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Is the pilot always to blame if things go wrong in a safety-compliant plane in the NHS?
The “purpose” of an air plane crash investigation is apparently as set out in the tweet below:
It seems appropriate to extend the “lessons from the aviation industry” in approaching the issue of how to approach blame and patient safety in the NHS. Dr Kevin Fong, NHS consultant at UCHL NHS Foundation Trust in anaesthetics amongst many other specialties, highlighted this week in his excellent BBC Horizon programme how an abnormal cognitive reaction to failure can often make management of patient safety issues in real time more difficult. Approaches to management in the real world have long made the distinction between “managers” and “leaders” and it is useful to consider what the rôle of both types of NHS employees might be, particularly given the political drive for ‘better leadership’ in the NHS.
In corporates, reasons for ‘denial about failure’ are well established (e.g. Richard Farson and Ralph Keyes writing in the Harvard Business Review, August 2002):
“While companies are beginning to accept the value of failure in the abstract-at the level of corporate policies, processes, and practices-it’s an entirely different matter at the personal level. Everyone hates to fail. We assume, rationally or not, that we’ll suffer embarrassment and a loss of esteem and stature. And nowhere is the fear of failure more intense and debilitating than in the competitive world of business, where a mistake can mean losing a bonus, a promotion, or even a job.”
Farson and Keyes (2011) identify early-on for potential benefits of “failure-tolerant leaders”:
“Of course, there are failures and there are failures. Some mistakes are lethal-producing and marketing a dysfunctional car tire, for example. At no time can management be casual about issues of health and safety. But encouraging failure doesn’t mean abandoning supervision, quality control, or respect for sound practices, just the opposite. Managing for failure requires executives to be more engaged, not less. Although mistakes are inevitable when launching innovation initiatives, management cannot abdicate its responsibility to assess the nature of the failures. Some are excusable errors; others are simply the result of sloppiness. Those willing to take a close look at what happened and why can usually tell the difference. Failure-tolerant leaders identify excusable mistakes and approach them as outcomes to be examined, understood, and built upon. They often ask simple but illuminating questions when a project falls short of its goals:
- Was the project designed conscientiously, or was it carelessly organized?
- Could the failure have been prevented with more thorough research or consultation?
- Was the project a collaborative process, or did those involved resist useful input from colleagues or fail to inform interested parties of their progress?
- Did the project remain true to its goals, or did it appear to be driven solely by personal interests?
- Were projections of risks, costs, and timing honest or deceptive?
- Were the same mistakes made repeatedly?”
It is incredibly difficult to identify who is ‘accountable’ or ‘responsible’ for potential failures in patient safety in the NHS: is it David Nicholson, as widely discussed, or any of the Secretaries of States for health? There is a mentality in the popular media to try to find someone who is responsible for this policy, and potentially the need to attach blame can be a barrier to learning from failure. For example, Amy C Edmondson also in the Harvard Business Review writes:
“The wisdom of learning from failure is incontrovertible. Yet organizations that do it well are extraordinarily rare. This gap is not due to a lack of commitment to learning. Managers in the vast majority of enterprises that I have studied over the past 20 years—pharmaceutical, financial services, product design, telecommunications, and construction companies, hospitals, and NASA’s space shuttle program, among others—genuinely wanted to help their organizations learn from failures to improve future performance. In some cases they and their teams had devoted many hours to after-action reviews, post mortems, and the like. But time after time I saw that these painstaking efforts led to no real change. The reason: Those managers were thinking about failure the wrong way.”
Learning from failure is of course extremely important in the corporate sectors, and some of the lessons might be productively transposed to the NHS too. This is from the same article:
However, is this is a cultural issue or a leadership issue? Michael Leonard and Allan Frankel in an excellent “thought paper” from the Health Foundation begin to address this issue:
“A robust safety culture is the combination of attitudes and behaviours that best manages the inevitable dangers created when humans, who are inherently fallible, work in extraordinarily complex environments. The combination, epitomised by healthcare, is a lethal brew.
Great leaders know how to wield attitudinal and behavioural norms to best protect against these risks. These include: 1) psychological safety that ensures speaking up is not associated with being perceived as ignorant, incompetent, critical or disruptive (leaders must create an environment where no one is hesitant to voice a concern and caregivers know that they will be treated with respect when they do); 2) organisational fairness, where caregivers know that they are accountable for being capable, conscientious and not engaging in unsafe behaviour, but are not held accountable for system failures; and 3) a learning system where engaged leaders hear patients and front-line caregivers’ concerns regarding defects that interfere with the delivery of safe care, and promote improvement to increase safety and reduce waste. Leaders are the keepers and guardians of these attitudinal norms and the learning system.”
Whatever the debate about which measure accurately describes mortality in the NHS, it is clear that there is potentially an issue in some NHS trusts on a case-by-case issue (see for example this transcript of “File on 4″‘s “Dangerous hospitals”), prompting further investigation through Sir Bruce Keogh’s “hit list“) Whilst headlines stating dramatic statistics are definitely unhelpful, such as “Another nine hospital trusts with suspiciously high death rates are to be investigated, it was revealed today”, there is definitely something to investigate here.
Is this even a leadership or management thing? One of the most famous distinctions between managers and leaders was made by Warren Bennis, a professor at the University of Southern California. Bennis famously believes that, “Managers do things right but leaders do the right things”. It is argued that doing the right thing, however, is a much more philosophical concept and makes us think about the future, about vision and dreams: this is a trait of a leader. Bennis goes on to compare these thoughts in more detail, the table below is based on his work:
Differences between managers and leaders
Indeed, people are currently scrabbling around now for “A new style of leadership for the NHS” as described in this Guardian article here.
Is patient safety predominantly a question of “teamwork”?
Amalberti and colleagues (Amalberti et al., 2005) make some interesting observations about teamwork and professionalism:
“A growing movement toward educating health care professionals in teamwork and strict regulations have reduced the autonomy of health care professionals and thereby improved safety in health care. But the barrier of too much autonomy cannot be overcome completely when teamwork must extend across departments or geographic areas, such as among hospital wards or departments. For example, unforeseen personal or technical circumstances sometimes cause a surgery to start and end well beyond schedule. The operating room may be organized in teams to face such a change in plan, but the ward awaiting the patient’s return is not part of the team and may be unprepared. The surgeon and the anesthesiologist must adopt a much broader representation of the system that includes anticipation of problems for others and moderation of goals, among other factors. Systemic thinking and anticipation of the consequences of processes across depart- ments remain a major challenge.”
Weisner and colleagues (Weisner et al., 2010) have indeed observed that:
“Medical teams are generally autocratic, with even more extreme authority gradient in some developing countries, so there is little opportunity for error catching due to cross-check. A checklist is ‘a formal list used to identify, schedule, compare or verify a group of elements or… used as a visual or oral aid that enables the user to overcome the limitations of short-term human memory’. The use of checklists in health care is increasingly common. One of the first widely publicized checklists was for the insertion of central venous catheters. This checklist, in addition to other team-building exercises, helped significantly decrease the central line infection rate per 1000 catheter days from 2.7 at baseline to zero.”
M. van Beuzekom and colleagues (van Beuzekom et al., 2013) and colleagues, additionally, describe an interesting example from the Netherlands. Teams in healthcare are co-incidentally formed, similar to airline crews. The teams consist of members of several different disciplines that work together for that particular operation or the whole operating day. This task-oriented team model with high levels of specialization has historically focused on technical expertise and performance of members with little emphasis on interpersonal behaviour and teamwork. In this model, communication is informally learned and developed with experience. This places a substantial demand on the non-clinical skills of the team members, especially in high-demand situations like crises.
Bleetman and colleagues (Bleetman et al., 2011) mention that, “whenever aviation is cited as an example of effective team management to the healthcare audience, there is an almost audible sigh.” Debriefing is the final teamwork behaviour that closes the loop and facilitates both teamwork and learning. Sustaining these team behaviours depends on the ability to capture information from front-line caregivers and take action. In aviation, briefings are a ‘must-do’ are not an optional extra. They are performed before every take-off and every landing. They serve to share the plan for what should happen, what could happen, to distribute the workload efficiently and to prevent and manage unexpected problems. So how could we fit briefings into emergency medicine? Even though staff may be reluctant to leave the computer screen in a busy department, it is likely to be worth assembling the team for a few minutes to provide some order and structure to a busy department and plan the shift.
Briefing points apparently could cover:
- The current situation
- Who is present on the team and their experience level
- Who is best suited to which patients and crises so that the most effective deployment of team members occurs rathe than a haphazard arrangement
- The identification of possible traps and hazards such as staff shortages ahead of time
- Shared opinions and concerns.
The authors describe that, “at the end of the shift a short debriefing is useful to thank staff and identify what went well and what did not. Positive outcomes and initiatives can be agreed.”
Is patient safety predominantly a question of “leadership”?
The literature identifies that overall team members are important who have a good sense of “situational awareness” about the patient safety issue evolving around them. However, it is being increasingly recognised that to provide effective clinical leadership in such situations, the “team leader” needs to develop a certain set of non-clinical skills. This situation demands more than currency in advance paediatric life support or advanced trauma life support; it requires the confidence (underpinned by clinical knowledge) to guide, lead and assimilate information from multiple sources to make quick and sound decisions. The team leader is bound to encounter different personalities, seniority, expectations and behaviours from members of the team, each of whom will have their own insecurities, personality, anxieties and ego.
Amalberti and colleagues (Amalberti et al., 2005) begin to develop a complex narrative on the relationship between leadership and management (and the patients whom “they serve”):
“Systems have a definite tendency toward constraint. For example, civil aviation restricts pilots in terms of the type of plane they may fly, limits operations on the basis of traffic and weather conditions, and maintains a list of the minimum equipment required before an aircraft can fly. Line pilots are not allowed to exceed these limits even when they are trained and competent. Hence, the flight (product) offered to the client is safe, but it is also often delayed, rerouted, or cancelled. Would health care and patients be willing to follow this trend and reject a surgical procedure under circumstances in which the risks are outside the boundaries of safety? Physicians already accept individual limits on the scope of their maximum performance in the privileging process; societal demand, workforce strategies, and competing demands on leadership will undermine this goal. A hard-line policy may conflict with ethical guidelines that recommend trying all possible measures to save individual patients.”
Conclusion
Even if one decides to blame the pilot of the plane, one has to wonder the extent to which the CEO of the entire airplane organisation might to be blame. The question for the NHS has become: who exactly is the pilot of plane? Is it the CEO of the NHS Foundation Trust, the CEO of NHS England, or even someone else? And rumbling on in this debate is whether the plane has definitely crashed: some relatives of passengers are overall in absolutely no doubt that the plane has crashed, and they indeed have to live with the wreckage daily. Politicians have then to decide whether the pilot ought to resign (has he done something fundamentally wrong?) or has there been something fundamentally much more distal which has gone wrong with his cockpit crew for example? And, whichever figurehead is identified if at all for any problems in this particular flights, should the figurehead be encouraged to work in a culture where problems in flying his plane have been identified and corrected safely? And finally is this is a lone airplane which has crashed (or not crashed), and are there other reports of plane crashes or near-misses to come?
References
Learning from failure
Farson, R. and Keyes, R. (2002) The Failure Tolerant Leader, Harvard Bus Rev, 80(8):64-71, 148.
Edmondson, A. Strategies for learning from failure, Harvard Bus Rev, ;89(4):48-55, 137.
Patient safety
Amalbert, R., Auroy, Y., Berwick, D., and Barach, P. (2005) Five System Barriers to Achieving Ultrasafe Health Care, Ann Intern Med, 142, pp. 756-764.
Bleetman, A., Sanusi, S., Dale, T., and Brace, S.(2012) Human factors and error prevention in emergency medicine, Emerg Med J, 29, pp. 389e393. d
Federal Aviation Administration, Section 12: Aircraft Checklists for 14 CFR Parts 121/135 iFOFSIMSF.
Pronovost, P., Needham, D., Berenholtz, S., Sinopoli, D., Chu, H., Cosgrove, S., Sexton, B., Hyzy, R., Welsh, R., Roth, G., Bander, J., Kepros, J., and Goeschel, C. (2006) An intervention to decrease catheter-related bloodstream infections in the ICU, N Engl J Med, 355, pp. 2725–32.
van Beuzekom, M., Boer, F., Akerboom, S., and Dahan, A. (2013) Perception of patient safety differs by clinical area and discipline, British Journal of Anaesthesia, 110 (1), pp. 107–14.
Weisner, T.G., Haynes, A.B., Lashoher, A., Dziekman, G., Moorman, D.J., Berry, W.R., and Gawande, A.A. (2010) Perspectives in quality: designing the WHO Surgical Safety Checklist, International Journal for Quality in Health Care, 22(5), pp. 365–370.
Some within Labour should not become a sub-party of opposition, particularly given "The Spirit of '45"
Many people in politics are ‘glass half full‘ people rather than ‘glass half empty‘, so the death of Baroness Thatcher last week provided a useful juncture of all parties to look at themselves to see where they’d got to. There has been much rewriting of history by the Conservatives to suit their political purposes. For example, the need for privatisation is explained because “the UK was a basket case” and “we even had a national removal vans company called Pickfords.” The Conservatives will need to look at ‘actual facts’ or their level of denial and lack of insight will ultimately kill them politically. A recent poll by ComRes, reported by Tom Pride at the weekend, has revealed that now, in 2013, the electorate are generally unimpressed with privatisation. And why should they be? Grahame Morris MP, MP for Easington, explains succinctly the problems in “The Red Book” (version 1, 2011):
“Of course, energy companies claim that they are only reflecting the vagaries of the international markets in coal, oil and gas. However, their increased profits and continued price increases suggest that not only have they made no attempt to insulate people from any increased costs but that they are making money rather than working in the best interests of their customers. The reason is that the energy companies are well aware that the idea of the well informed consumer is largely a myth. People are often confused by the proliferation of similar sounding deals or are reluctant to get involved in changing supplier.”
Perhaps “Ding Dong, The Witch is Dead”, as the popular song which reached No. 1 in the Scottish singles chart yesterday provides. As a weird antithesis of the sad death of Baroness Thatcher’s, Labour’s own ambassadors of New Labour have been touring the national TV and radio studios to consecrate the legacy of the Tony Blair government. These three ambassadors are Mr David Blunkett, Mr Alan Johnson, and Dr John Reid. It is widely reputed that New Labour was considered to be Baroness Thatcher’s ‘biggest achievement’ (or that could have been Tony Blair himself; the reporting of this is a bit unclear in the wide-ranging tributes which have ranged from hagiography to hate-ography). These three ambassadors are not of course to be compared to “The Three Witches”, described by Wikipedia thus:
“The Three Witches represent darkness, chaos, and conflict, while their role is as agents and witnesses. Their presence communicates treason and impending doom. During Shakespeare’s day, witches were seen as worse than rebels, “the most notorious traitor and rebell that can be.” They were not only political traitors, but also spiritual traitors as well. Much of the confusion that springs from them comes from their ability to straddle the play’s borders between reality and the supernatural. They are so deeply entrenched in both worlds that it is unclear whether they control fate, or whether they are merely its agents. They defy logic, not being subject to the rules of the real world.” Of course any resemblance of these three ambassadors to “the three witches” is totally a matter of pure coincidence as the old disclaimer goes, but their exact purpose is far from obvious. It makes sense for them to wish to appear that they are ‘building on the foundations” of Margaret Thatcher, but many believe that these foundations themselves are part of the problem and not the solution.
John Cooper QC rightly asked on ‘BBC Any Questions’ why Tony Blair had offered his advice in public rather than private. We have long been told about New Labour members ‘meeting in secret’, in organising some sort of crackpot renaissance just in case Ed Miliband fails, but I’m too old for conspiracy theories. Tony Blair can possibly compare himself to Margaret Thatcher in that he more-or-less told his party what he wanted to do, preferring to lead by conviction rather than consensus. As Owain Gardiner in “The Red Book” notes, “As Ed Balls memorably put it in his Bloomberg speech in the winter of 2010, politics is about shaping public opinion, not bowing slavishly to it“. However, the funeral of Baroness Thatcher in a ‘weird twist-of-fate’ has coincided with the birthday of Robert Croker or Noonan, otherwise known famously as Robert Tressell, author of the famous “Ragged Trousers Philanthropists”. It has nearly also coincided with the launch on DVD of ‘The Spirit of ’45’. The description of the film is as follows, “An impassioned documentary about how the spirit of unity which buoyed Britain during the war years carried through to create a vision of a fairer, united society. 1945 was a pivotal year in British history. The unity that carried Britain through the war allied to the bitter memories of the inter-war years led to a vision of a better society. The spirit of the age was to be our brother’s and our sister’s keeper.” Of course, the Liberal Democrats in 2013 aspire for ‘a fairer society, and a stronger economy’, but after a term in a Tory-led government which has seen the closure of many libraries and law centres and a double-dip recession (thus far), one has to wonder how this compares to the attempts of Labour in building a fairer society of its own. Of course, there is a temptation of Ken Loach to give his version of history as rosy as the Thatcherite version of her society, but it is ubiquitously conceded that there is a social housing crisis now (with many council houses, built through infrastructure investment, having been flogged off in the 1980s), a disastrous privatisation of the railways industry (leading to a fragmented service with death of a collective, public-sector ethos), and closure of coal mines which has led to destruction of whole mining communities.
A triumph is that “Labour Left”, formerly known as “GEER”, produced in 2011 its first version of ‘The Red Book’, edited by Dr Éoin Clarke and Owain Gardiner, and which is as relevant today as it was when it was first written and published.
At the time, Labour was still recovering from “New Labour”, and Prof Bev Clack sets out very nicely the background: “Seen in this way, socialism has little to offer western liberal societies that take as given the importance of fostering individual creativity. In shaping left-of-centre politics, one solution to this apparent mismatch has been to avoid using the “S” word. We are now “social democrats” or followers of “the Third Way”. As Peter Kellner notes, the word „socialist? first appeared in 1827 in the Co-operative magazine of Robert Owen. For the visionary Owen, a socialist was “someone who co- operated with others for the common good?. By defining socialism in this way, Owen directs our gaze to the individual who seeks to act ethically in society. This notion of the practical socialist challenges bureaucratic accounts of what socialism entails; but it also highlights the need to think again about the neo-liberal model of the “self” that has dominated the political scene for the last thirty years.”
It is currently vital that Labour is inclusive to the views of all members of society, especially the “working poor” who may feel very disillusioned with the route taken by Labour during the “New Labour” years. Looking forward to the future over coal, Ian Lavery MP is clearly looking forwards, not backwards: “There are other reasons why CCS/Clean Coal and the opening of new Coal Mines on which we could build new Clean Coal Stations that can provide a stop gap in our energy mix until renewable energy is able to fully meet the UK?s energy needs. Employment lost as a result of the closing of the pits in the 1980s was never replenished, and as a result high levels of worklessness exist in the coal mining regions of the UK today.” This is clearly then not just an economic argument, where Thatcherism could have been the first manifestation of true globalisation as Michael White argued in last week’s Guardian politics podcast; it is a genuine societal one, and the resentment is deep, as indeed the reunion of the Durham miners in Trafalgar Square this weekend demonstrated. Meanwhile, Rhiannon Lockley has been a member of Labour Left since its formation. She is a FE lecturer in the West Midlands in Psychology and Sociology. The disenfranchisement of the working class vote is a serious one, and a noteworthy impediment for Labour reconnecting with ‘lost voters’. Rhiannon writes,
“One of the most difficult problems facing the left in 21st century Britain is the need to reach and move forward from the understanding that huge numbers of working class voters are psychologically distant from their political objectives. This distance is much more complex than assumed in the traditional model of the unenlightened masses, where the message of socialism is viewed as providing the power to radically transform the workforce – the message is of course out there, but the resistance to it in the minds of the very people who should benefit from it the most is multi-faceted and robust.” There is an evident problem that Labour under Ed Miliband has to embrace, which is rebalancing society, as well as rebalancing the economy. Austin Mitchell MP, MP for Grimsby, establishes a clear narrative of facts which we know well: “The first deep problem is that the recession is deeper, harder and more serious in Britain than in any other economy. It will take more time and tougher measures to recover. Where Germany invested, restructured and formed close relationships between capital and labour to keep wages down and investment up, Britain, because of its overblown financial sector, has squandered the good times on a huge debt bubble which leaves everyone: families, companies, government, with a bigger collective debt burden than most.”
Members of Labour apparently did support the sale of council houses in the 1980s, but it is clear now that there is a shortage of council houses. Curiously, the link between a societal need for social housing and a desperate “kick start” for the economy appears to have been disconnected. Viewers of “The Spirit of ’45” will also be surprised to see Aneurin Bevan being secretary of state for both housing and health. And yet the link between health and housing is even more relevant under the new Health and Social Care Act (2012), as the new Act gives great emphasis on a need to reduce inequalities in health, and poor housing is a leading cause of illness and disease. In the red book, Dr Eoin Clarke interestingly observes,“The number of social houses built under John Major declined steeply, as did the number of council sales. But if one looks closely they can see that sales began to exceed builds under Major. This was an unsustainable path, and meant that it was inevitable council housing shortages would arise. Sadly, Tony Blair only intensified this folly, the number of council sales under Blair dramatically increased and the building of social housing halted.” Furthermore, there is little doubt that Labour’s narrative on tax is potentially confused. Labour has yet to forge clear policies on redistribution as well as predistribution, and yet there is a populist thirst already for a tax mechanism which seals off tax loopholes in corporate tax avoidance. Part of the drive for this perhaps has come from the perception of the lost money to the revenue through corporate tax avoidance, which makes the attack on ‘benefit scroungers’ look rather pathetic. This is definitely then work in progress, but Richard Murphy observes as early in 2011 in the “Red Book”, that, “Labour has apologised for tax for too long. Tax works. Tax is a good thing. Tax transforms people’s lives. Tax can be legitimately collected. If tax is not collected, when it is due, then injustice results. Labour has to embrace these ideas, and act on them. That is possible. Now is the time to do it.Though its detractors have characterised Labour Left in a number of ways, including “far left loyalism? (the loyalty being to Ed Miliband), the truth is that if Labour Left?s values of equality, redistribution and fairness are perceived as “far left”, then something has gone very wrong in the Labour movement as a whole..”
From midnight tonight, Mid Staffs NHS Foundation Trust goes into administration. This can be considered symbolic of a failure at Mid Staffs financially, and it is a decision taken by Monitor given the responsibility of regulating a neoliberal approach to the NHS, further advanced by the Health and Social Care Act (2012). One of the many reasons given for the poor performance at Mid Staffs through the Francis Reports is how this Trust “lost its way”, and gave up on being part of its local community (particularly dangerous when you consider that Foundation Trusts are thought to benefit from ‘autonomy’). And yet David Taylor-Gooby as early as 2011 identifies a crucial problem here: “Public Involvement does not simply mean going to meetings with nice lunches, as some NHS managers seem to think and approving decisions which have already been made. It means genuine involvement in the decision making progress, being made aware of facts and able to participate in decisions. Thus if difficult choices have to be made, such as closing a hospital, which may well happen when there is more community-based treatment, then people are involved in the debate at the beginning. It is when the public are confronted with a decision to close a facility without much warning that people become incensed and politicians jump on the bandwagon.”
Labour still has a real risk of throwing the baby out with the bathwater, but this would be a huge mistake given the real talent and intellectual rigour within Labour. Tony Blair warned against finding false comfort in the past, however there is much in the socialist legacy of Labour that Labour should be proud of. Tony Blair should watch with some degree of pride, “The spirit of ’45”, thinking about how the “working poor” pulled together to create a country that we can all be proud of. Likewise, he can also think about how he really has lost touch with the voters who hold the key for Ed Miliband to 10 Downing Street in 2015. Who knows, Ed Miliband as PM may have to make the arrangements for the political funeral of New Labour while he is in power, even.
The anatomy of a 'car crash' interview: Boris Johnson and Eddie Mair, 24 March 2013
The Bozza interview was the very last thing I expected to wake up to this morning!
I cannot verify the truth of any of the statements in this interview above.
Maybe this should appear on Tim Shipman’s list of “car crash interviews”, purported to be the greatest interviews in political history (link here)? I remember many of these interviews when they first aired. My personal radio favourite is of George Osborne’s ding dong with Evan Davis, from 6 December 2012 (here).
It is hard to describe how Eddie Mair (@eddiemair) managed to execute such a successful interview. First of all, he did not throw any ‘hissy fits’ at any stage himself; he did not look angry, he was not condescending, he remained polite, and simply gave enough metaphorical rope for the interviewee to hang himself with. It was helped, in my view, by setting up the interview with some standard political questions, which Bozza would have been able to hit for six, but what caused him to be caught out middle stump is interesting. I think he may have underestimated the bowler, hoped perhaps the umpire might have called a ‘wide’ but never did, but I think part of Mair’s success was his ability to bowl a few easy bowls for a few balls in the over, before successfully declaring Bozza out in what turned out to be a maiden over
The big NHS underspend: Andy Burnham writes to Jeremy Hunt
This is the rather dramatic start of the HSJ article yesterday:
At a time of a huge financial squeeze being put on hospitals and when treatments of all sorts are being cut or delayed (or “rationed”), it turns out that the Department of Health – the unit in charge of the NHS – has a huge surplus that it is returning to the Treasury.
Andy Burnham MP has written to Jeremy Hunt MP as follows.
Dear Jeremy
NHS Budget underspend
Figures published today by the NHS Information Centre show that in December 2012 there were 4,887 fewer nurses working in the NHS than in May 2010. This followed the Care Quality Commission Care Update, published earlier this month, which warned that 11% of hospital services inspected were failing to meet the standard on adequate staffing levels.
You can therefore imagine my surprise when reading figures published in the detail of the Budget document yesterday that show the Department of Health is expected to underspend against its 2012-13 expenditure limit by £2.2bn.
Furthermore, the table on page 70 of the Budget document appears to show that none of this has been carried forward to be used in subsequent financial years as part of the Budget Exchange programme.
At a time when the NHS is facing its biggest financial challenge, when almost 5,000 nursing posts have been lost since the general election, and when one in ten hospitals are understaffed, I find it staggering that £2.2bn of the NHS budget is to be returned to the Treasury.
It would be helpful if you could therefore answer a number of important questions.
1. Were you aware of the £2.2bn underspend before yesterday and did you authorise the decision not make any use of the Budget Exchange programme? Or were you overruled by the Treasury?
2. If so, when did you make your decision?
3. Can you confirm that this means the Department’s underspend for 2012-13 would be 2%, higher than the 1.5% figure that your Department says is consistent with “prudent financial management”?
4. Do you accept the recent findings of the Care Quality Commission that one in ten hospitals are failing to meet the CQC standard on adequate staffing levels? Did you consider this when making your decision?
5. Why did you not make use of this underspend to prevent job losses and ensure all hospitals have adequate staffing levels?
6. Yesterday, a Department of Health spokeswoman told the Health Service Journal that the NHS underspend would “still be available for NHS organisations to ensure high quality, sustainable health services are delivered to patients now and in the future”. Can you confirm that this will not be the case, as none of the £2.2bn underspend has been carried forward for future use?
I look forward to your response.
Best wishes
Rt Hon Andy Burnham
The plot thickens…
Even with an open goal, Labour insists on aiming for the crossbar
It’s become worse than embarrassing. Even with an open goal, Labour insists on aiming for the crossbar. The economy couldn’t be worse, people are experiencing massive social injustices, the workforce is going to be easier to sack in future, more disabled citizens are having to appeal just to keep their benefits, the NHS is being privatised, and yet Labour has taken months to complete a policy review. On top of this, people are now calling for Liam Byrne to be sacked. He has failed to mount an effective opposition on disability benefits, and three friends of mine only yesterday quit the Labour Party to join the Greens.
Labour is a horrific mess. It supported this week rushed legislation to legitimise what for many is socially abhorrent a policy goal. The problem facing activists is that if they leave the main Party the resulting party will be occupied with people like Liam Byrne. John Healey might as well have gone to Barbados for a year while the Health and Social Care Bill was being discussed. We are now about a fortnight away from the NHS being privatised. Ed Balls was ‘correct’ on the economy, yet it is a sign of George Osborne’s confidence (or arrogance) that he feels able to talk about ‘an aspiration nation’.
The general perception now amongst many Labour members is that Labour could not really give a shit about its core membership, or even core values. Legislation is currently being proposed where workers can apply for ‘shares for rights’, thankfully throttled by Lord Pannick QC in the House of Lords; or where it is easier to make workers redundant. Coupled with this, there is a sense that Labour is complacent, and take their real core membership for granted. This is extremely worrying, and will turn out to be fatal for the Labour Party if unaddressed. The failure of Labour to stop the privatisation of the NHS is possibly the most humiliating failure of the modern Labour Party. On the economy, Ed Balls is right to an extent to say that a reason that people mistrust Labour on the economy is that the economy has not been fairly represented in the media, but Labour does not address other issues which matter to its membership; such as law centres being shut down, meaning that ordinary members of the public do not have access to legal advice about housing or employment issues, for example.
This really is an open goal for Labour, but the workfare abstention this week was nothing short of an own goal. If Ed Miliband doesn’t complete a ‘root-and-branch’ review of why Labour has lost his way as part of the policy review, he does not deserve to be leader of the Labour Party. It is completely inadequate for Labour to say it will repeal the Health and Social Care Act in 2015, if only four people will only sign the early day motion for the new set of regulations to be scrapped. Maybe Andy Burnham is waiting for Liz Kendall to take up the policy, or Liz Kendall is waiting for Andy Burnham to move onto something different, but a lot of people have a lot of faith in Burnham compared to Healey, and yet the privatisation of the NHS legally complete. There is an onrunning philosophy that many things are a ‘fait accompli’ – for example, we’re stuck with an austerity agenda until 2018, and there is nothing we can do about it.
The danger is that people will simply stop engaging with politics altogether, or stop voting. They will not feel any more shafted than they are at the moment. However, people currently feel angry, and very upset that they have been disenfranchised so much. Of course, the response has been that anyone is free to participate in the website offering a wikipedia approach to policy formulation, but this does not explain why the Labour Party abstained on workfare. To have abstained on Workfare was an endorsement of a working principle which is a complete anethema to the values of workers, and which is a Godsend for corporates who wish to find cheap or free labour to maximise shareholder dividend. For Labour to have supported this was morally bankrupt, and highly offensive. It is not a victory that Ed Miliband wished to spend all night discussing Leveson, talking about the victims of press hacking. Many more people are victims of a failing economy, and are about to sacked more readily if the Government is able to pursue this policy, even though there is no correlation between economic growth and employment rights (in fact there is an inverse correlation.) Labour is in a shambolic state, and the seeds of much of this failing policy can be seen in New Labour. The Conservatives can point to Labour’s support for workfare in defending their stance on workfare. In yesterday’s Prime Minister’s Question, David Cameron simply fielded the question from Dame Ruddock about the Lewisham Hospital situation by saying that Labour had introduced the PFI policy in the first place. This is correct – while the Conservatives and their accountancy friends in the City initiated this policy, this was pursued at full throttle by Gordon Brown and Tony Blair. This is a difficult situation Labour finds itself in.
Labour is not in this horrific situation because it has not apologised enough. It has apologised for everything, including recently immigration. Whilst Labour feels embarrassed about its immigration policy, getting positive words about the value that Asian citizens contribute to the NHS for example is like getting blood out-of-a-stone. Bloggers, while occasionally mounting campaigns, remain loyal to failing planks of policy, and often offer unreasonable deference over issues which are clearly incorrect in the pursuit of social justice. It is left only to a handful of MPs, like Ian Mearns, Ian Lavery and Grahame Morris, to keep the red flag flying, and frankly without them the soul of the Labour Party would be dead. Under such circumstances, Labour does not deserve to win an election, let alone be in a hung parliament. It is frankly an embarrassment.
Verdict from the Secondary Legislation Scrutiny Committee about No. 2 Regulations 2013 (SI 2013/500)
National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013 (SI 2013/500)
To revoke the original Regulations, the substitute Regulations have to come into effect no later than 1 April. The compressed timetable inhibited the Committee’s normal scrutiny process and, to enable the Committee to report before the House rises for the Easter recess, we conducted a short targeted consultation addressed to the organisations which made submissions to us about the original Regulations. In addition, we received a number of unsolicited submissions from individuals. In spite of the very short deadline, we have received some constructive and thoughtful comments on the substitute Regulations for which we are grateful. They are published in full on the Committee website and quoted selectively below.We regret that some were unable to contribute because the timescale prevented them giving a considered view of some highly technical changes to the legislation. As we have made clear before, not least in our report on the Government’s new approach to consultation, the Committee has no doubt that policy-making is improved by effective and genuine consultation, and we are firmly of the view that the Department has allowed insufficient time to set this system up properly and enable thorough scrutiny. This instrument is drawn to the special attention of the House on the ground that it may imperfectly achieve its policy objective.
…
As a general point, it seems to us that implementation of the policy underlying the Regulations has been left too close to the intended implementation date. The original Regulations were laid on 13 February, only seven and a half weeks before coming into operation and allowing little time for familiarisation and training staff, particularly when so many other changes are happening simultaneously. We are assured that the regulator, Monitor, which will be overseeing the operation of this legislation, intends to put its guidance out for consultation in March, but, at the time DH
responded to our questions on 14 March, that had not happened. The Monitor guidance may resolve or aggravate the doubts expressed but neither the Committee nor the health sector had access to the proposed guidance when considering the proposed legislation. We do not regard this as good practice.
Secondary Legislation Scrutiny Committee
@Ed_Miliband's #budget #budget2013 response in full
Ed Miliband’s 2013 Budget response was as follows:
Mr Deputy Speaker.
This is the Chancellor’s fourth Budget, but one thing unites them all.
Every Budget he comes to this house and things are worse not better for the country.
Compared to last year’s Budget
Growth last year, down.
Growth this year, down.
Growth next year, down.
They don’t think growth matters, but people in this country do.
And all he offers is more of the same.
A more of the same Budget from a downgraded Chancellor.
Britain deserves better than this.
I do have to say to the Chancellor of the Exchequer, he almost need not have bother coming to the House because the whole Budget, including the market-sensitive fiscal forecast was in the Standard before he rose to his feet.
To be fair to the Chancellor of the Exchequer, I sure he didn’t intend the whole of the Budget to be in the Standard before he rose to his feet and I hope he will investigate and report back to the House.
Now, what did the Prime Minister declare late last year, and I quote:
“The good news will keep coming”.
And what did the Chancellor tell us today?
Under this Government the bad news just doesn’t stop.
Back in June 2010 the Chancellor promised:
“a steady and sustained recovery…”
He was wrong.
We’ve had the slowest recovery for 100 years.
Last year he said in the Budget there would be no double dip recession.
He was wrong, there was.
He told us a year ago that growth would be 2% this year.
He was wrong.
Now he says it will be just 0.6%.
He told us that next year, growth would be 2.7%.
Wrong again.
Now just 1.8%.
Wait for tomorrow the Chancellor says, and I will be vindicated.
But with this Chancellor tomorrow never comes.
He’s the wrong man.
In the wrong place.
At the worst possible time for the country.
It’s a downgraded budget from a downgraded Chancellor.
He has secured one upgrade this year.
Travelling first class on a second class ticket from Crewe to London.
And the only time the country’s felt all in it together, was when he got booed by 80,000 people at the Paralympics.
Mr Deputy Speaker, I’ve got some advice for the Chancellor.
Stay away from the cup final, even if Chelsea get there.
And, who is paying the price for the Chancellor’s failure?
Britain’s families.
In his first Budget he predicted that living standards would rise over the Parliament.
But wages are flat.
Prices are rising.
And Britain’s families are squeezed.
And what the Chancellor didn’t tell us, is that the Office for Budget Responsibility has confirmed the British people will be worse off in 2015 than they were in 2010.
It’s official: you’re worse off under the Tories.
Worse off, year after year after year. And wasn’t there an extraordinary omission from his speech, no mention of the AAA rating.
What the Prime Minister called the “mark of trust”.
Which he told us had been “secured”.
The Chancellor said it would be a humiliation for Britain to be downgraded.
So not just a downgraded Chancellor.
A humiliated Chancellor too.
And what about borrowing?
The Chancellor made the extraordinary claim in his speech that he was “on course”.
Mr Deputy Speaker, even he can’t believe this nonsense.
Debt is higher in every year of this Parliament than he forecast at the last Budget.
He is going to borrow £200 billion more than he planned.
And what did he say in his June 2010 Budget:
He set two very clear benchmarks, and I quote, “We are on track to have debt falling and a balanced structural current budget” by 2014/15.
Or as he called it “our four-year plan”.
This was the deal he offered the British people.
These were the terms.
Four years of pain, tax rises ….
The Prime Minister says from a sedentary position, borrow more, you are borrowing more.
And he just needs to look down the road, because the Business Secretary was asked and he said: “We are borrowing more”. From his own Business Secretary.
So these were the terms: four years, tax rises, and spending cuts, and the public finances would be sorted.
So today he should have been telling us:
Just one more year of sacrifice.
In twelve months the good times will roll.
Job done.
Mission accomplished.
Election plan underway.
But three years on, what does he say?
Exactly what he said three years ago.
We still need four more years of pain, tax rises and spending cuts.
In other words, after all the misery, all the harsh medicine, all the suffering by the British people:
Three years.
No progress.
Deal broken.
Same old Tories.
And all he offers is more of the same.
It’s as if they really do believe their own propaganda.
That the failure is nothing to do with them.
We’ve heard all the excuses:
The snow, the royal wedding, the Jubilee, the eurozone.
And now they’re turning on each other.
The Prime Minister said last weekend, and I quote:
“Let the message go out from this hall and this party: We are here to fight”.
Mr Deputy Speaker, they’re certainly doing that.
The Business Secretary’s turned on the Chancellor.
The Home Secretary’s turned on the Prime Minister.
And the Education Secretary’s turned on her.
The whole country can see that’s what’s going on.
The blame game has begun in the Cabinet.
The truth is the Chancellor is lashed to the mast, not because of his judgement, but because of pride.
Not because of the facts, but because of ideology.
And why does he stay in his job?
Not because the country want him.
Not because his party want him.
But because he is the Prime Minister’s last line of defence.
The Bullingdon boys really are both in it together.
And they don’t understand, you need a recovery made by the many not just a few at the top.
It’s a year now since the omnishambles Budget.
We’ve had u-turns on charities, on churches, on caravans.
And yes, on pasties.
But there is one policy they are absolutely committed to.
The top rate tax cut.
John the banker, remember him?
He’s had a tough year, earning just £1m.
What does he get? He gets a tax cut of £42,500 next year.
£42,500, double the average wage.
His colleague, let’s call him George, his colleague has done a little better, bringing home £5 million. What does he get in a tax cut?
I know the Prime Minister doesn’t like to hear what he agreed to, what does he get? A tax cut of nearly £250,000.
And at the same time everyone else is paying the price.
The Chancellor is giving with one hand, and taking far more away with the other.
Hard working families hit by the strivers tax.
Pensioners hit by the granny tax.
Disabled people hit by the bedroom tax.
Millions paying more so millionaires can pay less.
Now the Chancellor mentioned childcare.
He wants a round of applause for cutting £7bn in help for families this Parliament, and offering £700m of help in the next.
But what are the families who are waiting for that childcare help told? They’ve got to wait over two years for help to arrive.
But for the richest in society, they just have to wait two weeks for the millionaires tax cut to kick in.
This is David Cameron’s Britain.
And still the Prime Minister refuses to tell us – despite repeated questions – whether he is getting the 50p tax cut.
Oh he’s getting embarrassed now, you can see.
He’s had a year to think about it.
He must have done the maths.
Even he should have worked it out by now.
So come on.
Nod your head if you are getting the 50p tax rate.
They ask am I?
No I am not getting the 50p tax rate, I am asking whether the PM is.
Come on answer.
After all, he is the person that said sunlight is the best disinfectant, let transparency win the day.
Now let’s try something else. What about the rest of the Cabinet, are they getting the 50p tax rate?
OK, hands up if you are not getting the 50p tax cut?
Come on, hands up.
Just put your hand up if you are not getting the 50p tax cut. They are obviously … they don’t like it do they?
At last the Cabinet are united, with a simple message:
Thanks George.
He’s cutting taxes for them, while raising them for everyone else.
Now the Chancellor announced some measures today that he said would boost growth.
Just like he does every year.
And every year they fail.
I could mention the “national loan guarantee scheme”, he trumpeted that last year.
And then he abolished just four months later.
The Funding for Lending scheme, that he said would transform the prospects for small business.
The work programme that is worse than doing nothing.
And today he talked a lot about housing.
And the Prime Minister said this in 2011. He launched his so-called housing strategy, and in his own understated way he labelled it “a radical and unashamedly ambitious strategy”. He said it would give the housing industry a shot in the arm, enable 100,000 people to buy their own home.
18 months later, how many families have been helped?
Not 100,000.
Not even 10,000.
Just fifteen hundred out of 100,000 promised
That’s 98,500 broken promises.
For all the launches, strategies and plans, housing completions are now at the lowest level since the 1920s.
And 130,000 jobs lost in construction because of their failing economic plan.
It’s a failing economic plan from a failing Chancellor.
The Chancellor has failed the tests of the British people:
Growth, living standards and hope.
But he has not just failed their tests. He has failed on his own as well.
All he has to offer is this more of the same Budget.
Today the Chancellor joined twitter.
He could have got it all into 140 characters.
Growth down. Borrowing up. Families hit. And millionaires laughing all the way to the bank. #downgradedChancellor.
Mr Deputy Speaker, more of the same is not the answer to the last three years.
More of the same is the answer of a downgraded Chancellor, in a downgraded Government.
Britain deserves better than this.
If the Labour frontbench pull any further stunts like today, they don't even deserve a 'hung parliament'
It is thought that part of the reason that Ed Miliband was so keen to pursue ‘press regulation’ was that this was the first topic where there was a sense the public were on the side of victims. Miliband has not shown the same passion for the privatisation of the NHS, for example. On the other hand, today, the anger on Twitter and Facebook was really ferocious. To give you some idea about what sort of country this is, this was not even considered newsworthy enough to be included on the BBC news website. Opposing workfare was not a question about playing politics: it was very much about the lives of real people, morality and justice. The result of the vote of the second reading of jobseekers bill (aka “workfare” bill) was 263 vote for, and only 52 vote against. Labour MPs were asked to abstain.
Some MPs did make a “principled stand”, like John McDonnell.
Members of Labour are genuinely seething. Owen Jones is correct to flag this up as a “red alert” for Labour:
This one episode in itself has blown up “One Labour”. Sunny Hundal has written a very elegant blogpost here about how the ‘concessions’ over Workfare can’t really be considered concessions in the scheme of things. To understand why this has dramatically driven a ‘coach and horses’ through ‘One Nation’, you have to consider what Ed Miliband had sold “one nation” as. It was an idea where the economy couldn’t be divided into private and public, but where everyone had a part to play, including Unions and invested bankers, provided that there were “no vested interests”. Consequently, this meant society pulling in the same direction, in other words no division between rich and poor, North and South, unemployed and employed, disabled or non-disabled, etc. Why “one society” is clearly ‘left wanting’ is perfectly clear to witness as disabled citizens continue to feel uncomfortable with the welfare reform, and continue not to be inspired by Liam Byrne’s perceived lack of concern about their plight. Finally, it depends on a political process which we can all trust in. However, the last few days has seen shabby behind-the-scenes political manoeuvring which Labour in its old days of ‘beer and sandwiches’ could only have possibly had dreamt of; with party leaders up to 4 in the morning, with ‘interested parties’ such as Hacked Off.
Shiv Malik explains extremely well how this workfare situation evolved, in his article from today:
“Labour is expected to support the Department of Work and Pensions (DWP) in speeding a retroactive law through parliament that will overturn the outcome of a court of appeal judgment and ensure the government no longer has to pay £130m in benefit rebates to about a quarter of a million jobseekers.
The law has been hastily drafted by the government in response to last month’s ruling from three appeal court judges in favour of science graduate Cait Reilly and unemployed lorry driver Jamieson Wilson.
The court found that Reilly, who had been made to work unpaid in Poundland for weeks; Wilson, who was forced to work unpaid for six months, and up to 231,000 other benefit claimants had been unlawfully punished over the last few years because the government had failed to give them more than a few lines of regulatory information about the schemes they had to take part in.
In a move that has upset campaigners and activists, the parliamentary Labour party said it was likely to abstain from any vote expected on Tuesday and was pushing for concessions – including an independent review of the benefit sanctions regime – in return for allowing the jobseekers (back to work schemes) bill to be rushed through parliament at “lightning speed”.”
The situation is now an ugly one. The economy is about to enter a triple-dip, and Labour is still not trusted on the economy. Despite a perfect Keynesian narrative, people blame Labour for waste and profligacy, and there is no sign of this mistrust shifting. The current Coalition government have legislated for the privatisation of the NHS (all experts now agree it is a privatisation which is now experiencing difficult regulatory problems such as how to deal with ‘creamskimming’ aka ‘cherry picking’). John Healey was politically impotent in stopping the advance of the Bill through parliament. Labour implemented in its tenure a programme of PFI and now Trusts are saddled with debts from this ‘off ledger accounting’ at uncompetitive competitive rates – some hospitals will have to go into ‘managed decline’. Some Foundation Trusts, having been awarded ‘foundation status’, have had to declare themselves bankrupt, and it is generally conceded that setting up these hospitals was a convenient way of repackaging the NHS suitable for privatisation exactly like had happened in Spain.
Labour members have a right to be angry. Decisions like today show evidently that Labour is not afraid to ignore its key values or its core members. It has widely been advanced that the best that Labour can hope for in 2015 is a ‘hung parliament’, but this will be disaster with a ‘more of the same’ recipe for a stagnant economy, and a continued march of the privatisation of the NHS. Presumably Miliband will have to conclude his painfully protracted policy review at some stage, but his lack of concern about poor employment rights amongst workers has been conceded as nothing short of disgusting. We now have a maximum number of people in employment with no job security at all. Also, through the backdoor, this Government made it much easier to sack people, as George Eaton elegantly explains in the New Statesman:
“”While the Commons noisily debated press regulation, MPs elsewhere in the House quietly signed away workers’ rights. On a delegated legislation committee (a backdoor means of sneaking through contentious amendments), nine Conservatives and two Liberal Democrats voted to reduce the consultation period for collective redundancies from 90 days to 45.
At present, employers planning to make 100 or more redundancies are legally required to consult with trade unions and other employee representatives for this period to help minimise the impact and seek alternatives to job losses. Unite cites the example of Jaguar Land Rover, which proposed making over 1,000 staff redundant in 2009 but later avoided any job losses after identifying £70m of savings during the consultation.
The reduction to 45 days, based on a proposal in the infamous Beecroft report, means fewer companies will now adopt this enlightened approach. As John McDonnell, one of the seven Labour MPs who voted against the measure (only 18 MPs can sit on the committee), noted: “We know that the reduction to 45 days means that the opportunity for consultation is hopeless. It will not happen and will be meaningless. There will not be the time for the employees to work with the employers to look at alternative plans for that company.””
Liam Byrne is an influential member of the Shadow Cabinet. Nearly all of us are no longer “loving it”. It is a tragedy that many voters will not be able to turn to their MPs to stand up for their real-life concerns (though hats-off to Grahame Morris, John McDonnell and Ian Lavery who all voted “no” today). It had been a fairly safe bet that Labour would be in a “hung parliament”, but now, having clutched onto defeat from the jaws of victory, Labour could even look set to experience a resounding defeat, and they will have only themselves to blame. Some remnants of New Labour ideology clearly haven’t been excised from the Labour front bench; consequently we should be careful now.
Is it right for Labour "not to do God", nor even social justice?
Perhaps religion and politics don’t mix, but there is a certainly an appetite for moral and religious matters amongst some of the wider electorate at large. For ages, right wing critics have emphasised that the right wing “does” religion too, and the left does not have a monopoly on moral or religious issues. A fewer number on the left likewise feel that the right does not have a monopoly on business or enterprise, as they pursue, despite all the odds, the movement of “responsible capitalism”. In amidst all the turmoil of the implementation of the recommendations of the Leveson report, or furore about whether there was an ‘excess number of deaths’ at Mid Staffs (and if so, what to do about it), the Catholic Church elected a new Pope. Pope Francis has said that he wants “a poor Church, for the poor” following his election as head of the world’s 1.2bn Catholics on Wednesday. He said he chose the name Francis after 12-13th Century St Francis of Assisi, who represented “poverty and peace”. Spectators of UK politics will be mindful of the speech made by Margaret Thatcher on her election, for the first time, as Prime Minister outside Downing Street in 1979. Pope Francis urged journalists to get to know the Church with its “virtues and sins” and to share its focus on “truth, goodness and beauty”. He takes over from Benedict XVI, who abdicated last month. The former Argentine cardinal Jorge Mario Bergoglio, 76, was the surprise choice of cardinals meeting in Rome to choose a new head of the Church.
Changing the subject from religious figureheads to Mr Blair is interesting from the perspective of how the English political parties have latterly approached the issue of religion. There is a doctrine that religion does not play a part in politics, and particularly not when going to war with a non-Christian country. Tony Blair is reported to have said he had intended to echo the traditional closing remark of Presidents in the United States, in one of his speeches. These presidents typically sign-off television broadcasts by saying, “God Bless America”. For much of his time in office, Mr Blair was accused of adopting a “presidential” style of leadership, and became close to former American presidents Bill Clinton and George W Bush. His former director of communications, Alastair Campbell, once famously declared “we don’t do God”, when the then Prime Minister was asked about his beliefs.
Wind on a few years and you find the new Archbishop of Canterbury Justin Welby warning that changes to the benefit system could drive children and families into poverty. He said society had a duty to support the “vulnerable and in need”. His comments backed an open letter from bishops criticising plans to limit rises in working-age benefits and some tax credits to 1% for three years. The Department for Work and Pensions said meanwhile stuck to their tried-and-tested line that changing the system will help get people “into work and out of poverty”. Shadow home secretary Yvette Cooper told the BBC’s Andrew Marr Show that Archbishop Welby was “absolutely right” to speak out and described the proposals as “immoral”. So is this the beginning of a divide between the Church and parliament? Probably not a big enough divide who wish to see the disestablishment of the Church altogether.
Many recently would have been alerted by a tweet that used the hashtag ‘blacknoseday’. The sentiment behind it is in fact interesting. David Cameron, alleged to be the man responsible for cutting welfare benefits for the most needy in society, played a cameo role in a Comic Relief video. Nonetheless, Comic Relief made a record amount of money, it is reported. There is a further accusation that Cameron is encouraging us to donate to the charity by waiving VAT from sales of the song and covering this loss to the exchequer with money from the Overseas Budget. So now those people overseas who would have won direct government funding are relying on the UK population downloading a One Direction track.
And are Labour much better? Today, Dr Eoin Clarke’s peaceful rallies against the Bedroom Tax went very successfully, but against a background of discontent within Labour amongst activists. Shadow Cabinet member Helen Goodman MP, who served in the Department of Work and Pensions in the last Labour administration, said in a TV interview that that “We’ve said that the bedroom tax should only apply if people have been offered a smaller place to live and turned it down”. It appears that, time and time again, Labour have made half-hearted criticisms of welfare cuts, but Shadow Work and Pensions Secretary Liam Byrne has already said that Labour will make further cuts to the welfare budget if Labour wins in 2015.
Furthermore, Labour will not yet commit to reversing specific changes contained in the Legal Aid, Sentencing and Punishment of Offenders Act, the shadow justice minister said this week. However, Andrew Slaughter MP promised a future Labour government would ‘rebalance the justice system’ in favour of those seeking civil redress. It would also make more savings from criminal legal aid. The challenge for a future Labour government will be to ‘rebalance the justice system so that it can be seen to give access to justice to all… irrespective of their means’. And in the near future Labour wishes to back Iain Duncan-Smith on some retroactive changes to the law over workfare also. The DWP has introduced emergency legislation to reverse the outcome of a court of appeal decision and “protect the national economy” from a £130m payout to jobseekers deemed to have been unlawfully punished. The retroactive legislation, published on Thursday evening and expected to be rushed through parliament on Tuesday, will effectively strike down a decision by three senior judges and deny benefit claimants an average payout of between £530 and £570 each. Apparently, Labour will support the fast-tracked bill with some further safeguards and that negotiations with the coalition are ongoing.
So is it right for Labour “not to do God”, nor even social justice? All of this appears to be screaming out for Labour to say to its membership, ‘Go back to your constituencies, and prepare once again for a hung parliament.’ Laurence Janta-Lipinski, a pollster from YouGov, has recently revealed his survey which has Labour on 43 percent, the Conservatives on 34 percent and the Lib Dems and Ukip both on 8 per cent – suggested a Labour majority. However, he said that unlike in 1995 and 1996, “Labour are not so far ahead in mid-term to be assured of victory”, and “anyone predicting an election at this time is on to a loser. This far out before an election, I wouldn’t feel comfortable predicting a Labour or Conservative government or a hung parliament because all three of them are still possible. There is a good chance of a hung parliament at the next election. Realistically, it is the best the Liberal Democrats can hope for. Vince Cable is probably right to prepare for a hung parliament.”
There is a real sense now of Labour making its own destiny, where bad luck meets lack of preparation. Having laid the groundwork for the privatisation of the NHS, it might be time for Labour to cut its losses, and to concentrate on its ‘core vote’, or even its ‘founding values’. And it can look this time for Margaret Thatcher ironically for inspiration.
It's time we spoke about the "friends and family test"
Friends and family test
Mr David Cameron introduced ‘the friends and family test’ (FFT) at the beginning of this year. However, the FFT is based on a model developed to test satisfaction with consumer products. Clare Gerada, Chair of the Council of the Royal College of GPs, rightly questioned whether friends and family are proper judges of the NHS in all its complexity:
“The NHS isn’t Facebook, and healthcare isn’t a commodity like eating in a restaurant. And we must make sure that we don’t confuse issues around the NHS such as shortages, with the care that patients get from the staff that look after them.”
Dr Kailash Chand from the BMA Council likewise posited,
“Who can disagree with that?”.
Prof Peter Lynn, an expert on survey methodology from Essex University, says the findings may be unreliable.
“I have concerns about whether the friends and family test will actually provide data that allows meaningful comparisons of the performance of trusts – partly because of reliance on a single rather vague question and partly because hospitals will vary in how they approach patients and encourage them to answer the question.”
The government insists the test will give everyone a clear idea of where to get the best care, without piling costs on trusts. It says by checking on the NHS choices website, people will be able to see which trusts are in the normal range, those among the best and those among the worst.
Meanwhile, in a different sector, owners of pubs, restaurants, hotels and bars are all too familiar with “TripAdvisor”, which is loved and loathed in equal measures.TripAdvisor, which claims to have 75 million online reviews, allows people to post anonymously and without even proving they have been to the place in question. Getting a high or low rating can make or break a business. Chris Emmins of KwikChex, which investigates online reviews, believes there are as many as ten million fake reviews on the site by ‘trolls’ – someone who posts a deliberately provocative message with the intention of causing maximum disruption – who are either disgruntled former employees or rival businesses.
Emmins said:
“It’s war out there. Getting a top rating is crucial and yet one bad one-star review can hit the ratings so hard that it takes 20 five-star reviews to get the rating back.”
This is a wider example of the phenomenon called “shilling” in marketing. A shill, also called a plant or a stooge, is a person who publicly helps a person or organization without disclosing that he has a close relationship with that person or organisation. “Shill” typically refers to someone who purposely gives onlookers the impression that he is an enthusiastic independent customer of a seller (or marketer of ideas) for whom he is secretly working. The person or group who hires the shill is using crowd psychology, to encourage other onlookers or audience members to purchase the goods or services (or accept the ideas being marketed). Shills are often employed by professional marketing campaigns, and there is a danger that, like the original FFT has been imported, the practice of “shilling” could be imported too. Shilling is illegal in many circumstances and in many jurisdictions, because of the potential for fraud and damage, however, if a shill does not place uninformed parties at a risk of loss, but merely generates “buzz,” the shill’s actions may be legal. For example, a person planted in an audience to laugh and applaud when desired, or to participate in on-stage activities as a “random member of the audience,” is a type of legal shill.
