Features
Shock therapy for ailing British NHS?
by Dr Upul Wijayawardhana
That it invariably leads to disaster when politicians attempt to tinker with what they know very little about is well illustrated by what is happening to the British National Health Service (NHS). Unfortunately, the politicians who attempted to reform the NHS over the years, with disastrous consequences, seem to have completely disregarded the aphorism—if It ain’t broke, don’t fix it. Although it is fast heading towards the bottom of the league now, the British NHS once was the best in the world and many countries attempted to emulate it because it was a cost-effective system providing free healthcare to all, irrespective of one’s ability to pay. It stood as a testimony to the socialist foresight of the post-war Labour administration of PM Clement Atlee and his Health Minister Aneurin Beven, considered the ‘Father of the NHS’; he made the ever-true declaration: “No society can legitimately call itself civilised if a sick person is denied medical aid because of a lack of means.”
Although I am not a fan of his, I must admit that Keir Starmer deserves to be lauded for attempting to reverse that trend with his recent announcement. Giving a fillip to his administration, which has been faltering up to now, PM Starmer announced plans to get rid of a resource-draining quango, pointlessly duplicating the work of the Department of Health: NHS England employing 13,500!
Margaret Thatcher seemed very keen to reform the NHS, her motive probably being more political than anything else. She was toying with the idea of introducing a scheme for compulsory health insurance, but her Health Secretary Kenneth Clarke, who was against this idea, persuaded her to introduce a less controversial ‘trust’ system instead, which took hospitals away from the control of District Health Authorities. Despite being a far less successful system, Clarke wanted the UK to ape the Managed Hospital System in the USA! Clarke’s argument was that hospitals needed enhanced management with independence to compete in an internal market and created Hospital Trusts, in stages, beginning in 1990. To anyone with common sense it was a daft idea, especially the concept of hospitals competing with each other, but that is politicians for you! The downward spiral of the NHS started with the trust system and I have no hesitation in referring to this as the ‘Clarke’s Curse’!
Trusts were given further independence with the creation of ‘Foundation Trusts’ and other service providers like ambulance services also converted into trusts during the John Major administration that followed Thatcher’s. Towards the end of this administration a Private Finance Initiative (PFI) was set up where the private sector built hospitals and trusts had to pay back regularly with huge interest, like a mortgage. This scheme was enhanced by the Tony Blair administration, but, unfortunately, became a millstone around the neck later, some trusts having to declare bankruptcy!
Tony Blair, who became Prime Minister in 1997, could have changed direction to save the NHS but instead opted to continue with the Conservative health reforms. Perhaps, his New Labour was more Conservative than Labour! The most significant political change during the Blair administration was devolution of power, leading to the creation of the Scottish Parliament and the National Assembly for Wales in 1997, followed by the creation of the Northern Ireland Assembly in 1998. As health became a devolved subject with these changes, paradoxically, the Health Secretary of His Majesty’s government looks after the health services of England only! However, devolved health systems usually follow the English system but there can be significant differences like the prescription charge. It is only residents of England that pay for their medication, with a fixed prescription charge irrespective of the cost of medication, the current charge being £9.90 per item. Those with exemptions in England as well as residents of the other three devolved nations get all their medication free.
During the disastrous Cameron-Clegg coalition government, the Health Secretary Andrew Lansley decided to give the NHS in England an ‘independent arm’ and NHS England was created in 2013, which currently employs 13,500 staff, three times more than the Department of Health! NHS England is an executive non-departmental public body of the Department of Health and Social Care, which oversees the budget, planning, delivery and day-to-day operation of the commissioning side of the NHS in England and according to its website: “NHS England shares out more than £100 billion in funds and holds organisations to account for spending this money effectively for patients and efficiently for the taxpayer.”
All these reforms made the NHS top-heavy with management and the resources poured by governments went to feed the managers mostly, only dribbles going for patient care, and my experience at Grantham Hospital mirrored what happened across the rest of the country. When I started working at Grantham in 1991, it was a District General Hospital, which has been in existence since 1876, with 300 beds and a large estate with quarters for most employees. It was managed by a General Manager, a Matron, and an Estates Manager. When it became a Trust in December 1994, we had a Chief Executive with Directors in Medicine, Surgery, Nursing, Estates and Operations, all drawing hefty salaries, and many assistants! Later, it joined Lincoln and Boston Pilgrim Hospitals to form the United Lincolnshire Trust. By the time I retired, 20 years later, there were only 100 beds and much of the estate was in the hands of private property developers! Since then, it has become a shadow of its former self: there are no acute beds at all though around 3,000 houses have been built around Grantham during the past two decades. For any acute emergency, Grantham residents must travel to Lincoln, a car journey close to an hour!
Hospital overcrowding has got so bad that many hospital corridors are blocked with beds now. In fact, some hospitals have started advertising for staff to look after patients in corridors! Only thing missing yet are ‘floor patients’, which I presume is an impossibility because of cold floors! In spite of introducing corridor beds, too, patients often have to wait over 24 hours in Accident and Emergency Departments for a bed, lounging in chairs with drips and oxygen tubes! Imagine this happening in one of the richest countries in the world!
One of the biggest drawbacks in UK healthcare is the lack of private emergency care, private hospitals being geared to do elective work mainly. Therefore, even those who can afford to pay are at the mercy of the NHS for emergencies, in contrast to Sri Lanka where emergency care is readily available in the private sector; the fact that even a short stay can bankrupt is a different story!
I may be voicing the fears of the many who are waiting in the ‘departure lounge’ when I state that I prefer death to the ignominy of waiting in chairs or corridors.
Things are so horrible that shock therapy was badly needed. Though he had no choice, it was still brave of Keir Starmer to announce the demise of the redundant, wasteful NHS England. There are claims that job losses will come to nearly 30,000 and cost of the exercise would be in billions of pounds. Perhaps, there is some truth as NHS managers assume duties with water-tight fat severance packages! Even that short-term cost is justified to improve the NHS long-term, as there are no further depths to descend! I can only hope that Starmer’s decision will produce the desired result and, in the meantime.
Features
NASA’s Epic Flight, Trump’s Epic Fumble and Asian Dilemmas
Three hours after the spectacular Artemis II flight launch in Florida, US President Donald Trump delivered a forlorn speech from Washington. Thirty three days after starting the war against Iran as Epic Fury, the President demonstrated on national and global televisions the Epic Fumble he has made out of his Middle East ‘excursion’. It was an April Fool’s Day speech, 20 minutes of incoherent rambling with the President looking bored, confused, disengaged and dispirited. He left no one wiser about what will come next, let alone what he might do next.
There was more to April Fool’s Day this year in that it brought out the nation’s good, bad and the ugly, all in a day’s swoop. The good was the Artemis II flight carrying astronauts farther from the Earth’s orbit and closer to the moon for the first time in over 50 years. The mission is a precursor for future flights and will test the performance of a new spacecraft, gather new understanding of human conditioning, and extend the boundaries of lunar science. It is a testament to humankind being able to make steady progress in science and technology at one end of a hopelessly uneven world, while poverty, bigotry and belligerence simmer violently at the other end.
Terrible Trump
The four Artemis II astronauts, three Americans, Reid Wiseman, Victor Glover, and Christina Koch, and one Canadian, Jeremy Hansen, are also symptomatic of the endurance of America’s inclusive goodness in spite of efforts by the Trump Administration to snuff the nation’s fledgling DEI (Diversity, Equity and Inclusion) ethos. To wit, of the four astronauts, Victor Glover, a Caribbean American, is the first person of colour, Christina Koch the first woman, and Jeremy Hansen of Canada the first non-American – to fly this far beyond the earth’s orbit. All in spite of Trump’s watch.
Yet Trump managed to showcase his commitment to America’s ugliness, on the same day, by presenting himself at the Supreme Court hearing on the constitutionality of his most abominable Executive Order – to stop the American tradition of birthright citizenship. He keeps posting that America is Stupid in being the only country in the world that grants citizenship at birth to everyone born in America, regardless of the status of their parents, except the children of foreign diplomats or members of an occupying enemy force. In fact, there are 32 other countries in the world that grant birthright citizenship, a majority of them in the Americas indicating the continent’s history as a magnet for migrants ever since Christopher Columbus discovered it for the rest of the world.
And birthright citizenship in the US is enshrined in the constitution by the 14th Amendment, supplemented by subsequent legislation and reinforced by a century and a half of case law. Trump wants to reverse that. Thus far and no further was the message from the court at the hearing. A decision is expected in June and the legal betting is whether it would be a 7-2 or 8-1 rebuke for Trump. In a telling exchange during the hearing, when the government’s Solicitor General John Sauer quite sillily dramatized that “we’re in new world now … where eight billion people are one plane ride way from having a child who’s a US citizen,” Chief Justice John Roberts quietly dismissed him: “Well, it’s a new world. It’s the same Constitution!”
Trump’s terrible ‘bad’ is of course the war that he started in the Middle East and doesn’t know how to end it. Margaret MacMillan, acclaimed World War I historian and a great grand daughter of World War I British Prime Minister Lloyd George from Wales, has compared Trump’s current war to the origins of the First World War. Just as in 1914, small Serbia had pulled the bigger Russia into a war that was not in Russia’s interest, so too have Netanyahu and Israel have pulled Trump and America into the current war against Iran. World War I that started in August, 2014 was expected to be over before Christmas, but it went on till November, 2018. Weak leaders start wars, says MacMillan, but “they don’t have a clear idea of how they are going to end.”
There are also geopolitical and national-political differences between the 1910s and 2020s. America’s traditional allies have steadfastly refused to join Trump’s war. And Trump is under immense pressure at home not to extend the war. This is one American war that has been unpopular from day one. The cost of military operations at as high as two billion dollars a day is anathema to the people who are aggravated by rising prices directly because of the war. Trump’s own mental acuity and the abilities of his cabinet Secretaries are openly under question. There are swirling allegations of military contract profiteering and selective defense investments – one involving Secretary of War Pete Hegseth.
Trump’s Administration is coming apart with sharp internal divisions over the war and government paralysis on domestic matters. There are growing signs of disarray – with Trump firing his Attorney General for not being effective prosecuting his political enemies and Secretary Hegseth ordering early retirement for Army Chief of Staff Randy George. In America’s non-parliamentary presidential system, Trump is allowed to run his own forum where he lies daily without instant challenger or contradiction, and it is impossible to get rid of his government by that simple device called no confidence motion.
Asian Dilemmas
Howsoever the current will last or end, what is clear is that its economic consequences are not going to disappear soon. Iran’s choke on the Strait of Hormuz has affected not only the supply and prices of oil and natural gas but a family of other products from fertilizers to medicines to semiconductors. The barrel price of oil has risen from $70 before the war to over $100 now. After Trump’s speech on April 1, oil prices rose and stock prices fell. The higher prices have come to stay and even if they start going down they are not likely to go down to prewar levels.
There are warnings that with high prices, low growth and unemployment, the global economy is believed to be in for a stagflation shock like in the 1970s. Even if the war were to end sooner than a lot later, the economic setbacks will not be reversed easily or quickly. Supplies alone will take time to get back into routine, and it will even take longer time for production in the Gulf countries to get back to speed. Not only imports, but even export trading and exports to Middle East countries will be impacted. The future of South Asians employed in the Middle East is also at stake.
In 1980, President Carter floated the Carter Doctrine that the US would use military force to ensure the free flow of oil through the Strait of Hormuz. Trump is now upending that doctrine – first by misusing America’s military force against Iran and provoking the strait’s closure, and then claiming that keeping the strait open is not America’s business. Ever selfish and transactional, Trump’s argument is that America is now a net exporter of oil and is no longer dependent on Middle East oil.
To fill in the void, and perhaps responding to Trump’s call to “build up some delayed courage,” UK has hosted a virtual meeting of about 40 countries to discuss modalities for reopening the Strait of Hormuz. US was not one of them. While Downing Street has not released a full list of attendees, European countries, some Gulf countries, Canada, Australia, Japan and India reportedly attended the meeting. Which other Asian countries attended the meeting is not known.
British Foreign Secretary Yvette Cooper has blamed Iran for “hijacking” an international shipping route to “hold the global economy hostage,” while insisting that the British initiative is “not based on any other country’s priority or anything in terms of the US or other countries”. French President Emmanuel Macron now visiting South Korea has emphasized any resolution “can only be done in concert with Iran. So, first and foremost, there must be a ceasefire and a resumption of negotiations.”
Prior to the British initiative focussed on the Strait of Hormuz, Egypt, Pakistan and Türkiye have been playing a backdoor intermediary role to facilitate communications between the US and Iran. Trump as usual magnified this backroom channel as serious talks initiated by Iran’s ‘new regime’, and Trump’s claims were promptly rejected by Iran. There were speculations that Pakistan would host a direct meeting between US Vice President JD Vance and an Iranian representative in Islamabad. So far, only the foreign ministers of Egypt, Pakistan, Saudi Arabia and Türkiye have met in Islamabad, and Pakistan’s Foreign Minister Ishaq Dar flew to Beijing to brief his Chinese counterpart, Wang Yi, of Pakistan’s diplomatic efforts.
The Beijing visit produced a five-point initiative calling for a ceasefire, the opening of the Strait of Hormuz and diplomacy instead of escalation. The five-point pathway seems a follow up to the 15-point demand that the US sent to Iran through the three Samaritan intermediaries which Iran rejected as they did not include any of Iran’s priorities. The state of these mediating efforts are now unclear after President Trump’s April Fool’s Day rambling. In fairness, Pakistan’s Ministry of Foreign Affairs has announced that his country intends to keep ‘nudging’ the US and Iran towards resuming negotiations and ending the war.
While these efforts are welcome and deserve everyone’s best wishes, they have also led to what BBC has called the “chatter in Delhi” – “is India being sidelined” by Pakistan’s intermediary efforts? Indian Foreign Minister Jaishankar’s rather undiplomatic characterization of Pakistan’s role as “dalali” (brokerage) provoked immediate denunciation in Islamabad, while Indian opposition parties are blaming the Modi Government’s foreign policy stances as an “embarrassment” to India’s stature.
The larger view is that while it is Asia that is most impacted by the closure of Hormuz, with Singapore’s Foreign Affairs Minister Vivian Balakrishnan calling it an “Asian crisis”, Asia has no leverage in the matter and Asian countries have to make special arrangements with Iran to let their ships navigate through the Strait of Hormuz. There is no pathway for co-ordinated action. China is still significant but not consequentially effective. India’s all-alignment foreign policy has made it less significant and more vulnerable in the current crisis. And Pakistan has opened a third dimension to Asia’s dilemmas.
In the circumstances, it is fair to say that Sri Lanka is the most politically stable country among its South Asian neighbours. Put another way, Sri Lanka has a remarkably consensual and uncontentious government in comparison to the old governments in India and Pakistan, and even the new government in Bangladesh. But that may not be saying much unless the NPP government proves itself to be sufficiently competent, and uses the political stability and the general goodwill it is still enjoying, to put the country’s economic department in order. More on that later.
by Rajan Philips
Features
Ranjith Siyambalapitiya turns custodian of a rare living collection
From Parliament to Fruit Grove:
After more than two decades in politics, rising to the positions of Cabinet Minister and Deputy Speaker of Parliament, Ranjith Siyambalapitiya has turned his attention to a markedly different arena — one far removed from parliamentary debate and political intrigue.
Today, Siyambalapitiya spends much of his time tending to a sprawling 15-acre home garden at Vendala in Karawanella, near Ruwanwella, nurturing what has gradually evolved into one of the most remarkable private fruit collections in the country.
Situated in Sri Lanka’s Wet Zone Low Country agro-ecological region (WL2), Ruwanwella lies at an elevation of roughly 100–200 metres above sea level. Deep red-yellow podzolic soils, annual rainfall exceeding 2,500 millimetres, and a warm humid tropical climate combine to create conditions that make the region one of the richest areas in the island for fruit tree diversity.
Within this favourable ecological setting, Siyambalapitiya has become what may best be described as a custodian of a living collection—a fruit grove that now contains around 554 fruit trees and vines, many of them rare or seldom seen in contemporary agriculture.
Of these, 448 varieties have already been properly identified and documented with the assistance of agriculturist Dr. Suba Heenkenda, a retired expert of the Department of Agriculture. Together they have undertaken the painstaking task of cataloguing the plants by their botanical names, common Sinhala names, and the names used in ancient Ayurvedic and indigenous medical texts, assigning each species a unique identification number.
According to Siyambalapitiya, the Vendala estate is possibly the only single location in Sri Lanka where such a large number of fruit varieties—particularly rare and underutilized species—are maintained within one property.
“This garden came down to me through my grandfather, grandmother, mother and father,” he says. “It is a place shaped by three generations.”
The estate, he explains, began as a traditional home garden where crops such as tea, coconut and rubber were cultivated alongside fruit trees planted by family members over decades. Over time, however, it evolved into something much larger: a carefully nurtured grove preserving both common and obscure fruit species.
Siyambalapitiya recalls with affection one of the oldest trees in the garden—a honey-jack tree known locally as “Lokumänike’s Rata Kos Gaha.”
The story behind it has become part of family lore. According to village elders, his grandmother had brought home the sapling after visiting the Colombo Grand Exhibition in 1952 many decades ago and planted it near the house.
The tree soon gained fame in the village. Its tender jackfruit proved ideal for curry and mallum, while the ripe fruit was renowned for its sweetness.
“Ripe jackfruit from this tree tastes like honey itself,” Siyambalapitiya says. “Even the seeds are full of flour and can be eaten throughout the year.”
Yet age has not spared the venerable tree. It now shows signs of disease, and Siyambalapitiya and his staff have had to treat old wounds and monitor unusual bark damage.
“Once lightning struck it,” he recalls. “The largest branch began to die. Saving the tree required what I would call a kind of surgical operation.”
Such care, he says, reflects the deep attachment he feels toward the collection.
His fascination with fruit trees began in childhood. While attending Royal College in Colombo and living in a boarding house he disliked, Siyambalapitiya would insist that the family procure new fruit saplings for him to plant during his weekend visits home.
“That was the only ‘price’ I demanded for going to school,” he laughs.
Over the years the collection expanded steadily as he encountered new plants in forests, nurseries, and rural landscapes across the island.
The result today is a grove that includes traditional Sri Lankan fruit species, underutilized native varieties, forest fruits, and plants introduced from overseas.
Some species originate in Arabian deserts, while others thrive naturally in cooler climates such as Europe. Certain plants require greenhouse-like conditions, while others are hardy forest trees.
Managing such diversity is no easy task.
“One plant asks for rain, another asks for cold, and yet another prefers heat,” Siyambalapitiya explains. “Too much rain makes some sick, too much sun troubles others. The older trees overshadow the younger ones. You cannot feed or medicate them all in the same way.”
He compares the task to caring for a household filled with people from many nations and ages—each with different needs.
Despite the challenges, he believes the effort is worthwhile, particularly because many of the trees are native species that have become increasingly rare.
“If things continue as they are, some of these plants may disappear from our lives,” he warns.
To preserve knowledge about them, Siyambalapitiya is preparing to launch a book titled “Mage Vendala Palathuru Arana” (My Vendala Fruit Grove), which serves as an introductory guide to the collection.
The book, scheduled for release on April 18 at the Vendala estate, will be attended by Ven. Dr. Kirinde Assaji Thera, Chief Incumbent of Gangaramaya Temple,
Uruwarige Wannila Aththo, the leader of the Indigenous Vedda Community,
a long-serving former employee who helped maintain the plantation, and Sunday Dhamma school students from the region, who will participate as guests of honour.
The publication will also mark Siyambalapitiya’s eighth book. Previously he authored seven works and wrote more than 500 weekly newspaper columns offering commentary on politics and current affairs.
While working on the fruit catalogue, he is simultaneously writing another volume reflecting on his 25-year political career, including his tenure as Deputy Finance Minister during Sri Lanka’s most severe economic crisis.
For Siyambalapitiya, however, the fruit grove represents more than a hobby or academic exercise.
“The fruit we enjoy is the result of a tree’s effort to reproduce,” he says. “Nature has given fruits their taste, fragrance and colour to attract us. All the tree asks in return is that its seeds be carried to new places.”
That simple cycle of life, he believes, has continued for tens of thousands of years.
“And those who love trees,” he adds, “are guardians of the world’s survival.”
by Saman Indrajith
Pix by Tharanga Ratnaweera
- Four workers in charge of the four zones of the plantation
- Siyamabalapitiya explaning the evolution of plantation
- A foreign berry plant
- A Bakumba plant
- A rare jackfruit tree
- Siyambalapitiya pruning Pumkin Lemon plant
- Siyamabalapitiya explaning the evolution of plantation
Features
Smoke Free Sweden calls out to WHO not to suggest nicotine alternatives
It has been reported by the international advocacy initiative, ‘Smoke Free Sweden’ (‘SFS’) that many International health experts have begun criticizing the World Health Organization (WHO) for presenting safer nicotine alternatives rather than recognizing its role in accelerating decline in smoking.
As the world’s premier technical health agency, the WHO is empowered to support strategies that reduce morbidity and mortality even if they do not eliminate the underlying behaviour. Furthermore, it should base its guidance on evolving scientific knowledge, which includes comparative-risk assessments. Equating smoke-free nicotine alternatives with combustible cigarettes, is essentially putting lives at risk, according to the health experts contacted by SFS.
The warning follows recent WHO comments suggesting that vaping and other non-combustible nicotine products are driving tobacco use in Europe. This narrative ignores real-world evidence from countries like Sweden where access to safer alternatives has coincided with record low smoking rates.
A “Smoke-Free” status is defined as an adult daily smoking prevalence below 5% and Sweden is on the brink of officially achieving this milestone. This is clear proof that pragmatic harm-reduction policies work. Sweden’s success has been driven by adult smokers switching to lower-risk alternatives such as oral tobacco pouches (Snus), oral nicotine pouches and other non-combustible products.
“Vapes and pouches are helping to reduce risk, and Sweden’s smoke-free transition proves this,” said Dr Delon Human, leader of Smoke Free Sweden. “We should be celebrating policies that help smokers quit combustible tobacco, not spreading fear about the very tools that are accelerating the decline of cigarettes.”
It is further reported by health experts that conflating cigarettes with non-combustible alternatives risks deterring smokers from switching and could slow progress toward reducing tobacco-related disease.
Dr Human emphasized that youth protection and harm reduction are not mutually exclusive.
“It is critically important to safeguard against underage use, but this should be done by targeted, risk-proportionate regulation and proper enforcement, not by sacrificing the right of adults to access products that might save their lives,” he said.
Smoke Free Sweden is calling on global health authorities to adopt evidence-based policies that distinguish clearly between combustible tobacco – the primary cause of tobacco-related death – and lower-risk nicotine alternatives.
“Public health policy must be grounded in science and real-world outcomes,” Dr Human added. “Sweden’s experience shows that when adult smokers are given legal access to safer nicotine alternatives, smoking rates fall faster than almost anywhere else in the world.”
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