Dr Teck Khong: We should maintain our international aid spending - but we can make it smarter and more innovative

Dr Teck Khong is the Chairman of Conservative Friends of Malaysia and an approved list candidate.

Two years ago when the European sovereign debt crisis was starting to worsen, a challenge was posed to do something that would be beneficial for our party and our country. At the same time, there was growing awareness of a need to reconnect with the Commonwealth. An initiative was therefore launched with the focus on Malaysia and an exploratory trip to Kuala Lumpur was undertaken in February this year. From a NGO caring for vulnerable people and the learning disabled, there was a request for support with its delivery of healthcare services. Then, during discussions at the Malaysian Prime Minister’s Office, two issues emerged. One was a need to improve English Language skills and the other was a strong desire to escalate direct bilateral relations in the small and medium enterprise sectors. At a separate meeting, the directors of SME Bank of Malaysia expressed their wish to work with the British in developing trade and the exchange of technical knowledge in the small and medium enterprise sectors. The potential advantages for both countries were apparent but, sadly, without interest and support from parliamentary colleagues in Westminster, SME Bank of Malaysia signed a MOU with SME Bank of Russia earlier this month for the same purpose.

Dr Teck Khong: Independent assessment of sickness will stop claimants blackmailing GPs

Dr Teck Khong is an Approved List Candidate who contested Bradford North at the 2005 General Election. He is a Board Member of the Leicester City Clinical Commissioning Group. 

For the past 30 years as a GP, I have been dismayed and perplexed by the way in which the sick note has been abused as a substitute for earned income and its impact on the morale of those with integrity and who have decent work ethics. The announcement today that GPs will be stripped of their role in certification of those with so-called long-term sickness is overdue but welcome news, with a few important provisos.

I have written in this section of ConHome and argued with Conservatives, with my professional colleagues, and in public, that the system for sickness certification and the linked award of financial benefits were both in desperate need of a major overhaul. It is politically correct that policy reflects government responsibility to preserve the moral well-being of those they govern, and in a democratic and compassionate society ensure equity across all sections of the community. I often hear patients express their disapproval of those who they have seen living life to the full, enjoying all the perks of being certified sick and undertaking all sorts of activities apart from earning a living as they claim benefits. Only this week I signed, after much heated argument with three patients, sick notes for them when they were clearly capable of working. In one particular case, a single-parent woman in her late thirties who has never worked claimed that her obesity made activity demanded by various jobs offered to her difficult to fulfill. She also said that without uprated benefit payments, her children would suffer. Such cases of long-term sickness are not the exception; they are commonplace. Even worse are those who have been through emotional crises and who after a time away from employment, become demotivated and shelter behind the badge of prescribed anti-depressants.

Dr Teck Khong: It is competitiveness - not competition - that we should be promoting inside the NHS

Dr Teck Khong contested Bradford North at the 2005 General Election, is a Board Member of the shadow Leicester City GP Commissioning Consortium and founder of the think tank New Britannia.

Having worked in various NHS positions since the late 70s, I listened to the Prime Minister's speech at Guy's Hospital on June 14th with great anticipation, only to feel disappointed by the end of it. Later that afternoon, I attended a GP Commissioning Consortium (GPCC) board meeting which was more crowded than usual with non-executive directors and lay observers. The meeting dragged on but the decisions which were finally reached would have been no different had the non-board members stayed away. Of course it is important that all interests are considered at such meetings, but this and other current processes are mere tinkering of the much larger national problem which the Government must urgently tackle – how to achieve successful integration within the behemoth that is our NHS.

Leicester has one of the busiest Accident and Emergency (A&E) Departments in the country. A large proportion of its attendees have minor ailments that should be dealt with by their GPs. Such inappropriate use of the A&E is not entirely the fault of the doctors and nurses or the architects and planners. Getting those members of the public to co-operate with advice and improve the situation has not worked and has sometimes backfired. The addition of a hospital doctor, nurse and more lay people to the GPCC would not make any significant or beneficial difference to this type of problem. A primary care led consolidation of services would more easily resolve such difficulties. Integration will.

Dr Teck Khong: It’s time to consider real changes to the Health and Social Care Bill

Dr Teck Khong contested Bradford North at the 2005 General Election, is a Board Member of the shadow Leicester City GP Commissioning Consortium and founder of the think tank New Britannia.

The Health and Social Care Bill is a necessary step in the evolution of the NHS because of major challenges posed by changing demographics and turbulent economic conditions. Unfortunately, the Bill is handicapped by a lack of clarity about the long term impacts which would result from a shift in funding policy. It also misses the opportunity to address the fundamental flaws in the configuration of the health system.

Furthermore, the title of the Bill is a misnomer as its social component omits a much needed review of the ties between the benefit system and the NHS. Its present linkage to the NHS not only constrains the effectiveness of the NHS but it also conspires to undermine proposed reforms of our pensions and welfare system.

Apart from transferring financial responsibility to GP consortia, the other subsidiary principles of the Health and Social Care Bill are valid – the reduction of bureaucracy, the repositioning of decision-making processes and revision of social care provision.

With over 30 years of experience in the NHS, it is possible for me to track the changes that have contributed to the success and failure of various health policies. The most significant of these is the greater separation between primary and secondary care that has come about recently and exacerbated by the monetisation of medical procedures. The situation has become so ponderous that, unsurprisingly, hordes of clerical and managerial staff are required to negotiate and monitor contracts with their complicated financial arrangements.

Teck Khong: NHS reform must tackle the fundamental flaws in its management, its funding, and the maintenance of professional standards

Dr Teck Khong is a GP and law graduate who has held various appointments in the NHS since 1982. Concerned by its deepening difficulties, he entered politics with a view to improving it. He contested Bradford North In the 2005 General Election.

A few years ago, a caring GP was driven to suicide through being hounded for over-referral. GPs are told by Primary Care Trusts (PCTs) to cut down on referrals to save money and many comply without compromising safety. However, when a GP exhibits diagnostic skills and manages cases entirely competently, patients with unreasonable expectation complain to the PCT at a drop of a hat! The PCT, with its Customer Complaints Department will indiscriminately approach all complaints on the basis of “guilty until proven otherwise” without even checking their validity or indeed clinical importance. Such an attitude only drives doctors to distraction and wastes time and resources. Under perverse pressure, doctors choose one of several options – they give up on being good doctors and head towards the middle ground of mediocrity that fits all the PCT constraining parameters, or they quit their positions which are either filled with more of the mediocrity, or they simply retire.

Distraction and corruption of professional focus and values come in different guises and they also affect nurses. Tony Blair’s Cabinet Office issued a document in March 2001 entitled “Making a Difference – reducing GP paperwork”. The sad reality is the exact opposite has happened, with great cost to the public in many ways – more managers, more machines, more meetings, etc. Both doctors and nurses have to deal with inordinate amounts of form-filling and the majority are plainly stupid and unnecessary. The lesson is this: the more time a health professional spends on administration, the less time there will be for patients.

Another topical issue that is equally applicable to both primary and secondary care is service during out-of-hours. Although it is not difficult to resolve, there is a dearth of cogent progress. But there is the other side to the coin. At an out-of-hours clinic in a Northamptonshire hospital recently, there were a typically significant number of non-urgent calls – “can I get pregnant with my new boyfriend from unprotected sex even though I had a termination 2 months ago?”; “Can you help me with my weight problem as I get out of breath when I walk?”; “I want a doctor to visit me for my cystitis – can’t come out as I have 2 young children.”

Dr Teck Khong: The "Fit Note" is symptomatic of the Labour Government - unfit for purpose

Dr Teck Khong is a Leicester GP and a forensic physician for Northamptonshire Police who contested Bradford North at the 2005 General Election and remains on the Approved Candidates' List. Here he critiques the drive by the Department for Work and Pensions to reduce absenteeism and sickness benefit claims with the "Fit Note".

No one would deny that we need to tackle abuse of the benefit system; but the Labour Government's strategy to deal with the economic impact of unwarranted sickness leave with the "Fit Note" - due to be implemented today - looks set to create a huge range of difficulties and hit the vulnerable in our society.

Although sound clinical judgement is made in estimating the most likely time for sufficient recovery from a condition to enable a return to work, the reality is not so straightforward. Even clear-cut cases of specific illnesses have variations in recovery times depending on the severity of the condition in each case, the ability of the individual to recover, any associated complications and any unexpected interceding event. There are, of course, the more nebulous conditions without objective and demonstrable pathologies that vex both GPs and the Department for Work and Pensions and cost the country heavily with dubious validity of the claims.

With the Fit Note, a new feature not found in the sick note is the option of graded return to work. The difficulty then arises regarding what constitutes an appropriate gradation of workload increase. What are the implications of omitting a phased return to work or advising a phased return that is too rapid and an accident happens or health deteriorates as a result? I was medical officer to a major bus company that operated an all-or-none policy – either a bus driver was fit for work or was unfit; the manager informed me he was not prepared to take risks with partial working with the connotations of incomplete recovery. With the launch of the Fit Note, it is inevitable that the GP will be drawn into a legal minefield.

Dr Teck Khong is a Leicester GP and a forensic physician for Northamptonshire Police who contested Bradford North at the 2005 General Election and remains on the Approved Candidates' List. Here he critiques the drive by the Department for Work and Pensions to reduce absenteeism and sickness benefit claims with the "Fit Note".

No one would deny that we need to tackle abuse of the benefit system; but the Labour Government's strategy to deal with the economic impact of unwarranted sickness leave with the "Fit Note" - due to be implemented today - looks set to create a huge range of difficulties and hit the vulnerable in our society.

Although sound clinical judgement is made in estimating the most likely time for sufficient recovery from a condition to enable a return to work, the reality is not so straightforward. Even clear-cut cases of specific illnesses have variations in recovery times depending on the severity of the condition in each case, the ability of the individual to recover, any associated complications and any unexpected interceding event. There are, of course, the more nebulous conditions without objective and demonstrable pathologies that vex both GPs and the Department for Work and Pensions and cost the country heavily with dubious validity of the claims.

With the Fit Note, a new feature not found in the sick note is the option of graded return to work. The difficulty then arises regarding what constitutes an appropriate gradation of workload increase. What are the implications of omitting a phased return to work or advising a phased return that is too rapid and an accident happens or health deteriorates as a result? I was medical officer to a major bus company that operated an all-or-none policy – either a bus driver was fit for work or was unfit; the manager informed me he was not prepared to take risks with partial working with the connotations of incomplete recovery. With the launch of the Fit Note, it is inevitable that the GP will be drawn into a legal minefield.

Teck Khong: Reduced administration, the inculcation of individual responsibility and the support of personal choice are fundamental to reviving our health system

Dr Teck Khong is a Leicester GP and a forensic physician for Northamptonshire Police who contested Bradford North at the 2005 General Election. He is on the Conservative Party's approved list of parliamentary candidates.

Proposals for health policy changes are conventionally driven by budgetary considerations. This approach to financing the nation’s healthcare is complicated by a second major handicap of government management – adherence to certain anachronistic aspects of the NHS.

By a combination of nannying, removing the financial freedom of choice and perpetuating the grip on procurement and provision of healthcare services, successive governments have stifled the development of a genuine and an ethical market economy in health. This latter objective is mismanaged on the one hand by haphazard privatisation and on the other by disengagement with the professionals who are the mainstay of the NHS.

To stop the present inexorable descent into chaos, our health system should be revived in line with plans for major overhauls in other aspects of the national infrastructure – the pledge to small administration, the inculcation of individual responsibility and the support of personal choice.

Dr Teck Khong: The flaws in the NHS must be addressed by rebuilding it from its very core

Dr Teck Khong, a Leicester GP and a forensic physician for Northamptonshire Police, is on the Conservative Party's approved list of parliamentary candidates. Here he reiterates the key elements of a new health system which he first proposed at the 2003 Policy Forum on Health.

The debate about NHS funding does not really concern the average citizen when he or she is in good health and needs no medical attention. Funding constraints only come a real problem to the patient who desperately needs treatment that makes a difference to whether he or she can walk again, maintain or return to employment, do all the normal things that are taken for granted by a healthy person, or avoid premature death and enjoy life with loved ones. It is also a conundrum when a doctor is compromised in what he or she knows by professional instinct should be done in the best interests of the patient. For the doctor, anything less is an assault on his or her conscience and a subversion of integrity.

Devolution notwithstanding, it is important to ensure uniformity of access to medical services and compassionate care for all UK citizens. To maintain such equitable standards, there has to be deep and fundamental changes, some of which have not been properly addressed.

In the process of acting as the procurement agency for treatment primarily through the engagement of professional services, the government has progressively increased and vastly distorted this remit. It has created immense administrative structures that lack coherence and efficient management with the twin consequences of massive waste and poor results. How could a Strategic Health Authority justify the metamorphosis of one Family Practitioner into six Primary Care Trusts over a 20-year period when it would not invest in a neurosurgical unit for the same region?

Dr Teck Khong: The social problems driving ill health

Dr Teck Khong, a GP and forensic physician, is a parliamentary candidate of the Conservative Party. In this Platform piece he urges us to 'forget right and left' and just get the country back on its feet.

I work in a typical NHS health centre, with occasional stints at out-of-hours centres, caring for people of all social classes. Some nights and weekends, I attend to detainees in police stations because they can’t sleep, or have a rash or cough but did not have time or bother to see a GP, or are withdrawing from ‘gear’, have minor injuries from drunken brawls, or gained a few more scrapes while resisting arrest for burglaries or “got a real bad shoulder pain” having crashed a stolen car. And, of course, there are those call-outs for allegations of police assault because the handcuffs were tight or those who assert they cannot be locked up because they “suffer claustrophobia in the cells”. Sadly, these cases now outnumber other forensic examinations such as psychosis, suspicious deaths, and suspects and victims of physical and sexual assaults.

While some drug addicts have jobs, many have never worked and those who are still in work are likely to be unemployed before long. Apart from their own destruction, their cost to society must run into hundreds of thousands of pounds annually – treatments that rarely work, thefts to buy their heroin which costs anywhere from £30 to £300 a day, unemployment/benefit claims, treatment of serious infections such as hepatitis and AIDS, their prison upkeep, cost to the criminal justice system, etc.

Then there are detainees who say they can’t speak English and “need checking over in case they have some weird disease”…. How did we ever end up footing those huge bills for interpreter services, Language Line and legal aid?

Dr Teck Khong: Chinese addition for British politics

Dr Teck Khong, former Parliamentary Candidate for Bradford North and a GP,  ponders on a quiet corner of diversity politics. 

“Yes, can I help you? ….You speak very good English…Into the main hall and up the stairs to the left”. That was the other half of the dialogue between my daughter and the police at the security check-point at Westminster recently. She was joining me at the belated New Year reception of the Chinese in Britain All Party Parliamentary Group. Unfortunately, she missed the event.

My daughter, who looks impeccably Chinese, has an English mother and was educated privately. She graduated last year with First Class Honours in Law at the LSE. Of course, we don't go around shouting out such things, and neither are we expected to post our curriculum vitae on laptop bags, brief cases or even emblazon the back of our tee-shirts with our family pedigree. And what's there to be ashamed of, if I was a kitchen hand at a Chinese takeaway? Such social situations are commonplace and are tedious, sometimes even exasperating. 

As is often the case with these inter-racial encounters, I suspect the flow of stimuli and responses can cascade along pathways of misconception so what we then witness is an aggregate of flawed perceptions. The real reasons are legion, but as a whole, they represent some of the major hurdles for both the Chinese and the indigenous white population, and which is probably different from their respective interactions with other ethnic groups. 

Dr Teck Khong: We desperately need a doctor-patient leader, a latter-day Beveridge

Dr Teck Khong, Chairman of the Leicestershire Health Consortium and Director of Chirurgiae LLP, believes that the medical profession must defend the ideals of the NHS by being unified in true advocacy of patient welfare.

Working in different parts of the NHS and in various regions of the country over thirty years offers an immensely useful breadth of experience of our evolving health system. The changes have been mixed, but with the advantage of "insider" access to perspectives denied to the public, the overall trend is worrying indeed.

Commercial ethos and retail mentality have become pre-eminent in our health system today, thanks to mismanagement and defective policies. Political flirtations with consumerism over the past decade have resulted in a flurry of public-private betrothals which are now progressing to marriage contracts at an alarming rate and which are leading inexorably to the privatisation of large swathes of the NHS, despite the recent change of premiership.

Various large companies that are linked to the privatisation of the NHS have captivated the attention of the government with the sorts of market efficiencies and profitability only powerful commercial organisations seem able to achieve. By welcoming these big corporations, the government hoped to address the intractable problems of cost containment and inefficiencies. However, that is the basis of the most seriously flawed socio-political dogma of recent times.

Dr Teck Khong: A fundamental flaw in our benefit claims system

Dr Teck Khong, Candidate for Bradford North in the 2005 General Election, a GP and forensic physician for Northamptonshire Police, describes the flaws in incapacity benefit.

It has been reported recently that there are 1.65 million people who are unemployed, with a further 7.9 million defined as "inactive". Of the 2.67 million people on incapacity benefit, over half of them have been off work for more than five years. 

Earlier this year, the figure for incapacity benefit claimants who had been off work for five years or more was 1.23 million compared with just under 1 million in 2001, while total incapacity claimants rose only slightly to 2.43 million from 2.42 million. Despite Government assurances that the problem of widespread incapacity claims is being tackled by getting the long-term sick back to work, the Department for Work and Pensions figures show that the proportion of long-term incapacity benefit claimants has been rising steadily in recent years. In financial terms, Incapacity Benefit claims alone total more than £7 billion a year.

Dr Teck Khong: Building the British nationhood with honesty and openness.

Dr Teck Khong is a parliamentary candidate, a Leicester GP and forensic physician for Northamptonshire Police, and the founding chairman of the Leicestershire Health Consortium.

Malaysia is widely known for its verdant beauty and multi-racial harmony. But back in 1969, race and religious riots threatened to destroy that country. Its leaders had no choice but to acknowledge the underlying causes. They responded with a reaffirmation of secular government and Malaysia was transformed into an economic powerhouse.

The Malaysian experience offers some important lessons to us in our efforts to deal with social unease brought about by a rising tide of immigration, particularly illegal immigration and religious extremism. Laws on immigration are inadequate, and the processes for dealing with illegal immigration are hampered by a lack of both political commitment and consistent implementation. Tough decisions and actions are seriously overdue.

At the same time the monitor of social change – freedom of speech, a highly prized and democratic heritage – has fallen victim to political correctness. That is why concerns over immigration are expressed in two different ways – within the safe confines of private discussion and in public with words chosen for political safety. Such duality serves no purpose and achieves nothing apart from fomenting and escalating unrest.

Dr Teck Khong: Proposals for consumer-responsive healthcare

Dr Teck Khong, is a parliamentary candidate, Leicester GP and forensic physician for Northamptonshire Police, and the founding chairman of the Leicestershire Health Consortium.

Although funding and medical resourcing such as staffing and hospitals dominate the debate on the NHS, the balance between public health requirements and individual medical needs is the real issue. 

In remodelling the NHS, the government follows a global trend of policy shifting (here and here) from a model of all possible care for everyone, to one which delivers high-quality essential care to all based on cost-effectiveness. To facilitate this, elements of market-oriented economy are adopted to varying degrees in the hope that they will be matched by individual exercise of choice and responsibility. Real market benefits are unfortunately limited as rationing continues based on what services the government can finance and deliver. Furthermore, any rationing that excludes whole groups of the population is unacceptable, even though it is impossible to provide every conceivable service for everyone. 

As the NHS begins to specify its exclusions, the ethical argument will centre on the premise that taxes are paid into a health system that does not deliver all the expected services. Included will be such matters as impairment of individual right to life, and the use of potentially beneficial but expensive treatments that are unavailable from tax-funded provisions for otherwise debilitating or life-threatening illnesses.