Hello and welcome back to Last Orders. I'm Tom Slater, editor of spiked, joined by my co-host from the IA Chris Noden. How you doing Chris? I'm not too bad thanks Tom. Thanks for asking and of course, hello listeners. Absolutely. And also a big hello, a big welcome back to the show to Rob Lines from the Academy of Ideas. How you doing Rob?
I'm very well. Tom, thank you very much. So let's kick things off Chris. We're one of the stories that you've picked out, which is about some Tony Blair's ideas for the health service.
And I also want to talk about physicians associates, but let's focus on Blair for the minute because in these reading the room in brilliant style suggesting that if anything we've got too many GPs and that the answer to the issue of primary care in particular is to make more and more people go through fewer and fewer services and also for AI and chat bots to pick up some of the slack. Chris, do you want to tell us a bit more about this particular unpublished but leaked report
that has been doing the rounds a bit? Yeah, so Tony Blair has been suggesting that we use a lot more AI in healthcare and I haven't looked into his proposal on any length, but the important point is this should mean doctors being made redundant. And my long term plan for the NHS is to have every senior doctor and GP sacked and working in my salt lines and picking fruit, which is where I
believe they belong and that might wipe the arrogant snuggle for the faces. No, this is not necessarily popular idea with the British and local association, but anything that moves us a bit towards that point, I think is a good thing. In my opinion, GPs are only, they're any chat bots anyway a lot of the time. I mean, diagnosing something is clearly something a computer can do because you're just literally
crossing things out by process elimination, ideal for a robot. If Tony Blair hasn't called this thing chat GP and he's missed a trick, I think. But yeah, as I didn't bottle it into details, just like winding up doctors with this kind of thing. Obviously the doctors hated the idea. They immediately started going on about one of the people who donated money to the Tony Blair Institute who is doing AI. They probably started saying that this kind of was the privatising NHS at the time. They say
and that the data isn't safe in his hands. Tony Blair is kind of obsessed with collecting data. But to be fair, the health service is a different thing than he's a bad thing. I don't think there's very much joined up thinking when it comes to, you know, there's nobody constantly who's caring or so computers can help. At least remember who you are and what's long we hear, the other thing that would be a bad thing. So yeah, doctors are, yeah, they hate it because any attempt to
lighten their load, they see as a threat. They'll always say, oh, we're overworked to be doing too much low level stuff. But if someone comes in with an idea like that, more indeed, position, the social instruments would come onto. They can, they're thinking and talk about, well, the NHS has been privatised. Yeah, essentially, they they see quite rightly that this is a threat to
their job prospects for incomes in the long term. Rob, just to kick it to you for a second, what in pursuit of the country view, I suppose, can you not understand what people might be concerned about this plan? Not least because people are really feeling that they're not getting the kind of care that they want at the moment anyway. And on top of that, what Blair is talking about reportedly is going from primary care networks looking after like 30 to 50,000 people to actually,
they should look after about quarter of a million each. So you can understand what people would be concerned about. They surely a chatbot can't fill the gap in the way that Chris is suggesting.
Well, I mean, my recent experiences of chatbots, and certainly that's that is the case. Although the image in my head that I've got when Chris was talking was of primary care centres being replaced with lots of medical self-checkouts where you would just go in scan your, your, the chip that they've embedded into your arm and then just type in your symptoms like you're choosing bank to good on a supermarket check out. I mean, I think that AI at the moment is nowhere near good enough to
to sort of process what what people need from a medical diagnosis. But they could be could be used in by someone with a modicum of training to talk to you and actually come up with a better diagnosis or to point you in the right direction for things. I mean, essentially at this point in time seeing anybody or indeed anything in the NHS would be a step forward. I've lived in leaving here in five for three years and I don't think I managed to see a GP. I barely see the
dentist. So anything that would be a step forward, probably the physician's associate's idea or having non-GPs to see you in primary care is probably more of a goer at the moment and there are many advantages to it. But you know, I'm getting ahead of myself. And Chris, unless there's anything more you want to say on chat GP as you've memorably dubbed it. Well, all I would say is that it's very common for GPs and doctors in general to literally Google your symptoms now.
So the idea that we can't teach some sort of AI program to do exactly the same thing, I think, is is a bit of a far-fetched. The bloody 111 service or whatever it's called. I mean, we should say again it's supposed to like the load is completely useless because they just have a go at googling it but they're not confident enough to make diagnosis. So this they go to the GP. We can close that down quite happily and replace GPs with walk-in centres. You know, I like the idea of having a family
doctor. In an idea world you'd have a family doctor who sees you and your family for decades and then passes it on to another doctor and you get continues to get. But unfortunately, GPs have decided they don't want to provide that. Most GPs work part-time. Qt number of GPs are low coms. So you don't have a family doctor anymore. You don't have a constant due to care. So they wear our own living. I think my most people live. So if we're not
going to have that, then what's the fight on the GP? You might as well as have walk-in centres because you're going to see somebody different every time anyway. So get rid of the GPs as I will walk-in centre and yeah, a lot of it can be self-service check out. I'm concerned if you just want to get some, you know, repeat prescription, isn't it? I think that's correct. Increasingly dystopian vision. Should we talk about physicians associates a bit more,
unless there's anything more that you want to add there, Rob. Just because Rob just referenced it and also know that you've written something for the critic recently, Chris, about the kind of campaign against these physicians associates, you'll explain what they are and also why there's so much hostility to their existence from the existing kind of medical establishment. Yes, I've never heard of what I think it's about a year ago. I don't think probably most people
have. They've been working in the NHS since 2003, totally without any kind of controversy. There's not actually that many of them. There's only about 4,000 physician associates in the NHS as opposed to about 190,000 doctors and what indeed total NHS workforce and I think 1.3 million people now terribly understaffed the NHS. So they were just brought in, just as one of many auxiliary staff, you know, no different to nurse prescribers, which I mean were briefly controversial.
No, really, not really different to nurses to be honest with you, you know, I mean, there are people who are differently qualified than the NHS in its horses. Of course, you have associate and as well, and as well, why have you answered the goody thing? Yeah, but as you have auxiliary staff, its horses, of course, is not ever been used to be a fully trained doctor to deal with people who come through the door, obviously. And the less qualified they
are, the less they get paid, therefore, the more affordable they are. You can afford three PAs for our physician's associates for one locom GPs, certainly. And there's been a bit of a fewer rubat than whipped up entirely by the doctors and particularly the hardline doctors who now run the British Medical Association. So take over the BMA to 2022, kind of a core benign, you know,
entry isn't from a group called itself the doctors' votes. And they initially got their people on the board by saying we're going to stiffen the BMA's resolve, river gusts and the strikes. But they are also really gunning for a physician's associates because they see them as a threat. Again, it might be AI2, they're pribunge and and status and income. And so even as there's not many of these people working the NHS, the plan is to expand the role a bit and expand other roles.
And they're not just after the PAs, they don't want to gun for all these up and what they consider to be kind of low level, less qualified people. In order that, the government employs more consultants, more GPs and more junior doctors. And this is not good for the general public who just want to see somebody and are quite happy to see somebody like a PAA, my daughter, my daughter, PAA, they're afraid of minor things. No problem at all, exactly the kind of thing
that PAs should be, therefore. There has been a couple of legitimate concerns with regards to the concern that people may be mistaking PAs, foreign doctors or the PAs are kind of masquerading as doctors. That's the kind of stuff you can assault with general regulation. That's not what the VMA are after. The VMA wants to get rid of these people completely, they're called for a hot
or PAA recruitment. PAs are already literally booted out of their jobs. It's been an unbelievably ambitious campaign, like a lot of weird subcultures on Twitter, you don't realise it exists until you poke it one day. I poked it the other day a couple months ago. And it's just got a whole down like five days of constant attacks. I've written this piece from the critic knowing for well, it would revive these people. And yeah, I don't care, because I quite enjoy being the subjects of
a Twitch answer. It's good fun, but not everybody does enjoy it. And so a lot of people keep their head down on this particular issue. But yeah, these people have scum a lot of them. They really are ambitious, horrible people posting on the anonymous names claiming to be doctors. I've seen they are doctors. A lot of them set up another account. I mean, patients, not just doctors concerned about this type of patient, I think they should be back. It's like, wow, yeah. Okay, you're also more
of a patient. And every single thing you ever tweeted about is about physicians. So yeah, mad campaign against these people I want to stick up for the underdog. So I'm pointed out what this is really about, which is in particular in GP surgeries, you've got local GPs who for a long time were getting away with getting paid 15,000 pounds per month. I thought they could carry on this
drift forever because the health service is always short-served. And then a few GP surgeries, mainly in rural areas where they couldn't travel to doctors, they decided to start using more in the way of people like physician associates to help lighten the locust. They literally couldn't afford to be paying local doctors what local doctors thought they were worth. And so local doctors went to the Guardian to go to school because they were always loads of them to find a job in 80%
amount of work, local doctors can't find work. Rather than drop their wage demands, which is what you normally do in a market, they have decided to novel the competition. It's disgraceful really. And what do you think Rob? Do you share Chris's huge sympathy for these PAs and his white hot borderline obsessive hatred for GPs in this particular? I'm not sure I shared the borderline dysfunctional whatever hatred for GPs, but it seems to make perfect sense that we should be taking
the loan off them as much as possible. So the government has already made a big deal about going to your pharmacist for initial medical consultation. And basically most of us want to go to somebody who has some idea about medicine and say, what is this? I do I get it fixed. So I had an issue a few months ago, I got a train to D, slightly bashed myself on the journey and decided to do something very stupid, which is kick the train. And therefore,
nearly breaking my toe, badly bruising it. And then about three months later, my big toe started to fall off. And I just needed a medical professional to look at and go, is it all right? I mean, what do I do? It's pretty minor stuff. Eventually, I had to email somebody from podiatry, then my local health service. And they said, don't do anything, trim it a bit, it'll be fine. And there's just so much of what the health service needs to do, or would really help people
is just dealing with that quite minor stuff. And if it's a physician associate, whether it's an advanced nursing practitioner, we should another popular, not doctor, and first part of call. So there's a surgery in London, which is no GP's at all, it has three advanced nursing practitioners. And if I'm, it's very successful and very popular, because people get seen much more quickly if they're to wait on a GP. So I think that that's the role of a GP, fundamentally, to be a gateway.
You either does nothing wrong with you or it'll clear up. Here's a prescription for it, or I have to send you off to a consultant. That's what GPs do. So why not get somebody else who's just trained specifically in that job of triaging people and save the health service on awful lot of money in the process? And still having that face to face, content, I suppose, Chris, because not everything can be provided by the chatbot. Well, no, because I think, you know, you listen to
it all, Rob says, he's obviously quite right. You know, either they give you antibiotics, or they tell you there's nothing wrong, you'll get better on it. So, well, there's a specialist like I see why I can't be, we could do that 90% of the time. Anyway, let's not, yeah, in the meantime, we're still testing this technology out. Let's at least give people like physician associate to go. And what I said this, I've been accused of, we need to send this so one dimensionally,
people they got, are you the IAE's want to prioritize the health service? That's why I'm favor of physician associate. Like can anyone explain the logic there? Like what is the connection between physician associate associate working in GB surgeries, which are already bright, but what has got to do with the private? Nothing. It's just an outsource it to G4S would have the contract or something to provide all these physicians as they say. Well, it doesn't, none of it makes any
sense. It's just a, yeah, it's just a knee jerk. It's what they say to anything, you know, because they never get to the public go. You say to the stupid, proven British public, oh, these guys will prioritize the NHS, they will get on board straight away. And so this physician associate issue, which is pretty niche in a great scheme of things, has attracted the likes of, you know, Carol Vaughn and James O'Brien, because they appeal to this lowest-combin denominator of
they want to privatize the NHS. And also, this is a patient safety issue as well. This is what the public says wrongly is say when they're up to more money is actually it's about, it's about safety. It's like when the bloody so-called guards went on strike on Sun Rail years ago. It was obviously about money. There's no, it's about going to be a passenger safety. Of course, he lost. As soon as they give him some more money, they, they, they shut up and went back to work.
It's, yeah, so they weaponized the death, it's very sad death for somebody who was wrongly diagnosed by a PA and turned out to have a blood clot, which he then died of. Completely ignore the fact that exactly the same thing happened with a GP up in Scotland, only this year. And indeed, pretty much every week you'd be looked for stories and papers of doctors, misdiagnosing people with, you know, that resulting in terrible outcomes. You can do it, you know,
no one's going to say, let's sack all GP's, because GP's made a misdiagnosis. People might mistakes, especially in the NHS, but sort of, Sherry Pick, this, this one case and put it all over the news, which you have done for over a year now, every time PA is a mention this forward, it's caught up in it. It's just, it's pretty low stuff, I think, this whole campaign. I'm surely the biggest issue in terms of patient safety and inability to access any kind of
health professional whatsoever. That and the crucial importance of guards on trains, of course. But Rob, unless there's any more on that, should we turn to one of the stories that you picked out to talk about today, which I must say I wasn't aware of, and when I read the headline at least, I was pretty surprised to find out that a new report has suggested that alcohol consumption in Ireland has fallen by nearly a third since 2001. Do you want to tell us a bit about this and whether
and not those numbers are quite all they see? Well, I mean, yes. So the obviously the Ireland is famous for its pub culture and growing up. I spent many a holiday in Ireland with the family and got taught how to drink beer in Ireland. And so it was always a sort of a centipede of Irish society was the pub. And that would seem to be in decline, according to these figures,
which suggests that alcohol consumption is dropped by 31% since 2001. And I think that that is possibly quite plausible actually because of the pressures that have been faced by the Irish drinker. First of all, the smoking ban in 2003, meaning that the Irish pub was not anything like its old hospital self, the sheer price of alcohol anyway. So Dublin somehow manages to be even
more expensive than London for drinking and London is I'm altering enough. But then in two years ago, they introduced minimum unit pricing to make drinking at home or expensive my thoughts, Scotland was bad. But then I looked at what the minimum unit prices in Ireland and it's one euro per unit, which is about 84 pence at current exchange rates, which makes they do have very slightly larger units now. But you still a lot more ways in Scotland. Exactly. I mean, and that's
even, you know, even after a Scotland's price rises to 65 p in September this year. So the Irish drinker has been right on the thick end of it for quite some time in terms of just being able to enjoy a drink. And so it's no wonder that there's been some moderation of drinking habits just because
it's more expensive. But whether that's actually had any effect on the sort of a dangerous drinkers, I'm less sort of sanguine about as we saw in Scotland that actually minimum unit pricing has had very little effect on people's health in terms of your liver, cirrhosis and all that sort of stuff with drinkers up here. But yes, I can well imagine that the sociability of Ireland has been reduced somewhat considerably by the decline of drinking. Well, this is what success looks like
if you're in public health. You know, lots of pubs closing down and people unable to afford to drink as much as they would like to. I believe to be fair of the algorithm that have fallen in this century, at least in Ireland, from a fairly high base. I mean, how do you add to what extent this is actually the result of the policy is always difficult to say. I mean, it would make sense that something like we have a one-year-old floor price on the unit of outcome, all of a sudden.
The fact that that's only been in place for three years or so during which it hasn't been in decline that quarter of a debt. So it's been declining consumption. I mean, minimum pricing is a remarkably ineffective measure of the best of times. And of course, that has been a big drop in
drinking in Britain. You know, first, let's see, from about 2003 until the middle of the last decade, there was a quite significant getting off of 20% decline and per capita consumption, it didn't seem to have anything to do with any policies because there weren't any policies. It just, it was just changing tastes and, you know, regular readers will know how much I just like young people as well as doctors. They're not drinking sufficiently early. And in London,
when it comes to policy, you can't blame them. You know, we know regularly looking at a £7 pound of pipe out in London. It's absolutely bonkers, but not everyone in London, and plenty of people are actually aware of this food. So it's no real excuse. But yeah, the converiors reasons people are drinking less. And if that's what they want to do, that's fine with me, I guess, where it's not ready, but you know, in theory, it's fine with me. My principal say it should
be fine with me. And therefore it is. But if it's not because they've chosen to, it's because they've been priced down the market on the public closed down, then it's not a good thing. Whatever people in public health may believe. And Rob, just picking up on Chris's point there, about what a depressing trend this is, I suppose. Is there an argument that the part of this is sort of cultural as well, that for whatever reason, it's not just the fact that a pint in certain
places has crept over the seven pound mark, certainly in London. It's also the fact that maybe young generations or just that kind of this sort of more convivial pub life of previous generations
is sort of evaporated a bit. Yeah, I think that is true. And I think that part of that is, I'll suddenly in Ireland, because I've seen Ireland become much, much wealthier in the over the past 40 years when you know, going from going to stay with my cousins and then burning peat in the fireplace to, you know, everybody having technology jobs or whatever, then yeah,
Ireland is a very different place. And there's just other stuff you could be doing rather than just going to that you'll local every evening and drinking because there's only two channels on the TV. So in some ways, that's progress that, you know, you've got more options in terms of what
what you do with your time than just simply going to the pub. But yes, there is also this trend amongst younger people either not to drink or to drink less, but they're also having less sex and all sorts of other things that it's a sort of more risk of us youth that we're dealing with. So I think that is a trend. On the other hand, there has also been a long-term trend of abstention in Ireland. So I think it's something like a quarter of people in Ireland don't drink at all.
So the rest of them are keeping up a good track strike rate. And they're still, I mean, they're not the Latvians, they're not the Austrians in terms of putting it away, but they're still, you know, doing a pretty good job of drinking. But clearly, the environment in which the Irish drinker has to face now is a much more hostile one. And Chris, unless you've got any more on this, I want to
turn to a story that has become a part of your beat here. I think it's fair to say over recent months, which is the huge scandal before the election, which has now completely disappeared. So before the election, people will remember that there were these series of betting scandals involving people in and around the Prime Minister who were betting on the date of the election it affected a couple of prospective candidates or certainly it affected some higher ups within
the Tory party, also some close protection offices and so on. And you've been saying for some time that this was probably going to go nowhere as soon as Labour got into power. That seems to be the case, doesn't it? Do you want to tell us about some updates on this huge scandal which
has now completely disappeared from you? Yes, indeed. So as predicted, the MacPolice command was statement saying there will be no prosecutions in the, from now on under the, you know, about the political betting so-called scandal and that they haven't found anyone to prosecute under the, Mr. Cohn, there's some public office, yeah, that was the allegation. It was actually a slightly surprising because I thought there was going to be any prosecutions at all, it would be actually
that the MacPolice officers who were putting money on the date of the election. So these will be the guys presumably who are standing outside number 10, Downing Street and they got wind of when the election is going to be called and apparently one or two of them at least put bets on. That struck me as quite possibly misconduct in public office. So if anyone was going to have
the book for me, it would be them now. You know, skeptical people might say, well, the MacPolices are going to have to turn their own, possibly so or possibly there wasn't much of a crime.
And so if any in the first place, so they have dropped everything and they're saying, well, we're going to hand it over to the Gabbardy Commission now if they want to make some prosecutions or kind of, I'm not even sure the Gabbardy Commission can make prosecutions and look quite sure of the legal states is that I'm prepared to double down on my bet and say that nothing will come
out of that high. Rob, what have you made of all this? Well, I mean, some of it was a bit ludicrous anyway, like people betting six months beforehand that there would be an election in the first half of the year, I think, or before the end of July and getting payouts on that kind of thing. Well, they wouldn't do because it was in July, wouldn't it? The election.
No, no, no, I mean, I'm saying that some senior Scottish Tory put a bet on, which obviously did pay out, that the election would be called in the first half of the year or something,
and he put it on months. So he put it on months ago. It was just one of these kind of really shallow bits of sleaze mongering, which really suited the Labour Party at the time, because it brought back Echo's party gate and corruption and all that sort of stuff, which, again, suited the general weir sick of the Tories, Vi during the election campaign, but it was a bit dubious whether anything had done anything wrong, other than blind looking a bit stupid, really,
and not sticking, you know, doing things that were not very PR clever. But in terms of, you know, serious, this is not like sort of insider trading with like this billions involved. This is people sticking 100 quid on an election date, and it doesn't seem to have cost the rest of society anything at all. So I think it's a stormy the teacup rather, really. Well, yeah, it was, but it was blown out of proportion. People have said to me, well, what's the
matter that Tory's been losing anyway? Look, I'm not saying that political bedding gandled change to course of election. It probably didn't even have an effect on the number of seats ones on, but the electoral interference is electoral interference, the matter of what the outcome is. I see this being election interference, and the only possible justification you can have from going public in this way, in this unprecedented way, is if there's been some serious cruel misdeing, and there,
it doesn't look like that has been, I don't think there ever was. So I go back to what I said back in June, which is the scandal here is how this got out into the public domain in an extremely sensitive time. And I think the gandled commission has questions to answer, and I predict it, but then that there would never be a leaking quarry or anything like that. And that hasn't been the work,
it's been no suggestion, but there should be. And do we think the Labour Party started to get bitten by its own kind of sanctum in the middle of these never-ending scandals that has been the stuff in recent weeks about them appointing various Labour Apparachics to the jobs of senior civil servants. There's this whole scandal about Lord Alley and his past to number 10 Downing Street.
There's the fact that never gets talked about, which is that Sue Gray's son is now a Labour MP, and Lord Alley also donated specifically to his campaign, which is not to say that any of this is criminal, let alone really that much of a big deal. But do you think Kierstarm has kind of, I am Mr. Rawls, Mr. Standing Up Straight on all of these issues, is starting to unravel in the face of the grubby business of Westminster's politics? Yeah, it's been kind of hilarious how
quick it's become sleazy. I thought they would manage to keep it respectful for a while. I mean, the quantity just the fact that Sue Gray is there in such a high position about having ridden the report that Dan Morris Johnson is sleazy. Now, if I don't think people talk about how ridiculous that situation was and how living people would be if it was on the other thoughts and Labour. I still wasn't able to try to finish off a Labour Prime Minister and
got a job with the Tories. So yeah, I mean, I don't think Labour are going to be much different Tories than I would think it would be. And it's kind of surprising how sleazy it's got so early. But history tells you parties don't tend to clean up their actors time goes on. Do you know what I mean? It tends to get worse. So we could be in for an entertaining five years. Well, I mean, every political party has its sort of a hangers on. And I think that there will be
plenty of these, you know, being elevated to the Lords. People from NGOs being appointed to head quangos. But yeah, actually the only thing that the conservatives ever did wrong in this regard is that they kept appointing people from the left to run quangos and things like that rather than because they didn't want to be seen to be unfair. And Labour obviously has absolutely
no conscience on that side of things. So they're quite happy to just stick their people into all these posts or have donors become senior civil servants, which is just astonishing really. And they have, yes, no, no, no qualms about it whatsoever. That is unfortunately the business of government these days. And we should call all sides out whenever they do it because it is sleazy. Absolutely. I mean, it seems like they don't think it's a problem because it's the right kind of
people doing it now. So therefore, all other ethical issues should be put to one side. Rob, we're fast running out of time. I'm not sure if you've been on the show since we introduced this new final section, but I'm going to do it anyway, which is, or if you had to have one ban, what would it be? If you were dictated for the day, if there was just one thing that irretakes you on a daily basis? Well, I was in London. I had to deal with fortunate of misfortune of having to travel back from
London 10 days ago. And just when you keep the train in anger. No, no, no, no, that was early. That was merely travelling in Scotland. So I don't know, I wonder what I was angry. And there was a young woman, probably a student age sitting across the aisle from me who spent the entire trip from Berwick upon Tweed up to Edinburgh, an hour and a half, whatever it is, no, what must have been Newcastle to Edinburgh, an hour and a half of talking, doing having a
telephone call with the speaker phone arm because she was too lazy to put it to her ear. So I would have those people dragged out in the street. Or maybe a ban might be acceptable, but I think some traditional old punishments of the stocks or some other humiliation might be in order for that. Did you have a concert at Conference? Yes, because some people do that.
Well, I did, I did, I did, I did, I did, I did, I did, I did, I did, I did, I did, I did, I did, I did consider it, but I thought I might lose my brother, I get actually, so I just got, I'm going to, and at the side of I was trying to concentrate on something as well. And when you can hear her side of the conversation and a teeny version of the other side of the conversation is extremely distracting. So yes, that's one habit I would barren quite happily.
A very popular choice, I'm sure. Rob, Chris, thank you both very much. Cheers. You've been listening to Last Orders. Be sure to subscribe to this podcast, wherever you get to your podcasts. Please do take a moment to leave us a rating and a review. And if you'd like to support the show, why not become a spike to supporter? Just go to spikedhyphenonline.com slash supporters to sign up. That's spikedhyphenonline.com slash supporters.