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The real influencers of English dementia policy aside from #G8dementia



top 100

In a rather strange Stakhanovite way, certain health magazines are strangely obsessed with the fetish of the ‘top 100′. I am as such not a great advocate of, “Everybody has won, and all must have prizes.” immortalised by Chapter 3 of Lewis Carroll’s Alice’s Adventures in Wonderland, but as someone who has devoted all of his entire life to dementia academia I do find somewhat curious (to put it politely) the judgments of those outside the dementia field about who are most influential to other people outside the academic dementia field, in their “world of dementia”. However, corporates need ‘symbols’ of their ‘success’ to attract inward attention and investment, so I’ll simply leave them to their own pathetic whims.

The issue of who “influences” a given network is currently of huge interest in modern ‘actor network theory’ (ANT). ANT was first developed at the Centre de Sociologie de l’Innovation of the École nationale supérieure des mines de Paris in the early 1980s by staff and visitors. Network thinking has contributed a number of important insights about social power. Perhaps most importantly, the network approach emphasises that power is inherently relational. An individual does not have power in the abstract, they have power because they can dominate others.

Network analysts often describe the way that an “actor” is embedded in a relational network as imposing constraints on the actor, and offering the actor opportunities. Actors that face fewer constraints, and have more opportunities than others are in “favourable structural positions”. Having a favoured position means that an actor may extract better bargains in exchanges, have greater influence, and that the actor will be a focus for deference and attention from those in less favoured positions. However, a key deference is that the people mentioned below do not consider themselves as requiring deference or attention. Their devotion to the living with the dementias is crystal clear. There can of course be “inhibitors”. We all know who they are: they actively stifle the activities of some members of the community.

There are many laboratories around the world which publish widely in the world on cognitive and behavioural neurology: how people think, and the brain processes involved. Of the off top of my head, I can think of Prof Bruce Miller at the University of California and San Francisco, Prof Martin Rossor at the National Hospital for Neurology and Neurosurgery and University of London (UK), Prof Facundo Manes at Favorolo Hospital, Argentina, Prof David Neary at the University of Manchester (UK), and Prof John Hodges of NeuRA, Australia.

There are of course people in fields to do with living well, for example defining wellbeing, measuring wellbeing, assistive technology, ambient assisted living, design of the home, design of the ward, and design of the built environment. Research in all these areas in English dementia policy is currently extremely important. I would go so far as to say that the people successfully working in, and publishing on, these areas around the world are much more important than the health ministers and corporate representatives who spoke at the ‘G8 dementia’ conference last week.

One person who does deserve a special mention though, even though all must have possibly have prizes, is Beth Britton. Beth’s interview captured attention at last week’s #G8dementia, and rightly so. Beth’s father had vascular dementia for 19 years. It began when Beth was around 12 years old, and would go on to dominate Beth’s life in her teens and twenties. Her father, whom she clearly adores, went for ten years without a diagnosis and he then spent none years in three different care homes. He passed away in April 2012, aged 85.

Norman McNamara from Devon was diagnosed with dementia a few years ago when he was just 50. After his diagnosis, Norman, from Torquay, began blogging online about his experiences and during a phone call with a friend he had the idea of organising the first Dementia Awareness Day on 17 September 2011. Norman particularly is really helpful in offering insights about what it’s like to ‘live with dementia’. In his recent blogpost, for example, he talks about how he doesn’t wish to be seen as being on some ‘journey’. He talks poignantly about how he is ‘living with’ dementia, not ‘dying from’ dementia, stating correctly that we are all in fact dying if one took this approach.

Kim Pennock, from Thornton-le-Dale, gave up her part-time job at Beck Isle Museum to help care for her mother who has the dementia of the Alzheimer type. Kim has become one of only 50 worldwide ambassadors for a pioneering new project to make communities safer for people with dementia. When her mother was first diagnosed, Kim said the family found it almost impossible to find the information and help they needed. Conversely, Lee set up the incredible ‘Dementia Challengers’ website to help people with dementia and the carers the right info they need to help them to live well.

In Australia, Kate Swaffer is committed to meaningful dialogue with a wide range of stakeholders about the critical issues impacting a person living with a diagnosis of dementia and their loved ones. When a person with dementia ‘comes out’ about their diagnosis, and openly admits they are living with the symptoms of, and diagnosis of dementia, there are a number of reactions and responses. Kate is one of the world’s most powerful advocates for dementia and the elderly, living well with a diagnosis of dementia; and she describes herself on Twitter (@KateSwaffer) as an “author, poet, blogger, and always trying to be a nice person”.

Back in the UK, Fiona Phillips speaks directly from her first hand experience as her mother had Alzheimer’s until her death in May 2006 and her father, who was diagnosed with the disease shortly afterwards, died in February 2012. In January 2009, Fiona presented Mum, Dad, Alzheimer’s and Me, an incredibly moving “Dispatches” documentary on Channel 4, featuring Fiona talking candidly about her struggles caring for both her parents during their respective illnesses and investigating the difficulties faced by people with the dementia of the Alzheimer type, and their families to get adequate care and support. Fiona has written a book “Before I Forget”, about her relationship with her parents and their dementia.

There are certain people who do understand particular areas of dementia policy and education. Lucy Jane Marsters is one such example, being a specialist nurse. Gill Phillips has also been pivotal in raising awarneness, generally, of the significant to personal-centred approaches in questioning quite deeply entrenched assumptions. There are also some brilliant people in innovations, such as Mike Clark, Prof Andrew Sixsmith and Prof Roger Orpwood in telemedicine and telehealth. Activities and healthy living communities are also extremely important; despite challenges in funding, like many in the dementia world, Simona Florio has been utterly resolute in supporting members of the excellent Healthy Living Club in Stockwell.

For years, magnificent Scot Tommy Whitelaw travelled the world running global merchandising operations for the Spice Girls, Kylie and U2. However, over the past few years he had become a fulltime carer my late mum, Joan, who had vascular dementia. His motivation as a carer came from the love he had for his own mum, and his experience has shown me just how tough it is to live with dementia and how many struggles it can bring. For the last year, he has been collecting carer’s life stories to raise awareness. Tommy is now working on The Dementia Carers Voices project with the Health and Social Care Alliance which will build on my ‘Tommy on Tour’ campaign by engaging with carers, collecting their life stories and raise awareness amongst health and social care professionals on both dementia and caring.

Caring for someone with dementia clearly infuses some with an incredible passion for the subject which you simply is hard to match. Sally Marciano has talked openly about supporting her mum supporting her father who later died of a dementia. She has talked openly about how the system didn’t work properly, but is very constructive about raising awareness and educational skills in the healthcare sector.

In March 2013, filmmakers and scientists come together at an event to increase the public understanding of dementia. A series of short films about dementia was presented by James Murray-White, will precede a discussion with researchers from the University of Bristol and other institutions supported by “Alzheimers BRACE”, a local charity that funds research into Alzheimer’s disease and other forms of dementia. James’ activities include being a freelance writer, journalist, reviewer, and filmmaker. James was in fact featured in last week’s #G8dementia media coverage.

Sarah Reed’s mother had Alzheimer’s disease for ten years. As a result of this, she became passionate about the quality of life of older people, especially those with dementia.?? She left a design career to found “Many Happy Returns” in order to innovate, research and develop evidence-based products to connect young and old, especially those with dementia, more meaningfully. Her goal has to change the experience of dementia for those who have it for the better, by persuading care organisations and carers everywhere that good care counts for nothing without good communication – and then helping them to deliver it.

And of course there are some brilliant influencers in the world of medicine who don’t simply regurgitate the copy fed to them. Dr Peter Gordon has produced a number of original films and articles about the ethics of the diagnosis, particularly the need for a ‘timely’ rather ‘early’ diagnosis, and potential conflicts of interest between the medical profession and the pharmaceutical industry. Dr Martin Brunet has likewise become massively influential in articulating the debate, especially, from the medical profession’s perspective of a policy ‘target’ to increase diagnosis rates. While Martin’s work is not easy, his perspective and substantial experience as a GP is invaluable, particularly in redressing other people’s motives which can too easily be too motivated by surplus and profit.

And, of course, a top influencer, even though ‘all shall have prizes’, is Prof Alistair Burns. Alistair is the clinical lead for dementia in England, and has a highly influential position in NHS England. Alistair clearly has a number of different stakeholders with which he needs to have a fair legitimate discussion about English policy. He has nonetheless steered the policy through rather turbulent times. As a senior academic and person within higher education, and someone who clearly has a very ‘human perspective’ too, his contribution to English dementia policy has been much valued and much appreciated.

Actually, I’m being totally ingenious. Most of us are actually one big happy family in the network I’m in. We have our disagreements, but we value each other. We don’t inhibit one another (which is what can go wrong with networks). For a list of #dementiachallengers, please go to the list in the top right corner of this blog. You’ll see for example Charmaine Hardy, who cares for, and adores, her husband who has a very rare form of dementia called primary progressive aphasia. Though having a well deserved break for once in Norway, for once, you can catch her on Twitter!

A digital strategy for the ‘Dementia Challenge’ and the ‘Dementia Challengers’ website



There is a debate – yet to reach proper fruition – on the extent to which individuals can ‘maintain and manage their own health’, and that healthy living is not always an individualised, purely rational process of information-seeking and correct choices that result in improved health and independence (Henwood, Harris and Spoel, 2011).

Living well with dementia nonetheless appears to involve supporting individuals in making decisions appropriate for them, and these are decisions which directly affect their care and support. However, as a result of the dementia itself, a person’s mental capacity can change, and the nature of this decision-making process will change, with carers involved in reviewing the needs and preferences of individuals with dementia as their circumstances change. Whilst the focus of this book is not legal, and certainly an intention of this book is not to give any medical or legal advice, this chapter introduces the very important issue of independent advocacy services, as access-to-justice is an important feature of all civilised societies.

A key to making informed decisions is having full, accurate information.

However, the information can be incredibly overwhelming. Lee  (@dragonmisery) decided to organise this information for carers in an organised way. Her impressive website, “Dementia challengers: Signposting carers to online resources” (http://www.dementiachallengers.com), is a great place for information about dementia, and this website contains information specifically for carers.  Clearly, accurate and complete information such as on this website is essential for individuals with dementia and their immediates to be able to exercise control and choice properly in negotiating access to resources.

Dementia Challengers

A previous policy document, “Putting People First: A shared vision and commitment to the transformation of Adult Social Care”, amongst others, had made a close link between person-centred care and ‘choice and control’.

Ensuring older people, people with chronic conditions, disabled people and people with mental health problems have the best possible quality of life and the equality of independent living is fundamental to a socially just society. For many, social care is the support which helps to make this a reality and may either be the only non-family intervention or one element of a wider support package. The time has now come to build on best practice and replace paternalistic, reactive care of variable quality with a mainstream system focussed on prevention, early intervention, enablement, and high quality personally tailored services. In the future, we want people to have maximum choice, control and power over the support services they receive.

Lee is specifically mentioned by Anna Hepburn (@AnnaHepburnDH), Digital Communications Manager for Social Care, in an article entitled ‘Digital engagement on dementia’ on the Department of Health website.

As one of the #dementiachallengers, Lee (@dragonmisery) has set up the Dementia Challengers site to signpost online resources for people caring for someone with dementia. Nothing demonstrates better how the Dementia Challenge is more than a government initiative – and how it has its own digital life – than people who care about dementia creating their own digital community and helping others.

Anna Hepburn in her online article from 16th April 2013 then explains how this is consistent with the wider ‘digital strategy’ from the Department of Health (and other Government departments):

Digital isn’t just about publishing anymore. The Department of Health (DH) digital team certainly knows that, but there are plenty of people within the department – and across government – still to be convinced of the wider benefits of digital, or uneasy about new ways of working.

Tapping into this community provides a great opportunity for policy colleagues to engage with people with day-to-day experience of living, caring or working with dementia. I’ve learnt a great deal from them myself and now I want to find ways of extending those benefits to the dementia policy team. So this is the next step, to fulfil some of the central aims of the DH digital strategy – embedding digital processes in the way we work, giving policy colleagues the tools and confidence to engage digitally, and helping them identify the most appropriate digital tools and techniques for each stage of the policy cycle. And I’ll continue to try out new digital ways of opening up our work, such as the live blog from the Dementia Village, which helped extend the reach of the event.

Stephen Hale (@hmshale) is the ‘Head of Digital’ for UK Department of Health. The emphasis on open policymaking by the Department of Health is a welcome aspect of its digital strategy (Strategy). It is through this Strategy that the Department of Health have committed to using digital tools and techniques to improve upon an open policymaking process. The five stages are:

Stage 1: Shaping the policy product

Stage 2: Engaging stakeholders

Stage 3: Building robust analysis and evaluation

Stage 4: Finding practical solutions and enabling delivery

In the business sector, Gomes-Casseres (1996), in a very famous work called, “The Alliance Revolution: the new shape of business rivalry” has advanced the thesis of constructing networks actively to seek out and incorporate external knowledge into the innovative processes of businesses. Social networks play an important role in the sourcing and sharing of information, ideas, and knowledge, particularly where they span functional, divisional, and organisational boundaries. However, social networks are dynamic, personal, and unrecorded, and, as a result, they are difficult to manage and direct. Organisational networks also play an important role in the innovation process; they are flexible, enabling network members to reposition themselves more speedily in response to changes in technology and market. They also bring together distributed resources, knowledge, and competences.

The open innovation paradigm for firms, pioneered by Henry Chesbrough (2003), can be interpreted going beyond just using external sources of innovation such as customers, rival companies, and academic institutions, and can be as much a change in the use, management, and employment of intellectual property as it is in the technical and research driven generation of intellectual property. There are clear lessons to be learnt in the development of policy about dementia in a way that includes opinions of all stakeholders, not just the usual ones.

Useful readings

Chesbrough, H.W. (2003) Open Innovation: The new imperative for creating and profiting from technology, Boston: Harvard Business School Press.

Department of Health (2012) Department of Health Digital Strategy [20th December], available at: http://hale.dh.gov.uk/2012/12/20/the-dh-digital-strategy/.

Gomes-Casseres, B. (1996) The Alliance Revolution, The New Shape of Business Rivalry, Cambridge, MA: Harvard University Press.

Henwood, F, Harris, R, and Spoel, P. (2011) Informing health? Negotiating the logics of choice and care in everyday practices of healthy living, Social Health & Medicine, 72, 2026-2032.

Hepburn, A. (2013) Digital engagement on dementia. [16th April], available at: http://digitalhealth.dh.gov.uk/digital-engagement-on-dementia/

UK Government/LGA/ADASS/NHS (2007) Putting People First: A shared vision and commitment to the transformation of Adult Social Care, London: Her Majesty’s Stationery Office, available at: http://www.cpa.org.uk/cpa/putting_people_first.pdf.

Ed Miliband needs Labour to have a "differentiation strategy" of its own



Peter Hoskin in January 2012 famously in the Spectator published his version of the Richard Reeves’ famous “different strategy” of the Liberal Democrats as this parliament progressed.

 

 

When I tweeted briefly yesterday evening that David Cameron had acquired Obama’s advisor, Jim Messina, my followers who are UK Labour supporters were distinctly underwhelmed.  They certainly did not share the naked excitement of Allegra Stratton, the BBC Newsnight’s political editor who was behaving as if she’d won the National Lottery. My followers instead loyally to took this to mean that more people were needed to clean up after the shambolic implementation of policies, such as #RacistVan. Many stuck to the reasonable line that the number of electoral advisers is not strongly correlated with coherence of political ideology, nor indeed electoral success. That of course will be good for Ed Miliband, who currently has no official electoral “campaign head”, although he has a strong policy steer from Lord Stewart Wood. The media are obsessed about the scalp of Lynton Crosby, and some extent they have already obtained the scalp of Tom Watson MP. However, Owen Jones on the BBC ‘Any Questions’ debate last night was quite correct to identify that, even if he personally does not agree with it, the main thrust of the Conservative Policy is in fact very clear: e.g. chucking out of the country illegal immigrants, or being tough on those people who don’t believe ‘it pays to work’. The implementation of both of the policies of course has been cack-handed, in that the Home Office continue to use the #immigrationoffenders hashtag completely ignoring the issue that suspects only become convicts if tried with due process in a legal court of war. In fact, the use of the hashtag not only offends the legal presumption of innocence, but it also potentially runs into problems with ‘contempt of court’. Nobody likewise fundamentally disagrees with the ‘it pays to work’ idea, but resent of course the scapegoating of unemployed citizens, deplore the attitude of ‘zero hours contracts’ as alleged for multi-national companies, with an abject failure to understand the ‘work credits’ policy. However, the Conservatives are ably assisted by a BBC which maintains that it maintains editorial standards upholding ‘accuracy, balance and lack of bias’, even in the face of high profile failures such as the John Humphrys decision.  The Government can get away with a huge amount of misrepresentation, particularly ironic in their ambition for transparency and openness, as the debacles concerning the NHS funding and Iain Duncan Smith’s department demonstrate.

 

What Owen Jones has identified is that the Government appears to have a ‘vision’. Margaret Thatcher had a ‘vision’ too, which many people still profoundly disagree with.  ‘Being Ed Miliband’ is pretty predictable though. For Ed, some things go well, some things go not so well. For example, his 2010 conference speech on ‘responsible capitalism’ in Liverpool was widely panned to be to a bit of a ‘turkey’, but many argued that he called it right in fact on the illegal phone hacking allegations of corporates. To give him credit, the wider ideological battle has been progressing well with him, in that policies such as workfare, where corporates abuse their power, curries favour with the public. The public also have taken to the outsourcing scandals like ducks to water, fully resentful against G4s, A4e, and Harmoni for their widely reported problems. The slight poll-lead of Labour one could argue could be greater, but it is easy to overestimate the amount of disunity in the Conservative Party. The Conservatives have had a good few months, having parked the issue about the EU referendum for now, and most importantly with the UK economy having appeared to have turned a corner at 0.6% growth. Ed Balls always had a substantial problem with the fact that he had signed up to the austerity agenda, which appears to be delivering (despite the fact that the UK economy is much more crippled than it otherwise should have been, had it followed the lead of Barack Obama). The Labour Party appears to have been voiceless over the attack on employees’ rights (in unfair dismissal claims). On the Bedroom Tax, it gives a muddled message where it appears to object to it, but does not quite commit convincingly to repealing it if it were to come into office and power on its own in May 2015. As for disability issues, many disabled citizens are left utterly confused on what Labour’s precise stance about ‘universal credit’, and how it does not seem to have any opinions on the steady stream of citizens who have committed suicide on the distress of their benefits decisions.

 

 

There are two things to form a strategy for. One is Ed Miliband, and one is Labour, though their relative fortunes are necessarily linked. You can have a reasonable ‘go’ at branding Ed Miliband as the ‘decisive leader’ on the left, despite the usual predictable reports that he can’t make up his mind what type of wine to drink (he has to drink rosé as he can’t make up his mind between red and white). This is all rather reminiscent of how Gordon Brown was also alleged not to be able to make up his mind over what type of coffee biscuit to eat, though ultimately the ‘dithering’ mistake which ultimately cost Brown his career was not this coffee biscuit problem but a problem concerning when to hold the 2010 general election. For me, the fundamental problem is that Labour does not have a clear “differentiation policy” of its own. One massive lack of differentiation remains the economy, where Ed Balls somehow has to concede ‘success’ for the Conservatives while saying that he would like to do something differently. However, Balls does not seem to wish to do anything markedly differently, as he has signed up to the same ‘austerity cuts’, not particularly winning him friends in the Unions with low pay conditions. Labour can of course remedy this by saying that it will fundamentally redesign the economy anyway such living standards are a top priority, such as with implementing a national living wage (either through law or not). However, Labour’s determination not to ‘tax and spend’, and not particularly to wish to do anything aggressive on the rich-power divide which has been bad in all governments since Thatcher to varying degrees, might fundamentally undermine this potential argument for ‘fairness’ many desire. Also, on the NHS, Ed Miliband is not actually signed up to anything fundamentally different for the NHS. Andy Burnham MP is the man who ‘is driving the Conservatives round the bend’, according to Isabel Hardman from the Spectator, because all attempts to smear him have gone belly up. However, Burnham also knows that he is not fundamentally signed up to anything vastly different when it comes to efficiency savings or PFI. The Government could of course potentially get the big four accountancy firms to advise on how it could creatively avoid tax to salvage £20bn in efficiency savings before 2020, or could decide to stop allegedly illegal wars abroad, to make up this ‘funding gap’ in the NHS. However, apart from repealing the Act which builds on the direction of the NHS competition boards set up under Labour and reducing the private income cap of s.164(1)(2A) of the Health and Social Care Act, Labour does not have a drastically different offering on the NHS apart from repeating the tired mantra that “Labour is the party of the NHS”.

 

Actually, as a Labour voter, I don’t actually really care whether the Liberal Democrats self-destruct or not. I am vaguely interested in whether they might wish to go into a Coalition with the Labour Party 2015, but I suspect this would not be a popular move amongst many members of the Labour Party I know. Anyway, I don’t think it’s going to happen with Nick Clegg and Danny Alexander in the higher echelons of the Liberal Democrat Party. Vince Cable for them can be easily ringfenced as a one-man protest party, so I do not expect him to have much influence and power in that party, unless his guru Lord Oakeshott can go into turbodrive with a campaign should Nick Clegg decide to fall on his sword. On the other hand, people do tend to have very short memories in politics, so ordinary voters might have somewhat forgotten about the closure of libraries, the NHS reforms, the education support allowance, welfare reforms, the economy, all decent policies where the Liberal Democrats have well and truly shafted members of Labour (and the more left-thinking members of their own party.) On the other hand, another factor governs the fate of Labour apart from the performance of Ed Miliband. That factor, whether the Liberal Democrats can rise like a phoenix from the ashes, could yet produce a problem for Labour, but while this Liberal Democrats seem totally signed up to crackpot policies such as #racistvan and lack of plain packaging cigarettes, there is no sign that the Liberal Democrats wish to leave their suicide pact yet. They know full well that if they do, David Cameron will be ecstatic, and their party meanwhile is fucked.

 

 

 

Ed Miliband needs Labour to have a "differentiation strategy" of its own



Peter Hoskin in January 2012 famously in the Spectator published his version of the Richard Reeves’ famous “different strategy” of the Liberal Democrats as this parliament progressed.

When I tweeted briefly yesterday evening that David Cameron had acquired Obama’s advisor, Jim Messina, my followers who are UK Labour supporters were distinctly underwhelmed.  They certainly did not share the naked excitement of Allegra Stratton, the BBC Newsnight’s political editor who was behaving as if she’d won the National Lottery. My followers instead loyally to took this to mean that more people were needed to clean up after the shambolic implementation of policies, such as #RacistVan. Many stuck to the reasonable line that the number of electoral advisers is not strongly correlated with coherence of political ideology, nor indeed electoral success. That of course will be good for Ed Miliband, who currently has no official electoral “campaign head”, although he has a strong policy steer from Lord Stewart Wood. The media are obsessed about the scalp of Lynton Crosby, and some extent they have already obtained the scalp of Tom Watson MP. However, Owen Jones on the BBC ‘Any Questions’ debate last night was quite correct to identify that, even if he personally does not agree with it, the main thrust of the Conservative Policy is in fact very clear: e.g. chucking out of the country illegal immigrants, or being tough on those people who don’t believe ‘it pays to work’. The implementation of both of the policies of course has been cack-handed, in that the Home Office continue to use the #immigrationoffenders hashtag completely ignoring the issue that suspects only become convicts if tried with due process in a legal court of war. In fact, the use of the hashtag not only offends the legal presumption of innocence, but it also potentially runs into problems with ‘contempt of court’. Nobody likewise fundamentally disagrees with the ‘it pays to work’ idea, but resent of course the scapegoating of unemployed citizens, deplore the attitude of ‘zero hours contracts’ as alleged for multi-national companies, with an abject failure to understand the ‘work credits’ policy. However, the Conservatives are ably assisted by a BBC which maintains that it maintains editorial standards upholding ‘accuracy, balance and lack of bias’, even in the face of high profile failures such as the John Humphrys decision.  The Government can get away with a huge amount of misrepresentation, particularly ironic in their ambition for transparency and openness, as the debacles concerning the NHS funding and Iain Duncan Smith’s department demonstrate.

 

What Owen Jones has identified is that the Government appears to have a ‘vision’. Margaret Thatcher had a ‘vision’ too, which many people still profoundly disagree with.  ‘Being Ed Miliband’ is pretty predictable though. For Ed, some things go well, some things go not so well. For example, his 2010 conference speech on ‘responsible capitalism’ in Liverpool was widely panned to be to a bit of a ‘turkey’, but many argued that he called it right in fact on the illegal phone hacking allegations of corporates. To give him credit, the wider ideological battle has been progressing well with him, in that policies such as workfare, where corporates abuse their power, curries favour with the public. The public also have taken to the outsourcing scandals like ducks to water, fully resentful against G4s, A4e, and Harmoni for their widely reported problems. The slight poll-lead of Labour one could argue could be greater, but it is easy to overestimate the amount of disunity in the Conservative Party. The Conservatives have had a good few months, having parked the issue about the EU referendum for now, and most importantly with the UK economy having appeared to have turned a corner at 0.6% growth. Ed Balls always had a substantial problem with the fact that he had signed up to the austerity agenda, which appears to be delivering (despite the fact that the UK economy is much more crippled than it otherwise should have been, had it followed the lead of Barack Obama). The Labour Party appears to have been voiceless over the attack on employees’ rights (in unfair dismissal claims). On the Bedroom Tax, it gives a muddled message where it appears to object to it, but does not quite commit convincingly to repealing it if it were to come into office and power on its own in May 2015. As for disability issues, many disabled citizens are left utterly confused on what Labour’s precise stance about ‘universal credit’, and how it does not seem to have any opinions on the steady stream of citizens who have committed suicide on the distress of their benefits decisions.

 

 

There are two things to form a strategy for. One is Ed Miliband, and one is Labour, though their relative fortunes are necessarily linked. You can have a reasonable ‘go’ at branding Ed Miliband as the ‘decisive leader’ on the left, despite the usual predictable reports that he can’t make up his mind what type of wine to drink (he has to drink rosé as he can’t make up his mind between red and white). This is all rather reminiscent of how Gordon Brown was also alleged not to be able to make up his mind over what type of coffee biscuit to eat, though ultimately the ‘dithering’ mistake which ultimately cost Brown his career was not this coffee biscuit problem but a problem concerning when to hold the 2010 general election. For me, the fundamental problem is that Labour does not have a clear “differentiation policy” of its own. One massive lack of differentiation remains the economy, where Ed Balls somehow has to concede ‘success’ for the Conservatives while saying that he would like to do something differently. However, Balls does not seem to wish to do anything markedly differently, as he has signed up to the same ‘austerity cuts’, not particularly winning him friends in the Unions with low pay conditions. Labour can of course remedy this by saying that it will fundamentally redesign the economy anyway such living standards are a top priority, such as with implementing a national living wage (either through law or not). However, Labour’s determination not to ‘tax and spend’, and not particularly to wish to do anything aggressive on the rich-power divide which has been bad in all governments since Thatcher to varying degrees, might fundamentally undermine this potential argument for ‘fairness’ many desire. Also, on the NHS, Ed Miliband is not actually signed up to anything fundamentally different for the NHS. Andy Burnham MP is the man who ‘is driving the Conservatives round the bend’, according to Isabel Hardman from the Spectator, because all attempts to smear him have gone belly up. However, Burnham also knows that he is not fundamentally signed up to anything vastly different when it comes to efficiency savings or PFI. The Government could of course potentially get the big four accountancy firms to advise on how it could creatively avoid tax to salvage £20bn in efficiency savings before 2020, or could decide to stop allegedly illegal wars abroad, to make up this ‘funding gap’ in the NHS. However, apart from repealing the Act which builds on the direction of the NHS competition boards set up under Labour and reducing the private income cap of s.164(1)(2A) of the Health and Social Care Act, Labour does not have a drastically different offering on the NHS apart from repeating the tired mantra that “Labour is the party of the NHS”.

 

Actually, as a Labour voter, I don’t actually really care whether the Liberal Democrats self-destruct or not. I am vaguely interested in whether they might wish to go into a Coalition with the Labour Party 2015, but I suspect this would not be a popular move amongst many members of the Labour Party I know. Anyway, I don’t think it’s going to happen with Nick Clegg and Danny Alexander in the higher echelons of the Liberal Democrat Party. Vince Cable for them can be easily ringfenced as a one-man protest party, so I do not expect him to have much influence and power in that party, unless his guru Lord Oakeshott can go into turbodrive with a campaign should Nick Clegg decide to fall on his sword. On the other hand, people do tend to have very short memories in politics, so ordinary voters might have somewhat forgotten about the closure of libraries, the NHS reforms, the education support allowance, welfare reforms, the economy, all decent policies where the Liberal Democrats have well and truly shafted members of Labour (and the more left-thinking members of their own party.) On the other hand, another factor governs the fate of Labour apart from the performance of Ed Miliband. That factor, whether the Liberal Democrats can rise like a phoenix from the ashes, could yet produce a problem for Labour, but while this Liberal Democrats seem totally signed up to crackpot policies such as #racistvan and lack of plain packaging cigarettes, there is no sign that the Liberal Democrats wish to leave their suicide pact yet. They know full well that if they do, David Cameron will be ecstatic, and their party meanwhile is fucked.

 

 

 

The English dementia policy: some personal thoughts



 

The last few years have seen a much welcome progression, for the better, for dementia policy in England. This has been the result of the previous Government, under which “Living well with dementia: the National Dementia Strategy” was published  in 2009, and the current Government, in which the Prime Minister’s Dementia Challenge in 2012 was introduced.

Dementia is a condition which lends itself to the ‘whole person’, ‘integrated’ approach. It is not an unusual for an individual with dementia to be involved with people from the medical profession, including GPs, neurologists, geriatricians; allied health professionals, including nurses, health care assistants, physiotherapists, speech and language specialists, nutritionists or dieticians, and occupational therapists; and people in other professionals, such as ‘dementia advocates’ and lawyers. I think a lot can be done to help individuals with dementia ‘to live well'; in fact I have just finished a big book on it and you can read drafts of the introduction and conclusion here.

It is obviously critical that clinicians, especially the people likeliest to make the initial provisional diagnosis, should be in the ‘driving seat’, but it is also very important that patients, carers, family members, or other advocates are in that driving seat too.  I feel this especially now, given that there is so much information available from people directly involved in with patients (such as @bethyb1886 or @whoseshoes or @dragonmisery) This patient journey is inevitably long, and to call it a ‘rollercoaster ride‘ would be a true understatement. That is why language is remarkably important, and that people with some knowledge of medicine get involved in articulating this debate. Not everyone with power and influence in dementia has a detailed knowledge of it, sadly.

I am very honoured to have my paper on the behavioural variant of frontotemporal dementia to be included as one of a handful of references in the current Oxford Textbook of Medicine. You can view this chapter, provided you do not use it for commercial gain (!), here.

I should like to direct you to the current draft of a video by Prof Alistair Burns, Chair of Psychiatry at the University of Manchester, who is the current National Clinical Lead for Dementia. You can contact him over any aspects of dementia policy on his Twitter, @ABurns1907.  I strongly support Prof Burns, and here is his kind Tweet to me about my work.  I agree with Prof Burns that once individuals can be given face-to-face a correct diagnosis of dementia this allows them to plan for the future, and to access appropriate services. The problem obviously comes from how clinicians arrive at that diagnosis.

I am not a clinician, although I studied medicine at Cambridge and did my PhD on dementia there too, but having written a number of reviews, book chapters, original papers, and now a book on dementia, I am deeply involved with the dementia world. I am still invited to international conferences, and I personally do not have any financial vested interests (e.g. funding, I do not work for a charity, hospital, or university, etc.) That is why I hope I can be frank about this. Clinicians will be mindful of the tragedy of telling somebody he or she has dementia or when he or she hasn’t, but needs help for severe anxiety, depression, underactive thyroid, or whatever. But likewise, we are faced with reports of a substantial underdiagnosis of dementia, for which a number of reasons could be postulated. Asking questions such as “How good is your memory?” may be a good basic initial question, but clinicians will be mindful that this test will suffer from poor specificity – there could be a lot of false positives due to other conditions.

At the end of the day, a mechanism such as ‘payment-by-results’ can only work if used responsibly, and does not create an environment for ‘perverse incentives’ where Trusts will be more inclined to claim for people with a ‘label’ of dementia when they actually do not have the condition at all. A double tragedy would be if these individuals had poor access to care which Prof Burns admits is “patchy”. In my own paper, with over 300 citations, on frontal dementia, seven out of eight patients had very good memory, and yet had a reliable diagnosis of early frontal dementia. Prof Burns rightly argues the term ‘timely’ should be used in preference to ‘early’ dementia, but still some influential stakeholders are using the term ‘early’ annoyingly. On the other hand, I wholeheartedly agree that the term ‘timely’ is much more fitting with the “person-centred care” approach, made popular in a widespread way by Tom Kitwood.

I am still really enthused about the substantial progress which has been made in English dementia policy. I enclose Prof Burns’ latest update (draft), and the video I recorded yesterday at my law school, for completion.

Prof Alistair Burns, National Clinical Lead for Dementia

Me (nobody) in reply

 

 

We've just had a huge debate about the NHS. It's just a pity that it's been the wrong one.



 

 

 

 

Think of how much time we’ve just all spent, in thinking about the way in which services will be mostly put out for competitive tendering in the National Health Service. One of the first rules in law is that you fight your battles to the hilt, but, at first, you pick the right battles first. This is precisely what Labour appears not to have done. When Harriet Harman recently said on Question Time that the Conservatives are definitely not ‘to be trusted with the NHS’, Harriet curiously did not refer to the battle and war just won by the Conservatives (and Liberal Democrats) over NHS procurement. And yet the public desperately want Labour to stand up for the NHS. One member even suggested that, if Labour gave its unequivocal backing for restoring the NHS, Labour could even find itself with a massive vote winner.

 

Labour is clearly going through policy strands with a fine tooth comb, looking at, for example, the way in which multinational companies might employ workers at below the national minimum wage; effectively, controlling immigration through a wage policy. It does not appear to have worked out unequivocally whether it would reduce the rate of VAT, meaning possibly that the state borrowing requirement would temporarily increase. But do you see what they all did there? For days, weeks, or even months, we have been subjected to a relentless debate about EU immigration, when most surveys probably place the issue at number ten on the list of voters’ concerns. Unsurprisingly, the economy remains in ‘pole position’, but the ability of Labour to turn the opinion of the public, particularly in the South of England, away from the idea that Labour is ‘fiscally incontinent’ remains unconvincing. Labour is still considered to be the “tax and spend” party, for example, and Miliband appears painfully aware of that. So, when it comes to policy, there seems to be an odd combination of Labour shooting itself in the foot, or completely picking the wrong battles. And then you add in a complete inability to look at elephants in the room. Labour, to state the obvious, has no ability to implement any of its policies, if it is unable to win a General Election, and the confidence of Labour to win an election on its own is reflected accurately in Lord Adonis promoting his book that ‘if he were to form a new Lib-Lab pact, he wouldn’t start from here.

 

The NHS remains pivotal in Labour’s electoral chances, and Labour has been unable to use the resentment over the section 75 NHS regulations to maximise political capital. Why this should have happened in itself is interesting, as Andy Burnham, MP for Leigh, is a more than capable Shadow Secretary of State for Health. One of the issues is an ability to choose the right battle, possibly. Burnham, with some support from the right-wing media and thinktanks, has been banging on about integrated and whole-person care. Whether through conspiracy or cock-up, there will be short-term interest in how integrated care might be delivered. Think about a justification for State spending in the ‘mission impossible’ of implementing a NHS IT system. Why on earth would a right-wing libertarian government promote something which is national? Why on earth should you abort an ethos of ‘bonfire of the QUANGOs’ to introduce the biggest QUANGO in the country, viz NHS England? Whether you’re into conspiracy or cock-up, the integration of financial and medical information (including mental, physical and social care systems) allows for the perfect infrastructure for an insurance-based system. Insurance works on the basis of misrepresentation or non-disclosure to invalidate claims, so ‘big data’ serve a perfect storm for this. It won’t have escaped anybody’s attention that Labour (as indeed the Conservative Party) has been heading towards an insurance-based system for social care, so it does not require a massive ideological leap to think how this could be extended for all care with time. This does not involve any degree of paranoia, please note.

 

There is overwhelmingly an intellectual depravity in the bereft notion of producing policy through poll results and focus groups. New Labour clearly loved focus groups, with Philip Gould in ‘The Unfinished Revolution’ having devoted much airspace to developing a product in line with customers’ wishes. Of course, the Conservatives have a special affinity for polling organisations themselves, Nadhim Zadawi, in 2000 he co-founded YouGov and on its flotation became its CEO. YouGov is now one of the world leaders in political and business information gathering, polling and analysis. It employs over 400 staff on three continents and is listed on the London Stock Exchange. Again – it begs the question on why should Labour should wish to outdo the Conservatives on its own ability to use polling data? One of the polls which has become a toxic meme is how a high proportion of all voters would not mind who provides the NHS services, as long as it’s free at the point of use. However, this is intrinsically linked to other questions. Would you be prepared more in national insurance if it meant the NHS were able to provide a more comprehensive (universal) service?

 

It is indeed correct to state that the costs of renationalising the NHS might be overwhelming, although no accurate costings of this have ever been discussed properly. We do know, however, that the current cost of the NHS reorganisation is in the region of £3bn, but estimates of the actual cost inevitably have to be taken with a pinch of salt, as say the cost of Margaret Thatcher’s funeral. But to use this issue as a wish to stop discussion of this area is lazy, as one of the issues, as indeed as with Thatcher’s funeral, is that is this a sensible use of money compared to how it could be used elsewhere (so called “opportunity cost“)? Some people argue that the marketisation of the NHS has failed, in that any money spent on restoring a state-funded NHS would be money well spent. Restoring a state-funded service would get out of the idea of private companies being driven by maximising their profit margin, and not running a ‘more for less’ approach for delivering a service. Cynics might argue that the cost of restoring a state-run service is peanuts compared to waging a war abroad. Many remain unconvinced about the mantra that economic competition drives up quality, when it is the professional standards of healthcare staff, including doctors, nurses and allied health professionals, which appear to be at the heart of quality. The debate we have just had about the mode of procurement in the NHS was not one any of us as such elected; in other words, it has no mandate. If the Conservatives and the right-wing media appear so pre-occupied about having a referendum next parliament on our membership of the EU, many are (rightly) asking why Ed Miliband cannot ask for a mandate to take sensible decisions about the nature of the NHS. It is a given that there will always be a proportion of services which are outsourced to the private sector, but the question should be ‘how much’. Whilst a full-blown privatisation of the NHS has not happened yet, we have not even had a discussion of how much of the NHS should be outsourced.

 

And anyway Labour has to ask what really concerns all voters? In Mid Staffs and Cumbria, it is reported that there have been concerns about patient safety, and it may be mere coincidence that Labour failed to convince the voters in both places in the local elections over their offerings. However, there is certainly a ‘debate to be had’, about whether “efficiency savings” in the NHS are justified to produce surpluses in the NHS which get ploughed back into the Treasury (and therefore might be used for international overseas aid rather than frontline care.) Labour equally seems unable to look another ‘white elephant’ in the eye. That is of course the concept of a NHS hospital going bust. Should a NHS Trust which is in financial difficulty be simply allowed to go insolvent after a period of administration, or should the State pump money into it to maintain a local service to people in the community? This requires a fundamental reappraisal of how important “solidarity” and “social democracy” are, in fact, to Labour, and whether it wishes to use its extensive brand loyalty to have a mature, if sobering, discussion of the extent to which it wishes to fund a SOCIALIST National Health Service. Whilst in extremis it can be argued that a nostalgic return to ‘The Spirit of ’45” is not attainable, and is the wrong solution for the wrong times, there is a genuine perception that Labour has lost sight of its founding values. And why has this not been addressed in focus groups? It is well known that, in marketing, if you ask the wrong questions, you ubiquitously get the wrong answers.

 

Labour needs a mandate to confront these issues. And it should not be afraid to look for a resounding mandate, either. Whilst it might stick its fingers in its ears, and claim it’s nothing to do with them (arguing instead for integrated, “whole person” care), unless these ideological issues are confronted, NHS policy will continue to go down a right-wing path. For example, there is not much further to see GP ‘businesses’ being offered by the private sector, and the NHS pays for them; in this model, GP ‘businesses’ could operate under a standard 5-year contract, using NHS branding, under a ‘franchising’ model like Subway. And “The Tony Blair Dictum” is far from resolved, although currently there are issues more worthy of ‘firefighting’ in service delivery, such as the fiasco over ‘1111’. Labour’s problem is that it does not see the NHS as a ‘vote winner’, in the same way it doesn’t see the plight of disabled citizens experiencing difficulty with their benefits or people feeling genuinely threatened by ‘the bedroom tax’ as a top priority. Whilst Labour is unable to prioritise its issues in a way to align its aspirations with the concerns of the general public, there is no way on Earth it can hope to govern a convincing majority. If Labour wishes to learn a really useful trick from marketing, it could no better than to look at the ‘GAP analysis’ – looking at what the current situation is, and what the expectations of people are, and thinking how to get to a position of what people want. If people actually want a socialist universal, comprehensive NHS, paid for not in a private insurance system, Labour can be expected to work hard for a mandate to deliver this. If it doesn’t, that’s another matter, and it can witter on about whole-person care to its heart’s content.

We've just had a huge debate about the NHS. It's just a pity that it's been the wrong one.



Think of how much time we’ve just all spent, in thinking about the way in which services will be mostly put out for competitive tendering in the National Health Service. One of the first rules in law is that you fight your battles to the hilt, but, at first, you pick the right battles first. This is precisely what Labour appears not to have done. When Harriet Harman recently said on Question Time that the Conservatives are definitely not ‘to be trusted with the NHS’, Harriet curiously did not refer to the battle and war just won by the Conservatives (and Liberal Democrats) over NHS procurement. And yet the public desperately want Labour to stand up for the NHS. One member even suggested that, if Labour gave its unequivocal backing for restoring the NHS, Labour could even find itself with a massive vote winner.

 

Labour is clearly going through policy strands with a fine tooth comb, looking at, for example, the way in which multinational companies might employ workers at below the national minimum wage; effectively, controlling immigration through a wage policy. It does not appear to have worked out unequivocally whether it would reduce the rate of VAT, meaning possibly that the state borrowing requirement would temporarily increase. But do you see what they all did there? For days, weeks, or even months, we have been subjected to a relentless debate about EU immigration, when most surveys probably place the issue at number ten on the list of voters’ concerns. Unsurprisingly, the economy remains in ‘pole position’, but the ability of Labour to turn the opinion of the public, particularly in the South of England, away from the idea that Labour is ‘fiscally incontinent’ remains unconvincing. Labour is still considered to be the “tax and spend” party, for example, and Miliband appears painfully aware of that. So, when it comes to policy, there seems to be an odd combination of Labour shooting itself in the foot, or completely picking the wrong battles. And then you add in a complete inability to look at elephants in the room. Labour, to state the obvious, has no ability to implement any of its policies, if it is unable to win a General Election, and the confidence of Labour to win an election on its own is reflected accurately in Lord Adonis promoting his book that ‘if he were to form a new Lib-Lab pact, he wouldn’t start from here.

 

The NHS remains pivotal in Labour’s electoral chances, and Labour has been unable to use the resentment over the section 75 NHS regulations to maximise political capital. Why this should have happened in itself is interesting, as Andy Burnham, MP for Leigh, is a more than capable Shadow Secretary of State for Health. One of the issues is an ability to choose the right battle, possibly. Burnham, with some support from the right-wing media and thinktanks, has been banging on about integrated and whole-person care. Whether through conspiracy or cock-up, there will be short-term interest in how integrated care might be delivered. Think about a justification for State spending in the ‘mission impossible’ of implementing a NHS IT system. Why on earth would a right-wing libertarian government promote something which is national? Why on earth should you abort an ethos of ‘bonfire of the QUANGOs’ to introduce the biggest QUANGO in the country, viz NHS England? Whether you’re into conspiracy or cock-up, the integration of financial and medical information (including mental, physical and social care systems) allows for the perfect infrastructure for an insurance-based system. Insurance works on the basis of misrepresentation or non-disclosure to invalidate claims, so ‘big data’ serve a perfect storm for this. It won’t have escaped anybody’s attention that Labour (as indeed the Conservative Party) has been heading towards an insurance-based system for social care, so it does not require a massive ideological leap to think how this could be extended for all care with time. This does not involve any degree of paranoia, please note.

 

There is overwhelmingly an intellectual depravity in the bereft notion of producing policy through poll results and focus groups. New Labour clearly loved focus groups, with Philip Gould in ‘The Unfinished Revolution’ having devoted much airspace to developing a product in line with customers’ wishes. Of course, the Conservatives have a special affinity for polling organisations themselves, Nadhim Zadawi, in 2000 he co-founded YouGov and on its flotation became its CEO. YouGov is now one of the world leaders in political and business information gathering, polling and analysis. It employs over 400 staff on three continents and is listed on the London Stock Exchange. Again – it begs the question on why should Labour should wish to outdo the Conservatives on its own ability to use polling data? One of the polls which has become a toxic meme is how a high proportion of all voters would not mind who provides the NHS services, as long as it’s free at the point of use. However, this is intrinsically linked to other questions. Would you be prepared more in national insurance if it meant the NHS were able to provide a more comprehensive (universal) service?

 

It is indeed correct to state that the costs of renationalising the NHS might be overwhelming, although no accurate costings of this have ever been discussed properly. We do know, however, that the current cost of the NHS reorganisation is in the region of £3bn, but estimates of the actual cost inevitably have to be taken with a pinch of salt, as say the cost of Margaret Thatcher’s funeral. But to use this issue as a wish to stop discussion of this area is lazy, as one of the issues, as indeed as with Thatcher’s funeral, is that is this a sensible use of money compared to how it could be used elsewhere (so called “opportunity cost“)? Some people argue that the marketisation of the NHS has failed, in that any money spent on restoring a state-funded NHS would be money well spent. Restoring a state-funded service would get out of the idea of private companies being driven by maximising their profit margin, and not running a ‘more for less’ approach for delivering a service. Cynics might argue that the cost of restoring a state-run service is peanuts compared to waging a war abroad. Many remain unconvinced about the mantra that economic competition drives up quality, when it is the professional standards of healthcare staff, including doctors, nurses and allied health professionals, which appear to be at the heart of quality. The debate we have just had about the mode of procurement in the NHS was not one any of us as such elected; in other words, it has no mandate. If the Conservatives and the right-wing media appear so pre-occupied about having a referendum next parliament on our membership of the EU, many are (rightly) asking why Ed Miliband cannot ask for a mandate to take sensible decisions about the nature of the NHS. It is a given that there will always be a proportion of services which are outsourced to the private sector, but the question should be ‘how much’. Whilst a full-blown privatisation of the NHS has not happened yet, we have not even had a discussion of how much of the NHS should be outsourced.

 

And anyway Labour has to ask what really concerns all voters? In Mid Staffs and Cumbria, it is reported that there have been concerns about patient safety, and it may be mere coincidence that Labour failed to convince the voters in both places in the local elections over their offerings. However, there is certainly a ‘debate to be had’, about whether “efficiency savings” in the NHS are justified to produce surpluses in the NHS which get ploughed back into the Treasury (and therefore might be used for international overseas aid rather than frontline care.) Labour equally seems unable to look another ‘white elephant’ in the eye. That is of course the concept of a NHS hospital going bust. Should a NHS Trust which is in financial difficulty be simply allowed to go insolvent after a period of administration, or should the State pump money into it to maintain a local service to people in the community? This requires a fundamental reappraisal of how important “solidarity” and “social democracy” are, in fact, to Labour, and whether it wishes to use its extensive brand loyalty to have a mature, if sobering, discussion of the extent to which it wishes to fund a SOCIALIST National Health Service. Whilst in extremis it can be argued that a nostalgic return to ‘The Spirit of ’45” is not attainable, and is the wrong solution for the wrong times, there is a genuine perception that Labour has lost sight of its founding values. And why has this not been addressed in focus groups? It is well known that, in marketing, if you ask the wrong questions, you ubiquitously get the wrong answers.

 

Labour needs a mandate to confront these issues. And it should not be afraid to look for a resounding mandate, either. Whilst it might stick its fingers in its ears, and claim it’s nothing to do with them (arguing instead for integrated, “whole person” care), unless these ideological issues are confronted, NHS policy will continue to go down a right-wing path. For example, there is not much further to see GP ‘businesses’ being offered by the private sector, and the NHS pays for them; in this model, GP ‘businesses’ could operate under a standard 5-year contract, using NHS branding, under a ‘franchising’ model like Subway. And “The Tony Blair Dictum” is far from resolved, although currently there are issues more worthy of ‘firefighting’ in service delivery, such as the fiasco over ‘1111’. Labour’s problem is that it does not see the NHS as a ‘vote winner’, in the same way it doesn’t see the plight of disabled citizens experiencing difficulty with their benefits or people feeling genuinely threatened by ‘the bedroom tax’ as a top priority. Whilst Labour is unable to prioritise its issues in a way to align its aspirations with the concerns of the general public, there is no way on Earth it can hope to govern a convincing majority. If Labour wishes to learn a really useful trick from marketing, it could no better than to look at the ‘GAP analysis’ – looking at what the current situation is, and what the expectations of people are, and thinking how to get to a position of what people want. If people actually want a socialist universal, comprehensive NHS, paid for not in a private insurance system, Labour can be expected to work hard for a mandate to deliver this. If it doesn’t, that’s another matter, and it can witter on about whole-person care to its heart’s content.

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.

David Cameron and the Conservatives should be given credit for a challenging, if inaccurate, speech at their Party Conference




I think the main danger in misinterpreting David Cameron’s speech, written by Clare Foges and colleagues of the Conservative Party (including presumably David Cameron), is to do so without viewing it from the perspective of a potential Tory voter.

Individuals who are ardent Conservative voters, one assumes, are not distracted by factual inaccuracies in the narrative (such as how many people on housing benefit are unemployed, or how much borrowing this current government is doing). Certain things might have stuck in the minds of potential voters, such as the idea of an unemployed person in a bedsit queue-jumping in the housing ballot ahead of a person who’d dedicated his or her life for decades. To such people, the prevalence of benefit fraud is immaterial. Cameron tried to produce a narrative of the rich being punished for being successful, in his characteristically patronising explanation of how income tax works for Miliband’s benefit. A caller on Iain Dale’s show last night on lbc considered that he might vote for the Conservative Party, having voted for decades for Labour. He felt that his ambitions as a worker had not been recognised by the Labour Party, and was sick of it. Rather than blaming Cameron and his team for tapping into this ‘aspiration’, Labour runs a genuine risk of pursuing evidence-based politics while simultaneously failing to capture the sentiment and feelings of workers of this country.

How this situation has come about is interesting, but it is patently obvious that it has not come about overnight. Cameron indeed would be right in thinking that such a voter is not overly concerned about what Prof Michael Sandel or Prof Jim Hacker have to say about public good or predistribution particularly; the mental masturbation over intellectual sociological ideas might lead to an even greater disconnect between Labour and its missing voters. It is clearly of concern that there are millions of voters who cannot remember why they did not vote in the 2010 general election, but it is fair to say, probably, that not all of them produced a protest vote on account of the expenses scandal. While talk of whether Andrew Mitchell will survive is of immense interest to the Westminster village, it is curiously not the allegation that he may have said “fucking” or “pleb” that is the problem with the focus groups, but the fact that the Conservative Party do not consider themselves at one with the general public.

This is why Cameron’s pitch was effective, as it was ‘levelling’ with the public in a way that they largely comprehend. Labour has its own arguments why it increased public spending, but it seems that there is no appetite for such a technical debate; however much Labour wishes to debate it, the Labour Party are generally not trusted with the public finances. While ‘One Nation’ talk might be appealing, even after the forty-sixth repeat, if Labour cannot be trusted to be in control of the public purse, the most they can hope for is a Lib-Lab pact. The dynamics of a potential future Lib-Lab pact are interesting, in that the vast majority of Labour voters would not wish to enter into a pact with Nick Clegg still at the helm of the Liberal Democrat party. It becomes 50/50 if it’s any leader but Nick Clegg, and still most Labour voters stubbornly feel that Labour politicians are better at running the economy than the Liberal Democrats. It can be tempting for Labour members to think that the NHS is a ‘make or break’ issue, but this policy has been evolving for some time, especially under New Labour, with the emergence of NHS Foundation Trusts and clinical commissioning. Labour voters are not likely to get angry over the pay packets of private directors of healthcare companies at the ballot box, but are more likely to resent the Health and Social Care Act if quality is seen to suffer. While the NHS remains branded as an unitary NHS, this is unlikely to be the case, and the Conservatives can justifiably continue, perhaps, with their strategy of either not mentioning it, or describing it as a ‘modernisation strategy’.

The legal aid cuts might be a more productive way for Labour to reach out to the strivers. For example, due to the managed decline of law centres on the high street, access-to-justice for housing, immigration, asylum, welfare benefits, and employment advice, inter alia, is compromised. This is hardly in the best interests of strivers? Strivers are unlikely to be impressed by trading off their rights not to be unfairly dismissed for some shares in a company which cannot produce a dividend unless it has distributable profits. It might be that strivers do not particularly care whether the Human Rights Act is abolished or not, although its abolition might help to return a Conservative government. Individuals may be inclined to think that so long as he or she is not affected by torture, privacy, or freedom of expression issues, they are unlikely to be touched by the Human Rights Act, especially if legal aid for such matters is abolished. Cameron has also perhaps succeeded in painting the Conservative Party as firmly footed in the “real world”. There are two major issues for why Ed Miliband has trouble on this: the spending of Labour “even during the good times”, and the thirst by Miliband for the application of sociological theories which have yet to be tested in practice. The empirical evidence for ‘Nudge’ of course has never been compelling, but there is a sense that the standards that Conservatives apply for themselves are not the ones they apply to Labour.

So it comes to something when David Cameron calls trade union leaders “snobs”, but no amount of hatred for inverted snobbery will deliver Miliband a landslide for the 2015 general election. Practical problems emerge if Ed Balls signs up for an austerity agenda indistinguishable from the Conservatives, not least in the sense that workers will wonder why on earth they are still supporting Labour. Miliband does not want to be seen in the lap of ‘vested interests’ codeword for ‘trade unions’, but likewise he has not embraced a redistributive tax system targetting the very highest earners yet. Trade union members contribute up to 40% of the funding of the Labour Party, but, like the debate on public purse handling, Miliband is unlikely to sway the minds of voters on this. It is not improved aspiration from the middle class and centre that will win Miliband the 2015 general election, but it will be working class leaving Labour in droves in finding their aspirations unaddressed. One term oppositions are extremely rare, and Labour finds itself in a difficult position in perhaps having to rely on the Liberal Democrats to form a government having spent the last five years in slagging them off. Cameron’s speech yesterday was full of statements all good lefties would have found contemptible, but it was clever in that it was sufficiently practical (for example, not mentioning the ‘bash a burglar’ policy) that it did offer a course for government. As others have pointed out, this is not a speech that Cameron can ever give in future, if he fails to deliver. The starting gun for the 2015 general election has most definitely been fired, and the first ‘hurdle’ takes the form of the OBR assessment in a few weeks time about the UK deficit. Cameron has given himself in a sense a suspended sentence, but there are strict conditions for his future behaviour.

Despite the inaccuracies, Cameron's pitch was sufficiently effective to be of concern



 

I think the main danger in misinterpreting David Cameron’s speech, written by Clare Foges and colleagues of the Conservative Party (including presumably David Cameron), is to do so without viewing it from the perspective of a potential Tory voter.

Individuals who are ardent Conservative voters, one assumes, are not distracted by factual inaccuracies in the narrative (such as how many people on housing benefit are unemployed, or how much borrowing this current government is doing). Certain things might have stuck in the minds of potential voters, such as the idea of an unemployed person in a bedsit queue-jumping in the housing ballot ahead of a person who’d dedicated his or her life for decades. To such people, the prevalence of benefit fraud is immaterial. Cameron tried to produce a narrative of the rich being punished for being successful, in his characteristically patronising explanation of how income tax works for Miliband’s benefit. A caller on Iain Dale’s show last night on lbc considered that he might vote for the Conservative Party, having voted for decades for Labour. He felt that his ambitions as a worker had not been recognised by the Labour Party, and was sick of it. Rather than blaming Cameron and his team for tapping into this ‘aspiration’, Labour runs a genuine risk of pursuing evidence-based politics while simultaneously failing to capture the sentiment and feelings of workers of this country.

How this situation has come about is interesting, but it is patently obvious that it has not come about overnight. Cameron indeed would be right in thinking that such a voter is not overly concerned about what Prof Michael Sandel or Prof Jim Hacker have to say about public good or predistribution particularly; the mental masturbation over intellectual sociological ideas might lead to an even greater disconnect between Labour and its missing voters. It is clearly of concern that there are millions of voters who cannot remember why they did not vote in the 2010 general election, but it is fair to say, probably, that not all of them produced a protest vote on account of the expenses scandal. While talk of whether Andrew Mitchell will survive is of immense interest to the Westminster village, it is curiously not the allegation that he may have said “fucking” or “pleb” that is the problem with the focus groups, but the fact that the Conservative Party do not consider themselves at one with the general public.

This is why Cameron’s pitch was effective, as it was ‘levelling’ with the public in a way that they largely comprehend. Labour has its own arguments why it increased public spending, but it seems that there is no appetite for such a technical debate; however much Labour wishes to debate it, the Labour Party are generally not trusted with the public finances. While ‘One Nation’ talk might be appealing, even after the forty-sixth repeat, if Labour cannot be trusted to be in control of the public purse, the most they can hope for is a Lib-Lab pact. The dynamics of a potential future Lib-Lab pact are interesting, in that the vast majority of Labour voters would not wish to enter into a pact with Nick Clegg still at the helm of the Liberal Democrat party. It becomes 50/50 if it’s any leader but Nick Clegg, and still most Labour voters stubbornly feel that Labour politicians are better at running the economy than the Liberal Democrats. It can be tempting for Labour members to think that the NHS is a ‘make or break’ issue, but this policy has been evolving for some time, especially under New Labour, with the emergence of NHS Foundation Trusts and clinical commissioning. Labour voters are not likely to get angry over the pay packets of private directors of healthcare companies at the ballot box, but are more likely to resent the Health and Social Care Act if quality is seen to suffer. While the NHS remains branded as an unitary NHS, this is unlikely to be the case, and the Conservatives can justifiably continue, perhaps, with their strategy of either not mentioning it, or describing it as a ‘modernisation strategy’.

The legal aid cuts might be a more productive way for Labour to reach out to the strivers. For example, due to the managed decline of law centres on the high street, access-to-justice for housing, immigration, asylum, welfare benefits, and employment advice, inter alia, is compromised. This is hardly in the best interests of strivers? Strivers are unlikely to be impressed by trading off their rights not to be unfairly dismissed for some shares in a company which cannot produce a dividend unless it has distributable profits. It might be that strivers do not particularly care whether the Human Rights Act is abolished or not, although its abolition might help to return a Conservative government. Individuals may be inclined to think that so long as he or she is not affected by torture, privacy, or freedom of expression issues, they are unlikely to be touched by the Human Rights Act, especially if legal aid for such matters is abolished. Cameron has also perhaps succeeded in painting the Conservative Party as firmly footed in the “real world”. There are two major issues for why Ed Miliband has trouble on this: the spending of Labour “even during the good times”, and the thirst by Miliband for the application of sociological theories which have yet to be tested in practice. The empirical evidence for ‘Nudge’ of course has never been compelling, but there is a sense that the standards that Conservatives apply for themselves are not the ones they apply to Labour.

So it comes to something when David Cameron calls trade union leaders “snobs”, but no amount of hatred for inverted snobbery will deliver Miliband a landslide for the 2015 general election. Practical problems emerge if Ed Balls signs up for an austerity agenda indistinguishable from the Conservatives, not least in the sense that workers will wonder why on earth they are still supporting Labour. Miliband does not want to be seen in the lap of ‘vested interests’ codeword for ‘trade unions’, but likewise he has not embraced a redistributive tax system targetting the very highest earners yet. Trade union members contribute up to 40% of the funding of the Labour Party, but, like the debate on public purse handling, Miliband is unlikely to sway the minds of voters on this. It is not improved aspiration from the middle class and centre that will win Miliband the 2015 general election, but it will be working class leaving Labour in droves in finding their aspirations unaddressed. One term oppositions are extremely rare, and Labour finds itself in a difficult position in perhaps having to rely on the Liberal Democrats to form a government having spent the last five years in slagging them off. Cameron’s speech yesterday was full of statements all good lefties would have found contemptible, but it was clever in that it was sufficiently practical (for example, not mentioning the ‘bash a burglar’ policy) that it did offer a course for government. As others have pointed out, this is not a speech that Cameron can ever give in future, if he fails to deliver. The starting gun for the 2015 general election has most definitely been fired, and the first ‘hurdle’ takes the form of the OBR assessment in a few weeks time about the UK deficit. Cameron has given himself in a sense a suspended sentence, but there are strict conditions for his future behaviour.

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