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Selling integrated care on the back of austerity will be a big political mistake

June 26, 2013 9:27 pm / Leave a Comment

Andy Burnham, Shadow Secretary of State for Health, famously told the New Statesman fringe meeting last year, “It’s the economy stupid, but don’t forget about healthcare”, quoting the celebrated US election aphorism. There are many groups which Labour could choose to harness in the 2015 general election who feel they have been disenfranchised. This might include the NHS workers who saw their automatic pay rise disappear today, and who collectively have been feeling the pressures of a £2bn reorganisation which they did not request for. Also disabled citizens do not have any particular reason to like this government, with many welfare benefits decisions made by ATOS being overturned by appeal.

Austerity itself is a policy which is recognised by public health physicians to have had a detrimental effect on individuals’ psychological wellbeing. While austerity might test the mental resilience of people in current economic times, there has indeed been an academic debate about the impact of austerity on mental health in general, including the incidence of suicide in European countries. The Health and Social Care Act, in addition to being a voluminous and complicated piece of legislation, suffered some fairly textbook reasons in management of ‘barriers to change’. One was the often cited reason that the NHS is ‘inefficient’, howsoever that is measured, given that the NHS is actually one of the most efficient healthcare systems in the world, according to official data. Also, the business case for the change is not particularly compelling. Despite price competitive tendering of contracts in the NHS likely to cause an outsourcing of legal accountability and increased total costs, the section 75 regulations as finally enacted made price competitive tendering the default option. Also section 164(2A) means that NHS entities can earn not 50% or more from private sources of income, which is a huge percentage. Private companies exist in law to maximise shareholder dividend.

To sell then integrated care on the back of a failed austerity plan is therefore ludicrous, and yet that is exactly what George Osborne did today. Osborne talked about the ‘billions’ that would be saved in ‘joined up’ care, but this is not the sole goal of integrated care. Integrated care is not simply about saving money; it should be about offering healthcare that it is most suitable for a person or patient at any particular time. Also, the language of Osborne and Danny Alexander, Chief Secretary to the Treasury, was one that integrated care would only be of benefit to the taxpayer when considering the elderly. Danny Alexander, in discussion with Andrew Neil on the BBC today, talked about the ‘potential burden of the elderly’ to the taxpayer, which is an affront to those elderly citizens who have themselves contributed much to the fabric of the UK, in tax or otherwise.

Labour will be making a mistake too if it attempts to sell integration on the back of austerity. It is unclear sometimes quite whom Labour represents, when the private finance initiative (PFI) was strongly opposed by UNISON in the early 2000s. Despite being a creation of the John Major government, Labour had embraced PFI, and Osborne has sought to improve its implementation. Likewise, the actual rationale for integrated care cannot be sold as a money-saving exercise. The country is already deeply cynical of the billions of ‘efficiency savings’, apparently on the back of cuts int he workforce of thousands, not being ultimately being ploughed back into frontline care. The admiration of Chris Ham of Kaiser Permanente is well known, but there is no reason to disbelieve that Labour has no intention of embracing ‘managed care’. The language of the ‘dementia crisis’ has been racheted up of late, and if this is combined with a general ideological attack on the elderly, the narrative no longer becomes one of how we deliver care for all of the population, but how people can make private provision for their future through private health insurance.

Whenever such a debate is brought up, it immediately gets dismissed as ‘conspiracy theories’, but a genuine debate about how integrated care is being ‘sold’ to an exhausted public needs to be had. If today’s statements by George Osborne are anything to go by, part of the ‘case’ of the Conservatives appears to be very much an economic one. While management theory has never adequately resolved how stakeholders interact in forming strategy, if the debate on integrated party gets subsumed by any particular entity this could be detrimental. Labour may be 10-15% ahead in the polls on the NHS, but even Labour cannot take its support on the NHS for granted. Ironically, as the current Government discusses how to regulate against aggressive lobbying, maybe it’s time that the “vested interests” which Osborne so confidently mentioned today come under some scrutiny of their their own regarding the formation of English health care policy?

Time for the BBC to give up on the pretence of responsible journalism

October 23, 2010 7:55 pm / Leave a Comment

Today, I loved reading the Times on my iPad. Indeed, parts of the British media are world-class, and worthy of our reputation abroad. The Times and Financial Times are probably my most favourite media publications of all.

Unfortunately, in the run-up to the General Election, the BBC were without shadow of a doubt gunning for Gordon Brown – to lose. Many of my friends were appalled about the highly personal comments made towards him in both style and manner, and this includes so-called respectable people in respectable institutions (for example, Nick Clegg’s conduct in the Lower House in Prime Minister’s Questions). For the BBC and people like Adam Boulton, ‘Bigotgate’ was possibly a gift.

Some have said that senior presenters of the BBC, Laura Kuenssberg and Nick Robinson, put the most unbelievable gloss on the Tory Party, that a large number of my 2400 friends on Facebook were talking about not renewing their TV licence as class action protest. Maybe, taken as a whole, the BBC does not suffer from lack of impartiality, and indeed some of the output of the BBC is first-rate (for example, the Today programme). Some items on BBC online news would be more fitting for a tabloid on a bad day.

Right-wingers tend to claim the BBC has enormous left-wing bias, therefore providing evidence that it produces balanced coverage. My parents, who have lived in this country since 1961, used to have enormous respect for the BBC, and indeed the brand of the BBC used to be superb internationally, but now that they have zero respect for it. Whilst there used to be goodwill for ‘Beeb’, the illusion has nearly become shattered to an irreparable state. Now that its standards have declined so much, it is vital that an external entity should look at the functioning of the BBC as a professional media operation. The BBC investigates complaints internally mainly, leaving little recourse for complaints, because OFCOM’s terms-of-reference are so narrow.

The journalists are supposed to obey the Editorial guidelines of the BBC which are widely publicized, but within a single day it is ‘dead easy’ to find examples of problems in accuracy, balance and impartiality. However, one has to wonder whether journalists should declare a ‘conflict of interest’ in the same way that directors of companies in England have to declare a financial interest under the Companies Act (2006)? Does it matter that a highly influential person within the BBC News machine, Nick Robinson, was a prominent Tory at University? His argument will be that his professional manner can be divorced from his political views, in that a doctor with severe depression can be a psychiatrist, but might it be worth the while of the BBC to publish once-and-for-all some statistics on the volume of complaints for a definable and measurable period, such as the 2010 General Election? Throughout the election campaign, the coverage towards David Cameron and Nick Clegg was much more lenient than towards Gordon Brown.

The BBC has for some time been producing inaccurate coverage of news stories, some of which are clearly not in the overall public interest but constitute a ‘witch-hunt’ at best. The BBC regularly contravenes rules of responsible journalism as explained in Reynolds v Times Newspaper case from the House of Lords. The recent debacle has been that Question Time has been accused of demonstrating left-wing bias, when David Dimbleby was virtually shouting down answers given by Hillary Benn. Even when it comes to defamation, it is not a problem as they have a well-funded legal team, paid for by millions of tax-payers. Protecting the identity of ‘Stig’ in the public interest did not come particularly cheap, ‘reliable sources claim’.

Apparently, a Conservative source said:

Now, more than ever, is the time for the BBC to be careful and frame the debate responsibly so that the facts are properly heard. The spending review is a serious topic for all of us, it needs to be treated as such.’

Surely 150 days is a bit early for right-wing political paranoia to start setting in?

Today, we have a main news item concerning Wikileaks suggesting that all we see in the media may not be what is happening in real life.

How transparent is the BBC machinery? Sure, they can publish the salaries of Directors who are earning £500,000 a year, or more, but is this what is really ‘getting the goat’ of ordinary licence payers? Was it correct that the BBC refused to play the DEC humanitarian appeal? The Glasgow Media Group repeatedly has shown the BBC is more right wing in coverage; a genuine public interest point is that, with the BBC attacking pensions of BBC workers and now to make 16% cuts, we can expect even more right wing bias.

Take specifically what happened last Wednesday. An individual has written to me the following:

“My part of my union (Revenue & Customs, PCS) had a small demonstration outside our HQ @ 100 Parliament Street (opposite the HOP). I was offered a spot on the Radio 5 Question Time being held on the Green after the cuts were made. There was some confusion and I was advised that the BBC didn’t want any trade union representatives on air!!! However, a few of us hung around whilst the political heavyweights were being interviewed. No one from any UK news outlet paid us (or any other protesters) any notice at all.

However, my colleague was filmed by Al Jazeera – who seemed more interested in what the protesters were saying than the politicians. She also did a longish interview for a Danish TV station and an interview for the Portuguese press. I was intervied by Helsinki Sanomat in some depth. The European press were interested in the lack of action by the TUC. I was asked if I would rather be French. The day before we were followed by Japanese TV for a documentary there and today we were interviewed in London by the French TV.”

On the wars in Iraq and Afghanistan, it is mooted that BBC still broadcasts much more pro-war views, even when 76% think troops should be returned. The most sinister development in their editorial policy is that they appear parrot ‘we have got to cut the deficit’ views without even providing the evidence from the Nobel Laureate, Paul Krugman, and David Blanchflower CBE, that the cuts will be a disaster. The BBC then creates editorial imbalance by not presenting half of the argument, thus making the entire argument grossly inaccurate. It is then easy for the BBC’s Director General Mark Thompson to satisfy the Conservative PR machine to present the coalition’s cuts in a favourable light, and for George Osborne to claim that Labour has no alternative.

The spin that has been propagated on this is truly mortifying. No mention is made by the BBC that the Conservatives supported the Labour borrowing plan between 2001-2007, the UK had the lowest debt of G20 countries on entering the recession, the recession was truly worldwide (as they might be forced to admit when we go into a double-dip), and that the reason Labour does not wish to specific which would it cut first is (a) because Labour with the Fawcett Society think the budget contravenes the Equality Act (b) Labour does not agree with the macroeconomic policy in the first place. Labour has made it perfectly clear in the public record for a long time that it does not support the rate or depth of cuts. It is especially nauseating that the Coalition does not command any authority on narrowing the ‘tax gap’.

The BBC could do a lot for public confidence in its reputation by reporting on tax avoidance by millionaires, or reporting on the alternative funding of the public sector services, rather than what it seems to spend most of its time in: gutter, trashy witch-hunts to grab headlines, so-called “breaking news”.

The real reason that people appear to hate the cuts is actually – shock horror – because real people (not millionaires) hate the cuts. The Coalition will be hard pushed to find a city sympathetic to their cause – maybe Middlesborough was a bad choice, but I look forward to Question Time from the BBC, in my home city of Glasgow next Thursday.

It’s all getting a bit serious isn’t it?

Here’s a video of Adam Boulton ‘losing it’ with Alastair Campbell

and Nick Robinson potentially contravening the Criminal Damage Act (1971)

Your journalism is safe in their hands? I’m saying nothing..

Dr Shibley Rahman is a research physician and research lawyer by training.

Queen’s Scholar, BA (1st.), MA, MB, BChir, PhD, MRCP(UK), LLB(Hons.), FRSA
Director of Law and Medicine Limited
Member of the Fabian Society and Associate of the Institute of Directors

Letter from Alan Johnson before the CSR

October 20, 2010 11:17 am / Leave a Comment

As I post this message from Alan Johnson MP, I am watching a really dreadful performance by David Cameron on the BBC in Prime Minister Questions.

Shibley,??

I wanted to say something to you today, before I deliver our response to the Coalition’s Comprehensive Spending Review. George Osborne will insist that there is no alternative to his huge and unnecessary cuts – that is simply not true. There is a better way and that’s where you can help.??

This is about saying, “No. There is an alternative”. ??I’m going to be honest with you, being in opposition does not mean that we can oppose every cut, or pretend to be in government. But it does mean setting out a clear alternative to what we regard as a reckless gamble with growth and jobs – a balanced approach that gets the deficit down without endangering the recovery.??You’re the expert on your local area, or how your family will be affected, so click here to tell us your better way ??Today’s reckless gamble with growth and jobs runs the risk of stifling the fragile recovery. Our alternative will be fair and will recognise these are central to our economic strategy – not a side issue. It will treat the public as intelligent enough to understand that bringing the world economy back from the brink of catastrophe is not the same as paying off a credit card bill.??

We all know that we must tackle the deficit, but we must protect growth, public services, and all of us caught in the middle enduring the most unfair of these cuts, too.??

Alan??

I'm not a stalker, and why I'll attack BBC defamation

October 20, 2010 9:42 am / Leave a Comment

Let me get something straight. There are aspects of the BBC which are wonderful.

However, I have had a very unpleasant experience with the BBC. The BBC ran a series of headlines about me in 2006, as an individual junior doctor very early on in his career with a severe alcohol problem. I needed support not derision. The BBC argue that they are right to report that I was accused of stalking in the GMC hearing, which led to my erasure. I have never had a conviction, warning, caution or reprimand for “stalking”, and I will continue to express my disgust at the BBC for continuing to report this. I do not see any point in having it persist on their website so many years on, with no subsequent follow-up on my progress since, and my perception unfortunately is that it feels like a very personal unpleasant campaign against me. They are damaging my professional reputation in a reasonable observer (the meaning of defamation in the law), through a daily Google search, meaning that rehabilitation for genuine alcoholics in recovery for me is unfortunately impossible, and their corporate arrogance never fails to amaze for me. I am extremely happy that their budget is being slashed in the Comprehensive Spending Review, as their journalism is ridden with editorial inaccuracies, imbalance and lack of partiality. Glyndebourne is not paid for purely from the tax payer.

And as for the Murdoch press. I happen to think that the Times is a brilliant newspaper. I was reading it at the weekend, and competition law should not stifle success. Murdoch operates across different genres, different micromarkets in business, so I find the pluralism argument exaggerated. And, as it happens, I think the Daily Mail is wonderful, despite me being a lifelong Labour supporter!

[Update: Please read this article in the light of my biography. My father passed away in November 2010. I love him very much, but still live with my Mother. I nearly died in June 2007 during a 6 week coma, but as of this day I have been in recovery from alcohol. At the beginning of 2012, this was coming up to 5 years. Since 2007, despite my many skills, I have not been in a regular salaried job.

Dr Shibley Rahman is a research expert in dementia and research lawyer by training.

Queen’s Scholar, BA (1st.), MA, MB, BChir, PhD, MRCP(UK), LLB(Hons.), LLM, MBA FRSA (updated since time of the article)
Member of the Fabian Society

The comprehensive spending review, it's simples…

October 18, 2010 6:39 pm / Leave a Comment

Last week, I asked a London cabbie why he voted Tory. All of them are not voting for Ken Livingstone, but it’s an entirely different matter altogether why some of them don’t trust Labour with the economy.

At the heart of many of such people’s criticisms is the idea is that the state is overinflated, spending on it ballooned out of proportion especially in management, and that we did not invest when we could have afforded it. This ‘we didn’t mend the roof while the sun was shining’ may seem at face value entirely sensible, but I would argue that we should not set fire to the whole house as the roof is not right.

The real issue is that we need to get the deficit down without endangering the recovery, and central to that is not adopting a strategy which the Institute of Fiscal Studies and Confederation of Small Businesses have described as unfair. Norman Lamount said famously that unemployment is a price well-worth-paying, and the Labour current policy recognises that growth and jobs are central to our economic strategy – not a side issue.

It is often said that the general public should not be underestimated, but I wonder how many people genuinely stop to think about this in actuality. All parties need to treat the public as intelligent enough to understand that bringing the world economy back from the brink of catastrophe is not the same as paying off a credit card bill. ?For example, there are only very few companies who have a AAA* rating which are about to go ‘bankrupt’. George Osborne by claiming that Britain is about to go bankrupt is making a legal representation potentially – whether this misrepresentation is fraudulent, negligent or innocent, I’ll leave entirely up to you.

There has to be cuts but without growth, attempts to cut the deficit will be self defeating. ?A rising dole queue means a bigger welfare bill, and less tax revenue coming in. ?Perplexingly whilst the Government introduces a ‘bonfire of the QUANGOs’, the Government’s newest quango – the Office for Budget Responsibility – says that the coalition’s approach will cost jobs, and that those job losses will cost the taxpayer £700m in Jobseekers Allowance claims alone. ?The reputable management consultancy firm ?Price Waterhouse Coopers are forecasting that a million jobs will go as austerity takes its toll – half of them in the private sector.

The Conservative Party did not win the election, despite Labour losing it. They have no mandate for this policy, and the Liberal Democrats, for supporting this, through Nick Clegg will in 2015 or earlier be consigned to history.