they are still

costing the state a lot of money. There is an argument that if you

want that toxins into your body as a smoker, why should we pay for that?

To make the point that you are a net gain. No smoke or should feel any

guilt whatsoever for smoking because they make a massive contribution to

the welfare state in this country, and the NHS would actually struggle

without the tobacco taxes that smokers contribute. Do you say

smokers thank you? It cost the NHS because there is chemotherapy,

before they die, because there is cancer, chronic obstructive lung

disease, asthma, that cost the NHS a huge amount of money. It will kill

100,000 people a year. It is a real bargain! They are called cancer

sticks. I'm sorry, tobacco is a legal product. Smokers should not

feel guilty. It is a freedom of choice. I know a lot of people in

this country do not believe in freedom of choice but a great many

people do and that is why we are fighting on behalf of people who

smoke. I do not smoke. I am overweight. I know I need to lose

weight. It is not for the government to force me to use weight because of

sugar taxes. If there is not some sort of judgment made on lifestyle,

the argument is we all have to wait longer? I do not accept that. I

think the CCG blanket ban is totally wrong, it is unethical. What I have

missed so far in this debate is the cost benefit. I am talking diabetes.

It died diabetic -- is a diabetic type two person has bariatric

surgery, within days the diabetes disappears and we are spending ten

billion pounds a year on diabetic treatment, that is the cost surgery.

The surgery may cost ten ?50,000 up front, the nation as a whole will

benefit within two or three years in the savings that it has as a result

of no medications for diabetes. That is hugely important. You also have

to remember that one in five hospital beds are blocked by people

in hospital for diabetes who should not be there and this would be one

of the ways in which you could free up beds as well. By pouring more

money in, you would free up money. I just believe we cannot keep paying

?10,000 ?50,000 for gastric surgery. It has got to come to stop sometime

and I think in a minute, the NHS will go bankrupt. And I can tell you

that because we are putting too much pressure on the NHS. One thing you

have got to remember is progress. Raj will be able to say in the old

days, even ten years ago, bariatric surgery used to cost a lot of money.

But now new ways of balloon surgery, it will cost far, far less, but

still the returns will be there and therefore in the end, the country

will benefit by not having 3 million diabetic type to people.

The lady with a blonde hair, rationing? The food and drinks

industry needs addressing, there is some responsibility therefore super

sizing things. APPLAUSE

Those massive bottles, those massive deals.

Google giant cappuccinos that you could swim in. But people have a

choice not to drink these things. We can make up our own minds.

APPLAUSE I fancy a giant cappuccino!

Lots of people that are suffering from these physical problems and

look like they are self-destructing also have mental health problems. It

is easy from the outside to say that they should stop but we do not know

how easy that is. Mental health services are possibly more in

trouble and physical health services, the problem will continue.

Poverty is a driver? If we start thinking that lifestyle is simply a

matter of individual choice, we can get into trouble. There are

questions about access to support, access to healthy food, it is not

just managing demand on the unhealthy food but it is about the

availability of healthy lifestyle support at early stages. It is

partly about investment but also how we distribute that, who has got the

choice to lead a healthy lifestyle? It ends at being discrimination

related to property as well as discrimination related to choices

that people have made. More hands are going up in the audience.

Lifestyle choice is not necessarily a choice, because with benefits

people are being pushed, and low wages, pushed into food banks where

you are most likely going to get processed food, which is not good

for you, you will not get healthy food from a food bank so you are

creating another up swell of health problems. We will segue into that

debate shortly. I think one thing to potentially

tackle a second time offenders. After someone has had surgery for

the first time, potentially create some sort of contract which if they

preach that, for instance if they smoke and they suffer recurring

health problems, say that you had to pay for it now because you have

broken the contract and you had to suffer the consequences. What if you

have a skiing accident? No more skiing holidays? It is the same

thing. As a skier myself, if I suffered a serious accident, for

instance if I broke my leg, if I was skiing again I would know the risks

and I would take those precautions to make sure it would not happen. I

would not skiing off piste, I would not ski slopes that are too hard for

me. He is looking very off piste about this and cremation Marco you

would still want to ski and you might have an accident, are you

suggesting you should not be treated by the NHS because you break your

leg on a second occasion?! Is people choose to lead a destructive

lifestyle than they should suffer the consequences, I agree. What is a

destructive lifestyle? Drinking too much, smoking too much,

fornicating... Not fornicating! But the whole point I would like to make

is the NHS is short of money and we are spending ?12 billion a year on

foreign aid. Let's give that to the NHS for us. Now you are off piste!

What do you think, Dan Hitchens? Clearly there are issues around

funding which might have to involve rationing. Might have to? I was

struck by a BMA spokesman that said that targeting smoking and obesity

can look like targeting the poorest, and often in ways that look like

bureaucratic bullying. We need to be careful about how we do this. Lots

of health issues are stress-related, if somebody takes is stressful job,

should we refuse to treat them on that basis? Both stressful being on

a waiting list for a long time. The problem with the rationing is that

the clinical commissioning groups have no choice because of the

funding issues, they are doing things they do not particularly want

to do which are in breach of good practice, but they have to debate of

the funding. Unless you deal with the fundamental funding issue of the

choices you have to make between different sectors, we will get

nowhere. But rationing is likely to get worse, particularly with waiting

times, which will expand. If you slow down the activity by rationing,

you have unemployed doctors and nurses, which seems to be

extraordinary when you have people in pain and in distress. Thank you

very much. The next debate is on the way. Robert Beeson issues that came

up that will come up again. Stephen, thank you for taking the trouble to

come on The Big Questions this broke... Morning. -- to come on The

Big Questions this morning. If you have something

to say about that debate, log on to bbc.co.uk/thebigquestions,

where you'll find links to join We're also debating live

this morning from York, And are actions more

important than beliefs? So, get tweeting or emailing

on those topics now or send us This week a report

by the Trussell Trust, an anti-poverty charity motivated

by Christian principles, raised the alarm over how welfare

reform has been affecting Over the last year, over 400

Trussell Trust foodbanks have given out 1,182,954 emergency

food supply parcels. And 37% of these went

to feed children. 43% of all referrals

to Trussell Trust food banks - made by professionals such as social

workers, health visitors or schools liaison officers -

were because state benefits had And in areas where the new Universal

Credit is being tried out there's been a 17% rise in referrals

for emergency food. Some families are having to wait

over six weeks for their first Universal Credit payment,

and the Trussell Trust reports these longer waits have led

to problems with debt, rent arrears, evictions

and mental health issues. A from the aforementioned Trussell

Trust, what is concerning you about Welfare Reform Bill? It is deeply

concerning that Trussell Trust food banks in the last 12 months have

provided just shy of 1.3 million days worth of food supplies to

people in crisis, this is in 2017 in the UK. That is 1.2 million to many,

in our opinion. We should not need food banks, around 40% of people

referred to food banks because of problems with benefit payments, that

could be a delay to their benefit claim being processed. We have

looked specifically at Universal Credit, which is the new, simpler

benefit system that people are entitled to apply for and will be

moving onto, and in those areas of the country where Universal Credit

has been rolled out, in some cases there has been a threefold increase

more in terms of referrals for emergency food... Let me stop you on

Universal Credit, Deven Ghelani, you were at Iain Duncan Smith's Centre

for Social Justice and one of the architects for Universal Credit,

right? Over to you. I worked on this policy. When you ask if welfare

reform is working, you are asking if you are moving from a less good

system to a better one than you have currently. That has to be true.

Right now there are three agencies and the benefit system administering

the whole range of benefits which each have their own rules. That is

an incredibly complicated position for people to be in and it is

difficult for them to see what happens when they make different

decisions like moving into work. The aim of Universal Credit is to

simplify the system and support people into work. These are very

serious transitional issues that we are talking about, I am not trying

to reduce their impact at all. Are these problems inevitable? If you're

going to grasp the nettle of changing the system as large as the

benefit system no... People have got used to how it works now, that

doesn't mean it is right but they have got used to it. What you are

saying sounds very clinical, people are getting into debt, mental health

issues are coming along and you seem to be saying... Some people might

interpret it as saying let you have to crack a few eggs to make an

omelette. People are really suffering. I am acknowledging that

there will have to be changed. Some of the work that Trussell Trust

doesn't terms of supporting people is good, the Government has to do an

awful lot more in terms of supporting people through the

six-week transition period. But this has been going on for seven years,

since 2010. It has been a very slow roll-out, only now are larger groups

of people being moved on to Universal Credit and some of the

challenges are coming to the fore. Food banks are often the barometer

where we see some of the impact of changes. In food banks we are seeing

badgering the six-week delay, built into the system because Universal

Credit is paid in arrears whereas the previous benefits once, people

are going into debt in order to maintain household bills. Many

people relying on benefits or maybe even surviving on a low household

income who are in work have very little savings to get them through a

period of six weeks. For many others, if our expected wages were

going to be delayed for six weeks, there would be a whole range of

people that would struggle. If somebody gets into debt than that

creates problems for the household finances well beyond the six weeks.

APPLAUSE Welfare reform is a pretty popular

policy, Kate. It should not be. We will get onto

that. How would you design a system where you would not have a better

standard of living on welfare than in work? First, I want to say if I

were the architect of Universal Credit and responsible for some of

these welfare reforms, I would not be sleeping at night. We should not

be relying on charities to prop up the Social Security system. That is

an opinion. Now I will speak as a scientist. As a consequence of

welfare reform, we are seeing rising child poverty, soon won in all of

our children will be living in poverty. Two thirds of them in

houses where somebody works. We are seeing rising infant mortality for

the first time in decades. -- soon one in four of children will be

living in poverty. Speaking as a citizen, I think we should be

outraged at the morality of those reforms, we should be piling up the

body bags and those tiny infant cough and outside number ten and

number 11 Downing Street and making the Prime Minister and Chancellor

walk back and it every day -- we should be piling up those tiny

infant coffins. We are punishing the poorest, the disabled, the sick, we

are doing it at levels unseen of in this country since the end of the

Second World War. We should be ashamed of what we are doing.

APPLAUSE You had to break-out two separate

issues, one is changing how the system works and the second is how

much money, and there are separate debates about how much money you put

into the system, which is fundamentally what you are talking

about. We have a general election coming up

in a few weeks, Welfare Reform Bill see is that effectively take money

out of the system are incredibly popular. -- welfare reform policies.

People do not know about the damage they are doing because this is a

six-hour only just starting to show up. There is a fly. Those deaths can

be counted and are starting to be counted. Why do people have an idea

that it is not there at the moment and we wanted to be fair and we want

the situation to arise whereby... Because they are sold a pup about

the idea that people on benefits are shirkers, do not work. The majority

of people on benefits will be net contributed over their lifetime. If

you are a decent society you look after the poor, the sick and the

disabled until they are able to contribute, and if they can, you

look after them always. You do not punish them for their situations. If

you want to craft a new system with good intentions, that is great, but

you must look at the unintended consequences. You have to look at

the consequences of the current system. We are talking about change

and welfare reform, that is a huge issue. It is easy to forget that the

current system drives some of these similar outcomes that the Trussell

Trust is talking about, largely driven by cuts in the amount we

spend on welfare. The drivers beyond why people go to them has not

changed massively. Is your drive ensuring that people have a better

standard of living in work than on benefits? Is that your gold standard

driver? You need a simpler system where people can see that will be a

good and positive change, secondly that they are better off and will be

financially better off. It is fantastic to get people into work,

but not if it is precarious, low paid, zero I was contract. You need

a system where work capability assessments do not drive 600

suicides and ten people like Stephen away from the kind of employment he

would like to do. -- and drive people like Stephen away. I have

tremendous respect for the Trussell Trust, we wish it was less needed,

but everybody accepts that when you look at the welfare reform issue, to

be in work is better than to not speak because it leads to a higher

standard living and better sense going forward. We want people who

can work to be in work. Yes, there are clear problems that have been

highlighted in the implementation of the new scheme, but we see record on

climate rates, the highest on record since 1971. What kind of jobs they

are?! That people want to do. People want to do that because they accept

that if you can work you should and it is better to work. Lots of people

on Universal Credit are working. But they do not earn enough. I want to

go to the audience. I think it is very telling that when

you describe what the two debates were, one of the debates that was

not really happening is how this policy is essentially taking away

the minimum living standards that people have. You cannot force people

into work by just forcing them into extreme poverty. And also, when we

are having these kind of debates, we need to remember that we are not

simply talking about growth in jobs and so on. Most people in those jobs

as well on zero our contracts, often in poverty as well, so I think we

totally need to change the tone of the debate we are having around

this. In the back row? I work for a Christian homeless charity called

Restore which works alongside the food bank and works with Christians

against poverty. We aim to get people into employment, we give them

an address, we help them into their own accommodation at one of the

barriers we have is the Department for Work and Pensions because their

administration is terrible. You have a number for an enquiry line for

summer day with no money to ring that isn't free. You are on hold for

20 minutes. You are trying to get somebody in their own accommodation

and then they are hit with a loan they have to pay back or an

overpayment that they have to pay back and that has been set with the

Department for Work and Pensions. Yes, you're trying to get people

back to work but you shoot yourselves in the foot every single

time. Guess, in the grey jumper? I think the welfare issue you are

talking about is people making these decisions on behalf of the people

are those who have never experienced what the most vulnerable are

experiencing now? Is that the case, May? No, I got into reforming

welfare after being on benefits myself. I found it a hugely

complicated confusing mess, for Sunday he was good at navigating

these things. It is not true to say that the people on the front line do

not know about the real-life experience. One of the biggest

challenges is when you are developing policy and one of the

things we trying to now, is to make sure the experience of indentation

gets up to that policy level some of the challenges, the administration

challenges the DWP face, how to solve them and overcome them? It has

been a failure? No, I think it is a huge challenge and it is a huge

failing in the current system as well. We need to have a system in

place where you can look at a screen and see a person's circumstances and

note that person is entitled to this, that person needs that,

instead of second guessing and then saying, I made a mistake, I will

charge that person with an overpayment because it is not DWP's

fault, it is the person's fault because

they did not give the right information, apparently. I would

agree with that. Rachel, you wanted to come in earlier on. There is a

case about whose lives matter and whose experiences matter. I am

concerned that a system which has been designed with the best of

intentions but the lives of poor children and people with

disabilities are being treated as the unintended consequences that we

will sort out later of this great policy which will make everything

work fine. Who do we really expect? To some people's lives matter more

than others? Why are we not going first to the question how will this

change affect on a day-to-day basis right now the

lives of poor children? The people who have the least voice, the least

visibility and cannot even vote yet? That should be the starting point.

It would not be a bad place to start. We might find things get

better. Stephen, how do your benefits work? Are you happy with

the situation? Not at all. It comes round fortnightly and then I get a

lump some from the DNA, it is now called Pip. I would say give Theresa

May food bank about char and see how she feels about it. And also, I had

so many food bank vouchers from the Trussell Trust and I think they did

a wonderful job. If it was not for them, I would not be here today. I

am grateful for my benefits, but I regret it that I have got to get

benefits to live on, do you know what I mean? Because I do like it. I

want to get a job, I want to lose weight and get a job. Who supports

these benefit changes? You look at the polls, they are popular, who

will put the hand up and say they're a good thing and we are moving in

the right direction here? Nobody. Yes? I think it should be work that

pays better than benefits. It is as simple as that. It is the direction

of travel. Let's go to Adrian. The Trussell Trust does believe that the

benefits system does need to be reformed. Historically, as you

mentioned earlier, from 2004 when we first started our food bank network

in the UK, historically, benefit issues have always been the problem.

However, what really concerns us is the fact that there are a number of

more people experiencing a problem because of the six-week delay with

Universal Credit roll out, and it is only beginning to be rolled out

across the country. What really concerns us is as some of these

reforms have been implemented, we are seeing first-hand some of the

impacts of things which are not going well. We are heartened by the

fact that Damian Green in the Department for Work and Pensions

have opened their door to us, we are talking about some of the things we

have seen on the front line. Is it an improvement on Iain Duncan

Smith? We believe there could be some easy changes which make a

difference. We believe the six-week delay could be looked at and

reduced. More information is needed for people who move onto this. There

is local support available for people but they are aware of it as

they are transferring onto Universal Credit. Isn't that bad point of what

this stage roll-out is to find out what the major problems are. It is

interesting to see the government's response. Damian Green has looked at

changing work capability assessments. There is room within

the prism of the necessary reforms for the system to look at how they

are working and that is why they staged process is important. It has

taken seven years. You are replacing six sets of benefits. It is a system

so gargantuan that someone like May could not get through it when he was

on it. The issue is one of simplicity. You need to get to the

point of simplicity, understanding and making sure it does work. --

someone like May could not get through it. One is the need for

reform and the second one is resources. We need to put more

resources in for the poor. If you want to discriminate against the

poor, damage their health consequences, you will have an

enormously horrible society in the future. We need to invest in the

young. But if any political party says they are going to put up taxes

they get the whole tax bombshell thing and a whole lot of bad stuff

is thrown at them. We can overcome it. You can tax me more. Please tax

me more! I am a higher rate taxpayer, I would love to be taxed

more. Who would like to be taxed more? Who doesn't. Why don't you

want to be taxed more, name at macro? Running a system is very

complicated. This has been a huge feet so I run policy and practice

right now. It is to have building an organisation from scratch. I am

thinking business taxes here rather than personal taxes. You want to

encourage people at work and entrepreneurship. And putting up

taxes would discourage that? It certainly makes it harder. Yes? It

is very disempowering, the whole process. If you are trying to deal

with any part of the welfare system, trying to find out what your rights

are, to find out and get access, the description from the guy at the

back, trying to get on the phone, spending 20 minutes on a payphone,

the people who are putting this position are those who find it

hardest to express the situation are facing. Sometimes I feel the

situation is intentionally set up that way to stop people accessing

things they need the right to. I am happy to play more -- pay more taxes

that I do not trust politicians to put it in the right place. I would

like it to be earmarked for world their services. A short port to

concentrate the minds of those watching, to sort the NHS out, how

much would taxes have to go up by? It depends what choices you want to

make. You will have to spend more and there is no reason why you

can't. A lot of taxes have gone down. Inheriting stacks, corporation

tax, and a lot of us who are on income tax and National Insurance

would be prepared to pay more. Incrementally, if you want to put

another five or 10% in, particularly for the NHS. We say we would be

prepared to pay more in a situation like this. People are on sensually

-- people are essentially un-willing to pay tax. If you want to be a

citizen in this country you have to pay for the public services and for

the last six years we have not been paying for public services and you

can see the decay in the welfare system and the roads. If we vote for

the Tories to go in again to continue that, we are very strange

society which has damaged itself. You may say that. We will be

balancing those comments on this programming the next six weeks.

Thank you very much. You can join in all this

morning's debates by logging on to bbc.co.uk/thebigquestions,

then follow the link Or you can tweet using

the hashtag #bbctbq. Tell us what you think

about our last Big Question too - are actions more

important than beliefs? And if you'd like to be

in the audience at a future show, We're in Salford on May

14th for two programmes, the usual live programme

in the morning, and we're recording a special

on globalisation in the afternoon. And we're in London on May 28th,

again for two shows, the afternoon edition

being a special on Friday was the seventh

"Pay it Forward Day", inspired by the film of the same

name in which a young boy does three good turns for strangers

in need but on condition that they It's like a rolling version

of the Good Samaritan. And this year, the organisers

are hoping to inspire over 10 million acts of kindness

in over 75 countries. But some religions put more emphasis

and offer hopes of salvation based on what you believe,

whether you pray or take part in the sacraments,

rather than whether your deeds Are actions more

important than beliefs? I am delighted to welcome you, Mark,

Mark Cosens, from the church of Jesus and the latter-day Saints, the

Mormons. You believe it is very important to convert people, to get

people into your belief system. I am fascinated, even those who are dead,

a sort of retro act of conversion so that they can enter the kingdom of

heaven. Clearly, for you, it is what you can believe. An atheist can do

wonderful things, save lots of people, but if they are not a

Mormon... That is a common misconception, thank you very much

for giving me the opportunity to clarify that! I love to stand

corrected. I am a member of that church. I do not speak for the whole

church but I can share my understanding. So, belief and faith

very important. What we do matters. We all have free choice, free will,

and the way that we honour that and the sacrifices as a Christian, the

sacrifice and grace, is very important in this life and also the

life to come. Why do you spend so much time converting the dead? We

believe that everybody is alive in some sense, we are all spiritual

sons and daughters of God and everyone has the choice in this life

or the next life to receive the information they need, to make

choices about eternity. That seems to be saying to people, if you are

not a Mormon, no access to the kingdom of heaven. Some Jewish

people were extremely offended that you spent so much time converting

people who had died. Does that not tell us that it is what you believe

and what you adhere to rather than what you do? It is largely about

family. If we are wanting to live with God one day forever, to be with

the father who loves us forever, and family, then that is the highest

blessing, we believe. But there are other ways in which there is

contingency for all circumstances. So we have a Father in heaven who

loves us, and Jesus Christ who made it possible for us all to be saved,

that is everybody, to a degree. And then we believe there are benefits

and blessings which come to us in this life and the next, according to

the choices we make, and more importantly the people who we

become. Are there people in heaven who are not Mormons? It depends on

which degree of heaven you are talking about.

Rachel, Christian studies at the University of Leeds, it is it

essential to Christian theology, is it what you believe what you do? It

is a difficult opposition. Think about the idea of worship, that is

about what you trust in, Christian faith, at least, is much closer to

trust than a list of propositions on which she signed up to take the box

in. What do you trust, what is at the centre about you, what gives you

value, what do you shape your life around? It will affect what say

about things, it will affect what you do both in terms of prior, which

is something you do, and in terms of action in relation to other people.

Christians, their ultimate centre of value that they shape their lives

around is the story of a homeless, politically, socially and

marginalised victim of a miscarriage of justice and state violence. Name

names! There are lots of very interesting questions that you might

want to ask somebody who says there are -- says they are a follower of

Jesus Christ, both in relation to what they say and what they believe.

The other key point about faith, in Christian theology, this is the idea

that the goodness of God is primary and the goodness of people is

secondary. The goodness of people matters, but the point is not... The

point of religion is not that I am good, it is that God is good. This

would be a fairly standard way of presenting Christian theology. But

what you do for other people is surely more important than what box

you tick? Yes, but... I love theologians, yes, but. But the core

thing is what is the centre of value, what do you worship, what

makes you tick? It is not just actions, it is relationships,

feelings, how you see the world, how you perceive other people, human

nature. If you like, that radiates out into both beliefs and actions.

It is where life is centred. Dan Hitchens, if I may, Catholic, of

course. I think it is 40% of the SS were confessing Catholics. Do they

have more of a chance, so long as they have a deathbed confession

about all the bad stuff they did, more of a chance of getting eternal

life than the people they killed? That is a terrible thing to off

their relationship with God and give that all up. God is fire in that God

offers a relationship to absolutely everybody, it does not matter if you

are good, nice and respectable or a bad person. And if you turn your

back? That is the worst thing that can happen. Sur Nicholas Windsor, an

incredible man, he saved all of those Jewish children and decadent

-- dedicated his life to saving lives, even talking about it he was

amazing, he was an atheist, he turned his back on God, he lost his

faith, and you are saying that is terrible? We can never give up hope

for anyone. Christianity is offered... You are saying he will

not be in heaven, if there is one? The Catholic Church has said that

some people are in heaven, it has never said of anyone that they are

not, there is always hope and mercy of that. Judaism does not start from

this. Address what we were discussing? I am not terribly

concerned about what happens in the afterlife, because I just don't

know. Judaism is concerned about what we do today. I want to address

the principle of simply you abandoned his face... I will be with

you in a minute before we talk about Judaism, you went straight into your

speech about Judaism, you grimaced. I have no God. But it does not

prevent me being a member of society and doing everything I can to

improve the lot of my fellow beings. APPLAUSE

Judaism? I completely agree with that. For

some people, says helps them to do good things, and that is the point.

For Judaism we say it is founded on three things, prayer, learning and

good deeds. We look at the bits of the Bible where it talks about

justice, Justice shall you do. You can do good things without faith?

Competently. Absolutely. Judaism doesn't actually regard you as

needing to be Jewish to be a good person. We are not concerned about

the afterlife, you don't need to be Jewish to be a good person.

Nevertheless, for some people, their faith, their religion is what tells

them to do good deeds. Despite the conversation you had with Mark, I

know yesterday he was out planting trees in the local community because

that is a good deed that needs doing, he is inspired by his faith,

just as I am inspired by mine to be involved in mitzvah Day, energy

which date where we try to make a difference to the community, we give

up time and money to collect food for the food bank or to help tidy up

the garden of the homeless shelter. But hopefully you would do that if

you were an atheist? For some people, that is enough. For others,

the motivation, the challenge comes from my face. Is that self interest

because you want to get through the pearly gates? For some people, but

not in a Jewish context. As far as Judaism, the question we ask

ourselves is what can I do to live the good life? And I cannot do that

simply through prior and learning, it has to involves good deeds. What

about a monkey on his monastery, never out of his cell? I will not

answer for him. Who leads a good life? Nobody?! The lady in the back

row? The two different ways that you phrase the question of very

interesting. One says is it about good deeds versus belief, and one

version said is it about good deeds versus worship? I think everybody

has to look at their motives for doing good deeds, because in

everybody's life there comes the moment where you think this homeless

guy is not grateful for what I am doing for him, why am I doing it?

Whether you are an atheist or a humanist or a Zen Buddhist, whoever

you are, there is something in you telling you why you are doing that,

and at times you had to find that. My own experience, if we look at the

worship, people expressing a religious faith, in a power greater

than themselves -- than themselves, whether the Christian God or another

God, most of the people I see in Church three times a week also the

people helping the homeless three times a week. The more religious

people genuinely are, the more they seem to get engaged with their

fellow human beings and to the nitty-gritty of helping each other.

Discuss. That was a fascinating moment that you ask who he feels

they lead a good life? People in this room do amazing things, working

for the Trussell Trust, I am sure there are others doing incredible

things, nobody can really say they read a good life, that is the

Christian claim that however many good things you do, you can do all

the most wonderful things but we need something more... But those

people have a humanistic philosophy and want to make the world a better

place but they do not believe in the sky fairy, as they put it, they

would find that extremely offensive that you have to have God to be able

to do good. Who would like to express a view en masse? I don't

need is a mythical creature in the sky to tell me how to good things.

APPLAUSE I don't believe it will happen

anyway. It would be even better if you did?! I think this is the only

chance we get, we will not have a second chance, let's do good things

now and not bother about somebody up there telling us what is right and

what is wrong. In the maroon top? I think that is maroon. I think so! I

personally find that my religion encourages me to be a good person,

but I would never force my opinion on anyone. I believe strongly that

regardless of beliefs, it is an individual responsibility to be a

good and kind person and monks are society. I think that is the most

important thing amongst all of us. -- be a good and kind person amongst

our society. Empathy predates religion. Rachel? It is interesting

that nobody was prepared to put their hands up and say they were a

good person. They are hiding their lights under bushels. The point I

was trying to make is that one very simple expression of the Christian

gospel is it does not matter, God lives you anyway. It is not that you

need to believe and that will help you to be good, it is more baseline

than that. You are loved, you matter, you deserve respect, you are

worthy whatever, yeah? Whether you are living a good life or not. It

comes back to what I said earlier, it is about the sort of society that

we are, are we prepared to look at everyone and say, yes, you matter?

Are we prepared to have welfare and health policies and interactions in

political advice which will say that to everybody. You are a Quaker, you

would be against a military budget, for example? Yes. You would want to

plough that money, the weaponry that we sell and the military budget,

back into welfare and so forth? Yes. But I am also saying that just

because... Being a Quaker house to do with being turned towards

nonviolence, being called into a path of nonviolence. It does not

mean knowing where that will take me and it does not mean being able to

impose it on anyone. The good thing about nonviolence, by definition you

cannot force anybody else to do it. This is the path I walk. I see that

in a lot of things that are the people say. Life is a test, nobody

should force anybody to believe or do anything... Unless they are dead!

That is very funny... That is what you do! We don't. Nobody is forced

to do anything, dead or alive. We have choice always. If we want to be

with our families, there needs to be away we are unified. I do believe in

God, but what I believe in is that when you die, you get judged, when

the time comes, you get judged. When you die... You either go to heaven

or hell, that is what I believe. But what I do believe in... When you

become a Christian you believe in giving to the needy, the poor,

living a different life to what you are reading before. My life was

really nasty and bad, but now I am trying to lead a life... Your faith

has helped you? Then, that is the thing, people believing that their

belief leads them to be good? 20 seconds. Whatever the basis for

people acting to do good, whether religion or not, it does not really

matter. What I would say is that for a lot of people, religion is what

gets them there. If we look back, it is in the Ten Commandments, the

morale to that religion gives us. Religion can make you very, very bad

as well. Absolutely, but religion has a bad rap. Thank you.

As always, the debates will continue online and on Twitter.

We're back from York next Sunday for a special on humanitarianism,

Thank you for watching. Thank you very much indeed.

APPLAUSE