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I think as far as the SHA is concerned Tony Benn was respectfully indifferent.
I’m a Bennite.
In the last few days, I’ve heard a lot of commentary from Blairites and supporters of the SDP criticising Tony Benn for making the Labour Party unelectable.
I have spent much time listening to all of his audiobooks again and again. Some of the analysis has been spot on: see for example the comments by Steve Richards. But some of it has been quite dreadful.
Tony Benn had a rare gift. Whatever your strong views on how much damage he did, maybe, he was very good at explaining his perspective, and not being ashamed of it. He boasted of talking with Keith Joseph and Enoch Powell, even though he profoundly disagreed with them.
There’s been a lot of ‘his eloquence was brilliant’.
For me, it’s worth saying he was a very good orator, but he had a clear vision. In terms of journalism, his copy was good. That’s why he was a charismatic leader – he had his own vision, and his own followers.
While the old tired arguments are rolled out about how his proposed industrial legislation was unworkable, and how he was in the dock of the unions like a weirdy cult, it cannot be dismissed that there are many who agree with him.
A lot of it can be seen as motherhood and apple pie stuff, but his feelings of solidarity, co-operation and social justice are clear cut.
He could negotiate even the most problematic issues for socialists.
On equality, he said famously on the radio that he did not feel this meant that everybody should be equal; this meant that “obstacles in your journey” should be removed, which would have made even the most erudite of commentators on social mobility blanche. You can hear him voice this comment in person in a programme recently presented by David Davis MP about the political outlook of Benn.
Tony Benn MP was never a member of the Socialist Health Association (SHA). I don’t think he would’ve been ‘sickened’ as such. It’s just that in close to seventy years of his diaries he never mentioned the Socialist Medical Association or SHA once.
I think as far as the SHA is concerned Tony Benn was respectfully indifferent.
Some of the more famous phrases which Benn uses to set out his viewpoint, which some feel produced an unworkable synthesis, I feel demonstrate what would have been his concerns about the modern day policy of the Labour Policy.
I am mindful he does in fact mention Prof Allyson Pollock and Dr Julian Tudor-Hart in his final set of diaries “An autumn blaze of sunshine” as people he likes.
I think he was therefore interested in the future direction of the NHS under Labour, the political party he always supported despite his parents being Liberals. It was his wish that he should see a Labour government next, and in fact he had his diary marked with the date of the 100th birthday he would ultimately never witness.
Tony Benn was not on an advocate of global markets, but rather an advocate of domestic sovereignty. He always believed in the concept of people being to vote out laws legislated for by elected officials. That’s why he resented the European parliament so much.
That’s why what he would thought about Andy Burnham MP going to Strasbourg next month to negotiate an opt out from TTIP is so interesting.
This is simply a personal view, and not meant to represent any views of anyone apart from me.
“If we can find the money to kill people, we can find the money to help people.”
This is directly relevant to all the endless talk, mainly under successive Conservative governments, that the NHS is unsustainable or unaffordable. And yet Benn used to remark often that you never hear of Generals running out of money to bomb citiess.
“In the course of her life, Mrs Thatcher took on half of the British population and tried to coerce them to her will and she did not succeed. But she was a conviction politician, a sign post not a weather cock; but one that I always felt was pointing the wrong way”
Tony Benn is reported as having said that the Labour Party is not inherently socialist, but there are socialists in it, in the same way there are Christians in the Church of England (according to him.) Nye Bevan was indeed a visionary, who has been rarely, if at all, been matched in calibre since. Benn often referred to the ‘spirit of ’45’ in which quite radical visions, such as the founding of the NHS, had been proposed.
“In the course of my life I have developed five little democratic questions. If one meets a powerful person – Adolf Hitler, Joe Stalin or Bill Gates – ask them five questions: “What power have you got? Where did you get it from? In whose interests do you exercise it? To whom are you accountable? And how can we get rid of you?” If you cannot get rid of the people who govern you, you do not live in a democratic system.”
Accountability has always been a problem for the top echelons of the NHS, so I wonder what he would have made about the seeming lack of responsibility for disasters such as Mid Staffs. The official line was that it was inappropriate to ‘blame’ anyone for Mid Staffs, and that we should adopt a culture of learning from failure.
“I now want more time to devote to politics and more freedom to do so”
This, for me, is quite reminiscent of what friends of mine who are no longer on the Central Council of the SHA feel about their own personal continued devotion to a socialist NHS in contradistinction to the progress of the SHA.
Anthony Neil Wedgwood “Tony” Benn, PC (3 April 1925 – 14 March 2014)
Benn, Bevan and Burnham: continuity of care?
One of the lasting legacies of the introduction of the Andrew Lansley Health and Social Care Act (2012) is that it was a massive betrayal of trust. It explicitly did not appear in the Conservative manifesto. It was clearly a Lansley ‘vanity project’ which cost billions to implement.
While the purpose of this Act was promoted in a number of different marketing ways, the Act, nearing five hundred pages, is in fact incredibly simple.
It sets up a market based on competitive tenders. It sets up a beefed up economic regulator. It sets up the climate for ‘liquidation camps’ that only Frederich Hayek could have been truly proud of.
That was basically not a vision that most people had for the NHS in these demanding times.
With not a single clause on patient safety, save for abolition of the National Patient Safety Agency, it was clearly not drafted to prevent another Mid Staffs.
With this level of mistrust, there are people who think integrated care is a shoehorn for a private insurance system.
And yet paradoxically the latest NHS reforms seems to have taken a lot of wind out of the sails of a move towards an insurance-based system as proposed by Reform a few years ago. Whilst Kaiser Permanente seems to still quite chummy with certain think tanks, it’s clear the voters in majority want a properly funded national health service funded out of taxation.
Against this backdrop, care of older people is possibly not what anyone would want it to be currently.
Labour has indeed a long legacy in the NHS history, but is clearly now looking to the future. It is argued that ‘whole person care’ can complete Bevan’s vision, uniting the NHS with social care. This would mean one service looking after the whole person – physical, mental and social. Indeed Andy Burnham at this year’s Party conference recalled the “spirit of 45″. This vision would be symbolic for beginning to bring to a close the marketisation and privatisation of the health service.
Labour have pledged to repeal the Health and Social Care Act 2012, which is fragmenting the service.
And yet a decade ago the Health and Social Care (Community Health and Standards) Act 2003 Commencement (No. 1) Order 2003 was the most controversial piece of legislation to come out of the then government’s 10 year strategy for the NHS in England. This piece of legislation, which abolished government control of NHS trusts by turning them into competing independent corporations called foundation trusts, was a major policy reversal. The concern then was it could lead to considerable local variation in services and endangers one of the NHS’s founding principles–to provide equal care for equal need.
Beep, beep – this vehicle is reversing.
Labour has set up an independent commission under Sir John Oldham to examine how health and social care can be integrated. Ed Miliband feels that this is is the biggest challenge in the history of the NHS. This in part addresses the gap between NHS and care demand which is expected in coming years, and current funding.
There is absolutely no doubt that integration is being damaged by the government’s “free market ideology”, a point freely conceded by the corporate competition lawyers.
The great attraction of the Whole-Person approach, with the NHS taking responsibility for coordination, is that it can be in a position to raise the standards and horizons of social care, lifting it out of today’s cut-price, minimum wage business.
It is clear from Tony Benn’s brief interview with Emma Crosby that Benn has concerns. Benn in his latest diaries, “Autumn blaze of sunshine”, talks of various medical issues which have caused him to come into contact with the caring professions. Benn most obviously feels that valuing care workers has not been a priority of English society by any stretch of the imagination. Benn most obviously wants this to be addressed in some form in a future Labour government.
There has been much said about valuing social workers, but the profession of social care work have been equally vocal about voicing their hard-felt concerns. It is possible that social care careers could be more valued and young people able to progress as part of an integrated Whole-Person workforce. This is yet to be seen.
So an NHS providing all care – physical, mental and social – could be held to account by powerful “patient rights”.
The approach, unlike the Health and Social Care Act (with the exception of the surgeons), has been welcomed by professionals in the Royal Colleges. For example, the Royal College of Psychiatrists has argued that ‘a parity approach’ should enable NHS and local authority health and social care services to provide a holistic, ‘whole person’ response to each individual, whatever their needs. They have also argued that this should ensure that all publicly funded services, including those provided by private organisations, give people’s mental health equal status to their physical health needs.
Central to this approach is the fact that there is a strong relationship between mental health and physical health, and that this influence works in both directions. Poor mental health is associated with a greater risk of physical health problems, and poor physical health is associated with a greater risk of mental health problems. Mental health affects physical health and vice versa.
And it’s clear that ‘whole person care’ is not some weird science fiction. A number of local authorities have already signed up to become “whole person care innovation councils” in a programme led by Labour’s shadow health secretary Andy Burnham. The councils are already taking the first steps towards turning into reality Mr Burnham’s vision of a single health and social care service. Under these Labour plans more care will be provided directly in people’s homes, there will be a greater focus on prevention and better co-ordination between different branches of the system.
In the 21st Century, the challenge is to organise services around the needs of patients, rather than patients around the needs of services. That means teams of doctors, nurses, social workers and therapists all working together. This ideally means care being arranged by a single person who you know – ending the frustration of families being passed around between different organisations and having to repeat the same information over and over again.
This seems to be the sort of thing which Tony Benn would like too.
But it is a marked shift in gear. It means a greater focus on preventing people getting ill and more care being provided directly in people’s homes so they avoid unnecessary hospital visits. Keeping frail individuals out of hospital will clearly be one of the ‘next big things’ in English health policy, whoever is in government after May 7th 2015.
It will be quite a culture shock to move the NHS from an organisation being pump-primed for global multi-national expansion. But the NHS has been through worse changes. This one might actually be useful.
Which Tony will win on the NHS? ‘Social democracy’, please meet ‘democratic socialism’.
At the heart of the ‘perfect storm’ about the NHS is a mediocrity of some managers, lack of ability from some NHS ” leaders “, and some inexperienced or unknowledgeable junior politicians and the civil service, who are crippling the best efforts of the frontline clinicians. Not helping is the split personality of the UK Labour Party which has seen an unbearable tension between socialism and neoliberalism. A good short-cut to understanding this difference in opinions is to examine how Tony Benn and Tony Blair have considered the NHS.
Benn hates the idea that ‘the left’ destroyed the Labour Party, and this chicken is yet to return to roost. Baroness Thatcher’s biggest achievement might have been New Labour, but it might be sensible now to conceptualise ‘New Labour’ as a political experiment. It can be to all extent and purposes it can be considered now to be a separate party to Labour proper. As we enter Conference season, it would be helpful if Ed Miliband could begin to form a vision of what he wants the NHS to be like. Without this vision, Miliband will be floundering, firefighting, and be lost in an ideological abyss. Benn is genuinely intrigued ‘why the Labour Party ignores people’, and thinks that capitalism prefers to see their policies ‘advocated from the left’. That is why Sean Worth may be so keen to write blogposts for the Socialist Health Association. This could be conceptually similar to Rupert Murdoch liking New Labour. “People don’t believe what they’re told, and people don’t listen to them”, complains Benn, and this is especially true in how NHS managers and politicians have approached the running of the nHS.
Tony Benn has not substantially changed his views on socialism for a number of decades, and while Ed Miliband is a card-carrying ‘social democrat’, Tony Benn’s view of ‘democrat socialism’ made famous in 1978, now published as “Why America needs democratic socialism”, does now perhaps merit further scrutiny. Benn’s argument that many in the general public advocate a form of “the left”, further left than Labour, is not ill thought out either. Privatisation, which has brought excessive profits for a few, has not turned out to be a democratising process at all due to the dynamics of neoliberal oligopolies. Privatisation is not popular. Benn has never seen socialism as a destination on a railway line, but sees socialism as an “ongoing struggle”. Benn, conversely, thinks the Thatcherite “revolution” was to ‘wind up the welfare state’, in much the same way as Reagan wished to unwind ‘The New Deal’, and undermined by the failure of monetarism. He cites that he senses that ‘people realise that they don’t have any power’, and is strongly critical of the unelected nature of corporatism, meaning that the power invested in the undemocrat Central Bank, World Trade Organisation, IMF and multinational corporates has effectively led to a ‘one party state’. One can imagine what Benn thinks of the creeping corporatisation of the NHS. Benn argues instead that people feel that they are not being represented any more, and nothing could be further from the truth than the inability of Labour and the Conservatives to discuss the McKinsey Efficiency savings or the private finance initiative strategy.
The media “rejected socialism”, according to Benn, so did Mandelson, Blair and Kinnock. However, Benn weirdly enough has not given up the faith. As for private ownership, Benn argues that we are using taxpayers’ money to subsidise the railways which would otherwise run at a loss.
Benn thinks that clinicians and nurses should be involved in the management of the NHS, which is somewhat reminiscent of the ‘co-determination‘ strategy in Germany of corporate management. Ed Miliband is in fact known to be very keen on this model of corporate governance, as it is consistent with his view of ‘responsible capitalism’. Benn opines at 26 mins in:
“Absolutely. They’ve got all these management consultants. I don’t wish to insult management consultants. There’s a lovely story I heard years ago. It’s about a boat race between a Japanese crew and NHS. Both sides practice long and hard. The Japanese won by a mile. So the NHS faced with this problem set up a working party. The working party report that the Japanese crew had 8 people rowing and 1 steering, and the NHS crew had 8 people steering and 1 rowing. So they brought in management consultants who confirmed the diagnosis. They suggested that the NHS crew should be completely restructured with 3 Assistant Steering Managers, 3 Deputy Steering Managers, a Director of Steering Services, and a rower incentivised to row. They had another race. They lost by 2 miles. They laid off the rower for poor performance. They sold off the boat. There are too many management consultants and not enough managers in the hospital. When I went to Havana years ago, they took me to their hospital, I didn’t wish to see the equipment. I asked how the hospital is run. We discuss everything. The first meeting is one chaired by the management, the second meeting is one chaired by the Unions, and the third meeting is. So I really am not in favour of this top down view at all, and I feel industrial democracy has an appeal and people feel that they’re kicked about…”
At about 11 mins in of this second film, there is a clear contrast in tone with Tony Blair interviewed by Will Hutton in the film “The Last Days of Tony Blair”:
“Tony Blair:“Actually in the NHS it is the reforms around putting the patient at the centre of the system, choice, competition, incentives for the system to treat better, and more … those are the structural changes.”
Will Hutton: Those are the things you were criticising the Conservatives for in 1995, 1996, 1997, the markets, incentives, and the “wrecking ethos”, and here you are talking about ”
Tony Blair: Again it’s a fair point. Although it’s true there were elements in the 1990s which we brought back, on the other hand – it’s done in a more fundamental way. It’s done in a far more equitable way.”
Blair thinks of ‘communities’ as the dividing line between him and Thatcherism – as expressing solidarity and standing by the weak, more important than the “rights” of individuals. This ‘confirmed Christian’ ‘Good Samaritan’ ethos has somehow got lost in translation in Blair’s legacy, and will be savaged by the Health and Social Care Act (2012) which has acccelerated a fragmented NHS which is not comprehensive. These ‘community values’ are not to be seen in A&E departments being sporadically shut nationally. Miliband is likely to be supposed to be interested in this sense of justice in his view of social democracy, but this is indeed a common interface with democratic socialism. The problem is that these attempts at triangulation, bridging ‘left and right’ before, have been publicly strained, for example in Tony Giddens’ ‘Third Way’ which Giddens himself moots might have been a failure.
Blair thinks his approach is more “equitable”, but this can be fiercely debated. Blair talks of his love for his independent schooling system, and wishes that the best elements of this should be brought into the state system. The problem of these “academies” is that this is a repudiation of a ‘comprehensive’ system. While Blair is criticise a uniformity in low standards, reducing barriers to entry for private health providers driven by the bottom line, even that means compromising patient safety for profit, could make the final stage of NHS outsourcing and privatisation explode. Many members of the General Public do in fact the NHS to be properly funded, and do wish for a comprehensive system free-at-the-point-of-use. For all of Blair’s talk about asking the communities what they want, nobody has yet asked the general public whether they want to outsource services to India to make the bill cheaper. They are however wary of political decisions being made behind their back. In an article in the Health Services Journal, many will read with interest Patricia Hewitt’s view that, “Former health secretary Patricia Hewitt said trusts were either trying to access the fast growing sub-continental market ? estimated to be worth £110bn by 2017 ? or to harness Indian expertise”, but they will also be mindful of Hewitt’s own professional interest in opening up new private (perhaps emerging) markets in healthcare (see for example this article).
For this political issue, triangulation between ‘democratic socialism’ and ‘social democracy’ is not necessary. The neoliberal market is a boon for increasing profits in a crowded market for some. All the evidence suggests that this market will drive up health and social inequalities, and indeed increase the cost of running the NHS massively through waste and inefficiency. The final denouement of course comes from the destination of the transition we are now embarked upon; this unelected move will take us up to an estimated 31% of the budget going on admin. and wastage (as beautifully articulated by the Himmelstein and Woolhandler papers). Tony Blair may believe that ‘it doesn’t matter who supplies services in the NHS’, but for nurses about to be made redundant it does matter. Outsourcing these services to India will bring resentment, as well the exploding budget spent on management consultants; it is estimated that the NHS reorganisation, whilst creating massive turmoil, has cost billions so far. Nobody has ever bothered to criticise the impact of the inefficiency savings in delivering unsafe and uncompassionate care, and not thought to link it to the general state of the economy which has been a disgrace under the present Coalition of Conservatives and Neoliberal Democrats.
Miliband should repeal the Health and Social Care Act (2012), which does not even contain a single clause on patient safety. Miliband should also scale back massively the extent to which the NHS services are outsourced to the private sector, marketed fraudulently under the NHS label. He should most of all restore a properly funded comprehensive NHS free-at-the-point-of-use with a safe level of minimum clinical staffing. He needs to restore the Secretary of State’s duty for the NHS in this regard.
If we are so desperate about £20bn McKinsey efficiency savings, why are we spending £80bn on #HS2?
We need Ed Miliband!
We have lost 5 million voters since 1997.
Michael Meacher MP has written an extremely informative post on it here. An except of it is:
Labour won in 1997, not because of Blair or New Labour mantra, but because the electorate was heartily sick of the Tories and wanted them out at any price. John Smith would have won by a huge margin too. But having won in 1997 on the back of virulent hostility to the Tories, Blair in two further elections then achieved the biggest loss of voters of any party in modern times. The Labour vote collapsed by almost 4 million from 13.5 million in 1997 to just 9.6 million in 2005. For someone who was such a monumental failure to claim any credibility in predicting political success takes one’s breath away – like someone who’s engineered a train crash telling people how to cut the accident rate.
So, it turns out that we lost 4 milion of them between 1997-2004, despite massive achievements of Labour. Frank Dobson urges the party faithful to identify the policies which were popular, but not to ‘defend the indefensible’.
Nonetheless, Frank feels that Ed Miliband “.. is the best fitted to take on the task to lead our Party to success.”
Sorry this video is cut short. I ran out of tape.
That’s why it may be necessary to move ‘more than a millimetre’ away from Tony Blair’s “New Labour”, which a man that Blair admires immensely, Tony Benn, has called a different party.
Happy memories indeed for supporters of one of more of the Tonies.
Tony Blair – The Journey : A failure to tackle inequality is a dangerous precedent for Labour
Actually, reading a book with such a careful index is like reading the abstract of a scientific paper. You can easily miss out the best bits, and get such a soupçon that you totally miss out on the real flavour. This could be the detriment of understanding Tony Blair, or possibly be an advantage. Despite my protestations which principally come from the Andrew Marr interview on the BBC, I went into the journey with an open mind, I hope..
The thing I instantly liked about “The Journey” is that it is easy to underestimate the nadir from which Labour actually came at the height of Margaret Thatcher’s popularity. I remember in my 20s what a disaster the Conservatives had become internally, and how they had virtually imploded on the issue of Europe (a topic which still threatens their infrastructure today). So, it was for me as Blair described indeed, having lived through the experience that Tony Blair talks about. I feel that I can actually empathise with his account, even though I have zero emotional intelligence, arguably, myself.
I had got used to defeat myself, I didn’t expect Blair to win, when I was at the age of 23, having experienced so many defeats in the past for me during the Thatcher generation. Quite early on in the book, Tony Blair seems to have an acknowledgement of not making his writing too self-congratulatory. Whether he’s actually succeeded on this I feel is a very tough call. His prosaic style varies from being candid emotionally, to being rather unemotional, as if he is talking in ‘legal speak’. However, the sense of excitement is there, as well as some sense of expectation management.
Some things in the book are pretty predictable. For example, the glowing reference of Alastair Campbell shines through. However, I find Blair very unclear on obvious certain failures of domestic policy. For example, I don’t feel that Tony Blair really tackles head-on the equality (inequality) divide. An epiphenomenon of this is that neither ‘poverty’ or ‘inequality’ are words are in the index, which I am sure that Tony Blair didn’t compile. There is an appearance of lip service to the Fabian Society, on a somewhat academic footing, with a surprising acknowledgement of Tony Benn and Tony Crossland at the University of Oxford. Blair seems to identify the problem:
“Once so altered, [Benn and Crossland] became staunch advocates of social action and of the party of the trade unions and the working class whose lives had to be liberated from the conditions of poor housing, poor education and poor health care.”
Critically, there is no explanation – or even an attempt at an explanation – of whether improvements in social indequality were achieved. However, it does seem that the culture of Blair, with the emphasis on September 11th, Gordon Brown, Alastair Campbell Iraq and Islam, seems to have somewhat overshadowed all this, and this really shows in the book. These topics have been described extensively elsewhere, so I won’t mention them. However what I did find incredibly interesting that a much publicised move was that of Gordon Brown to reduce the capital gains tax to a rate of 15%. Even Blair calls this move by Brown as heralded by politics than any real conviction, so the overwhelming impression for the reader like me is that Gordon Brown deliberately wished to court the city against any notion of anti-business rather than having thought carefully about the social and economic sequelae. Robert Peston has indeed cited this as a reason where the Blair/Brown axis failed, and I agree. Was the Labour government successful on this single issue, irrespective of Iraq or Afghanistan, more school and nurses, etc.? No.
This is a big deal, because parties tend to lose when they systematically alienate groups of people. I noticed this with Margaret Thatcher first of all, but I have latterly felt that Gordon Brown and Tony Blair did this with the working, middle and upper classes. “Somethings got to give” as Marilyn Monroe said, and it must before the next election, in addition to Labour formulating a coherent response to the effect of cuts on the economy and real people.
Is he a great leader? Well, he certainly achieved a lot, but it’s a moot point whether he made his domestic policies so toxic so as to make them rather uninspirational. Thankfully, there are other features of a good leader, such as intelligence, passion, focus, risk-taking and enthusiasm, and you can conceivably argue that Blair had all of these in abundance.
