At one level, it is incredibly frustrating. How does the world’s only superpower with a population of 330 million present a choice of Biden versus Trump for a second time? They will have a combined age of 158 at the next presidential election.

Of course, events may intervene to change the players. Biden will be 81 and has a less than robust medical history. He looks and sounds frail although this may be deceptive. His stutter accounts for a good amount of his verbal wobbles. As for Trump, he has many potential legal battles ahead, all more serious than the Stormy Daniels one. My bet is that he also has more health issues than publicly acknowledged.

Still, as Biden declares his 2024 candidacy, and Trump currently leads the Republican nominee pack (but don’t count out DeSantis…), it looks like a re-run battle for the soul of America.

If it has to be Biden as the Democrat’s nominee, it has to be Biden for President…

What is at stake?

• Ukraine. Biden will support their war with Russia to the end. Trump, Putin’s friend, will not. Neither will Trump defend NATO’s role
• Democracy. Republicans have introduced over 150 restrictive election bills at State level and another 27 election interference bills increasing partisan involvement in electoral outcomes. A Trump victory would boost attempts to limit mail-in voting, strengthen voter ID laws at the expense of minorities, shorten early voting and eliminate same-day voter registration. One only has to look at the Fox News versus Dominion lawsuit, which led to Fox paying $800 million in damages for knowingly misleading viewers on the integrity of the last presidential vote, to understand the fragility of democracy in the US
• Broader civil rights. Biden has introduced laws to protect same-sex marriage in the face of an increasingly right-wing, politicised Supreme Court. He has introduced laws to protect access to reproductive health care and also issued an Executive Order to protect access to abortion care after the Supreme Court overturned Roe versus Wade. All these initiatives are highly vulnerable to a Trump victory
• Climate. Biden introduced the largest ever federal climate plan leading to a huge growth in green technology innovation. Over 1 billion tons of greenhouse gases will consequently be removed from the atmosphere by 2030 setting the globe well on its way to reaching emissions targets. This would almost certainly be reversed under Trump

The list goes on. Nobody would say Biden is remotely perfect and one could argue his solutions to many problems too often involve expanding the State at federal level. But, my, the alternative would be a disaster.

If it has to be Biden as the Democrat’s nominee, it has to be Biden for President. Never Trump or any of his extremist cohorts.

Sat recuperating from a recent leg injury, dreading a quiet news day on a Friday despite much daytime snoozing, and up pops the Deputy PM’s resignation.

Oh dear. Sunak has made a reasonable fist of being PM so far, even closing the polling gap with Labour. And now this.

The problem for Sunak, of course, is that he has to take responsibility for all the Tories’ 13 years in power, and he can’t escape his party’s past, particularly when it incoporates five often chaotic leaders.

Sunak has the makings of being a highly competent PM long-term, but got the job too late. Rebuilding international relations, a new NI protocol with the EU, and mostly sensible economic policies are all pluses. But set against these are clumsily managed public sector strikes with deep rooted causes, an obsession with ‘small boats’ driven by the Right, an NHS/social care crisis, depleted local government services, and the behaviour of several of his colleagues generally.

Despite a commitment to higher standards in public life, it is this last issue that is causing crucial damage right now. Raab is his third cabinet departure, and Sunak is starting to look careless. At the very least, the trade-offs Sunak made to become PM seem more and more costly, and he still has the grim Home Secretary, Suella Braverman, at his side.

The baggage is heavy. Can we honestly say we feel better after over a decade of Tory rule? No, and that is what will do for the government in the end.

This blog is increasingly critical of Labour. Few believe a Labour government will be much better, not knowing what they stand for. What are their guiding principles? What are their core policies? Some of their potential ministers are already starting to grate.

But with today’s events, it again matters less and less. Sunak can’t outrun a tsunami. It is time for a change, and voters know it.

Day 8, and I am still in Lancaster Hospital, having had my tendons sown back on to my left knee. A simple story of my lovely (less lovely now!), boistrous black labrador pulling me over on a steep slope.

I always felt avoiding the NHS at a bank holiday and in advance of a doctors’ strike was a sensible thing to do. It seems you don’t always have a choice…

So, what are my observations of the NHS at first-hand?

First, the staff here are lovely. Three cheers for Ward 37! They really care, and whilst I am sure some NHS staff do just the basics, not here.

Second, morale seems low with a disappointing level of confidence in the management of the Trust or NHS generally. Poor communication, endless management initiatives, and a lack of joined up practices or budgets undermine their capabilities to do the best job.

A small example of poor organisation. I got admitted Good Friday night, waiting only 3 hours for a bed. Nil by mouth for an operation that never happened, despite available surgeons, as no specialist radiographers on call over the Easter break. A second nil by mouth and still no relevant radiographers until Tuesday. Then, a third, and I was finally operated on on Thursday.

During the process, I asked whether there were radiographers elsewhere on call but out of the question. Budgets and records are ring-fenced by Trust, so there was no flexibility there. I asked to go home and come back to avoid bed blocking, but if I did I would leave the ‘system’ and be admitted as an out-patient in 2-3 weeks time despite the severity of the injury. The matron and surgeon strongly advised me to stay put.

To make things more difficult, when I am discharged tomorrow and slowly make my way to London, I have to take my records in paper form with me to UCL’s A and E department to get the required crucial follow up treatment. There are no transferable online records here.

My general ward is full of the elderly, many with dementia. It is sad to see, and the pressures on this basis are only going to rise. Lack of care at home or in homes is a clear factor. It is piling on the pressure. Many lament the demise of halfway house cottage hospitals, which were so beneficial for helping the elderly recuperate, and I simply do not understand why social care, not small boats, is the government’s top priority.

All against the backdrop of A and Es filling up partly due to lack of GP access.

I have seen at least some of the best (people) but often the worst (structural) of the NHS on view. Money, of course, is a factor, but so is a bloated NHS managerial class, siloed organisation and politicians who seem unable to challenge and prioritise a crucial yet failing public service.

As America’s 45th president appeared in a New York court for allegedly making illegal hush money payments to a porn star and others, breaking campaign finance laws in the process, it is worth remembering that in a functioning democracy, nobody is above the law, even Donald Trump.

Time for Trump to be held to account…

At a lunch party in the US last week, I suggested America feels like the 4th century AD Roman Empire… in decline. Nobody disagreed, even a couple of Republicans. Of course, it will remain the world’s premier superpower for decades, possibly centuries due to its military capabilities, but the increasingly polarised political discourse is fracturing society and undermining the ability of the US to govern itself.

The Democrats are not without blame, with splits between moderates and the hard left, but responsibility for this decline relies firmly with Trump and the supine GOP. Shame on them.

Trump is a known liar, without morals who lauds autocrats around the world, including Putin. How the GOP allowed him to take over their party, with his conspiracy theories, extreme language, contempt for the law, and refusal to accept his election defeat, is one for the history books.

But the consequences are stark. Increasingly extreme political debate is becoming a democratic threat.

Evidence of this is everywhere in opinion polls. A third of Americans do not believe Biden won his presidential election legitimately. One in five think political violence is justified on occasion. A third of voters would prefer autocratic rule over a weak, democratically elected leader. Two-thirds think US democracy is in crisis. Democracy is overwhelmingly the preferred form of governing but the headwinds opposing it are strong.

So, the solution? The GOP and MAGA crowd need to unite with the Democrats to remind the public it was democracy that made America great in the first place. Campaign finance laws need to be revised to cap election spending. State laws that undermine election officials and dissuade minority voters from participating in elections need to be withdrawn. Term limits need to apply to an increasingly politicised Supreme Court.

Umm… a very tall order. The crisis in American democracy is not going away anytime soon…

Happy Easter!