Energy suppliers have been failing vulnerable customers, the sector’s watchdog has said, as people face a cold and costly winter.

Ofgem told all 17 firms that took part in its review to improve, with five found to have severe weaknesses.

Among its findings were examples of suppliers setting debt repayments so high that customers decided they could not top-up their pre-payment meters.

But some of the suppliers hit back, calling the review “incomplete”.

Consumer groups described the regulator’s report as “hugely concerning” at a time when people were being hit by bills double the level of last winter, amid the soaring cost of living.

 

The five suppliers identified by the report as having “severe weaknesses” were Good Energy, Outfox, So Energy, Tru Energy and Utilita – which prompted a strong response from some of the firms.

“Moderate weaknesses” were found at suppliers E (Gas & Electricity), Ecotricity, Green Energy UK, Octopus and Shell.

Ofgem said that seven others had shown minor weaknesses, including British Gas, Bulb, EDF, E.ON, Ovo, Scottish Power and Utility Warehouse.

The regulator said some of the worst examples of poor practice included suppliers failing to read the meters of customers who could not do so themselves.

It also found that some vulnerable customers were unable to contact their supplier to top up their meter or to request support credit.

In some cases, debt repayment rates were set so high that vulnerable customers self-disconnected – in other words, did not top-up their prepayment meter when the credit ran out.

Neil Lawrence, Ofgem’s director of retail, said “most suppliers” took their responsibility to protect vulnerable customers seriously and added firms had launched new initiatives – including dedicated phone lines.

“Although we are seeing some very good practice in parts of the industry, we can see there is still much more to be done.”

He added: “We’ve seen a number of failings across the board which need to be urgently addressed.

“It’s going to be a very challenging winter for everyone and customers must be confident they are getting the help and support they need.”Almost 7.4 million people in Britain use prepayment meters for their energy

It is Ofgem’s third review into various aspects of suppliers’ treatment of customers. The first demanded action on soaring direct debit demands and the second found more help was needed on payment plans for those struggling to pay.

This latest review required suppliers to give evidence about how they identified and kept records of customers in a vulnerable situation, and whether they were added to a priority register for help.

Suppliers also gave information about free gas safety checks and vulnerable prepayment meter customers.

All the suppliers that submitted data to the regulator were told they must improve their practices.

Ofgem said that in general, there were risks that people were not identified as vulnerable and given the support they were entitled to.

But questions have been raised for the regulator itself, which has been accused of being asleep at the wheel when bills are soaring and suppliers failing.

In response, it said it had moved proactively, rather than waiting for issues to be reported.

‘Top priority’ to help

To help households with higher bills, the government introduced a cap to limited price rises, meaning a typical home pays £2,500 a year for gas and electricity. However, the cap is on the unit price of energy, so those with higher usage will pay more.

This cap has been extended for 12 months from April, but will be at a higher level, so a typical household will pay £3,000 a year. Various cost-of-living payments have been announced to protect the more vulnerable, but charities and consumer groups have warned that many will still face a particularly tough time this winter.

Rocio Concha, from consumer group Which?, said suppliers needed to up their game to help people on the lowest incomes.

“It is hugely concerning to see Ofgem has found that so many energy firms are falling short on the support they provide to their most vulnerable customers,” she added.

However, Energy UK, which represents suppliers, said many firms had gone beyond what they were required to do by the regulator.

“Identifying and supporting vulnerable customers is already a top priority,” said Dhara Vyas, director of advocacy at Energy UK.

“Our members have responded swiftly to Ofgem’s review – including providing additional documentation to demonstrate where processes were already in place, and will continue to look at all the ways they can make sure people get the help and support they need.”

Some of the suppliers named as having the biggest problems reacted strongly to Ofgem’s report.

Simon Oscroft, co-founder of So Energy, said: “Over the course of the last months and weeks, we have provided Ofgem with extensive additional information related to this review and we are disappointed that Ofgem has proceeded on the basis of incomplete information, and in a manner that may now cause vulnerable customers unnecessary concern.”

A spokesman for Utilita said: “Ofgem’s report does not represent where we are as a business today, nor does it acknowledge the significant progress we have made – and are making – since its initial assessment in early summer.”

The BBC has contacted Good Energy, Outfox and Tru Energy for comment.

The days of “cheap labour” must end to wean the UK off its “immigration dependency”, Labour leader Sir Keir Starmer will tell business leaders.

Sir Keir will call for a plan to train British workers and move the economy away from its “low-pay model”.

But he will accept the need for skilled foreign workers and promise a “pragmatic” approach to immigration.

His speech comes at a time when businesses are calling for more migrant labour to boost economic growth.

The Labour leader’s speech to the Confederation of British Industry (CBI) conference in Birmingham will follow that of Prime Minister Rishi Sunak on Monday.

Mr Sunak told business leaders having “proper control of our borders” was one of the immediate benefits of Brexit and said curbing illegal migration was the “country’s number one priority right now”.

He spoke after CBI director-general Tony Danker said the UK needed more foreign workers to drive economic growth as the country faces a deep recession.

“People are arguing against immigration – but it’s the only thing that has increased our growth potential since March,” Mr Danker said.

There was considerably less migration during the Covid-19 pandemic than in previous years and the number of EU citizens moving to the UK has dropped since the UK left the European Union.

The Office for Budget Responsibility has forecasted a decline in net migration, with the number expected to settle at 205,000 a year from 2026 onwards.

Brexit is “already delivering” benefits and opportunities for the UK, the prime minister says.

In his speech, Sir Keir will set out what the UK’s immigration policy would look like under a Labour government, should the party win the next general election.

He will promise an immigration system that works better for the needs of business and recognises the need for skilled workers from abroad.

But he will stress that any changes to a points-based migration system “will come with new conditions for business”.

“We will expect you to bring forward a clear plan for higher skills and more training, for better pay and conditions, for investment in new technology,” he is expected to say.

“But our common goal must be to help the British economy off its immigration dependency. To start investing more in training up workers who are already here.”

Sir Keir will outline Labour’s plans for reform, which include:

  • Ensuring all employers able to sponsor visas are meeting decent standards of pay and conditions
  • Speed up visa delays to avoid labour shortages damaging the economy
  • Introduce training and plans for improving pay and conditions for roles that require international recruitment
  • Reforming the migration advisory committee to project future trends more accurately

Sir Keir spoke about immigration in an interview with the BBC last week, saying the UK was recruiting too many people from overseas into the NHS.

The rise of legal migration to the UK was one of the most prominent political issues in the country ahead of the EU referendum in 2016.

Former Conservative Prime Minister David Cameron once promised to get immigration down to the tens of thousands a year.

Net migration – the difference between people coming to the UK and those leaving – has been over 200,000 since the late 1990s.

Under Sir Keir’s leadership, Labour has ruled out a return to the EU single market, which guarantees citizens of member states the freedom to live and work anywhere in the bloc.

Labour’s policy on Brexit has divided the party, with some calling for a much closer relationship with the EU on different terms.

Sir Keir’s speech comes as Mr Sunak denied that ministers could look to realign the UK with EU laws.

Some Tories have been angered by suggestions the government was weighing up a Swiss-style relationship with the EU.

But the prime minister told the CBI conference on Monday that the UK “will not pursue any relationship with Europe that relies on alignment with EU laws”.

Turkish air strikes target Kurdish militants in Syria and Iraq

ISTANBUL: The Turkish defence ministry said early on Sunday it carried out air strikes on outlawed Kurdish militant bases in northern Syria and northern Iraq, which it said were used to carry out attacks on Turkey.

The strikes targeted bases of the outlawed Kurdistan Workers Party (PKK) and the Syrian Kurdish YPG militia, which Turkey says is a wing of the PKK, the ministry added in a statement.

Turkey said on Tuesday it plans to pursue targets in northern Syria after it completes a cross-border operation against the PKK militants in Iraq, following a deadly bomb last weekend in Istanbul.

The government has blamed Kurdish militants for the blast on Istanbul’s Istiklal Avenue on November 13 that killed six people and injured more than 80. No group has claimed responsibility for the blast on the busy pedestrian avenue, and the PKK and SDF have denied involvement.

The Kurdish-led Syrian Democratic Forces (SDF) said late Saturday that Turkish aircraft shelled two villages populated with internally displaced people in northern Syria.

“Turkish bombing of our safe areas threatens the whole region,” Mazloum Abdi, the chief commander of the US-allied SDF, tweeted.

Turkey has conducted three incursions so far into northern Syria against the YPG militia. President Tayyip Erdogan has previously said Turkey could conduct another operation against the YPG.

Pakistan Army to continue efforts for rehabilitation of flood victims: COAS Gen Bajwa

RAWALPINDI: Chief of Army Staff (COAS) General Qamar Javed Bajwa on Sunday said that the Pakistan Army will continue all-out efforts to expedite the rehabilitation of the flood victims being undertaken with the support of federal and provincial governments, said Inter-Services Public Relations (ISPR).

According to the military’s media wing, the army chief made the remarks after inaugurating a pre- fabricated village constructed for the flood-affected people who lost their homes in Balochistan’s Lasbela.

The village, Laal Gul Goth, was badly devastated in recent floods with livestock, personal belongings of people and basic infrastructure completely lost.

The pre-fabricated village includes a primary school, is lit by off-grid solar power and has also been provided with a tube well, said the ISPR. Frontier Works Organisation (FWO) completed this project in record time as this was promised to the villagers by Pakistan Army.

During the visit, FWO Director General Major General Kamal Azfar briefed the army chief about the progress of rehabilitation work for flood affectees.

The COAS met teachers and students of newly renovated primary school at Lal Gul Goth and local villagers, said the military’s media wing.

Later, the COAS interacted with the troops of Quetta Corps, FWO, Frontier Corps (FC) Balochistan and Pakistan Coast Guards and appreciated their efforts during rescue, relief and rehabilitation process in recent flooding, read the statement.

Earlier upon arrival, the COAS was received by Commander Quetta Corps Lieutenant General Asif Ghafoor.

Chaman border set to reopen today after over a week

The decision to open the border was made during a meeting between Pakistani and Afghan officials, Chaman Deputy Commissioner Abdul Hameed Zehri told the media on Sunday.

The details of the talks and the decision to open the border had been conveyed to the civil-military liaison committee of Chaman, which agreed to open the border for trade and travel from Monday.

Consequently, the immigration offices of the Federal Investigation Agency (FIA) and Pakistan Customs would also be opened, officials said.

Mr Zehri said that during the meeting, Afghan Taliban officials expressed anger and grief over the November 13 incident and assured the Pakistani authorities that the “terrorists” behind the incident would be arrested and strictly punished.

Pakistan had shut Friendship Gate after shooting from Afghan side

Both sides also decided to take concrete steps to avoid a repeat of such incident.

The border closure since last week resulted in suspension of trade between both countries through the Friendship Gate. A large number of trucks carrying Afghan transit trade goods and containers carrying import and export goods were stranded on both sides.

While confirming the border closure for an indefinite period, Chaman DC Zehri last week said: “A man crossed into Pakistani side at Friendship Gate from the Afghan border and opened fire at the security personnel posted at the gate, resulting in the martyrdom of one soldier and injuring two others.” Shortly after the incident, the official said, the Afghan personnel opened fire on Pakistani forces, which retaliated and the firing continued for some time.

Pakistan border authorities immediately summoned a flagship meeting of the Afghan forces and demanded that the armed men, who had fired at the Pakistani security personnel, be handed over to the Pakistani authorities, but the negotiations remained fruitless at that time, as Afghan officials refused to hand over those involved in the firing, official sources said. The exchange of fire resumed in the evening, which officials said continued with small intervals.

The Chaman border, some 100km northwest of Quetta, is one of the major international border crossings and is used by thousands of people on a daily basis. On the Afghan side, it leads north into Wesh town in the Spin Boldak district of Kandahar province.

Pakistan had earlier refused to reopen the Friendship Gate for transit trade and crossing until the authorities got the custody of the attacckers.

A couple of days later, Pak­istani authorities on humanitarian grounds and as a goodwill gesture allowed several hundred Afghan nationals, who were stranded in Chaman due to the border closure, to cross into their country from another area, considering that there were patients among them who had come to Pakistan for treatment.

A spokesperson for the Afghan interior ministry last week told Reuters that the clash had occurred between border forces from both sides due to a “misunderstanding” and the incident was being investigated.

The Afghan border authorities explained that the Taliban forces were not involved in the shooting at Friendship Gate.

“They might be terrorists who were involved in firing,” the officials said.

For US, Pakistan remains key regional ally, India global partner

“India is an invaluable partner, not just in the region but as it relates to a lot of the United States’ shared priorities across the world,” said the department’s Principal Deputy Spokesperson Vedant Patel while commenting on Washington’s ties with New Delhi.

US Secretary of State Antony Blinken and Indian External Affairs Minister S. Jaishankar “remain in close touch as they need to”.

In response to Dawn’s query on US-Pakistan relations, another State Department official said: “The United States values our long-standing cooperation with Pakistan and has always viewed a prosperous and democratic Pakistan as critical to US interests.”

State Dept official says Washington has always viewed prosperous, democratic Pakistan as critical to US interests

The official explained that internal political changes in Pakistan do not impact Washington’s desire to maintain its relationship with Pakistan as it “remains unchanged”.

In recent statements, US officials have insisted that they no longer see Pakistan from India or Afghanistan’s perspective.

Instead, they acknowledge Pakistan as an important country of more than 220 million people, with nuclear technology and borders with some key nations like India, China, Iran and Afghanistan.

‘New Asian power’

India, however, has been placed in a different league. On Sunday, when India assumed the G20 presidency, CNN noted that the group’s “criticism of Russia shows the rise of a new Asian power. And it isn’t China”, it’s India.

Days before the G20 summit in Indonesia, Secretary Blinken met Mr Jaishankar in Phnom Penh and said in a tweet that he discussed “ongoing efforts to expand our partnership and mitigate the effects of Russia’s war on Ukraine” with the Indian minister. “The US supports India’s G20 presidency,” he added.

 

The United States is one of the founding members of this group, along with Canada, France, Germany, Italy, Japan, the United Kingdom, and the United States. China, Russia, India, and others joined later.

India will host the next leaders’ summit of this group of industrialised nations in New Delhi in September 2023.

In its updated page on India, the State Department notes that “the US-India strategic partnership is founded on shared values including a commitment to democracy and upholding the rules-based international system”.

The United States and India “have shared interests in promoting global security, stability, and economic prosperity through trade, investment, and connectivity”, the department adds.

In a similar page on Pakistan, the State Department says that the United States “works closely with Pakistan on a wide array of issues ranging from energy, trade and investment, health, clean energy and combating the climate crisis, to Afghanistan stabilisation and counterterrorism”.

The United States “has been one of the largest sources of foreign direct investment in Pakistan and remains Pakistan’s largest export market,” it adds.

In describing its relationship with India, the department stresses the importance of the global role it expects New Delhi to play while Pakistan is seen as an important ally in combating terrorism and stabilising Afghanistan.

‘Divergent views on China’

In a recent report published by the Hudson Institute, 10 US scholars of South Asian affairs noted that several aspects of the US-Pakistan relationship had changed over the last decade.

“Most importantly, a US-India entente has emerged, and a peer rivalry between China and the US is developing,” they added, underlining how the US desire to contain China had strengthened its ties with India.

The authors also note that “a geostrategic competition with Russia and China that involves Pakistan and Afghanistan … may be an opportune moment to lay the foundations for a sustainable US-Pakistan relationship”.

They suggest that a modest, pragmatic relationship between the US and Pakistan, one not based on exaggerated expectations on both sides, would involve understanding that Pakistan and the US will continue to see Afghanistan through different lenses but can cooperate to maintain peace in that country and alleviate its people’s suffering.

Besides, attitudes towards India at both the elite and popular levels in Pakistan will, at best, change slowly.

Moreover, public opinion in both the United States and Pakistan acts as a constraint on bilateral relations.

They say there is little the United States can do to induce Pakistan to change its overall strategic calculus, which is based on Pakistan’s understanding of its security environment.

They also acknowledge that “the US and Pakistan have divergent views on China”.

Several Beijing districts shut schools as Covid-19 cases rise in China

China is fighting numerous Covid-19 flare-ups, from Zhengzhou in central Henan province to Chongqing in the southwest and for Sunday reported 26,824 new local cases, nearing the country’s pandemic peak in April. It also recorded two deaths in Beijing, up from one on Saturday, which was China’s first since late May.

Guangzhou, a southern city of nearly 19 million people that is battling the largest of China’s recent outbreaks, ordered a five-day lockdown for its Baiyun district, its most populous. It also suspended dine-in services and shut night clubs and theatres in Tianhe, home to the city’s main business district.

The latest wave is testing China’s resolve to stick to adjustments it has made to its zero-Covid policy, which calls for cities to be more targeted in their clampdown measures and steer away from catch-all lockdowns and testing that have strangled the economy and frustrated residents.

Asian share markets and oil prices slipped on Monday as investors fretted about the economic fallout from the intensifying Covid-19 situation in China, with the risk aversion benefiting bonds and the dollar.

Several Chinese cities began cutting routine community Covid-19 testing last week, including the northern city of Shijiazhuang, which became the subject of fervent speculation that it could be a test bed for policy relaxation. This sparked worry among some local residents.

But late on Sunday, Shijiazhuang announced it would conduct mass testing in six of its eight districts over the next five days after new daily local cases hit 641. It also encouraged residents to shop online and ordered some schools to suspend in-person teaching.

“They lasted a week,” said one popular comment on Weibo on Shijiazhuang’s curbs, which was among the most viewed topics on the social media platform.

The capital Beijing reported 962 new infections, up from 621 a day earlier. Its sprawling Chaoyang district, home to 3.5 million people, urged residents to stay home, with school going online. Some schools in Haidian, Dongcheng and Xicheng also halted in-person teaching.

The People’s Daily newspaper, the mouthpiece of the Chinese Communist Party, on Monday published another article reiterating the need to catch infections early but avoid take a “one-size-fits-all” approach, its eighth such piece since China adjusted policy earlier this month.

‘Feeling the stones’

China’s recent efforts to make its Covid-19 curbs more targeted have sparked investor hopes of a more significant easing even as China faces its first winter battling the highly transmissible Omicron variant.

Many analysts expect such a shift to begin only in March or April, however, with the government arguing that President Xi Jinping’s signature zero-Covid policy saves lives and is necessary to prevent the healthcare system being overwhelmed.

Experts warn that full reopening requires a massive vaccination booster effort and a change in messaging in a country where the disease remains widely feared. Authorities say they plan to build more hospital capacity and fever clinics to screen patients and are formulating a vaccination drive.

Oxford Economics said it only expects an exit from zero-Covid in the second half of 2023, with vaccination rates for the elderly still comparatively low.

“From an epidemiological and political perspective, we do not think the country is ready yet to open up,” it said in a Monday report.

Hao Hong, chief economist at GROW Investment Group, said in a separate note a gradual and managed reopening may already be underway, with rounds of back and forth as China “crosses the river while feeling the stones”.

“Despite the mounting challenges, it is not a question of whether China will reopen, but a question of over how long a period and how best to manage to minimise healthcare costs and potential lives lost,” he said. “We assign a probability of 4/5 to the gradual reopening scenario.”

People at a gay club in the US state of Colorado have been hailed as heroes for subduing a gunman and preventing a deadly shooting from being even worse.

Colorado Springs Mayor John Suthers said one patron grabbed the attacker’s own gun and hit him with it during the shooting in Club Q on Saturday night.

Another club-goer reportedly helped to keep the gunman pinned down until police arrived.

The gunman killed five people and injured 25 more before being arrested.

The suspect, named by police as 22-year-old Anderson Lee Aldrich, is now in police custody.

Mayor Suthers described the intervention of several club-goers as an “incredible act of heroism”.

“The call came into the police at 11:57pm. Police were on the scene by 12:00 – an amazingly quick response,” he told CNN.

“This incident was over by 12:02, and that’s largely because of the intervention of at least one, possibly two, very heroic individuals who subdued this guy… appears to have taken his handgun with them… and used it to disable him… not shoot but hit him with the gun, and disable him.

“But for that, as tragic as this incident is, it’s a horrible crime, it could have been much, much worse but for these heroic actors,” the mayor added.

Governor of Colorado Jared Polis, who is gay, praised the “brave individuals who blocked the gunman, likely saving lives in the process”.

Matthew Haynes, one of the club owners, told the New York Times that “dozens and dozens of lives” had been saved.

At an earlier news conference, police chief Adrian Vasquez made similar comments.

“Initial evidence and interviews indicate that the suspect entered Club Q and immediately began shooting at people inside as he moved further into the club.

“While the suspect was inside of the club, at least two heroic people inside the club confronted and fought with the suspect and were able to stop the suspect from continuing to kill and harm others.

“We owe them a great debt of thanks,” Mr Vasquez said.

Hundreds of mourners held a vigil in Colorado Springs on Sunday night

Police are still trying to confirm exactly how many people were injured, adding that some people took themselves to hospital.

An investigation is now under way to determine whether the shooting was a hate crime, and if more than one person was involved.

A statement on the Club Q Facebook page thanked “the quick reactions of heroic customers that subdued the gunman and ended this hate attack”.

“Club Q is devastated by the senseless attack on our community,” it added.

The venue was hosting a dance party at the time of the attack, and had planned to hold a performance event on Sunday evening to celebrate Transgender Day of Remembrance.

Joshua Thurman, 34, was in the club at the time of the shooting.

At first he thought the shots were part of the music, he told the Colorado Sun, but he later ran to take shelter in the club dressing room.

“When I came out there were bodies on the floor, shattered glass, broken cups, people crying,” he said.

“There was nothing keeping that man from coming in to kill us. Why did this have to happen? Why? Why did people have to lose their lives?”

Mr Thurman, who lives near the club, said it was an important part of the local gay community. He believes he knows one person who was killed.

Bartender Michael Anderson said he heard three bangs and saw the “outline of a gun” in the suspect’s hands.

“What I can’t stop thinking about is the visuals of the evening. Of the bodies, of the blood, of the broken glass, of the carnage in the wreckage and seeing a safe place turned into a war zone,” he told KKTV.

The state of Colorado has seen other mass shootings, including at a supermarket in Boulder in 2021 in which ten people were killed.

In 2015, three people were killed in a shooting at a Planned Parenthood Clinic in Colorado Springs.

President Joe Biden said Americans “cannot and must not tolerate hate”.

In a statement from the White House, he said: “Places that are supposed to be safe spaces of acceptance and celebration should never be turned into places of terror and violence. Yet it happens far too often.

“We must drive out the inequities that contribute to violence against LGBTQI+ people.”

In 2016, 49 people were killed in a shooting at the Pulse gay club in Orlando, Florida. At the time it was the deadliest mass shooting in US history.

NHS leaders in Scotland appear to have discussed abandoning the founding principles of the service by having the wealthy pay for treatment.

The discussion of a “two-tier” health service is mentioned in draft minutes of a meeting of NHS Scotland health board chief executives in September.

They also raise the possibility of curtailing some free prescriptions.

Scotland’s Health Secretary Humza Yousaf insisted the NHS would stay publicly owned and publicly operated.

He added that health services “must always” be based on individual patient need and “any suggestion” that it should be about the ability to pay was “abhorrent”.

The minutes of the meeting seen by BBC News are marked “in confidence not for onward sharing” and highlight the degree of official concern about the sustainability of Scotland’s NHS in its present form.

They include suggestions that hospitals should change their appetite for risk by aiming to send patients home more quickly, and pause the funding of some new drugs.

According to the minutes, the meeting began with an update about “recent conversations” with NHS Scotland chief executive Caroline Lamb.

The group were then advised that they had been given the “green light to present what boards feel reform may look like” and that “areas which were previously not viable options are now possibilities”.

Describing a “billion pound hole” in the budget, the minutes warn that it “is not possible to continue to run the range of programmes” the NHS currently offers while remaining safe “and doing no harm.”

And they warn that: “Unscheduled care is going to fall over in the near term before planned care falls over.”

The minutes note “concern” about an alleged lack of clinical input into political decision-making which, they say, leaves some Scottish government suggestions feeling “divorced from reality of life and purpose of service.”

They highlight an alleged “disconnect from the pressure that the boards are feeling and the message from SG [Scottish government] that everything is still a priority and to be done within budget”.

They also state: “Concern was noted that there may be siloed discussions ongoing within Scottish government that do not include CMO/CNO (Chief Medical/Nursing Officer).”

There is a suggestion that “fundamental reform” of the primary care model “must be on the table”, and that the success of the NHS has been built on a model “that no longer works today”.

However, Mr Yousaf told the BBC: “The Scottish government’s policy could not be clearer, our National Health Service must be maintained to the founding principles of Bevan – publicly owned, publicly operated, and free at the point of need.”

Presentational grey line
Analysis box by Lisa Summers, health correspondent, Scotland

Growing numbers of people are already delving into their savings because they can’t stand the anxiety and pain of waiting for the NHS.

And there have already been clear warnings from doctors and nursing staff that things are unsafe and standards have dropped.

Why? Because there are not enough staff to meet ever growing demand

Against this backdrop, it is no surprise that reform is being discussed at the very highest level. But to see in black and white such radical ideas from NHS chief executives – even contemplating things like designing a two-tier system or pausing spending on drugs development – is extraordinary.

To see them spell out a disconnect between NHS leaders and the Scottish government shows how worried they are that the message to the public that the health service is not working as it should, is not getting through.

When I first started out reporting on health issues over five years ago now, doctors said there has to be a frank public conversation about what we can expect from the NHS.

These may be draft notes – not firm proposals – but it shows how fundamental some of the changes being discussed are.

Presentational grey line

The NHS was established on 5 July 1948 after Labour Health Secretary Aneurin Bevan promised “a universal health service without any insurance qualifications of any sort…available to the whole population freely”.

But controversial charges for dental and eye care were introduced within three years, contributing to Bevan’s resignation from the government.

In recent years health services across the UK have been beset by immense challenges including the Covid pandemic, an ageing population and staffing shortages.

Chancellor Jeremy Hunt said in his Autumn Statement on Thursday that the country must ask “challenging questions” on how to reform all public services for the better, including the NHS.

He was speaking as Scotland’s first minister, Nicola Sturgeon, told Holyrood that the pressure on the NHS is greater than it has ever been at any point in its history, but the amount the Scottish government is able to invest in the health service is dependent on decisions taken at Westminster.

‘Two-tier system’

The concept of free universal healthcare has been at the heart of the NHS since it was created in 1948

The minutes of the NHS Scotland meeting summarise “themes, issues and ideas” during 45 minutes of discussions on Wednesday, 21 September, about “what a transformed NHS could look like”.

They ask “what can be done with the financial constraints that we have?”, and point out that some members of the public “are already making the choice to pay privately” while the NHS is “picking up the cost for life enhancing not life-saving treatments”.

It is in that context that the suggestion to “design in a two-tier system where the people who can afford to go private,” appears.

At one point the minutes note that it is “almost easier to identify what it is not possible to do anymore than what is/will be”.

There is a proposal to change “the risk appetite from what we see in hospitals,” suggesting a target for patients to be discharged to their home for treatment after a maximum of 23 hours.

“It is not gold standard but what other countries can do without an NHS,” it adds.

According to the draft minutes, other points noted at the meeting included:

  • A potential “review” of the “cost of long-term prescribing [of drugs] where there are alternative options”
  • An option to “Pause funding of new development/drugs” unless they can be proved to save the NHS money
  • The potential for efficiency savings because “there are still vast areas of waste in service in governance and all-day meetings etc”
  • Considering applying a charge for freedom of information requests
  • Stopping care services altogether and instead sending patients home for care

The health secretary said he routinely meets with the Scottish government’s senior clinical team, which is led by the Chief Medical Officer.

Mr Yousaf, who praised the “exceptional work” of NHS staff, added: “There is also frequent engagement between ministers and NHS board chief executives, and daily discussions between the Scottish government and individual health boards on service performance and pressures.

“Our NHS and care services continually evolve to meet the changing needs of the people of Scotland, and reflect changes in practice and medicine. In our five-year NHS Recovery Plan we have outlined our commitment to continued investment and reform of the NHS, alongside delivering the National Care Service.”

‘What is the real focus?’

The minutes of the September meeting also detail discussions about the government’s proposed National Care Service (NCS), and state that: “There are a group within SG who recognise that it may not be possible to provide what it was initially proposed within NCS.

“Their challenge is how to get off that promise and do something different.”

They also suggest that “£800m for NCS does not make sense” given the huge funding challenges for the NHS,

In recent weeks ministers have been under pressure about exactly how the new care service would work and be funded.

In its final section the minutes include a suggestion that clearer priorities must be established for the NHS.

“Everything is a top priority, what is the real focus?” they ask, with the summary of the discussions concluding, bluntly: “The fundamental model of healthcare is not working for us.”

Pakistan seeks world help for revival of Afghan economy

“We need to revive the Afghan economy — its banking system — and for that purpose the Afghan assets which are held abroad need to be injected back into the Afghan financial system,” Ambassador Munir Akram said on Friday.

He urged the international community also to fulfil the UN secretary-general’s appeal for $4.2bn in humanitarian assistance to Afghanistan.

The appeal for unfreezing the Afghan assets was directly addressed to the United States which froze $7bn of Afghan assets in its custody after the Taliban retook Kabul in 2021.

Calls for unfreezing Afghan assets to address humanitarian crisis

Suggesting a “pragmatic approach” in dealing with Afghanistan, Mr Akram said the international community’s first priority should be bringing an end to the humanitarian crisis in that country.

Peace in Afghanistan was of “vital concern” to Pakistan, said the envoy, adding his country had hosted more than 3 million Afghan refugees for more than 40 years now.

“We know all the legal arguments about holding these resources back and why and wherefore,” said Amb Akram while referring to the US decision to froze Afghan assets.

“But you need a roadmap to see how to rebuild the Afghan economy,” he added, noting that the Organisation of Islamic Cooperation was giving careful thought as to how to accomplish the task of injecting the Afghan assets, held abroad, back into the country’s system.

If the humanitarian crisis does not end, there would be another flow of refugees that Afghanistan’s neighbours would have to accommodate, he said.

“So, we need to deal with the humanitarian situation,” he said.

Pakistan, he said, was also concerned with terrorism emanating from Afghanistan. “We are still suffering attacks from across the border from the [banned] Tehreek-e-Taliban Pakistan (TTP), which receives sponsorship from other sources,” he pointed out, noting that Al Qaeda was a shadow of its past.

He said the real threat came from the militant Islamic State group and from TTP.

“Even as a closest neighbour of Afghanistan, with shared culture and history, we still have difficulty in dealing with them because there are other factors at play, and we know what they are.”

Ambassador Akram said Pakistan was with the international community on its concerns about the rights of women and inclusivity in Afghanistan. “But one also has to see the reality of Afghan society, of what is Afghanistan,” he emphasised.