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Does a seismic democratic deficit bode well for the NHS?

May 27, 2014 5:31 am / 3 Comments

As far as “earthquakes” go, this was not a bad one for Ed Miliband.

Did the earth move for him?

Probably not, as, in the European elections, Labour finished behind UKIP but ahead of the Conservatives, while its vote share was up by nearly 10% on 2009. In the local elections, Labour boasted of wins in areas such as Cambridge, Croydon and Crawley where it hopes to gain parliamentary seats next year. Labour took comfort from a strong performance in London, a key general election battleground with 73 seats, where Ukip’s appeal proved less potent. But arguably Labour’s gains fell well short of the 400 council seats experts said it needed to show it is on course for general election victory. A Ukip surge in Essex saw Labour lose control in Thurrock.

Is it Ed Miliband’s fault that Ed Miliband or even Labour seem out of touch with the rest of the country? Or could Miliband be doing more? Critics have argued that ‘the cost of living crisis’ is synthetic, but such critics have tended to be metropolitan journalists who spend much of the time abroad anyway.

Are the people in London basically wrong? Labour seized control in battleground London boroughs including the council said to be “David Cameron’s favourite”. Hammersmith and Fulham has been hailed as an exemplar by Mr Cameron, but Ed Miliband’s party claimed a coup by snatching the borough. After sweeping the local elections, Labour dominated Lewisham’s European election vote too, taking 32,507 of the borough’s votes, ahead of the second-placed Green Party, who won 10,228 votes. UKIP finished third (8,720), ahead of the Conservatives (8,161). The Lib Dems trailed-in fifth (4,252). These of course have been huge battlegrounds for the NHS.

And Nick Clegg looked upset and tired. The Liberal Democrats’ strategy going into this campaign had been to try to attract pro-European voters with an appeal for an open-minded, generous-hearted Britain, but going head-to-head with UKIP leader Nigel Farage in a TV debate back-fired. By far the most significant policy announcement made by the Lib Dems at their conference last year was that the party will pledge to protect the NHS and schools from cuts after 2015. Nick Clegg suggested that both budgets should be ring-fenced until 2020. And, under the 2012 Legal Aid, Sentencing and Punishment of Offenders Act, implemented earlier this year, access to legal aid in civil cases has already become far harder for children and young people under the age of 25.

UKIP spokesperson Suzanne Evans is reported as saying that UKIP did not make a breakthrough in London, in part due to the capital’s “well-educated” population. But what are these arguments that Labour is taking to the capital on the NHS? Chuka Umunna, MP for Streatham, is for example citing the £3bn top down reorganisation which nobody voted for, the “efficiency savings” returned to the Treasury without being put back into frontline care, and the problems in the A&E service known as the “barometer” of the NHS.

The inevitable refrain will be to question whether Labour did enough on this occasion to head towards Downing Street. On the good news, it does not think it’s already done it. The media have given Ed Miliband a pasting for not remembering the name of a local leader, nor for eating a nutty with due etiquette. But these are not make or break issues for people concerned with the NHS, like the amount spent on the private finance initiative, safe staffing, the concerns of whistleblowers, whether the NHS can afford or have the energy yet to implement whole person or integrated care.

UKIP is apparently going to hone in on a few geographical areas and to consolidate efforts on developing policy. One of the policy areas it must develop is in the NHS, where it has given off a garbed mood music through Paul Nuttall MEP on making the NHS more ‘efficient’. There has even been talk of GP charges in the UKIP repertoire. This would all matter if UKIP were a serious contender. Whilst it still appears likely with first past the post they are unable to make gains in electoral seat numbers it seems likely that they have the ability to be a pain the arse for a number of seats in London. With the Liberal Democrats having been annihilated again, and rumours of their death once again exaggerated, it is uncertain how pervasive immigration is going to be in the 2015 general election. While immigration appears to have gained an elevated importance, because of the effect it has in other policy areas (such as immigrants ‘using our NHS’ or ‘stealing our NHS’), it is perhaps possible that Labour is still not showing an ‘electoral leg’ by signing up to the austerity agenda (e.g. NHS ‘efficiency savings’), not considering how to increase taxation to fund the NHS and social care adequately, or even taking fully the argument to the public that health pervades much of Labour’s message, for example in housing or education. It would pervade more of their message if they were true socialists of course, but many dispute whether the Labour Party has ever demonstrated much socialism to write home of since Hugh Gaitskell and Nye Bevan.

As the late Tony Benn would have remarked there’s a definite sense of history repeating itself. Maybe in the rural leafy suburbs, where citizens are not yet surrounded by cosmopolitan comrades, people are so struck with the fear of globalisation that they cannot bear to bring themselves to vote Labour. And there is some sense to that, as Labour is a card carrying member of free movement of capital as well as free movement of persons. But Labour does wish to promote an unique selling point of giving empoyees’ rights compared to multinational companies (though it has to be said that UKIP has struck a chord with many on the left wing by slagging off multinational companies).

The question of whether London is representative or not of a democratic deficit or not is relevant in that we do not know yet whether Labour is following or leading. Whenever the question of leadership in any political party rears its ugly head, the question is: and replace with whom? There may be some who believe that Ed Miliband should be replaced by Andy Burnham, Yvette Cooper or Chuka Umunna, but there are possibly as many who believe that he should not be replaced by one of these three. Ironically, the person who stands to influence the NHS policy the most for Labour, whether it’s on ‘efficiency savings’, the overall spend or the NHS, Ed Balls MP, is generally not flavour of the month.

Whatever, the 2015 election will thankfully not be won by Nick Robinson getting excited about Nigel Farage. It will be, not to be hyperbolic, be a make or break election for England, especially regarding the NHS is concerned. Now is the time that true socialists should make their opinions clear about what they want to see from a future Labour government. On the list of ‘things to do’ are regulation of healthcare professions and repeal of the Health and Social Care Act (2012), and. while these issues are far more sophisticated than anything UKIP have to offer, one of the reasons why people might be exasperated with Ed Miliband and Labour is a distinct lack of national policy. And people do care about the NHS to vote on NHS issues: see, for example, arguably, those who did vote Green or the National Health Action Party whom some people say offer quite an attractive offering on the NHS.

And what we’re all trying to avoid from Labour is too little too late. This is above all what many of us got a flavour of from the local and European elections, despite some good gains.

Rumours of the political death of Ed Miliband have been greatly exaggerated. But he can’t be a ‘one trick pony’.

May 24, 2014 12:22 am / 2 Comments

The ‘rumours of my death’ quotation, attributed originally to Samuel Langhorne Clemens, has a long history.

Ed Miliband’s political journey, via Haverstock Hill Comprehensive School and Oxford University, by comparison has been much shorter. He does not appear to have gone via many checkouts along the way, though his nearest checkout would have been at Morrisons at Chalk Farm Road had it existed then.

But socialism did exist then. Miliband is clearly intent on fixing markets, but socialism, arguably, would prefer to get rid of them. Such an analysis will inevitably take you through hybrid economies, or the feasibility of the implementation of socialism in various countries. But the refrain that Ed Miliband is not a ‘socialist’ does not particularly appear to worry him.

Whatever Miliband’s formulation on the structure and function of the National Health Service, it’s more likely to be interesting than him eating a chip butty, or whether he can remember a local leader’s name from a dimly lit studio in London.

Miliband’s view on the running of the health and social care system may not often openly discuss payment by results or root cause analyses in patient safety, but nor does Mr Farage’s. Ultimately, Miliband needs to produce a vision on the NHS is more coherent than Farage’s, Clegg’s, or Cameron’s.

And this job is not particularly difficult. Clegg will be interested in the goals of competition lawyers, and Cameron with that of private providers. Farage is yet to unleash his crack squad focus group on health, so we have no idea what his offering will be.

You’d be forgiven for thinking that Ed Miliband is totally buggered politically. But the pained expressions of John Mann and Graham Stringer as sore losers undermine their credibility as critical friends.

They are readily available for vacuous commentary from a supine BBC, which hailed the finding of zero councils for UKIP as an ‘earthquake’.

And Labour did perform on decent objective measures, such as the overall number of seats and the popular share of the vote. One of the myriad of untold stories is the complete implosion of the popular support of the Conservative Party. That Party know they’re stuck with David Cameron, and no Tory wants to break ranks ahead of Newark (a seat likely to be won by the Tories.)

Patrick O’Flynn, chief communications officer for UKIP, may be congratulated on producing Nigel Mirage, a figment of a new Jerusalem in politics which does not exist.

The UKIP message is claimed to be ‘selling on the doorstep’, but it does not seem to be selling particularly well on the doorsteps on metropolitan centres of England such as Newcastle, Manchester, London, Birmingham or Bristol.

To say it is an earthquake is a disingenious as selling cod roe as caviar. Sure, Ed Miliband needs to be more convincing about the ‘cost of living’, but most people can smell a rat when it is Andrew Neil, recently returned from Dubai, who complains that the ‘cost of living’ message is not getting through. Or Patrick O’Flynn, former Chief Political Editor for the Daily Express, is responsible for selling the message that the modern political class continues with the same Oxbridge types on a revolving door basis.

The BBC may have captured the safe seat of Nick Robinson (no innuendo intended), but rumours of Ed Miliband’s demise or death have certainly been greatly exaggerated. While the ‘35% strategy’ clearly promotes a strategy of the bland leading the bland, it has succeeded in completely annihilating the Liberal Democrats as a credible force in politics.

Ed Miliband must up his game, and have a very clear vision on the NHS which he can articulate without looking strained. While the ‘cost of living crisis’ may be resonating, particularly with some in London, Ed Miliband cannot be seen as a one trick pony, particularly if real wages overtakes the cost of living later this year as predicted.

Whether or not UKIP gets sucked in to fill this vacuum depends on UKIP’s ability to co-form a Government. And for this it needs MPs. The idea of Liberal Democrats repealing their own legislation, propping up a Labour administration with insufficient numbers to form a majority, is simply enough to fill anyone with dread.

But Labour does need some support from the chattering classes, particularly existentialist Green voters in the Guardian.

The nature of political discourse suffers when everything turns into an acute crisis

May 10, 2014 2:48 pm / 2 Comments

There’s little doubt that many find the nature of political discourse in the UK entirely contrived. Politicians, with few noteworthy exceptions, can look as if they’re not taking issues seriously, mouthing words from a script given to them, and appear utterly self-serving.

The King’s Fund have given their view on what might happen in the general election of 2015, with an increasing number of people interested in the NHS. But the fundamental issue remains that many people do not feel as if they voted in any sense for the policy changes in the NHS just coming to an end. Various campaigners, including these two, have tried their best to articulate a general unease amongst various voters, but it seems as if Ed Miliband is much more keen to mention repeatedly ‘the cost of living crisis’, rather than refer to what is happening to the NHS.

It wasn’t that long ago since we heard there were ’24 hours to save the NHS’, in a charge that ended up taking on a rather cartoonish character some non-Labour supporters allege.

By definition, all crises must come to an end. Labour’s difficulty with the current ‘cost of living crisis’ is that many feel that the causes of the ‘crisis’ have been a slow burn for ages, including changes in the energy market under a previous Labour administration. So Labour can attempt an argument that ‘not the right people are benefiting from the recovery’, in much the same way there’s been the wrong type of snow on some train lines. But the massive problem with this argument is that the people who might be benefiting from the economic recovery might be exactly the same people whom Labour tried to woo in the Blair-Brown years.

Yes, that’s right.

These are the same people Lord Mandelson has been ‘intensely relaxed’ about. Labour over its dead body would not like to bring in a whopping property tax to clobber very wealthy people. Polly Toynbee in a Guardian podcast recently remarked that it was possible that a person could see an increase in the price of his own house more than the net profit of going out to work (deducting presumably transport) expenses. And yet this is the sort of stuff which Piketty is interested in, and which Labour would rather not touch with a bargepole. So one has to enquire casually does Labour actually know what a crisis is?

“I don’t think other people in the world would share the view [that] there is mounting chaos” were in fact the precise words of the then Labour Prime Minister, Jim Callaghan.

Some have mooted that the three words, “Crisis – what crisis?” helped bring down the last Labour government in 1979, even though the man generally thought to have uttered them – Jim Callaghan – did not in fact do so. And yet the Sun journalist who fashioned that headline caught the popular impression of a government unaware of a very serious state of affairs which had sneaked up on it. Indeed, much politics is about image – and certainly Labour want to implant in people’s minds an impression of an out-of-touch incompetent administration not ‘fit for purpose’.

Crises in medicine are though interesting and precisely defined. An “Addisonian crisis” or “adrenal crisis” is a constellation of symptoms that indicates severe adrenal insufficiency. This may be the result of either previously undiagnosed Addison’s disease, a disease process suddenly affecting adrenal function (such as adrenal haemorrhage), or an intercurrent problem (e.g. infection, trauma) in someone known to have Addison’s disease (the latter is therefore ‘acute on chronic’). It is a medical emergency and potentially life-threatening situation requiring immediate emergency treatment. Characteristic symptoms can include a sudden penetrating pain in the legs, lower back or abdomen, severe vomiting and diarrhea, resulting in dehydration, a low blood pressure, a reduced level of blood glucose, and confusion.

Ed Miliband also feels his crisis is very real, if not as such ‘life threatening’. Miliband has previously promised to rescue Britain’s struggling middle classes by boosting their living standards as he warns that the “cost-of-living crisis” will last for at least another five years. He that living standards are “the greatest challenge of our age” and will be at the heart of his party’s general election campaign next year. He has rejected calls from within his own party for him to change his strategy because the economy is improving.

But there may be trouble ahead for Miliband. The “cost of living crisis” is about to turn around, according to a forecast from the Institute for Fiscal Studies (IFS). In its so-called green budget, the IFS predicted that wages will start to rise faster than inflation in just a few months’ time, but it also warned that public spending cuts would continue to hit consumers. In particular, it said spending on the NHS was due to fall by 9% per person over an eight-year period. However, it did forecast that consumers would see their real wages – which allow for inflation – increase for the first time in five years. Likewise, ahead of the Eastleigh by-election, Iain Duncan Smith reported Britain faces a “crisis” of increased immigration from Romania and Bulgaria, as all three major parties consider their response to the UKIP Eastleigh surge. Called to the Commons to explain how the government plans to deal with new immigrants from within the European Union once existing restrictions are lifted next year, the work and pensions secretary said he was working to “tighten up” what benefits were payable to new arrivals.

“There is somewhat of a crisis over this,” he said. “Some people want to come here solely to claim benefits.”

Twitter is incredibly democratising for political parties, liberating them in getting their message across. David Axelrod, Labour’s newly appointed senior strategist and Barack Obama’s closest long-term political adviser, will apparently make mobilisation of Labour’s grassroots central to the election campaign. Axelrod himself has stressed that he could not help Labour succeed at the next election without the mobilisation of local communities, adding – in his first effort to energise Labour members – that the world would be watching the outcome of the 2015 vote. The Guardian has revealed that Axelrod was joining the Labour campaign team as a senior strategist. And Miliband has been talking about creating a ‘social movement’ for ages, perhaps inspired by his brother’s interest in ‘Movement for change’. But also the great thing about Twitter is that one can easily out the postcode lottery of pledges made by the main political parties – what a LibDem says in Cumbria might turn out to be very different to what a LibDem says in Oxford, say on the NHS.

“Lucky Generals” are the ad agency that produced the broadcast for Labour. Apparently the controversial Party Election Broadcast, known as “The Un-credible Shrinking Man” has not just been produced as a brief comedy experiment. They have been paid good money to obey instructions from their client – the Labour Party, to deliver strategically against what they have been told are the Labour Party’s goals. That’s “the 35 per cent strategy”. As the political arithmetic under the constituency boundaries means Labour only needs to poll the 35 per cent it currently polls to win a majority (as opposed to 42 per cent for the Tories), Labour appears to have decided to hold on to what it’s got. That PEB is designed to do two things to the Lib Dems. It tells disaffected voters from 2010 who have defected to Labour why they should stick with them. And it signals to the Liberal Democrats now, they can forget to aspire any repetition of Matthew d’Ancona’s “In it together” with Miliband’s Labour.

In a way, the persistent pathology in the National Health Service has lasted for decades. Factors include a chipping away in real terms in overall budget, poor budget allocation, PFI loan repayments, the need for efficiency savings, nurses not getting pay increases, delays in A&E, delays in seeing a GP, and so on. But there is concern that such a ‘lean’ large entity will simply be unable to bear any small shock to the system. Astra Zeneca and Pfizer are much in the news headlines these days. They are both powerful multinational pharmaceutical companies which have much in common with film companies. They will both produce their fair share of bananas and donkeys, but they only need one huge blockbuster to survive. Similarly, the Labour Party, if it found its blockbuster policy, might find itself with a consistent poll lead of a few percentage points in the run up to the General Election to be held on May 7th, 2015. The reason the ’35 perent’ strategy might be sensible for Labour is that the risks of a blockbuster going wrong for Labour are huge. This is Labour’s election to lose, given the massive unpopularity of the current Con-Dem coalition for a number of diverse reasons.

A ‘blockbuster’ might indeed come in the form of the Labour Party producing a political signal to bring all the PFI hospitals immediately into state control – but many of these contracts are due to run out in 2017-9 anyway; or might be to ‘renationalise the NHS’ , building on the left populist strength of the desire to renationalise the railways. The latter, a sort of ‘reverse clause 4’ moment for Ed Miliband, could be boom or bust for Miliband, but no-one would really know until the move is executed. Miliband would almost certainly for the chop if Labour lost the general election in 2015. But how he lost it, if indeed he does, can only be a matter of speculation now. It is widely predicted that UKIP will ‘win’ the European elections, with the Labour Party coming second. But what happens in third place is of considerable significance – might the Green Party manage to capture a lot of disaffected voters themselves, throwing the Liberal Democrats into 4th place?

If that materialises, what happens to the Liberal Democrat and Green vote between 2014 and 2015 is of massive significance. The problem that Ed Miliband has is that the cost of living crisis may not be a sustainable crisis. But an opportunity for Ed Miliband is that the performance of the NHS continues to decline, such that there is a genuine acute-on-chronic crisis in the NHS. Campaigners on the NHS have done a terrific job so far, but the best is yet to come (or ‘the worst’ depending on your perspective).

If you don’t stand for something, you’ll fall for anything

May 8, 2014 5:07 pm / 2 Comments

There are in fact very few people who have never made a mistake.

But if you don’t stand for something, you’ll fall for anything.

On the same day that the group “Progress” announced that they were looking forward from ‘New Labour’, Alex Andreou gave a powerful first-hand account of why he wished to vote Green in the European Elections.

Yesterday, Labour revealed its latest PPB, “The Un-credible Shrinking Man”.

On the downside, it contain no details of policies about what Labour intends to do in the next parliament, and has been criticised for trivialising politics.

But arguably it has succeeded in ‘getting people talking’. And supporters of the Labour Party argue that the ‘schoolboy politics’ is no worse than the attack that Gordon Brown caused unilaterally a world recession.

There is less than one year until the General Election to be held in the UK on May 7th 2015. At this point in time, Labour is barely ahead in the opinion polls.

Whilst it’s felt that the ‘cost of living crisis’ is very important to Labour and Ed Miliband, there’s no doubt of the existence of groundswell of opinion which wants Labour to do something on the NHS.

Andy Burnham MP has made clear that the direction of the NHS currently is wrong – he wants more integration, less fragmentation. He says that Labour took the market approach too far, and specifically wishes to repeal the entire Health and Social Care Act (2012) and the clause 119 empowering fast closures of ‘failing’ NHS hospitals.

He has also laid out a vision for ‘whole person care’, where the NHS will take responsibility for the whole care of a person, including social care. Local authorities could be well placed to make commissioning decisions, linking up to community leisure clubs, education or housing.

But there’s a feeling that Labour needs yet further a ‘big idea’ which could give them a sustainable margin of a few points ahead of all the other major political parties.

It is quite unlikely that the minimum pricing of alcohol or standard packaging of cigarettes are the hugely populist policies Labour can introduce, not least because of Labour’s dense phobia of offending libertarian sensitivities.

There’s always enough money for an allegedly illegal war, the Chilcot Inquiry or high speed 2. Possibly at the back of the mind of Labour’s voters is a commitment for a well funded NHS and social care system. Paying off PFI loans may not be an enforceable manifesto pledge, but an intention to do something significant about PFI might be hugely popular.

It seems likely too that the general public hate sudden closure of local A&Es and hospital facilities. The public need to be reassured that redesigning of services is not out of a overzealous drive to cut the welfare state, but there are proper mechanisms in place to listen to what patients in the NHS in their locality want.

They say the greatest asset of any organisation are the people within it. Labour can do no harm in listening to nurses, doctors, other healthcare professionals, or even other political parties who might be sympathetic to a socialist approach.

At the moment, it seems that the general public feel that the pendulum has swung too far in the opposite direction, with a keenness to bend over backwards for the benefit of corporates including the pharmaceutical industry.

Labour of course needs space to get its message across, which is difficult with the current media, and it will inevitably need some time. A concerning issue is whether Ed Miliband has left this too late, and what rabbit is pulled out of the hat is a bit anaemic-looking in the event.

Above all, it’s not entirely clear what Labour stands for. Andy Burnham MP and his entire team are undoubtedly doing their best, but being in opposition means that they are not able to get their way on certain issues fully, such as negotiation of the investor protection clauses in the EU-US free trade treaty.

But there are some aspects of policy which Labour does need to distance itself from, such as running the NHS to profit private shareholders rather than providing a comprehensive health service. It needs to lay down markers that it believes the protagonists of competition in the NHS overplayed their hand.

In an ideological vacuum for the Labour Party, many socialists are genuinely concerned that the Labour Party will plump for off-the-shelf corporate policy ‘ready meals’, instead of putting due attention into a carefuly-designed homegrown recipe.

It may have to go as far as forming a spirit of ’45, but this will not be easy. But surviving the last Con-Dem government shouldn’t be in principle worse than surviving the Second World War.

I love GPs

May 7, 2014 6:05 pm / 1 Comment

A blogpost on general practice in the UK would not be complete without a smiling person with a stethoscope, in the same way that all articles on dementia must have wrinkly hands on display.

I have nothing particularly clever to say about primary care at this point.

But have I ever mentioned that I do love GPs?

My regular Doctor, Stuart, whom I virtually always see, knows my medical history backwards. And it’s not for the ‘faint hearted’.

I became physically disabled at the age of 33, during a two month coma, successfully managed on the ITU of the Royal Free in Hampstead.

Stuart knows I am no longer depressed.

Stuart knows I have had no epileptic fits since I gave up drinking alcohol.

Stuart knows I’ve been in recovery from a severe alcohol dependence syndrome for about seven years now. He can do whatever gamma glutaryl transferase levels he wants to look for surrepticious drinking, if he so wishes.

Primary care does intrigue me, as my late father whom I adored was a single-handed GP outside of Brighton for about 30 years. Things have changed a lot. I dare they’re about to be transformed again.

I am also an asthmatic, and therefore I was lapping up all the media missives about being empowered by the NHS.

I craftily got an emergency appointment the same day by phoning up at 8.30 am.

The GP I saw (not Stuart) was excellent.

Admittedly, I gave a perfect history of someone who needed to be stepped up from the British Thoracic Society guidelines for asthma, from inhaled salbutamol to inhaled salbutamol and inhaled steroid.

I left with a prescription for clenil – #happy.

I might have overplayed my hand. At one point, I was dangerously close to being referred for spirometry. “I am a lifelong non-smoker”, I declared emphatically!

Ho hum, but living with various chronic conditions does give me a lot of insight in how the NHS functions behind all the shouting of Westminster.

I moaned on Twitter yesterday that I might have to have my inhaler technique checked to get my prescription for clenil.

A GP educator commented wryly, “We’re in a no-win situation. We’re complacent if we don’t assess you, we’re obstructive if we do.”

Anyway – stet – I love GPs.

Please, if you’re a GP, vote in the RCGP elections. Four of them follow me on Twitter.

For once, I am saying nothing.

Trisha GREENHALGH, Simon GREGORY, Clare GERADA, Mayur LAKHANI, Philip WILLIAMS, Martin MARSHALL, David MUMMERY Joanne REEVE, Steve MOWLE, Clare TAYLOR, John COSGROVE, Stuart SANDERS, Sue RENDEL, Mary LOWTH, John CHISHOLM, Chandra KANNEGANTI, Elaine McNAUGHTON, Martin BRUNET, Hussain GANDHI and Stephanie de GIORGIO.

Some should be very afraid of Thomas Piketty. We may not be all customers of the NHS now.

May 1, 2014 4:54 am / 8 Comments

Let me buy into the ‘Piketty bubble‘ momentarily, in a tenuous discussion of his book ‘Capitalism in the 21st century’ in relation to the National Health Service.

Since the 1980s, a change in terminology began in England.

Patients in the National Health Service became increasingly known as ‘users’, or as ‘customers’. Throw forwards to 2014, and Chuka Umunna in the UK Labour Party proudly boasts ‘we are all capitalists now’.

Cynics might argue that ‘bringing the lowest out of the poverty’ makes everyone into a capitalist, but I probably wouldn’t talk in such strong terms.

There is a clearly a huge public appetite for a frank discussion on ‘inequality’, on how wealth can be accumulated in the very few and how the super-rich are growing ever distant from those of the bottom of the wealth scale.

Piketty argues that for ‘disruptive’ super events such as the Great Depression or World Wars, inequality would have got far worse.

The most solid part of Piketty’s narrative, as I am sure the author himself would himself concede, is the historical part reviewing what happened in the 19th Century.

And yet, even if the super-élite such as Lord Stewart Wood and Tim Livesey of Ed Miliband’s circle don’t want to buy into it public, a fairer re-distributive taxation system appears not to be on the cards.

Such a fair taxation system is the most parsimonious solution to the ‘funding gap’ presented before the NHS. But to the exasperation of right-wing think tanks the NHS ‘sustainability gap’ has been revealed finally as the Emperor’s New Clothes.

The NHS is a system packed full of brilliant minds but who are collectively underfunded.

And that’s also where the narrative of the right-wing think tanks also runs into problems. Much to the annoyance of the same right-wing think tanks, ‘patients’ have not been successfully rebranded as ‘customers’. We might not be all capitalists now.

In fact, it may be more specific than that. ‘Google’ is the new ‘essential utility company': are we all consumers of multinational corporates now?

And this matter creates a further important ideological discussion, reincarnated for modern times.

It was mooted only yesterday by Prime Minister David Cameron that Labour has resisted all successful transfers of resources into the private sector, such as British Telecom or Royal Mail.

Most members of the Coalition governing parties can bring themselves to mention the ‘P’ word with regards to the NHS, especially with the wealth of a few investors who have benefited handsomely from the initial public offering of the Royal Mail having gone up into the stratosphere.

But the idea of wealth being concentrated in the hands of the few private sector operators goes to the heart of the public displeasure of the outsourcing and privatisation of the NHS through the Health and Social Care Act (2012).

That’s because here it is a matter of life or death. In simple terms, nobody wants to live in a society where a child with a rare genetic disorder, such as juvenile metachromatic leukodystrophy, is denied a potentially life-saving treatment, such as bone marrow transplantation, because of an inability to pay.

This argument also reaches another level, when you consider that all the main political parties are gradually converging on the concept of unified personal budgets for health and social care. While ‘top up payments’ appear to have been ruled out, it is uncertain whether this pretence will be kept up for much longer.

Lord Norman Lamont, not known for his intellectual prowess, claimed last night in his skinny dipping into the Piketty bubble that the only way to achieve ‘equality of opportunity’ would be to abolish inheritance tax. This is clearly as ludicrous as saying that the only way to achieve ‘equality of opportunity’ for alternative qualified (private) providers, or economic parity, would be to abolish the NHS. Oh wait.

The promise that the NHS is free, comprehensive and free at the point of need may be in large part correct, but is clearly not wholly true if very expensive treatments, such as the breast cancer drug Kadcycla, are rationed.

Shareholders and directors of large organisations may have a rather different opinion from those carers on zero-hour contracts who literally don’t know whether they’re coming or going.

There is an economic distinction between the ‘inequality’ arguments and the ‘cost of living’ arguments, but the former may indeed more easily adaptable for Ed Miliband’s new political messaging guru David Axelrod.

In terms of the sheer politics, campaigning on inequalities in health service provision is a big win (or “low hanging fruit”); some other, albeit hugely important, public health topics less so.

Indeed, some should be very afraid of the translated Thomas Piketty narrative, not least certain prominent members of the main political parties.

Piketty has helped to show that economics is not a ‘dismal science’, but is profoundly relevant to our society.

And, for that reason alone, we may not be all customers of the NHS now.

Andy Burnham needs a mandate to secure the future of the NHS

March 18, 2014 5:58 pm / 13 Comments

The media are obsessed about making immigration a make-or-break issue for political parties. Column inches are devoted to UKIP totally disproportionately to the number of MPs they actually have.

While George Osborne will squeak his aspirations for hardworking people, ‘putting right what so badly wrong’, the country is less than impressed. He will ask for credit while doing his lap of honour, completely oblivious to the cost-of-living crisis forced upon the British public through unfettered privatisation of public services causing distorted competitive markets. However, Osborne doesn’t understand the distress of disabled human casualties at the hands of ATOS. He is instead obsessed by a race to the bottom which has made insignificant progress in tackling corporate tax avoidance. He has made little progress in the exploitation of workers in zero-hour contracts.

It is said that the civil service are already making plans for a Labour government on May 8th 2015. Anyone who has lived through Lord Kinnock asking ‘Are you all right?’ in the Sheffield Rally of 1992 will know not to count their chickens while they are still in the incubator.

Jeremy Hunt’s strategy of trying to frame Andy Burnham for all the woes of the NHS has spectacularly backfired. Hunt, trapped by the legacy of Lansley’s “Health and Social Care Act” which he dares not mention, gets nostalgic about Mid Staffs in the same way that motorway drivers slow down on the opposite carriageway at the sight of a car crash, but he has offered no constructive solutions about how efficiency savings don’t turn into dangerous staffing cuts. Hunt is also spectacularly lacking in insight as to why NHS whistleblowers don’t appear to be protected, despite all the promises. He talks and acts like somebody who has little experience of how the medical and nursing staff do their professional work and seems unconcerned about citizens losing their local hospitals.

The media have also been given a free run in running down the NHS. Memes such as ‘the NHS is unsustainable’ have gone unchallenged remorselessly, with think tanks known to be sympathetic to private health providers offering impassionate advice. The statement ‘the NHS is unsustainable’ has become dangerously confused with the statement ‘the NHS is underfunded’, with NHS Trusts running a deficit more of a sign of the notion we can’t afford the NHS rather than we’re giving it sufficient resources. Once you frame the narrative in these terms, it gets extremely dangerous for right-wing politicians. The debate no longer is about cutting your coat according to your cloth, a phenomenon clearly familiar to people with low incomes, but instead the debate turns into the people with the higher incomes in society not ‘pulling their weight’. The public seem keen to ‘out’ the nonsense of Osborne’s claim “we’re in it together”. And the right – even though there is no evidence that the left believe the opposite – certainly don’t want to go down the road to looking as if they’re unpatriotly running the country down “because we cannot afford it”.

And of course we are never going to be able to trust the Conservative administration when legislation appears from nowhere to implement a £2.4 bn reorganisation. We seem to be able to afford this, and yet we cannot afford a pay rise for the majority of nurses in the NHS. And if we can’t afford the NHS, how come many Trusts are running the bare minimum of frontdoor staff, while millions are returned unspent to the Treasury? Managers might be fulfilling their four hour target but medical teams in the rest of the hospital are left picking up the pieces over investigations not requested or results not followed up. For many, the economy and the cost of living crisis are huge issues. But the NHS also remains a totemic issue for Labour.

Andy Burnham needs to establish a few basic groundrules. He has pledged to repeal the loathesome Health and Social Care Act, and to remove clause 119 ‘the hospital closure clause’. He definitely needs to pledge to make sure that the NHS is not privatised further under his watch. He needs to be unashamed of securing an adequate level of funding, even despite the neoliberal fetishes of austerity currently.

This might stop ill-informed political commentators from spewing out their corporate memes for the duration of a Labour government. But time is running out – for those of us who wish to protect the NHS, we need to stop looking inwards, but need to start campaigning hard.

Why doesn’t Noel Edmonds buy the NHS?

March 18, 2014 1:00 pm / 2 Comments

In theory, it’s perfectly possible for one person to buy the entire NHS if rich enough.

I suppose HM The Queen could buy the NHS in theory.

Noel Edmonds suddenly popped up in a most unusual interview with Jeremy Paxman last night. He was talking about his ideas to buy the BBC.

In a way, the BBC, despite its fiascos such as the Jimmy Savile Scandal, is a ‘national treasure’. Likewise, the National Health Service is considered to be outstanding, by some, despite noteworthy scandals such as what was happening at Mid Staffs a few years ago.

Edmonds’ language that the BBC is ‘sleepwalking to destruction‘ is reminiscent of Isabel Oakeshott’s complaints about the NHS being ‘unsustainable’ last week.

In a tirade against the NHS, Oakeshott launched an eyewatering gobbledegook compilation of corporate memes on last week’s Question Time, which was as intellectually coherent as a typical response on the Jeremy Kyle show.

Edmonds refuses point blank to say who his ‘like-minded’ allies might be, reminiscent of the corporate veil so readily utilised by private companies utilised in areas of public interest.

The refusal of Jeremy Hunt in legislating for parity in transparency requirements through freedom of information legislation, in comparison to the alacrity with which the Coalition government has legislated on parity of providers in a health ‘market’, has gone from the ridiculous to the sublime.

It also threatens patient safety.

Curiously, as one of Edmonds’ justifications for taking over the BBC, Edmonds cited it would protect some channels from being shelved, and it could likewise get rid of BBC dead-wood.

Nobody in the private sector has ever justified taking over services in the NHS on the grounds that they would be cut in the NHS. That’s because the private sector are interested, whether they concede to it or not, in cherry picking – high volume low cost products and services.

In this conceptualisation, ‘Mr Blobby’ is the TV equivalent of a hernia operation.

One can only wonder how comprehensive Edmonds’ TV output would be: whether it might be more profitable to make lots of Top Gears than ‘Book of the Week’.

And it’s likely that Edmonds’ team will lead on strategic exports, to help with profits. The NHS has yet to identify what its principal export is likely to be.

But Douglas Alexander MP, on the same Question Time, is right.

For whatever reason, successive Conservative governments have emphasised how unaffordable the NHS is. As somebody in the Question Time studio audience rightly pointed out, is it the case that the NHS is unaffordable or unfunded properly?

The NHS is funded out of general taxation currently, and to all intents and purposes many argue that the TV licence is a form of indirect taxation. But they are clearly different funding strategies.

Edmonds admitted, “Oh God No! I hope the BBC’s Charter isn’t renewed.”

Likewise, many have asked for the sacred cow for the NHS to be sacrified.

But – “The NHS will last as long as there are folk left with the faith to fight for it”

The “official top 40″ of my most viewed articles on the SHA website this year

December 31, 2013 12:45 am / 2 Comments

I have done around 200 blogposts for the SHA website this year.

According to the website statistics which we receive, this is the official top 40 of my top viewed websites on the Socialist Health Association blog this year.

Thank you if you’ve read any of my blogposts this year!