Monday, 24 October 2016


16.1 million voted REMAIN – 48%. When we have lost our banks and key industries, creating immense poverty, the LEAVERS will change their votes – but it will be too late.


This is an EXCEL chart of the UK constituencies – 
but it shows what the 650 MPs would vote in Parliament - not the referendum result:

LEAVE  - 24%
REMAIN - 75%

Sent: 23 October 2016

To: Noel Hodson
Subject: Better off out


You refer to the disaffected mob and unemployed shipbuilders. 

Do please look at the actual result. 

Every area of the UK voted to leave except for London, Scotland and Northern Ireland. 

You saw the letter I sent you recently. 

The people who Tony-H met in France and Germany are educated intelligent people and they want to leave too, they are envious of us. Ask yourself why if it is all as hunky dory as you think. 

Answer : there is more going on than your analysis encompasses. Why do these people envy our position? Find the answer to that and maybe your eyes will be opened. 


My view of the 30,000 bureaucrats (employed /unelected like all public servants) in Brussels etc., is that they try to make all the trans-border factors work peacefully across 550M people and 28 countries. Most important is food – hence the Common Agricultural Policy, Wine Lakes and Grain Mountains. Then there are Transport, Telecoms, Health, Money, Police/ Security, Energy, Air Pollution, Education Basics, Space, Science, etc. Their job is to action the will of the elected MEPs. Including our scrappy lot from the UK. 30,000 is about the same size as Stockport Council employees – it is not overblown. Most of each Member’s contributions (an agreed fraction of the VAT we collect) is, by tortuous agreement, fed back to the donor – across that donor’s regions. A part of the money is diverted to the poorest Members, like Greece, to ensure we are surrounded by prosperity and have strong borders. The bureaucrats make mistakes. But we have been central to it all and have had a loud voice in all the decisions. Mistakes can be and must be reviewed – constantly. But in 47 years of maze-like complexity it has worked well – and will continue to work well.

There is no sensible reason to want to see the organisation break-up; as the world heads towards World Government (for the same trans-border issues reasons, globally). The red-tops hysterical “straight bananas” and “throwing-back-fish” and “Euro going bust” stories are utter nonsense promoted by “Elvis Presley alive on Mars” journalists; and by vested interests, as always, trying to escape rules and regulations and make another (tax-free) quick buck. My hopeful forecast is that these forces will fail and the EU will continue to prosper. It is we in the UK who will suffer as we ditch 60 years of hundreds of carefully crafted agreements – and cast ourselves out into the cold Atlantic. All major nations will give preference to the 500M Common Market. We are already globally being side-lined as irrelevant. We will be quickly dismantled with The City going abroad (it is only blips in computers) and all our main manufacturers relocating their HQs and factories.

It is a terrible mistake to embrace Brexit – whatever the unemployed shipbuilders in Hartlepool may think. Farage has convinced the disaffected mob that all their woes are caused by the EU. Trump is doing the same in the USA, blaming Washington. That is utter nonsense. They are of our own making and we could fix them. But not if we are going to focus our top resources for the next 20 years on re-negotiating hundreds of trade agreements , instead of getting on with our own productivity. The UK is not restricted by the EU in doing business globally. After 20 years of decline and re-negotiations, we will end up just as were in May 2016 – same red-tape, same trade barriers, same trading partners, and a disunited kingdom – but we will be a bankrupt, bent-banana, lonely, drowning island.

That is my forecast - unless we rapidly grow-up.


From: John

Sent: 22 October 2016
To: Noel Hodson
Subject: Re: Better off out

You have ignored what Tony's  contacts said about how clever we were to be getting out before the EU disintegrates. 

If you were right it would be difficult but it won't work out like you say. 

All EU Brussels people are positioning themselves on the hard line because they are terrified other countries want to leave. When the negotiations are actually done the self interest of each of the other 27 countries will be foremost and their exporting companies will be lobbying them hard for an agreement whereby they can continue to export to the UK. 

This is survival for the UK rather than being consumed in the fires of the failing EU. 



On 22 Oct 2016, Noel Hodson <> wrote:

I’m all for constantly reviewing our contracts with Europe and all nations. One of the Telegraph letters cites 52 nations that have trade agreements with the EU. What is ignored is that the agreements took 20 years to negotiate. In business terms it is a gross waste of time, effort and direction to dump all the past 50 years of UK deals – and re-do them. If it works don’t fix it. In the meantime, the world thinks we have blown it and Sterling is devalued. A famous restaurant reports that its salmon purchases have just “doubled” in price – terrible for upper-crust diners. Most supermarkets are predicting 10% price increases. The EU is saying “no soft Brexit …so sod off”. It will be chaotic for 10 to 20 years. Most investment decisions will be postponed. Britain will freeze and decline. We don’t have to do this.


From: John

Sent: 21 October 2016
To: Noel Hodson
Subject: Re: Better off out

It's observation of what's happening rather than personal opinion. 

Doesn't Tony H's email say it all. First hand accounts of the attitudes of intelligent well educated people in several EU countries. They think it's doomed. 

Also, we are not walking away from our customers. We are leaving a political framework but trade will continue with European countries just as lots of other countries have access to EU markets. 
It is simply not correct to say we are walking away from a section of our overseas market when what we are doing is leaving the EU political construct. Trade will continue. 

On the concept that the EU has prevented wars there is also the view that it is NATO that has done this not the EU. 
Further, the EU is causing civil unrest with its treatment of Southern European countries and policies on migrants. Expect this to escalate. 


On 19 Oct 2016, at 13:39, Noel Hodson <> wrote:
Thanks Tony H, John and Tony-L for your texts. I interpret them as encouraging a break-up of the EU. Why? It has brought peace to Europe for 60 years – which is its primary purpose. I have long advocated reduction of the UK population – but this could be done by our clever, highly-paid diplomats within the EU – just as we have negotiated other special deals. Better that than walking away from 47% (500M) of our best customers. PS – I’m not given to economic-exaggeration. Devaluation reports fluctuate between 16% and 19%. With other direct costs some economists calculate 20% losses = $1.2 trillion = $50,000 per household (about). The costs will increase annually. The poorest will bear most of these costs.

Contrary to The Telegraph’s views, here is a Tweet I sent this morning:
“ Brexiteers who say devaluation is good for the UK. Send me 17% of your savings and I'll agree with you”


From Tony-L

Sent: 19 October 2016 12:58

Subject: Better off out

John, most people to whom I speak on the matter favour Hungary or Greece. However, I understand from friends living and working in Amsterdam for a few years now that the Dutch are very unhappy with the EU. I think an EU banking collapse will precipitate a major change first.


Most interesting, from your conversations which will be the next country to vote to leave the EU?




Sent: 19 October 2016 11:53

Subject: Re: 2nd Referendum


I'm sorry but I really can't agree with all! I was in France and Italy last week and am now in Germany... I am often having conversations with different people in these countries and they all basically think we're very clever to get out before the whole nonsense of the EU goes for a ball of chalk..which it most certainly will! Yes short term grief I agree and it's not pleasant paying 10-15% (don't exaggerate it's not 20%) more for everything ...although a cup of coffee here is still far cheaper than in UK.. roughly 1.20 € for a single expresso.. A couple of weeks ago on my way back from Heathrow I called in at the motorway services on M40 near Thame and against my better judgement allowed the person I was with to go to the stand alone brand spanking new Costa Coffee...even you couldn't begin to guess what they wanted for a single expresso ... £3.50!! I just couldn't believe it ..I gave them a piece of my mind and stomped out of the place! 

Last night I was at a drinks party just S of Munich and I was talking with an eminent doctor and a couple of his very bright female assistants and they all think Merkel is nuts and tell me that probably 90% of Germans would be glad to see the back of her in next March elections - but as yet no one else of presidential quality has come forward. 

I was also taking to a very wealth American woman who lives in Dallas ..she is pro Trump... A point she made as indeed did my wife that if a woman is being "groped" the power lies with her. If she's offended then bash the bloke hard round the head or indeed knee him in the balls! 

The last debate between The Donald and Hilary is tonight ..may the best man win!

Get over it! We're out of Europe .. allow the picture to unfold .. we are strong and very much admired in Europe apart from by the complete idiots who run the so called European Parliament... load of second rate bureaucrats! 


Best wishes for an exciting future! 

Tony H
On 18 Oct 2016, 
Dear John & Tony
As the UK walks away and deliberately insults 47% of its best customers, Doing a Ratner; as Sterling plummets making us 20% poorer; and as Theresa May, Trump-Hugging-Fake-Tan-Farage, and their demented cronies try to force or sneak through Brexit, based on The Will of The Halfwits who believed the Leavers-Lies; and against the votes of 16.1 million intelligent UK Remainers – against Scotland, N. Ireland and London – in the chaotic turmoil created by this government, you might not have signed this Petition for a 2nd Referendum. Sign it now:
PS – And please circulate it.

Noel Hodson

Thursday, 20 October 2016



William Hague and Theresa May lament the low interest rates paid by borrowers and demand that savers should get more unearned, risk free income. (Top Tories accused of foisting blame on Carney for the impact of austerity – Guardian 19Oct 16). Hague is now a City man, via Teneo, HSBC and others; as is May’s husband, Philip, at $1.4 trillion offshore, tax-free Capital Group

UK Households owe mortgages and overdrafts of £1.6 trillion (Aug 2016)

A 1% rise in Base Rate will gouge £16 billion a year, every year, from poor to rich, the majority from young to old, effort and risk free, creating misery, stress and homelessness – and all of it will flow through the banks and offshore funds, like a refreshing shower of gold. Is there no limit to the greed and irresponsibility of The City & Wall Street and their persistent lobbyists?   

Noel Hodson - Director
Tax Reconciliations, Oxford UK,

Wednesday, 12 October 2016


London - Above us the Waves.

My notes - not necessarily accurately expressing the panel's views:

Prof Brian Cox - Chair
Prof Brian Hoskins (maths)
Prof Kate Jones (biodiversity)
Oliver Morton (The Economist magazine)
Prof Keith Shine (climatology)

CO2 is now 400.97 ppm. Average over last I million years was 300ppm.
Last 200 years temp rise is 0.8C - proved to be due to humans

CO2 is 0.4% of atmosphere, which is 10,000 trillion molecules
One carbon atom uses/ generates 1 unit of energy to join the umbrella but blocks or locks in 100,000 units of energy.  100,000 : 1
Ocean is not mopping up CO2 as previously hoped.

Sea temperature is best guide
Old days, they drew up a bucket of water and stuck a thermometer in it.
Ships records go back 200 years.
Essential to correct/ harmonise old data-sets - e..g from Fahrenheit to Centigrade etc From wooden to iron buckets.

Spring is earlier
Autumn is later
Already 1/6th extinction of current species
Forecast 10 billion humans
Animals can Move, Expire or Evolve as planet warms
Will humans die off???

TIPPING POINT - not yet reached, still hope.
Greenland melting will take thousands of years yet. (I don't think so)
CO2 (greenhouse gas) persists for thousands of years

+2C rise, measured since pre-industrial revolution (200 years)
Now we have +1C rise
2C should hold it at 400ppm
So...  it might stay under 2C

NO human extinction - but could be major die back.


Now - we use 79% fossil fuels.
Target by 2030 is for 65% renewables

CLIMATE MODELS use worlds largest computers - getting more accurate.
Feedback of data makes for reliable Expert Systems - daily updates
Most effective counter measure is to increase cloud cover.

Basically silly - vacuum out CO2, put  a sunshade in space; scatter particles in the upper atmosphere;
Unsafe, impractical, unpredictable.
Interfering with water, clouds, weather etc over other nations - could cause wars
The crop growing nitrogen cycle has been human geo-engineered and it works.
Bio-fuels are worse than useless - a crappy idea.
Solutions must be global.
Best - is solar power. Solar Soar Solar.

INDIVIDUALS - change your behaviour - home heat/cooling - travel
Most of all - lobby your governments for immediate action.
The UK has had a major influence on helping China go green.
BREXIT will internationally sideline the UK, which led the Paris talks.
Most Brexiteers are also climate-change-deniers - and vote for Trump.

CURRENT SYMPTOMS - are critical. Action this day.
Look at the data. Historic tables at e.g. England and Wales Precipitation Data.
Extreme weather is on the increase world-wide.
e..g Hurricane Mathew has 6 metre SLR surges. E.g. New Orleans floods
Single extreme events are up 40% in the last 40 years - caused by warmer seas.

Climate Change Act.
Only 27 MPs out of 650 have science degrees
BUT - Governments have cooperated to fix the Ozone holes over the Poles.
In 1988 Margaret Thatcher supported the Royal Society's work on global warming.

END - Prof Cox said "If this were a BBC programme I would have to provide Climate-Sceptic balance - but it isn't, so I won't" Cheers from the 600 audience.

(I sent in a question - How fast are the ice-caps melting. What is the timetable? - It wasn't tabled. Physicists tell me that no-one has yet figured out how to calculate it)


Tuesday, 11 October 2016


Reuters - 11 Oct 2016 - Trade-weighted sterling hit a nearly-eight-year low of 74.0 at the Bank of England’s first morning print of the index, which measures the pound’s broader strength. It was also half a percent weaker at 90.51 pence per euro.
Some traders cited a Financial Times report that Russian bank VTB may move its European hub to Frankfurt, Paris or Vienna as having added to worries of financial sector cutbacks inLondon due to Brexit.
“There is nothing to go on on the data front today, but concerns surrounding our ever increasing current account deficit have reignited discussion around the widespread impact such a hole can create,” said Tobias Davis, head of corporate treasury sales at Western Union in London
Neil Wilson ETX Capital - 11 Oct 2016 - GBP/USD crashed through the $1.23 handle to around 1.2284, its lowest level since last week’s gyrations. It’s not unreasonable to think that ferocious flash crash was just a very tentative toe in the water and the pound is now plunging headlong into the abyss.
Sterling seems to be looking for a level and it’s really unclear where that could be and so bargain hunting is a risky game to play at the moment. The $1.20 handle earmarked by many before the referendum is definitely in play as everyone seems to be short sterling at present.

WAR WITH RUSSIA - LETTER TO THE GUARDIAN - 13TH OCT 2016 - Turncoat, bumbling, embarrassing  Boris Johnson today attempts to obscure his idiocy and the already immense costs of Brexit by declaring war on Russia. As winter closes in, he just has time to use the Royal Prerogative to march on Moscow - alone. (Conservative ex-ministers warn May of Brexit risks – Guardian 13 Oct 16). Repetition of “the-people-have-spoken” does not give this hapless, incompetent Cabinet a mandate to spend the next 3 years bankrupting Britain. They should follow all the other leading, lying Brexiteers and resign with their tails between their legs. Time is very short if we are to restore business-as-usual and rescue our economy. The nation needs a coalition of Remainers to reverse this lunacy – Now!  

Noel Hodson

Following traitorous, ex-Prime Minister David Cameron's 52% to 48% Brexit referendum, the government and media now deny the existence of the 16.1 million intelligent 48% REMAINERS, cleaving to Tory education Minister Michael Gove's statement "We have had enough of Experts!" and they elevate the majority IQ challenged LEAVERS - those who voted "Out" only to register a protest against the Ivy-League elite who run the UK and siphon all the spare wealth to tax-havens. These LEAVERS, stalwart-peasants, the Longbow-Men of Agincourt, and Sons-of-the-Kings-of-the-Waves, and Your-Country-Needs-You World-War-One canon-fodder, understandably had difficulty analysing the myriad complexities of the UK quitting the EU - thinking that the vote was really about kicking out the Tories. They didn't and couldn't know that quitting the largest and wealthiest market in the world would sideline and bankrupt the UK and consign us to the dustbin of history.
"THE (STUPIDEST) PEOPLE HAVE SPOKEN" - Our currency, Sterling - once the world's reserve-currency, then trading at $5 to the Pound, has collapsed since June 2016 by 17% -which Murdoch's idiotic Brexit media machine is hastily trying to tell us is "a good thing". And this week, the Tories, 1922 Committee, whose KKK-like, old-white-males dominate Prime Minister Mrs May, have forced her, our new Prime Minister, to announce a ban on foreign students - one of our largest currency earners and most valued global exports. Next, she will ban tourism - because that beer-swilling anti-European little fascist fake-tan rat-bag, Nigel Farrage, doesn't like to hear foreign languages on his local train to London. All these exceedingly stupid "The People Have Spoken" anti-business moves have impoverished the UK by 20% - since June. Would President Trump or President Hillary have made such nationally-destructive decisions? 

The UK does not have to quit Europe - it is not too late to regain our sanity. 

LETTER TO THE GUARDIAN - STUPID - STUPID - STUPID: Following Jonathan Freedland’s “Who speaks for the 48% as we lurch to extreme Brexit?” (Guardian 8 Oct 2016) we urgently need a leader, now, today, to form a coalition to represent the Sixteen-Million-One-Hundred-and-Forty-One-Thousand-Two-Hundred-and-Forty-One (16,141,241) intelligent Remain voters. BBC News reported last week that Paris is inviting London banks and hi-tech start-ups to defect, to escape Brexit. In the global “free-markets” Sterling has collapsed by 17% against the dollar and Euro. Renault-Nissan might pull out. Mrs May’s Three-Stooges have lost all credibility.  Our nation is being ruined while moronic Brexiters gormlessly repeat “The people have spoken” and “Brexit means Brexit”. It will get much worse. We cannot watch our nation being bankrupted by the mob who believed the Leavers-lies with no idea of the consequences.  Do NOT trigger Article 50. We do not have to leave and commit economic suicide!

Noel Hodson - Director
Tax Reconciliations, Oxford UK,

Monday, 10 October 2016


Last night's 2nd US Presidential Debate (9 Oct 16) said nothing new. Hillary remained dignified under fire from Donald over her alleged "30 years of inaction" as a Senator, and about husband Bill's incontinent infidelity and for hiding her personal e-mails.

Donald didn't do his Liberace pouting and posturing as much as he did in the 1st debate.; but he did threaten to jail "crooked Hillary" when he is President. But, People in Glass Houses - will Hillary encourage the IRS to swoop on Donald first - and throw him into the deepest dungeon? Who, I wonder, signed all those tax-free Trump tax-returns and Balance-Sheets?

Hillary supports Obama-healthcare; Donald hates it. He will ban Syrian refugees and send all migrants home (including his father's and his wife's families?), and he will arm all school-children and lunatics, stop Chinese steel-dumping and Make America Great Again. The tedious repetition of worn out old soundbites is less exciting than watching 2 hours of TV soap adverts.

Hillary again apologised  for circumventing Defence Dept. e-mail protocols. She might point out that whistle-blower Edward Snowden published millions of "secure" Defence e-mails. As Mr Trump might say "Boring - Boring - Boring". But I suppose it is necessary for these scripted, rehearsed contenders to endlessly repeat simple semi-literate slogans to win over the "still undecided" among the great, unwashed, unintelligent masses. They both expressed their deep love for marginalised ethnic voters. Donald stopped short of finding a Mexican to hug.

Wash-your-mouth-out-with-soap, demented, dirty minded Donald, apologised and wept crocodile tears for his disgusting "locker room groping" talk captured on video. The emerging spin is that all men talk like that behind closed doors. We don't. If Trump keeps that kind of crude, immature, misogynist company then he is not fit to have any political power at all. This sad old lewd bully needs mental-health treatment, in a secure environment. The only politician to ride to his rescue is the fake-tan, rat-faced, beer swilling, European MP, Nigel Farage, who spends his life trying to destroy the European Union while on their payroll, and who celebrates Trump as "an old silverback gorilla" - presumably meaning that lecherous rich dirty old men have a natural right to grope and assault women and "grab them by the pussy", as Donald boasts he does on first meeting an attractive woman, before trying to fuck them - particularly, he says, if they are married.

There are sex therapy clinics where these two elderly gropers can get medication and counselling.

 BBC - 11 Oct 2016 - The most senior elected US Republican official has said he will not defend Donald Trump, after remarks he made about groping women led to outrage.
House of Representatives Speaker Paul Ryan vowed to focus on defending seats in Congress, but did not end his endorsement of the party's nominee.
Mr Trump tweeted that Mr Ryan should not waste his time fighting him.
Earlier Democratic rival Hillary Clinton cast doubt on Mr Trump's apology for the 11-year-old remarks. On Sunday, Mr Trump described his words as "locker-room talk". 

In the UK, the new Theresa May led Tory Brexit government is also appealing to the Don't-Knows and Can't-Think and My-Brain-Hurts voters, - but on a massive scale. 

Wednesday, 28 September 2016


28 SEPTEMBER 2016  - I watched the televised debate between Hillary Clinton and Donald Trump, broadcast on 26th September. 

Hillary Clinton was the consummate professional, as would be expected of a senior world politician who has occupied and bestrode the corridors of power for decades, and had her home in the White House as First Lady. If a wealthy casino and hotel owner such as Trump had sought a meeting with her as Secretary of State, I guess she would have met him - they are both major New York figures - but probably have kept him at arms length, and given him eight minutes, before her aides politely escorted him off the premises, pressing an autographed photo into his hand; and before she returned to serious national issues. States-person Hillary was on top form.

My 50 years of tax-accountancy leads me to guess that Trump's 1995 and earlier huge bankruptcies left thousands of unpaid creditors in millions of dollars of debt, and, as Vanity Fair explain, built up tax-losses on his Atlantic City casinos that Trump carried-forward to subsequent years. "Smart" as he says: his creditors take the hit and he claims the tax losses. With an auditor's hat on, I would examine if he has taken both advantages - claiming tax-relief on his suppliers' losses, which he never paid - which would be illogical - he can't have both. The audited accounts of the time would show $900 Million of losses - but Trump's legitimate tax-loss should be what he personally paid - not what his creditors lost. His subsequent tax-returns should have corrected any over-claims - i.e. claims on Other People's Losses. The next question in my mind is who bailed him out? However "smart" Trump thinks it is to pay no taxes and leave his suppliers in the lurch, bank and mortgage lenders are usually more astute. For him to re-start after such huge failures, somebody cleaned up his blackballed credit-rating; which may have left him indebted to on-shore and off-shore loan sharks. Is "President" Trump in hock to those folk? Are there massive off-balance-sheet debts? Is he rich or bust behind the scenes? His "smart" affairs spanning the US and many tax-havens are very complex. For "Complex" in accountancy, always read probably-fraudulent: ENRON had the most "complex" net of companies which defrauded billions of dollars from shareholders & creditors, paid no taxes and had their auditors, Arthur Andersen, then the most prestigious in the world, shut down for fiddling the accounts. I SAY AVOIDANCE - YOU SAY EVASION 

It was the first time I had watched Trump in action, other than 30-second sound-bites on TV news. I was astonished to see that he is incapable of forming a coherent sentence; mixes syllables from different words to make new words with incomprehensible meanings; and blusters nonsensically through contorted body language, tortured smiles and grimaces, like a double glazing salesman suppressing acute indigestion. How on earth does he attract any support from anyone, irrespective of their education, politics or job? We have all, rich or poor, dealt with fumbling salesmen and seen through their shallow trumpery and promises. How does this man, with his ridiculous blonde toupee, seduce and command a large following of fellow Americans? 

The gestures that most struck me were his peculiar hand and finger movements which he employs to emphasise a point when he runs out of words and simply repeats whatever slogan enters his mind at that moment, while cricking his head sideways and grotesquely puckering his lips. When caught out in debate or challenged personally, Trump goes through these gyrations and responds very waspishly. At first it put me in mind of the Monty Python song - He's a Lumberjack and He's OK - but there was an older memory that was nudging through from the past - particularly when Donald turned his grimace into a lip-smacking winning smile for the cameras. In the 1950's my mother liked to watch Liberace on our little black & white TV and I sometimes watched that King (or Queen) of showbiz performers,draped in white furs, jewels and sequins, crooning and grinning at us from Behind the Candelabra. He was doing Liberace.

Donald was using the same nods, winks, frowns, soundbites and flummery, with similar hand gestures, to win adulation and applause from his fans. All that was  missing from the act was Dear Mother and Brother George. Donald has learned that words do not matter when communicating with the great American public. He writhes, he agonises, he weeps, he bullies, he gossips, he struts, he flounces, he flicks his peroxide wig, he flaunts his sparkly, shiny wealth, he stabs,  he needles, he spurns the establishment, he cries all the way to the bank, he preens, he twinkles and sympathises and empathises with the mute, impoverished, ignored masses. He seduces millions with his empty, meaningless banter and antics. 

Move over Liberace - prancing Donald has stolen all your gimmicks and your limelight - and America is entranced. The American Dream Has Come True. My mother would have loved his gigantic, self-serving showman's ego. And, at the end of his life, he will press the nuclear button and take us all with him, in a brilliant puff of light, over the rainbow, to Nirvana - Beyond The Casino Candelabra. 


Enron  and bent accountants: 


Tuesday, 20 September 2016


After 40 years of practice as a doctor in south London, aged 70, with no complaints from patients in those 40 years, following this excellent report by the NHS in June 2015, Dr Zigmond was dragged into a disciplinary hearing courtroom the day after he returned from a week's holiday; with no time to prepare, facing 8 hours of lawyers' questions and hundreds of pages of "evidence", was not allowed an adjournment or appeal - and had his office and surgery shut down without notice - with a closure notice on the door. Patients are distraught, the surgery team are in shock and Dr Zigmond is in despair. Buy his book and send a note of support.

The ousted doctor: 'My patients' souls matter most' - The Guardian › Society › Health
Dr Zigmond at Amazon books

2 days ago - Dr David Zigmond had plenty of time for his patients – but not for bureaucracy. Now the plug has been pulled on his surgery. Angela Neustatter ...

What changed from the excellent 40 years record in June 2015 to September 2016? Dr Zigmond had a book published, chronicling his experience of de-humanising changes in the National Health Service over his lifetime, entitled:

"They" obviously didn't like his book and "they" shut him down; overnight, without notice, and barred his patients. This is his diary of the shocking event. 

My view: The doctor has been abused by vicious, poisonous "colleagues", intent on forcing people into "compliance" with their pen-pushing and computer report rules - or ruining them. It wholly illustrates the articles Dr Zigmond has been publishing for decades, mapping the takeover of caring medical services by zombie robots. This injustice needs an instant Judicial Review, before the medics and patients lose hope.

Intelligent Monitoring Report Dr David Zigmond (St James Church Surgery) St James Church (North Aisle) Thurland Road London SE16 4AA June 2015
EXCELLENT - 59.2% - 86.2% - 91.4% - 89.8% - 92.00% - 91.5% - 97.9% - 72.3% 

GPPS004: The percentage of respondents to the GP patient survey who stated that they always or almost always see or speak to the GP they prefer. (01/01/14 to 30/09/14) 59.2% 

 -GPPS014: The percentage of respondents to the GP patient survey who stated that the last time they saw or spoke to a GP, the GP was good or very good at involving them in decisions about their care (01/01/14 to 30/09/14) 86.2% 
 GPPS015: The percentage of respondents to the GP patient survey who stated that the last time they saw or spoke to a GP, the GP was good or very good at treating them with care and concern. (01/01/14 to 30/09/14) 91.4%
 GPPS020: The percentage of respondents to the GP patient survey who stated that the last time they saw or spoke to a nurse, the nurse was good or very good at involving them in decisions about their care (01/01/14 to 30/09/14) 89.8%

 GPPS021: The percentage of respondents to the GP patient survey who stated that the last time they saw or spoke to a nurse, the nurse was good or very good at treating them with care and concern. (01/01/14 to 30/09/14) 92.0% 

 Dr David Zigmond 1-495556335 Domain ID: Indicator description (time period) Observed Average Numerator Denominator Z-score Z-score range Intelligent Monitoring Report June 2015 GPIM V102 Page 9 of 9 Caring 

GPPS025: The percentage of respondents to the GP patient survey who described the overall experience of their GP surgery as fairly good or very good. (01/01/14 to 30/09/14) 91.5%

 GPPS001: The percentage of respondents to the GP patient survey who gave a positive answer to 'Generally, how easy is it to get through to someone at your GP surgery on the phone?'. (01/01/14 to 30/09/14) 97.9%

GPPS023: The percentage of respondents to the GP patient survey who were 'Very satisfied' or 'Fairly satisfied' with their GP practice opening hours. (01/01/14 to 30/09/14) 72.3% 


 September 2016
Death by Documentation:
The penalty for corporate non-compliance

David Zigmond
© 2016
Our organisational efforts to assure fail-safety, uniformity and probity can easily – in excess – turn destructive beyond anyone’s wish or anticipation. This tale tells how such ‘mission creep’ happens and how it is sustained. The more laws the less justice – German proverb

In the last twenty years the ethos of our Welfare services has changed exponentially: from colleagueial supportive trust to managerial litigious mistrust. In medical practice the erstwhile medical authorities mostly acted as supportive administrators to doctors’ more autonomous judgements and activities. Current management, by contrast, is increasingly about identifying ‘outliers’ and fault, and then exercising control or elimination.

These changes are inimical to small General Practices and their unrivalled opportunities for high quality personal and family doctoring. To serve modern regulatory requirements GPs are now – almost entirely – corralled and managed in increasingly large and depersonalised practices.

The coerced demise of a long-established and previously well regarded exemplary small practice illustrates this process, and the price we pay.

February 2014
‘That wasn’t too bad, was it? I rather liked them. I think they liked us, here, too. They certainly listened…’ Sara, the Practice Manager, closes the front door behind the two exiting Care Quality Commission (CQC) Inspectors. Her sigh is soft, tired and appreciative.

I agree: for this first inspection we had been probed, questioned and examined with the best kind of professional intelligence: dialogic and sharp, yet always with a view to a greater whole – with good sense and sensibility.

They dextrously sampled and witnessed the ethos of my small practice: engaging with patients and my staff, often sitting watchfully and unobtrusively to see our interactions. After that they perused and enquired about some procedural records.

Seeming satisfied with these, the Inspectors’ attention shifted to personal infrastructure: how did I manage and sustain all this? What were my definite priorities? What would I then compromise? What did this cost me, personally?

Yes, I agreed with their questions’ implications: to keep long-term, good quality personal healthcare is hard: it depends on well-nourished and well-perfused headspace and heartspace. So I described our endless choreography between the personal and institutional. And how, when it is impossible to do both, it must be the personal that takes precedence: institutional requirements are then relegated or sometimes avoided altogether. I gave examples: judgements to bypass detailed data collection boxes, or contextually clumsy prescribed care-pathways.

The Inspectors pressed me for my explanations of such judgements, my discernments. I drew a parallel with what they were doing with us, now: they could not sample or know everything by exhaustive procedure. So the skill is wise and pragmatic selection and compromise: from the accessible parts they would apply their imaginative intelligence to extrapolate a likely and meaningful whole, and then they would apply their best judgement. Yes, the Inspectors agreed, there is no certainty in such human complexity; the skill is to construct and offer our best informed and shrewdest judgements. This is not easy – it required nuance and delicacy: too direct an approach may destroy or disperse what we are trying to see. We are here like naturalist-observers: often we must be stealthy, still and part of the landscape – that way far more will come to us.

The two Inspectors resonated with this and talked around my metaphor. ‘Yes’, the older concluded. ‘Our approach has to be skilfully and subtly different on each occasion – we can then see much more of the important things that are going on, good and bad … If we don’t do that our better judgement will be blind.’

As Sara closes the front door, she turns to me and smiles.

‘Well, whatever their report I think they got a good sense of us’, I say.


The CQC report, publicly displayed for the next two years, glowed with positive acknowledgements.


February 2016
A Clinical Commissioning Group (CCG) meeting. The atmosphere is wearied and listless, acquiescent though fractious. The GPs forming its nucleus are obligated to attend by the Health and Social Care Act: theoretically they have an executive role but they feel more like political prisoners. This paradox is important – it illustrates how our institutions have massively misconceived the vocational psychology of healthcare: why and how we may wish to offer often difficult care for others. The result? An ever-increasing human and community waste and misunderstanding. Now we cannot contain, sometimes even survive, the effects of this. For years I have publicly and recurrently warned of this. I do so again today. I meet the usual kind of diplomatic avoidance and mollification.

As the meeting limps dutifully to a close, Dr C, a veteran colleague, approaches me inquisitively.

‘Have you been CQCd yet?’ I am struck by how the noun of this institution has been turned into a verb, to which I now serve as a passive recipient.

‘No’, I say simply, but I know he has a message as well as a question.

‘Well, you should be careful. They can be very nasty…’

‘Oh, I think I’ll be alright. I found them helpful, intelligent and sensible last time…’ I am thankful but cheerfully disregard him.

Dr C’s look is of irony laced faintly with pity. He gives a twitch of a shrug and turns away.


July 2016
Sara spends much longer with the Inspectors than we expected and leaves them looking apprehensive.

‘They’re very different to those we had last time. They don’t really want to discuss anything – just check documents and endless certificates. Some of them – the more obscure ones – I couldn’t find…’ A contrite hand rises to console her mouth.

It is now my turn. The Inspectors enter my room. After necessary greetings and seatings, a rhetorical question:

‘Your Presentation?’

‘I’m sorry … what’s that?’

‘It’s the preliminary part of what you should have prepared for this CQC inspection. We informed you of this in a detailed email. Don’t you read them all?’

‘No, I don’t. Certainly not all. Not if I want to stay alive in this job…’

‘What does that mean?’ their uneasy incomprehension already glares with disapproval.

‘Well, it’s an enormous problem. Everybody knows it, but we can’t tackle it. The ever-increasing electronic traffic numbs our brains, dumbs our speech and often displaces off-screen reality. Email encephalopathy is an enervating institutional disease. If I want to save my time, my Mojo and my sanity then I must be selective … Anyway, I think my semi-deliberate lack of preparedness is better now for us all.’

They are both busy note-keeping, their questioning frowns seem mirrored. One of them asks: ‘How can not preparing something be better?’

‘Well, I can explain. In my experience “presentations” easily become feints of PR: careful conjurings, editings and polishings. Slick packages. Choreographed distractions and distortions to get the other person to see what we want them to see, and conceal or opacify all else. An inspection is wonderful host territory for all this. No, I don’t want to perpetuate this “spin culture”: I think it has replaced, often dangerously, more natural and authentic dialogue in our NHS. I don’t want to do that here, or anywhere.

‘So, let’s talk: a conversation. That way you’ll get a more real view of our struggling, flawed but wholesome little world here and my role in it: what I do well and happily; what I do not; the compromises I make; the rewards I get; how I hold it – and myself – together … I want to be candid: warts and all…’

I pause, to see if they are receptive. There is a jerk of the scribbling pen – a green flag to continue.

I go on to talk of the complex challenges – and gratifications – of providing bespoke, personal continuity of good medical care in our inner city. My human results reflect what I believe is mostly good work: extremely high patient satisfaction rates since records began, no serious complaints (ie requiring a formal hearing), stable and enduring staff expressing affectionate loyalty, low staff sickness rates and no substantial accidents…

 ‘How do you achieve that, then?’ asks an Inspector.

‘By assuring my priorities: personal contact and understanding – relationships. If they’re good, the rest usually follows: morale, cooperation, attentive intelligence … But what we have to secure first is headspace and heartspace: those are essential. Other things much less so.’

‘What is less important?’

‘Ah! That’s where we come to what I’m not so good at: what I selectively relegate or discard.’

‘What are those things?’

‘Oh, mostly formalities to demonstrate corporate compliance: contextually unuseful and irrelevant data-inputting, some health and safety meetings or trivial regulations, sticking rigidly to Care Pathways when I deem them counter-productive. All that tick-box stuff…’ My hand flips away.

‘Give us an example.’

‘Well, I haven’t had a staff-minuted meeting about a Muster Station in case of fire. The premises are small, with four rooms, one straight corridor, a front door and a rear emergency door. It is quite clear what we should do: go to the exit away from the fire.’

‘But there are more serious omissions. For example you have no evidence of Child Protection Training…’

I sigh with encumbered irritation. ‘Well, I went for an afternoon course.’

‘Well, where is your Certificate?’

‘Probably stuffed in a bag somewhere. I’m sorry. Look, that course was so useless for me it wasn’t worth certifying. I was in a hot room with about a hundred practitioners of very varied grades and experience. For three hours we were lectured and instructed by a specialist nurse and social worker. They said, basically: “Children are neglected and abused more than we realised. Obviously this is serious and often stealthily concealed. This happens more with struggling, conflicted or unstable families – but certainly not only. Be vigilant. Contact us.”

‘I know this well. I’ve been working thoughtfully with families for years. I don’t need to take half a day away from my work to be crop-sprayed in this way. What I do need – and what has now vanished – is easy access to an experienced colleague who personally advises and sees things through, both with me and the patients…’

The silence has grown leaden and glowering.

One of the Inspectors, Dr S, a neatly suited and formally mannered man in his mid-fifties, clears his throat. ‘We have found other areas of concern. In Mental Health. Your under-diagnosis of Depression and Dementia. This may indicate your lack of providing a good service to certain patients.’

‘Oh, I don’t think so. Look, when someone contacts me anguished with, say, a broken love-bond, an inassimilable bereavement, a humiliating impasse at work, or a haunting from old traumas, I am not going to spend that delicate time with them filling in a formulaic – often clumsy – depression or risk-factor analysis. If I do that I may gain points with the compliance system, but at the risk of losing the patient. So, to avoid all that, I code such people differently: “Emotional Problem”, “Work Stress”, “Family/Marital Problem”, etc. In carefully using those kinds of discernments I believe I am then freer to provide better care. Inconveniently for our current systems, that involves trusting the practitioner with those many deviations … But we do have to trust to make those decisions.’

‘So, you don’t see a place for the recommended diagnoses, templates and pathways?’ The Inspector’s voice is dry.

‘Well, only sometimes. It’s complicated, of course. My skills must have the professional autonomy to decide about this patient, now: is organisational compliance here likely to be helpful, unnecessary, or even deleterious?’

‘And your approach to dementia: is it similar?’

‘Oh, yes! And for similar reasons…’


‘Complexity and context. Failing cognition is only rarely decisively treatable by doctors. Yes, we can help with certain risk factors. We certainly should offer our most informed guided support and advice. But ‘Dementia’ becomes mostly a relational and social problem: does the declining person have robust, and intelligently affectionate care-taking from significant others? Who are they? Do they need guided support? and so on … It’s the same for all of us, when we decline with age…

‘These problems increase with our ageing population. As a frontline GP I have to rapidly identify and weave these myriad and delicate threads to create a personally meaningful, useful and accessible whole. But I can only do that well when I can use my human and technical skills freely – when I am the choreographer. An institutional template often obstructs all this…’

‘So, again, you choose to depart from established procedure?’

‘Yes, sometimes. It’s a tricky paradox. With these kinds of problems I can be a better doctor when I avoid doing what the institution might expect. I choose when and how to override institutional procedures…’

Dr S is looking at me with quizzical caution.

‘But I am very thoughtful about how I do so’, I quickly add, as an insulating caveat.

‘I’m sure. But nevertheless you do feel you have the right to “cherry pick”, when you choose?’

‘Yes, that’s true’, I answer simply and softly, though I am already sensing a darker subtext to the question.

‘Thank you. I have no more questions.’ Dr S looks down at his notepad: his smile, to himself, seems consummate.

This meeting has been difficult but I want an amiable farewell: I chat as we are disbanding.

I ask Dr S ‘Are you still in practice?’

‘Oh no. Not for three years now.’

‘Why did you retire?’

‘Well, I’d accumulated a very good pension, so I could leave easily!’, he beams. ‘I’m just doing this [CQC inspections] now.’

‘From practitioner to judge’, I say: a serious banter.

‘Yes, I’m doing a University Masters Degree in CQC Inspections’, he answers, with enthusiasm.

‘Ah’, I respond simply, with rather less enthusiasm.

‘And what keeps you going, in your fortieth year as a GP?’, he enquires, as if he cannot imagine.

‘It’s like a happy second family here, this small practice. Through all our joys and sorrows we get to know one another: patients, receptionists, clinicians. And amidst this, with my human and technical skills, I can sometimes be really helpful. At other times we can, at least, be a personal comfort, support and witness to Life’s inexorable sorrows. We all here want to come to work in the morning. Where else could I get such satisfactions?’

Dr S registers his own simple ‘Oh’ and shoots me a brief smile that is bemused but not hostile. He is now standing at the door, about to leave.

I offer my hand, to say farewell. His grasp seems reticent and ambivalent.


The coup de grace was coordinated with brilliant and shocking efficiency: a lightning strike worthy of Blitzkrieg.

It came three days later, on a Friday night at 6pm. My receptionist received a call from a Senior Officer at the CQC notifying me of their intention to close my Practice on the next working day, Monday morning. The charge is that my Practice was found by Inspectors to be massively and irremediably unsafe and must be closed immediately. This would be done by an emergency legal procedure, through a Magistrates Court Order.

At the time – until a few hours before the set hearing – I was on a brief holiday, in France. I was uncontactable and oblivious of these rapid and shocking (for me) developments. Tired from a very long train journey I was unprepared and disorientated by such overwhelming and draconian measures.

I arrive flustered, hurried and alone to the Court. The CQC has assembled massive and well-armed forces to encounter my unsupported and unbriefed solitary enfeeblement: a solicitor, a barrister, a CQC Director, a CQC Compliance Officer and a Medical Expert (in what?). They all have hundreds of pages of meticulously prepared and filed ‘evidence’ against me. I cannot see how they could have assembled such thoroughly destructive documentation between them within three working days: there must have been much prior briefing and planning.

I immediately ask the Magistrates for an adjournment, but the barrister is adamant that this should not be granted: that my Practice is so extremely hazardous that the public need immediate protection, by its closure. Public safety must here, exceptionally, take precedence over natural justice. The Magistrates acknowledge they have never encountered this problem before and, bewilderedly, opt for safety. They rule in favour of the barrister: whatever complexities emerge, at least the public will now be protected.

This Court hearing will turn out to be extraordinarily long – eight hours. The Chair of the Magistrates will later describe what is (for them) unprecedented length and difficulty.

Throughout the long day there are Court adjournments for respite and procedure. Outside the courtroom I am expected to wait, seated, in a bare ante room which I must share with my CQC prosecutors, my assailants. This is awkward and they understandably create maximum physical distance, avoid looking in my direction and mutter very discreetly amongst themselves. In another context I would think they looked amiable. To loosen the tension a little I say: ‘Look, we can see how difficult this is and I want to make it a bit easier, just for now. I can see you are all “just doing your job”, following procedure. Yes, that’s hard for me, but I shall argue my case and bear no personal animosity toward you. None of you know me, so I understand that – for you – it’s a technical and institutional matter.’

I notice two of them look at me briefly, signal a tentative smile and say a quiet ‘Thank you’. They seemed touchingly grateful for this: mercy from the condemned.


In this strangely cohabited space the ‘other side’ give me copies of the voluminous prosecution documents. I have time only to briefly peruse some of them: a thorough reading and response would take me days.

Very soon I can see the professional profile they have constructed: reckless or feckless, casually or deliberately unsafe, uninsighted, disobedient and unreformable – in short a gross and intolerable liability to any public service. With ironic gloom I conjure cartoon scenarios. A uniformed senior policeman in front of TV cameras issuing a statement: ‘We have been warned of the great danger this man poses. Members of the public should not approach him directly, but instead immediately contact the authorities’. Or a shouting tabloid headline: Dangerous Doc Exposed! Authorities find years of concealed danger to the public. How many have died?

In my brief time for perusal I can merely identify some misattributions or inaccuracies. Maybe I will have the opportunity to designate them: many will go unchallenged.

But my more substantial legal vulnerability lies elsewhere: I have already frequently acknowledged deliberate and thoughtful non-compliance. I will never deny this.

My self-defence – however much I am allowed – will have to also address this. So, in the courtroom, I offer a few parries and corrections to (what I think are) documented errors. My main thrust, though, is an appeal to natural justice, as opposed to strict legality.

Yes, I argue, all can easily see areas of non-compliance. I have long argued that this, selectively, must be done if we are to provide our best personal care for others and (importantly) ourselves: that over-regulation, paradoxically, is destructive to much of our best healthcare. I have vigorously argued the reasons for this, often, in public, and in many publications.

The lawyers prompt my return to their combat arena of legalities – their many showcased items – but I am trying to break away, to view the bigger picture – the whole – the overall integrity of myself and my Practice.

Despite the lawyers’ stymies, the Magistrates ensure some (if inadequate for me) time to do this. What is this bigger picture? Well, it’s much longer, too. I attempt a brief, well-documented profile: thirty-nine years as a Principal GP; never a formal complaint needing a hearing; excellent long-lasting and warmly appreciated staff and close colleagueial relationships; never – until now – any litigation; never on-premises serious accidents; far-above average patient experience feedback, consistently and for many years; robust good health and humour; highly regarded and well-known academic and journalistic output; similarly acclaimed teaching … The Magistrates are attentive.

I continue. With all this – for decades, and no sign (yet) of personal decline – what is the real life evidence that I am a serious risk, professionally or environmentally? Wouldn’t that now be long evident, and from many sources?

No, the barrister argues, you are flagrantly unsafe. All the regulation and requests for documentation are there to assure safety. Therefore, if you do not comply fully you become unsafe.

So, I reply, I am guilty (of unsafety) unless I submit to all your procedures and then get a certificate of compliance from you (the CQC) saying I am safe. Guilty unless proven innocent: innocent only by submission – a stark inversion of natural justice! Doesn’t this – the self-referring system of proceduralism – eventually become a folly of officious abstraction? Isn’t that what is happening here? No, the barrister assures the Court: such devices are there for our communal protection.

I take a contiguous, but different, tack and then appeal to the Bench: my exceptionally good real-life record (ie not the one abstracted recently by the CQC) has been possible only because I have created the professional autonomy to decide on priorities with my Practice and patients. That is my skill and my ethos – to employ my good faith and judgement to make the best compromises. Our current error – as enacted by this CQC action – is to assume that every possible risk, problem and adverse situation can be prevented or solved by ever-increasing regulations of compliance, monitoring, management and penalties. The truth of this is very limited, but we (eg the CQC) are exerting this principle far beyond these limits. The resulting trespass is egregiously – though inadvertently – damaging of healthcarers’ vocational ethos, spirit and healthy colleagueiality. Hence our evidence of another kind throughout the NHS: collapse of staff morale, health, career longevity, satisfaction, recruitment … Overstrict parents rarely produce what they, or anyone else, say they want.

This – increasingly for a decade – is what I have been trying to avoid. This is why – very selectively and conscientiously – I have openly chosen non-compliance. To serve as a good personal and family doctor I must sometimes compromise or discard my unworkably dense matrix of regulation.

Real-life General Practice – like so much of our lived (rather than abstracted) lives – is the art of the possible. Only rarely is it completable or perfectible. To suppose otherwise will teach us painful lessons: that is what we are struggling with, here and far beyond.

I am relieved and grateful to the Magistrates for allowing me the time to say all this. Even more so that they seemed genuinely interested and supportive, despite their professionally neutral demeanour.

Not so, not surprisingly, the barrister. All this, he says, is beside the prosecution’s argument and evidence: that I have been knowingly disregarding – flouting even – of clear regulations. Other argument, explanation or mitigation is irrelevant.

Within this narrow legal frame I can see he is right. I am guilty as charged. My heart sinks.

I am wanting to say: ‘But the whole (evidence from life) is more than the sum of its parts (evidence from procedures). We must – whenever we can – pursue and grant precedence to the whole.’ I look around the Court. After many hours I can see it is now wearied to a standstill. I do not think they can be further receptive to me. I decide to say nothing.

The Magistrates adjourn for their final, private conference.


Another thirty minutes. We are assembled for the summary and verdict.

The senior Magistrate delivers this: ‘In my twenty-seven years on The Bench I have never encountered a case of such length, interest and complexity. Yet at the end of the day we are all subject to the law, and this Court’s task is to administer the law, not to express opinions about any such laws or regulations.’

She turns to look at me directly: ‘It is with reluctance, but necessarily for this reason, that we find for NHS England and against the doctor. To his credit the doctor has been open and honest – both verbally and in documents – about his failure of compliance to clear regulations, but this becomes indefensible in terms of his contract of employment. NHS England is thus legally entitled to immediately effect its remedial procedures.’


After eight hours we all leave slowly, sagging with fatigue.

I extend a friendly hand to each member of the hit-squad. They initially stiffen warily with surprise, but then loosen as they perceive my gesture is unusual, but not an ironic trick. I smile and say: ‘You did a difficult job well for your employers. Of course, I don’t agree with what you’ve done: for me, this may be the law, but it’s not justice. I understand the principle, but see only, and much, damage from this decision. I have so many mixed feelings about all this, but not about you: not personally.’

For the first time each individual holds my gaze. They each smile with a sweet-sad sincerity and say a lingering and deliberate ‘thank you’.

At the end of all this very long procedure we have – only now and briefly –found and recognised our common humanity.

I feel a tug of intense grief: it is mixed strangely with relief.


Notices are put up on the front door of my Practice informing of its closure of services and where patients may now go.

As I walk away from the front door Ronald approaches me. I knew him as a docile adolescent and he now approaches me as a thickset middle-aged man with a cumbersome gait and a habitual aura of trusting – but never really articulated – anxiety. This is evidently worse now.

‘I’ve heard, doctor … Can’t you be my doctor any more?’

‘No. Not from now on. I’m really sorry. But I’m pleased I was able to offer a bit of help over the years…’ I am trying to buoy us both up, offer us both something positive.

‘But why is that? Don’t you want to go on?’ I think Ronald hopes that his question will bring a reversal. His eyes glisten with stemmed tears.

‘Oh, no. The Authorities have decided I’m not modern enough. I’m not really what they want. There’s all sorts of regulations I have to follow…’

‘Can’t you do that?’ His question sounds pleading.

‘Probably not. I’d exhaust myself and I wouldn’t be able to be the kind of doctor I believe in … how I’ve tried to be with you all those years.’

‘So they think they know, better than you, how to be my doctor, do they?’ His voice is earnest and slow: this sounds like a real question, without guile or rancour.

I respond in kind. ‘Yes, I think that’s right. You see, they pay the money, so they make the rules.’ I try to sound simple, neutral and benign. I exclude much else.


Later, outside the NHS City Gates, my severed professional head will be displayed on a spike. It will not need much comment or explanation to spread the necessary message. Corporations can function only with hegemony, and hegemony necessarily must have compliance, and when have we ever achieved mass compliance without publicly displayed, draconian penalties?


‘Oh dear! That’s terrible news … I’m so sorry. How did it happen?’

Dr E, a young doctor now senior in my CCG, sounds genuine in his shock, kindness and commiseration. He is an intelligently humane man but stressed, I think, by the diplomatic strain and responsibility of shepherding very difficult schemes of governance that he (privately) does not believe in. With delicate and opaque skill he has signalled this to me previously, while always ensuring protective ambiguity.

‘I’m really sorry’, his voice lowers further with the repetition and sadness. ‘You know this is going to leave a massive gap for us. You’re going to be greatly missed…’

‘How so?’ I am touched and a little perplexed: I have previously sensed his wish for me to be more silent, or even absent.

‘Well, you’re the one who always said the bold and challenging things other people want to, but never would. You’re older and you’ve had this honest – some would say tactless – courage. But these things needed to be said … now there won’t be anyone to say them…’ His voice fades into a faint desolation.

‘Why don’t you, E?’, I ask, trying to revive him.

E is silent for several seconds before side-stepping: ‘Yes, but how are you David? Do you have enough support?’ He is sounding brighter and stronger.


As I enter my exile I await a formal CQC report: a pillory, a publicly displayed penalty for non-compliance.

I am thinking that there are times in life when we must choose between personal integrity and survival. I am grateful that this – my most serious test – has been encountered so late in my career.

I am thinking, too, of the elemental questions of all relationships and welfare: what do other people want and need? How do we (think we) know? Who decides, and how?


Some eyes need spectacles to see things clearly and distinctly: but let not those that wear them therefore say that nobody can see clearly without them.
– John Locke, An Essay Concerning Human Understanding (1690)

The young man knows the rules: the old man knows the exceptions.
– Portuguese proverb

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