I'm putting this online to preempt the inevitable Evening Standard headlines claiming that Jeremy Hunt has today spared Lewisham Hospital's A&E department.

From his statement today:

On the emergency care proposals, Sir Bruce was concerned that the recommendation for a non-admitting Urgent Care Centre at Lewisham may not lead, in all cases, to improved patient care. While those with serious injury or illness would be better served by a concentration of specialist A&E services, this would not be the case for those patients requiring short, relatively uncomplicated treatments or a temporary period of supervision. To better serve these patients, who would often be frail and elderly and arrive by non-blue light ambulances, Sir Bruce recommends that Lewisham hospital should retain a smaller A&E service with 24/7 senior emergency medical cover. With these additional clinical safeguards, and the impact that this is likely to have on patient and clinician behaviour, Sir Bruce estimates that the new service could continue to see up to three quarters of those currently attending the Lewisham A&E.

So, the new 'smaller A&E' would serve up to 75% of existing A&E visitors.

From the TSA's report:

54) Urgent care services are well established at Guy’s Hospital and Queen mary’s Hospital Sidcup. The TSA recommends university Hospital Lewisham provide these services also, with a view to treating at least 50% of the people currently attending the A&E and urgent care services at the site. This would mean that urgent care services will continue to be available locally and it will also help to minimise the impact on the four remaining A&E departments in south east London.

55) Analysis included in the TSA’s draft report suggested around 77% of university Hospital Lewisham’s current A&E activity would remain at the hospital under this scenario. However, a number of responses to the consultation suggested that this estimate was too high. Therefore, further analysis was undertaken and, based on practice elsewhere in London, a revised figure of 50% has been used for the modelling that underpins the TSA’s recommendation.

So, the TSA's proposal – to keep Lewisham's Urgent Care Centre – was estimated to serve somewhere between 50 and 77% of existing A&E visitors, depending on who you ask. The UCC is, according to the hospital website, designed to "see and treat patients with non-threatening illnesses and injuries".

In addition:

It is proposed that a paediatric ambulatory service is developed as part of the urgent care service at university Hospital Lewisham.

And also:

Older people are also relatively frequent users of A&E services and are more than twice as likely as others to be admitted to hospital following an A&E attendance. Therefore, the proposed changes have significant implications for the continuity of care for these patients. However, older people who would currently present with problems at university Hospital Lewisham could benefit from being admitted to a step-up facility

So: the TSA's recommendation was for the UCC to be retained at Lewisham, with provisions for the elderly and the development of a service for admitting some patients.

What Jeremy Hunt is proposing, however he chooses to dress it up, appears to be just that.

This Sunday I attended the Jubilee Protest, organised by the Republic campaign for a democratic alternative to the monarchy in the UK. And so this week I have had, on a couple of occasions, been asked to explain just why I support the Republican movement (no relation to the GOP). This is actually rather difficult, because:

A) If you believe that the monarchy is fundamentally undemocratic, and you're asked why, it's a little like being asked 'Why don't you agree with kicking puppy dogs in the face?'. The answer seems so screamingly obvious that it's tempting to be glib or sarcastic and not even answer properly. And:

B) Some people assume that, by nature of not wanting the queen as an unelected head of state, you also must wish bodily harm or humiliation on her. Which, given that she's a lady of some years, is especially horrible. So they assume that you're probably the kind of person who would probably quite enjoy kicking puppy dogs in the face*, and don't really want to discuss constitutional issues with you.

Neither is particularly condusive to a civilised discussion on the subject. So, for the sake of a proper discussion, here's why I care about this enough to go and stand in the pouring rain for five hours when I should have been at home fussing the cats, finishing Skyward Sword on the Wii or studying intransitive verb patterns in Japanese.

1) Democracy

I like democracy. I think that, given the alternatives, the most intellectually defensible system of government in this day and age is one where the actions of a country are determined by its citizens. Direct democracy by constant referrenda is effectively unworkable, so the tried and tested method is to use elected representatives.

We already have this, to an extent, in the form of local democracy and an elected chamber in Parliament, but ultimately our Prime Minister and Government act by the grace of the monarch. Parliament is opened by the Queen, who reads out the intentions of 'her government'. Laws voted for by Parliament only become law once given Royal Assent.

The monarch also has, among his or her reserve powers, the ability to prevent a bill being debated in parliament. It's common belief that such intervention is a matter of ancient history, but this was last invoked in 1999.

And kind of role is not reserved to the sitting monarch. Prince Charles has an effective right of veto over issues that might concern his interests, and has been repeatedly accused of meddling** in matters with which he disagrees.

So at the moment UK citizens may vote for whoever they like, but one particular lady can, by virtue of birth alone, overrule them all. I'd suggest it's not a huge mental leap to think that this is a bad thing.

Obviously, the role of the monarchy isn't the only part of the UK democratic process that is, in fact, deeply undemocratic. I'm also in favour of an elected second chamber and a form of proportional representation for the lower chamber.

2) Money

Secondary to the issue of democracy, there's the cost. Hit hard by the global financial crisis, the UK's health service and education system are under huge strain. The monarchy reports its own costs per annum at around £32 million, but this excludes huge expenses such as the cost of security (Republic uses a figure of £100m for that, but it comes from press reports and is likely to be a finger-in-air estimate).

The Duchies of Lancaster and Cornwall both provide a huge income directly to the monarchy, growing year on year (for example, DO Cornwall, 2009-10, £17.2m), and yet direct funding from taxpayers via the Civil List has almost trebled (or doubled, accounting for inflation), since 1991 (under £5m to around £15m/annum).

Put simply, this is a system that takes money from taxpayers and hands it, by the tens-of-millions, to a family who are already millionnaires. At a time when the Government is cutting benefits for the disabled because we 'can't afford them. It's obscene.

Question 1: What about the tourism?

Democracy and money are the reasons I'd like to see the monarchy replaced by a republic. The most common counter-argument, at least to the latter, is tourism – doesn't the Royal Family bring lots of tourists to the UK to spend cash? This seems to make sense, but when you look at the numbers, the palaces rank fairly low on the UK's top tourist draws. Last year Buckingham Palace, boosted by the wedding, attracted a record-breaking almost 600,000 visitors, beaten by Windsor at 680,000 – the British Musem and National Gallery, meanwhile, recorded over 5 million apiece.

If anything, opening the palaces up full time would be a huge boost to tourist spending – the Palace of Versailles, notably free of monarchy for some time, attracts millions of visitors each year (estimates vary between 5m and 15m). People come here for the history, and the monarchy belongs as a part of that – something for visitors to read about in the Buckingham Palace museum (we're really not about to knock it over and build a car park, now.)

Question 2: What about Tradition?

This is less compelling, as simply having taken place for some time does not make something right. It's also interesting to note that many of the 'ancient' ceremonies associated with the UK monarchy are relatively modern inventions.

Question 3: What about the Queen?

Many people admire the queen and her many years of work. They ask who would replace her diplomatic role, but the answer to that is pretty straightforward – the United States is not, after all, noted for its inability to conduct dimplomatic meetings and visits, despite a lack or monarch. In fact, it seems to be doing relatively well on the international stage.

As for the future of the house of self-styled house of Windsor, that's one of the trickier questions – such a system cannot be unwound overnight. I would be in favour of transferring a substantial part of one of the Dutchies to the family, granting them both privacy and funds, so long as they declaim all right to their former titles in perpetuity. Any attempt to act as a kind of monarchy in exile would void the agreement, with the lands and money reclaimed by the state.

Question 4: Would you prefer President Blair?

Yes, if the country actually voted for him again. I'd suggest this is unlikely. Ditto Thatcher.

And that's about the size of it. No guillotines, and no kicked puppies. And if you disagree with me, the good news is that you're in the majority – for now – and, as a believer in democracy, I don't advocate any change until the majority of citizens support it.

Just wait until you see King Charles, though..

* For the record: I do not.

** For the record: great word, meddle.

Restore Justice is a fairly odious campaign to distract popular attention from the numerous failings of the coalition government obtain a parliamentary vote on the possible restoration of the death penalty in the UK. It has a website at http://www.restorejustice.org.uk, which looks like this:

So. Quite apart from crimes against Photoshop and dubious politics (and the total absence of information on who's behind it, and the lack of a charity number, and the soliciting of donations..), doesn't the website look familiar? Here's the website of the charity Reprieve UK, which represents the rights of prisoners, today:

Almost identical. Of course, both sites use the popular WordPress blogging engine, so it could be that both are using the same free or paid-for theme – the fact that the two look almost identical doesn't mean that one has copied code from the other.

But take a moment to check the CSS style sheet on the Restore Justice website:

.. and wait, what's this? A number of styles even hard-link to images on the Reprieve server. Stay classy, 'law and order' campaigners – and the idiots behind this should probably count themselves lucky that Reprieve didn't get around to doing a bit of clever server-side redirection on those images.

I'm sure we can all agree that what's needed is a "Restore CSS Justice" campaign, in which web designers found to be using other people's work have their own styles cut off one by one until their website begins to resemble something shown in Netscape 4.x back in the late '90s. Anyone care to donate?

So, about the riot:

I saw tweets suggesting it at 8am.

I saw the BBM messages encouraging it at 4pm.

By the time I got home, there was a police cordon around most of Lewisham. Shops in Hither Green were shut.

On Manor Park, a group of kids (really, kids) swaggered with a huge bottle of Pimms. I wondered where the hell they'd got that from.

When I got to the A20, I saw which shop they'd looted it from. They'd smashed the shit out of everything around the Dirty South pub. The atmosphere was fucking horrible.

I took the photo above at about 9pm, after the mayhem had moved on to Catford. A lady coming from the Lee direction stopped me in the street. She said something like "They've smashed everything, it's awful".

The next day, this. All around the Dirty South – outside the area the police could protect – shops were looted. Down by the Lewisham Centre, burned out cars. I took a few photos of the damage, here.

And now what?

Apropos this latest round of ill conceived nonsense, I found this in my notebook where I scribbled it over lunch on the floor outside Number 10, or something. Enjoy.