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Culture and diversity in living well with dementia
This is a very important chapter to me.
Culture and diversity considerations are hugely pervasive in all of English dementia policy: from the point of timely diagnosis and throughout the course of post diagnostic support.
These are the academic journal references I wish to include in my chapter for my book ‘Living better with dementia: champions for enhanced friendly communities”.
Please do let me know of any initiatives, projects, published papers or reports that you should like me to include in this chapter.
What is listed below is only a start. It does include blogposts, which I intend to include too.
This chapter is of course hugely relevant to global dementia policy.
Aminzadeh F, Byszewski A, Molnar FJ, Eisner M. Emotional impact of dementia diagnosis: exploring persons with dementia and caregivers’ perspectives. Aging Ment Health. 2007 May;11(3):281-90.
Botsford J, Clarke CL, Gibb CE. Dementia and relationships: experiences of partners in minority ethnic communities. J Adv Nurs. 2012 Oct;68(10):2207-17. doi: 10.1111/j.1365 2648.2011.05905.x. Epub 2011 Dec 11.
Bowes A, Wilkinson H. ‘We didn’t know it would get that bad': South Asian experiences of dementia and the service response. Health Soc Care Community. 2003 Sep;11(5):387-96.
Burns A, Mittelman M, Cole C, Morris J, Winter J, Page S, Brodaty H. Transcultural influences in dementia care: observations from a psychosocial intervention study. Dement Geriatr Cogn Disord. 2010;30(5):417-23. doi: 10.1159/000314860. Epub 2010 Nov 12.
Chan WC, Ng C, Mok CC, Wong FL, Pang SL, Chiu HF. Lived experience of caregivers of persons with dementia in Hong Kong: a qualitative study. East Asian Arch Psychiatry. 2010 Dec;20(4):163-8.
Connell CM, Gibson GD. Racial, ethnic, and cultural differences in dementia caregiving: review and analysis. Gerontologist. 1997 Jun;37(3):355-64.
Day A, Francisco A. Social and emotional wellbeing in Indigenous Australians: identifying promising interventions. Aust N Z J Public Health. 2013 Aug;37(4):350-5. doi: 10.1111/1753 6405.12083.
Friedman MR, Stall R, Silvestre AJ, Mustanski B, Shoptaw S, Surkan PJ, Rinaldo CR, Plankey MW. Stuck in the middle: longitudinal HIV-related health disparities among men who have sex with men and women. J Acquire Immune Defic Syndr. 2014 Jun 1;66(2):213-20. doi: 10.1097/QAI.0000000000000143.
Johl N, Patterson T, Pearson L. What do we know about the attitudes, experiences and needs of Black and minority ethnic carers of people with dementia in the United Kingdom? A systematic review of empirical research findings. Dementia (London). 2014 May 22. pii: 1471301214534424. [Epub ahead of print]
Khan F, Tadros G. Complexity in cognitive assessment of elderly British minority ethnic groups: Cultural perspective. Dementia (London). 2013 Feb 21;13(4):467-482. [Epub ahead of print]
Kirk LJ Hick R, Laraway A. Assessing dementia in people with learning disabilities: the relationship between two screening measures. J Intellect Disabil. 2006 Dec;10(4):357-64.
La Fontaine J, Ahuja J, Bradbury NM, Phillips S, Oyebode JR. Understanding dementia amongst people in minority ethnic and cultural groups. J Adv Nurs. 2007 Dec;60(6):605-14.
Lim YY, Pietrzak RH, Snyder PJ, Darby D, Maruff P. Preliminary data on the effect of culture on the assessment of Alzheimer’s disease-related verbal memory impairment with the International Shopping List Test. Arch Clin Neuropsychol. 2012 Mar;27(2):136-47. doi: 10.1093/arclin/acr102. Epub 2011 Dec 23.
Llewellyn, P. The needs of people with learning disabilities who develop dementia: A literature review. Dementia 2011 10: 235-247.
Low LF, Anstey KJ, Lackersteen SM, Camit M, Harrison F, Draper B, Brodaty H. Recognition, attitudes and causal beliefs regarding dementia in Italian, Greek and Chinese Australians. Dement Geriatr Cogn Disord. 2010;30(6):499-508. doi: 10.1159/000321667. Epub 2011 Jan 20.
Manthorpe J, Moriarty J. Examining day centre provision for older people in the UK using the Equality Act 2010: findings of a scoping review. Health Soc Care Community. 2014 Jul;22(4):352-60. doi: 10.1111/hsc.12065. Epub 2013 Aug 17.
McCleary L, Persaud M, Hum S, Pimlott NJ, Cohen CA, Koehn S, Leung KK, Dalziel WB, Kozak J, Emerson VF, Silvius JL, Garcia L, Drummond N. Pathways to dementia diagnosis among South Asian Canadians. Dementia (London). 2013 Nov;12(6):769-89. doi: 10.1177/1471301212444806. Epub 2012 Apr 26.
Morhardt D, Pereyra M, Iris M. Seeking a diagnosis for memory problems: the experiences of caregivers and families in 5 limited English proficiency communities. Alzheimer Dis Assoc Disord. 2010 Jul-Sep;24 Suppl:S42-8. doi: 10.1097/WAD.0b013e3181f14ad5.
Nakanishi M, Nakashima T. Features of the Japanese national dementia strategy in comparison with international dementia policies: How should a national dementia policy interact with the public health- and social-care systems? Alzheimers Dement. 2014 Jul;10(4):468-76.e3. doi: 10.1016/j.jalz.2013.06.005. Epub 2013 Aug 15.
Price E. Coming out to care: gay and lesbian carers’ experiences of dementia services. Health Soc Care Community. 2010 Mar;18(2):160-8. doi: 10.1111/j.1365-2524.2009.00884.x. Epub 2009 Aug 25.
Prince M, Acosta D, Chiu H, Scazufca M, Varghese M; 10/66 Dementia Research Group. Dementia diagnosis in developing countries: a cross-cultural validation study. Lancet. 2003 Mar 15;361(9361):909-17.
Regan JL. Ethnic minority, young onset, rare dementia type, depression: A case study of a Muslim male accessing UK dementia health and social care services. Dementia (London). 2014 May 22. pii: 1471301214534423. [Epub ahead of print]
Rovner BW Casten RJ, Harris LF. Cultural diversity and views on Alzheimer disease in older African Americans. Alzheimer Dis Assoc Disord. 2013 Apr-Jun;27(2):133-7. doi: 10.1097/WAD.0b013e3182654794.
Stokes LA, Combes H, Stokes G. Understanding the dementia diagnosis: the impact on the caregiving experience. Dementia (London). 2014 Jan;13(1):59-78. doi: 10.1177/1471301212447157. Epub 2012 Aug 3.
Sun F, Ong R, Burnette D. The influence of ethnicity and culture on dementia caregiving: a review of empirical studies on Chinese Americans. Am J Alzheimers Dis Other Demen. 2012 Feb;27(1):13-22. doi: 10.1177/1533317512438224.
Werner P, Karnieli-Miller O, Eidelman S. Current knowledge and future directions about the disclosure of dementia: a systematic review of the first decade of the 21st century. Alzheimers Dement. 2013 Mar;9(2):e74-88. doi: 10.1016/j.jalz.2012.02.006. Epub 2012 Oct 24.
Wilkinson, H, Kerr, D, Cunningham, C. Equipping staff to support people with an intellectual disability and dementia in care home settings Dementia vol 4(3) 387–400
The GMC will know what is wrong with their fitness to practice procedures for unwell doctors
The GMC are conducting a review into their ‘fitness to practise’ FTP, procedures.
The independent review into deaths of Doctors who have been on their Register, awaiting FTP, is about to be published soon one hopes.
I have decided to write the GMC a last minute contribution to this consultation.
I am on currently on the Medical Register, having been erased from it in 2006/7. It is beyond reasonable doubt that I was severely ill with an alcohol dependence syndrome.
You’ll get fewer people than me wishing the GMC well, still.
I feel that the support for unwell Doctors in the National Health Service, and any hunger for scalps of Doctors will feed into this.
The question is whether the GMC can fit itself into a wider system of learning from mistakes and also supporting Doctors ‘in trouble’.
I have learnt much from my time, not least becoming into recovery from alcoholism, and being physically disabled for the first time.
But I thought it would be incorrect not for me to make some polite views known. As I say, I wish the GMC well. I am also regulated by the Solicitors Regulation Authority, so I will expect the GMC to obey a new Act of Clinical Regulation if it comes into law pursuant to the English Commission’s proposals.
General Medical Council
3 Hardman Street
Manchester
M3 3AW
Dear Sir
Re GMC Consultation over fitness to practice procedures
It is with interest I have been following your consultation over fitness to practice (FTP) procedures for the medical profession.
I have thus far tried to keep out of these discussions. I myself was only restored to the medical register earlier this year pursuant to a full Medical Practitioners Tribunal Service (MPTS) panel hearing. I can say with all honesty that being returned to your Medical Register was the happiest moment of my entire life. I consider a massive honour to be there now, and indeed became quite tearful taking about it at the recent BMA Careers Fair held in North London a few weeks ago.
My regulation with the General Medical Council (GMC) has been simultaneously ‘the best of times and the worst of times’. I had resisted of commenting on it, because I can hardly been said to have been detached from the processes. But I have gone through the full regulatory loop.
I also have, since my erasure in 2006, re-trained in law, having even obtained a Masters of Law. I feel that proportionality runs like letters through a stick of rock in all the work the legal profession does. Balancing competing interests is what lawyers do. It is what the GMC has done since 1858, reflected as well in your current tagline.
I have also, as explanation, successfully completed a MBA. I decided to study an area called ‘performance management’. I don’t feel this term is particularly helpful, but the discipline has a lot to offer both the legal and medical profession. I had become regulated by the Solicitors Regulation Authority back in January 2011, following a full due diligence procedure.
At the outset, I should wish to apologise for this short note. But I was moved by your current Chair, Prof Terence Stephenson, who told an audience of us at the Practitioners Health Programme in Swiss Cottage, London, that change is totally possible; however, it tends to be ineffective through loud criticism from the sidelines.
That is why I wish to address your concerns head on.
I feel personally my erasure was completely correct. In response to the Chairman of my MPTS panel who asked me whether my time had ‘gone badly’, I disagreed; I said “it was a complete disaster”.
Nearly a year after direction to erasure, in 2007 June I was blue lighted into the Royal Free Hospital. I had a cardiac arrest and epileptic seizure, with a rampant acute bacterial meningitis. I was then kept on life support for six weeks. I became physically disabled. The NHS, though, saved my life.
I have now been in recovery for seven years at least. I do not in any way condone the events which led to my erasure, but in law I believe that ‘but for’ my alcoholism these events would not have happened.
The direction of travel seems pretty clear. Despite a temporary stalling in the response to the English Law Commission, I feel it is likely the proposals for a root and branch reform of clinical regulation will take place shortly. I full support Niall Dickson in this.
Patient safety is paramount. But the balancing of competing interests is not the reputation of Doctors or the reputation of the regulator, but rather the needs of the patients compared to Doctors trying to do their professional work.
It is often forgotten that many Doctors feel mortified if they make a mistake. But the sheer volume of medical mistakes made daily, for example in medication errors, makes it untenable that every doctor who has ever made a mistake should face a tough public sanction.
Furthermore, cracking down too heavily on Doctors in the medical profession is completely countercurrent to the drive to learn from mistakes in the NHS. There should be a learning culture, and in the drive for quality complaints should be acted upon as gold-dust.
I have every confidence that a well respected medical profession will be possible through a well respected GMC. Ensuring high standards in medical profession is not only achieved through regulation. It will only be possible if seniors in the medical profession show leadership as to the skills they wish to see flourish in the health and care sectors.
There is no doubt for me that the investigations process is too long. There are clear ways in which the GMC departs from the standard English law (e.g. regards costs, telling you how long investigations will take, ambiguities in the civil standard of proof of applied). During that time, the mental health of certain Doctors appearing before the GMC will markedly deteriorate due to stress. Low self esteem is a massive problem in people like me who have faced alcoholism or, in the case of others, other substance misuse problems. When you add to this the trial by media which is out of the GMC’s control, the perfect storm can be utterly disastrous.
One of the principal ways in which the GMC departs from the law currently is how there is little emphasis to manage disputes at a local level. Mediation and arbitration is very important under the civil procedure rules of English law, prior to litigation. The GMC approach is adversarial.
I should like enforcement of the current code of conduct, with a view to solving problems rather than publicly sanctioning Doctors as the key priority, to be important. The enforcement of the national minimum wage, for example, has proved problematic, despite it being a very good piece of legislation. Likewise, one can easily argue that requirements for Doctors to express concerns about inadequate resources, or a duty of candour, are already enshrined in the code of conduct, and have been so for many years now.
I mean my short note with complete goodwill. The GMC has an incredibly important function to perform. I am currently under two professional regulators. Since my erasure, I have spent 7 years in recovery, nearly finished five books and graduated in three degrees and one diploma, so rehabilitation is perfectly possible in my view.
As such it’s going to be impossible for the GMC to ‘do outreach’ as regards the health of Doctors. I openly admitted to your MPTS panel that I failed in not putting myself under a GP. I worry about junior Doctors who are worried to seek help over medical issues, because of concerns about their careers. Patient safety is paramount. During time of a lengthy investigation by the GMC, with mental illness not under control, a Doctor due to be appearing in front of you can go from poor health to catastrophic health. They can become in total denial and lack insight.
Whilst I will note why you may not wish to ask about health issues because of various statutory instruments in the English law, one might consider whether it might be proportionate for there to be a ‘middle man’ overseeing sick Doctors. This is essential for separation of powers between the regulator and the regulated. The Practitioners Health Programme and Doctors Benevolent Fund deserve national resourcing. This is not solely an economic case; it is a moral one, I strongly feel.
I trust the GMC will act impressively in response to these demanding issues in due course. Please do not hesitate to contact me should you need to.
Kind regards.
Yours faithfully,
Dr Shibley Rahman
cc [REDACTED]
My own medical career may be over, but the GMC must reform their procedures for sick doctors. Lives depend on it.
One of the ways that the General Medical Council will try to pin you down is if you appear blasé in any sense about your own behaviour, or lack insight into its repercussions.
I have a psychiatrist in West London who oversees my recovery. I am a barn door alcoholic now in recovery. One of the wisest things he has ever said to me is that it is impossible to ignore the distress I caused to friends, family and others. I think about this every day of my life in fact. It has left an indelible trace on Google, which I do not wish to forget. That’s why I have never asked for it to be removed.
I get upset that the BBC considers my tragic case of erasure from the Medical Register as ‘entertainment’. Behind this titillating story was someone who was in massive distress, and to some extent continues to be in distress.
I have learnt the General Medical Council (GMC) is only doing its job. Reports, like the latest damning one by Civitas on how the GMC treats sick doctors badly, come and go. And nothing really changes.
But I remember all too well what happened to me. I repeat that I find my behaviour then, as a different person, disgusting and unacceptable. But things came to a head when I was blue-lighted in at the beginning of June 2007 with an asystolic cardiac arrest which I was very lucky to be resuscitated out of. I then spent six weeks in a coma. I was fighting for my life, with drips, a central line, and the full army of Intensive Care machinery. The Consultant at the Royal Free warned people I was not expected to leave the hospital. I was clearly a very sick man.
My late father came to visit every day when I was learning how to walk and talk again at the National Hospital for Neurology and Neurosurgery. That’s where I had spent six happy months, while healthy, learning about general neurology and dementia. It’s where I developed a lifelong interest in neurodegenerative disease, which pervades through my post-doctoral fellowship at the Institute of Neurology thereafter, my mention in the Oxford Textbook of Medicine, and my own book on wellbeing in dementia.
I am happy now that, having learnt how to walk and talk, I was invited to the Alzheimer’s Association International Conference in Copenhagen last month, and I went to the Alzheimer’s Show in Manchester and London this year. My friends include people living with dementia, and they tell me what’s important in policy now.
I remember though the days of having to hide my name on blogposts or my Twitter account. I remember how I was frightened to show myself in public in the last few years. I remember how my circle of friends completely collapsed, though I am happy with the very small number of very close friends I have now. I still continue to get trolled, like no tomorrow, with words like “Disgusting” and “How do you live with yourself?”
I do also remember how the General Medical Council took years with their investigations. I remember the torrent of newspaper articles explaining how likely it would be I would be struck off. I remember thinking how this was an inglorious end to my ten years training to be a Doctor, a profession which I still feel honoured to have been in once.
But the General Medical Council protracts out their investigations. The GMC never got round to appointing a clinical supervisor (very odd) even though my independent clinical examiners had concluded that I had a severe alcohol problem. So it rumbled on for a few years with my mental health in free fall. Dynamite.
This is extremely risky – dangerous – for the sick doctor. If you lack insight or if you’re in denial you can be finished (as indeed the numbers of people reported to have committed suicide while waiting for their Fitness to Practise sessions show).
I remember how I totally ‘lost it’ in 2005 a year before my final hearing. I had long left a medical job, but I just fell apart while still waiting for my GMC hearing. I went on a massive bender sat alone sobbing into my drink in a pub in Notting Hill very close to Portabello Road, ended up being sectioned, and then was suspended by the GMC.
A year after I was erased, with no job and no family or friends virtually, my life really did take a nosedive. I sat in pubs all day from opening time to closing time. I was done for drunk and disorder offences.
But I woke up after a six week coma, newly disabled, but with a new purpose. I did three books on postgraduate medicine, and I became regulated by the Solicitors Regulation Authority. I have three degrees, my Bachelor of Law, my Master of Law, and my Master of Business Administration, as well as my pre-solicitor training.
I didn’t get very far when I bothered going up to Manchester for my restoration application. The GMC hadn’t bothered to do a basic conflicts session, so the meeting was adjourned after one day. My friend Martin Rathfelder made it to support me. He like Jos Bell and Kate Swaffer are true friends.
It’s a miracle that I didn’t have a relapse being in the City where I had been with my late father, where I was erased, with plenty of bars and restaurants, with plenty of memories. It’s like you’re being set up to fail by the GMC – or else they are incredibly incompetent when it comes to dealing with people with mental health issues.
But I did get as far as asking the panel if I could hold the hearing in public this time. I want to explain to the whole world why and how alcohol destroyed my life, and caused distress to others.
I think the GMC did the right thing in getting rid of me from the medical profession, but I am still bemused why one consultant in West London asked me to sort it out by giving me a phone number of the Priory, did not refer me to Occupational Health, and did not offer me sick leave. I am bemused why various consultants described me as looking dishevelled and alcoholic, and yet allowed me to finish my medical jobs in London, without referring me to Occupational Health. I even ran a number of cardiac arrests successfully, while being allowed to finish that job where the consultants complained some years later, because I had obtained my Advanced Life Support qualification. The practical thing to do would have been to refer me, give me sick leave, assess me, and get me back to work, if conceivably possibly. The alternative was a vindictive complaint, albeit a correct one, years after the event.
By the time I was erased, the GMC had been given five reports from five independent doctors stating clearly that my primary problem was a severe alcoholic dependence disorder, and that I desperately needed help.
I never received this help until the NHS saved my life a year later.
The GMC will wish to ‘win their case’ and I strictly speaking am not allowed to bring any of this up in case it reaks of bitterness.
The GMC opposed my application to explain all this and my recovery in public. The panel rejected the GMC’s case.
In my view, Clare Gerada’s “Practitioner Health Programme” is a necessary lifeline for those are sick Doctors, and who fall under the London jurisdiction.
Prof Gerada is a true inspirational NHS leader.
Needless to say, I’ve never had an alcoholic drink for more than seven years, since my coma. I’m one of those guys who has no off switch after one drink, such that I’ll either end up in A&E or in a police cell.
My case will now be held in Manchester beginning August 20th 2014. If you want to begin to understand how sick doctors cope, or do not cope, please feel to come along.
The case for dementia screening: business case-based or evidence-based?
Dementia screening: what’s the problem?
Whatever your political ideology, you can’t help be aware of the various vested interests at play in society.
Dementia is no different. Evidence-based policy is public policy informed by rigorously established objective evidence. An important aspect of evidence-based policy is the use of scientifically rigorous studies to identify statistically-signfiicant conclusions, capable of improving policy-relevant outcomes. A business case, on the other hand, captures the reasoning for initiating a task. The logic of the business case is that, whenever resources such as money or effort are scarce, they should be in support of a specific business need, such as delivering a financial surplus or profit.
What is “screening for dementia”?
In the UK, physicians have been pretty clear that screening healthy people for disease or risk factors is justified only if there is strong evidence that the benefits outweigh the harms. Primary care, and the media at large, can also help to open up a new market by referral to private health providers of screening services.
The “worried well” have traditionally tend to be natural targets, but it has been mooted recently that convincing someone that he or she “needs” to be screened for dementia is made much easier by the fact that she or she may be very frightened about such a diagnosis (Fox et al., 2013). Indeed, earlier this year, some leading medical practitioners warned that, “private health screening companies are using scare tactics to persuade people to part with their cash.”
Screening for dementia in England has been mooted before publicly, and largely has been driven by politicians rather than academics. Screening is defined as the process of identifying apparently healthy people who may be at increased risk of a disease or condition. They can then be offered information, further tests and appropriate treatment to reduce their risk and/or any complications arising from the disease or condition.
A specific problem to do with dementia is that dementia in fact covers a huge number of different causes with different clinical presentations, so it is not possible that there would be a single one ‘test’ for likely dementia in a person who is still living. Alzheimer’s disease, epitomised by early memory loss, is thought to be, by far, the most common type of dementia worldwide.
Are there any benefits of screening for dementia?
An evidence-based analysis of the likely benefits of treatment is important in any medical specialty. Dr Aseem Malhotra queried recently in the BMJ why an asymptomatic and active former US president, George W Bush, receive a stent after a yearly check up. Malhotra cites that, in economic terms, the average purchasing cost of the machine that works the pump is about £40 000 (a specialist cardiac hospital may buy one or two of these), and the individual pumps come at about £800 a patient. .
For the past few decades, scientists have been trying to identify reliable markers of substances found in the fluid surrounding the brain which might act as a marker of the most common type of dementia, Alzheimer’s disease, long before the onset of dementia. Other groups have desperately been trying to scan the brain to see if they can spot subtle changes in the brain much earlier on the onset of symptoms. Even parking aside the costs of these approaches, the results of these aggressive endeavours in biomarkers and neuroimaging have been poor.
There is no ‘cure’ for Alzheimer’s disease currently. “Cholinesterase inhibitors” constitute a class of drug used for Alzheimer’s disease, but the very modest effects of treatments to improve memory such as the cholinesterase inhibitors have in fact been well known for some considerable time (Holden and Kelly, 2002). At the time of writing this article, these drugs were not shown reliably to slow down the rate of progression in the majority of clinical patients with this disease from any published study.
A mild cognitive impairment (“MCI”) is a clinical diagnosis in which deficits in cognitive function are evident but not of sufficient severity to warrant a diagnosis of dementia (Nelson and O’Connor, 2008). It might be attractive to think that MCI is a preclinical form of dementia of Alzheimer Type, but unfortunately the evidence is not there to back this claim up at present: only approximately 5-10% and most people with MCI will not progress to dementia even after ten years of follow-up (Mitchell and Shiri-Feshki, 2009).
However, it is argued by some that, In terms of service provision, one major issue is that in current systems less than a half of people with dementia have a formal diagnosis made, or contact with specialist services, at any time in their illness (National Audit Office, 2007). Such diagnosis and contact often only occurs late in the illness and in crisis when the opportunities for harm prevention are limited, according to Banerjee and Wittenberg (2009).
Leifer (2003) legitimately asks, “why diagnose a disease in its earliest stages if it cannot be cured?” A compelling reason is provided that patients and their friends or family have the moral right to know their diagnosis. On a practical level, it is reasonable to argue that any potential hazards can be minimised or eliminated (e.g., driving, use of a stove), and education of caregivers regarding the disease and its implications will allow them to adjust and adapt over a longer period of time.
Moral panic
There has been much interest in working out why there has been a sense of ‘moral panic’ about certain public health messages. Dementia has often been presented as an ‘epidemic’ in the media, and Campos and colleagues (2006) believe that part of the answer may lie with overlapping (and often conflicting) set of economic interests among various public health constituencies. They cite that many of the leading obesity researchers who have created the official standards for what constitutes ‘overweight’ and ‘obese’ have also received sizable funding from the pharmaceutical and weight-loss industries.
People with financial interests seek out ways of affecting the social or political climate in which their business-oriented activities can thrive, to create new wealth. Tullock’s (1967) paper in the Western Economic Journal (now Economic Inquiry) is the foundational event in the theory of “rent seeking”. Whether intended or not, the recent “Prime Minister Dementia Challenge” has created a perfect environment for such activities to take place.
Unfortunately, it is completely legal for the companies to offer these screening services, but their promotion of these services contrasts with the stance of the NHS which introduces screening programmes only after a robust review of the evidence against internationally recognised criteria by the UK National Screening Committee (McCartney, 2009). The UK National Screening Committee (“UKNHSC”) is responsible for making recommendations for screening across all clinical areas, including cancer. The last review completed in June 2010 decided that the UKNHSC did not recommend systematic national screening for Alzheimer’s disease in the UK.
This was yet further confirmed only a few months ago in the finding from a systematic review that screening the population for dementia offers no clinical benefits, while potential harms such as the risk of depression, anxiety, stigma or loss of independence remain unexamined in any study the researchers could find (Hawkes, 2013). The study was presented this week at the Alzheimer’s Association International Conference in Boston.
All in it together?
There is now a ridiculous situation where even medics might be ‘divided’ over this issue. While the academic community is pretty consistent in their criticism, there is currently a policy in place for GPs to be paid for meeting targets in tests related to the dementia diagnosis known as “QOF” (currently under review.)
The ‘political drive’ in the UK most famously came under fierce criticism in the BMJ as follows:
Expanding the diagnosis of dementia mostly increases profit for corporations and industries involved with developing screening and early-diagnosis tests, and pharmaceutical and complementary medicines marketed to maintain cognition in old age.
.. The desire of politicians, dementia organisations, and academics and clinicians in the field to raise the profile of dementia is understandable, but we risk being conscripted into an unwanted “war against dementia.
(Le Couter et al., 2013)
The academic community, nonetheless, have possibly played a part in feeding this commercial “market”; they are themselves dependent on financial grants to survive. The ‘Googlescope’, i.e. word searches through Google Scholar within the health-related literature, shows up a remarkably well-ordered increase in the proportion of papers mentioning ‘risk’ over 5-year periods from the 1950s to the present day (Heyman et al. 2009).
Conclusion
In any objective ‘Fact Check’, one cannot perhaps help avoid the conclusion that the case for dementia screening has been business case-led or evidence-based. It is a sad observation that the dementia policy is more to do with the economic, social and political power of vested interests rather than in the hands of experts who know about this field. Hopefully, with time, this mess will resolve itself.
Selected readings
Banerjee S, Wittenberg R. (2009) Clinical and cost effectiveness of services for early diagnosis and intervention in dementia. Int J Geriatr Psychiatry. 2009 Jul;24(7):748-54.
Campos P, Saguy A, Ernsberger P, Oliver E, Gaesser G. (2006) The epidemiology of overweight and obesity: public health crisis or moral panic?Int J Epidemiol, 35(1), pp. 55-60.
Fox C, Lafortune L, Boustani M, Dening T, Rait G, Brayne C. Screening for dementia – is it a no brainer? Int J Clin Pract. 2013 Aug 16. doi: 10.1111/ijcp.12239.
Hawkes N. Systematic review finds no benefits to population screening for dementia.BMJ. 2013 Jul 19;347:f4638. doi: 10.1136/bmj.f4638.
Heyman, B. Alaszewski, A, Shaw, M, Titterton, M. (2009) Risk, safety and clinical practice: health care through the lens of risk. Oxford: Oxford University Press.
Holden, M., and Kelly, C. (2002)) Use of the cholinesterase inhibitors in dementia, Advances in Psychiatric Treatment, 8, pp. 89-96.
Le Couteur DG, Doust J, Creasey H, Brayne C. Political drive to screen for pre-dementia: not evidence based and ignores the harms of diagnosis. BMJ. 2013 Sep 9;347:f5125. doi: 10.1136/bmj.f5125.
Leifer BP. Early diagnosis of Alzheimer’s disease: clinical and economic benefits. J Am Geriatr Soc. 2003 May;51(5 Suppl Dementia):S281-8.
McCartney M. (2012) What companies don’t tell you about screening. BMJ. 2012 Mar 28;344:e2311. doi: 10.1136/bmj.e2311.
Mitchell, A.J., and Shiri-Feshki, M. (2009) Rate of progression of mild cognitive impairment to dementia -meta-analysis of 41 robust inception cohort studies. Acta Psychiatr Scand, 119(4), pp. 252-65.
National Audit Office. 2007. Improving Services and Support for People with Dementia. TSO: London.
Nelson, A.P., and O’Connor, M.G. (2008) Mild cognitive impairment: a neuropsychological perspective, CNS Spectr, 13(1), pp. 56-64.
Tullock, G. (1967) The welfare costs of tariffs, monopolies, and theft. Western Economic Journal, 5(June), 224–232.
CV here
Reconfigure in haste, repent at leisure
Monitor has just announced that it intends to conduct an investigation into the challenges faced by small district general hospitals (DGHs) in their efforts to provide high quality and sustainable care. The regulator is asking for views from patients, providers, commissioners, healthcare professionals and other interested parties.
Even in the ‘neoliberal landscape’, there is a coherent economic argument that smaller DGHs can be more flexible, nimble and resilient in coping with the economic challenges of the NHS, as elegantly described in this recent Health Services Journal article.
District general and smaller hospitals are still populated by Doctors there with approximately at least ten years of medical training under the belt. So the idea that they are offering a second-rate service for the common medical emergencies is a fraudulent one.
Sure, it is possible to frame an argument that you can deliver a ‘mega hospital’ a bit like a “mega dairy“, but the argument that ‘big is more efficient’ is genuinely barking up the wrong tree.
For example, you will always need Doctors, nursing and allied health professional teams to deal with the ‘bread-and-butter’ of the acute medical take. This might include chest pain, acute shortness of breath (including acute severe asthma), acute exacerbation of an inflammatory bowel disease, an acute pneumonia, an acute headache, and so on.
Patients, understandably, wish to get to a local hospital without any fuss, and to be set on course for the correct treatment. They can of course be referred onto specialist centres if need be (for example an acute headache might be a bleed in the brain which requires neursurgical evacuation.)
The irony is that even people who understand markets appreciate that the market is ‘segmented’. It is impossible to address the needs of your ‘customers’, unless you understand what groups of customers desire.
The essential management steps of virtually acute medical emergencies are the same whether or not you happen to be in a district hospital or a large teaching hospital. This is because there is an acceptable standard of treatment of what clinicians would do for patient safety reasons.
For example, if you’re having an acute severe asthma attack, you are almost certainly going to have your treatment as described here on p.62 onwards of the British Thoracic Guidelines on asthma.
Monitor curiously mentions that ‘it does not wish to pre-empt the outcome’. This is extraordinary messaging. If it really really was confident about not pre-empting the outcome, why did Monitor feel to mention it at all?
We all remember David Cameron’s “no more top down reorganisations” pledge at the Royal College of Nursing Congress. The other classic is from August 2007, where Cameron promised a “bare knuckle fight” with the then Prime Minister Gordon Brown, when he launched a campaign to safeguard district hospitals.
There are reasons why one cannot be reassured about what is happening.
Whilst Lewisham won its landmark fight at the Court of Appeal against the Secretary of State for Health this week, it has just been announced that two accident and emergency (A&E) units in London are to be downgraded.
Furthermore, it is reported that fast-track hospital closures through extension of the powers of the Trust Special Administrator, have been tagged onto the Care Bill through an amendment which has received widespread opposition.
And the previous mood music hasn’t been great. For example, in their pamphlet, “Dealing with financially unstable providers”, the King’s Fund stated that:
For a competitive market to work, it is argued that there must be consequences for inefficient providers and those who do not attract patients. Again, this requires a mechanism by which providers that lose business are allowed to fail and exit the market.
The Monitor consultation therefore feels, instead, somewhat like an undertaker doing a ward round on the intensive care unit populated by critically ill patients.
Fundamentally, the problem here is one of equitable access to healthcare in the NHS.
Suppose I offered you a choice between a carton of milk in your local corner shop which you can easily walk to, or from a supermarket five miles away. You can only get to the supermarket by getting in the car. It’s the same carton of milk. Which shop do you prefer?
The issues about ‘access to medicine’ are complex. They are also hugely relevant to what sort of society we want.
It would be a grave error to ignore the views of professionals such as Dr Jonathon Tomlinson, who for example here in the London Review of Books describes a typical surgery of his.
CV here
Making the initial training contract application to the graduate recruitment officer
Different recruiters will have their own ways of assessing these forms. Some look at the holistic nature of the form, more than others. Some require cover letters, but others do not, and such firms put a lot on emphasis on their cover letters. This document is not supposed to provide the substrate of a ‘perfect answer’ for the “marking matrix” used by these firms, but is supposed to provide clues as to the rationale for asking the question in the first place.
Competencies are knowledge and skills statements and not task statements. For example: conducting the meetings is a task. In order to do so, one needs required competency. Therefore, in this case the required competency is the combination of skills to make an agenda, to promote a healthy group process, to resolve conflicts, to manage time etc.
General suggestions
- Be clear in your own mind why you want to join the firm and why you wish to become a commercial lawyer. What is it that really interests you about the work we do? Match what you’ve got to what they’re looking for. Most employers nowadays select against criteria. The more precisely you match them, the harder it is for them to avoid interviewing you! A detailed list of what they’re looking for often comes with the application form but, if not, go systematically through their website or recruitment literature; you may find it especially useful to look at their graduate recruitment pages, especially “what we’re looking for” and any statements of competences or shared values of the firm. Knowing precisely what they want will help you match up your own qualities when you complete the form.
- You’re applying to a commercial law firm so you will be expected to know about the world of business and the issues that affect the firm and its clients. It’s probably worth your while if you identify one or two key business or legal news stories that interest you and follow them for at least a few weeks before the interviews, so you can talk quite broadly about the main issues.
- Take your time. Look at various websites, brochures, careers fairs, presentations, and other online resources like http://www.allaboutcareers.com/ . Time spent preparing is time well spent. It’ll make those “why do you want to work for us?” questions so much easier. With longer forms you may need to break it into chunks, filling the form in over two or three sessions.
- Make it easy for the graduate recruitment officer. Give your answers a clear structure. Directly match the skills they want to your own, using headings if necessary. Think about what sets you apart from other applicants. This is your chance to sell yourself, so use a range of examples from both inside and out of university to highlight your skills and achievements.
- Where’s the evidence? Many applications lack the individuality injected by small bits of specific detail which make them come alive. Give relevant interesting examples - go into detail. Make every effort to include practical examples of when and where you’ve demonstrated the skills they want.
- Don’t be modest. Application forms (and interviews) are all about letting people know what we’re good at.
- Treat it like an exam i.e. answer the question! Recognise a multi-part question and tackle all its parts separately, using sub-??headings or breaking it up into paragraphs. Treat each bit separately – don’t smudge it into a single answer.
- Don’t be afraid of your failures. Application forms can read like an unstinting list of successes. It’s sometimes worth going on to analyse the lessons learned – why did things go wrong, how might you do them differently next time?
- Vary it! Get together a list of examples you might use. You can call on all sorts of things - holidays, summer jobs, flatshares, voluntary work, committees. Then go through the form, considering which example is strongest for each of the answers. Think about the job you’re applying for, and try to use the most relevant examples.
- Don’t overdo the academic. Employers seek rounded individuals, adept in a number of situations, not people whose main experience of teamwork, achievement, challenge and communication comes through their course.
- Attention to detail is a key skill for a lawyer and this starts with your application, so check thoroughly for grammar and spelling errors. his is the number one training contract application mistake to avoid on every recruiter’s list. There are good reasons for this. It is something that can be easily avoided. Quickly pasting your work into a word processor for a grammar and spelling check should get most of the job done. Printing a hard copy and proof reading it, with a pen in hand, will do the rest. Do this when you are completely cold to what you have written, the next morning for example. Making these types of mistakes shows a lack of attention to detail, which is not taken lightly by prospective employers. Given the type of service that Law firms provide to their clients, attention to detail is especially important. Errors in drafted legal documents expose cracks in a firm’s amour of professionalism. You can imagine that a client will then start to question the firm’s competence in other less visible but more important areas. Drafting errors also provide ammunition for the opposite side and their lawyers. In the manoeuvreing that happen during negotiations it is much harder to hold your ground and assert your side of the argument if your work is being questioned for lack of quality.
- Copy and pasting. There are no shortcuts to a well-written and constructed application. Next to spelling and grammar errors, cutting and pasting from other sources is not only a waste of time with applications, but also easy enough to detect. Copying and pasting is often betrayed by inappropriate or incorrect information. Addressing the application to the wrong person or company happens all too often.
? “Give an example of ..”
Competency-based questions often involve you demonstrating these key attributes so really think about the answers you give and explain your examples in full. Examples should have a clear structure to highlight your skills and achievements but remember to answer the question succinctly. If you need help with structure, you may want to think about the STAR technique:
- Situation
- Task
- Actions
- Results
A good way of dealing with this type of question is by using the CAR approach. CAR stands for Context, Action, Result. It helps you to structure your answer as a convincing way. The CONTEXT forms an introduction, describing the scenario you faced, date and place. The ACTION forms the main body and should be the longest part. The RESULT is the conclusion, and, like the introduction, should be quite short.
Other aspects might include:
- Try to give quantifiable results if possible.
- If the result was negative, then say what you learned from the experience, and what you would do differently next time. Sometimes interviewers will ask you about a situation where you were unsuccessful. This is an excellent opportunity to demonstrate how well you learn lessons from failure, but also to demonstrate qualities such as resilience (to bounce back and try again); determination; strength of character (when the going gets tough, the tough get going!); flexibility; initiative; and lateral thinking. There is a saying that “The most successful people have failed the most” as the best way to learn is via your mistakes.
- Don’t go into too much background detail – keep to the point! Often there isn’t enough room to use the CAR approach, but it’s still worth keeping in mind when you prepare your draft answer. Think of the most relevant examples, rather than the most “impressive”.
- Use action verbs to improve your content.
? Background
“[X] has minimum academic requirements, so before completing our application form please give careful consideration to the following questions:
Do you have 3 A levels at grades A, B, B or equivalent? (N.B. Taken in one sitting and NOT including General Studies.
Have you gained or are you realistically expecting to gain a minimum 2.1 honours degree or equivalent?
Have you previously made an unsuccessful application to []?”
? Languages
Multiple languages can be added by selecting the language, and fluency levels.
? Education
Percentage grades are now required for undergraduate and postgraduate subject results. You are required to ensure that your institution details and results are correct. You must include at least one secondary and one undergraduate record (including all results). You are also obliged to provide a complete breakdown of all your grades by subject, obtained during secondary school and university. Please list your all of your GCSEs and A’? Levels or international equivalent.
? “How did you hear about us?”
Various options are given. See also the section on “Firm choice” below.
? Referees
You are normally required to enter details of two employers at least, sometimes one academic and one vocational.
? Other details
Excluding motor offences not resulting in a custodial sentence or disqualification from driving, have you ever had a criminal conviction (including any spent conviction which, by virtue of the Rehabilitation of Offenders (Exceptions) Order 1975, should be disclosed)?
You will need to disclose any criminal convictions anyway if you wish to gain student enrolment with the Solicitors Regulation Authority to do the Legal Practice Course.
Do you have any disability for which you require any assistance for during the selection process?
As well as being a practical point such that “reasonable adjustments” can be made for any assessments you do, including for online assessments, the law firm will be interested in issues of accessibility for the place in which you have your interview/other assessments, or any necessary adjustments (e.g. special lighting, ergonomic chair) consistent with the Equality Act [2010].
? Work experience
Please set out details of your work experience. (Normally 4 + “others”)
Many large solicitors’ firms run formal work experience schemes, generally known as vacation placements. As well as shadowing solicitors and completing small, discrete tasks there may well be presentations about the firm and its work and a number of social events. Unsurprisingly, vacation placements are extremely popular – it can be harder to get onto one than to get a training contract. Most vacation placements will have fixed closing dates. As well as spending time with a solicitors’ firm, other good forms of legal experience include volunteering at a Citizens Advice Bureau or law centre.
? Detailed questions
? Activities, interests, positions of responsibility
Please give brief details of your key non-academic extra-curricular hobbies, activities, leisure interests, highlighting any positions of responsibility whether at school, university or otherwise.
Describe your biggest achievement and/or most demanding position of responsibility you have held to date; why did this achievement stand out for you, and what did you learn from this?
This question is trying to assess how you manage your time. What have you been or are you doing whilst studying at university or Law School? If you are involved with any sporting or charity work tell them all about it - be specific. Talk about what you have done, what contribution that has made and what you gained from your involvement. These activities provide opportunities to develop skills that will be useful at work and your response should show that you understand this. A simple list of things that look good is less important than offering evidence of what you’ve gained from them. If possible, show how your interests have developed your skills, for example in teamwork, business awareness, or communication. Try to show results in terms of objectives set and achieving improvements. These sections are often quite tight, so some say it’s permissible to provide an answer in note form.
? Prizes
Please provide details of any academic prizes, distinctions, skills, scholarships and any other noteworthy achievements. In the case of skills please specify level of proficiency.
Sometimes the question will specify which “level” of your education these refer to, e.g. school, college or university.
? Firm specification
Please explain why you think you are well suited to [], and have chosen to apply to [] for a training contract or vacation scheme placement? why you think you would make a successful trainee?
[X] is a leading UK law firm. How do you think we are distinct from other law firms?
All [X] trainee solicitors are based in our [Y] office. Please give your reasons for choosing to live in or around and train at the [Y] office.
Again this question is trying to determine your commitment to a career and specifically your commitment to their particular law firm. Recruiters look for motivation, commitment and enthusiasm. So, why have you chosen them? Is it because you have spoken to trainees and like the sound of the firm’?s working environment? Have you researched their work and found a specific case / area interesting? Do you have relevant industrial experience? Do you have a language or are from a country that they have clients / offices in? Is there something particular about their training that appeals to you? Show that you have done your research about the firm and that you are genuinely interested in them.
Apparently most law students do extensive research in fact into their choice of firm. It’s also worth noting that @AllAboutCareers and @AllAboutLaw are very helpful in this regard, as well as “The Training Contract Handbook”.
? Career motivation
What qualities do you think you possess to be a successful lawyer in location [X] with [Y]? Which areas of law interest you and why?
Please explain what attracts you to a career as a solicitor at an international business law firm, with reference to other careers that you might have considered and why you chose not to pursue them.
This question tries to determine your commitment to a career in law: the thinking and research you have done about the profession and what you want from a career as a lawyer. Can you demonstrate enough commitment and interest in law to persuade the firm to invest money and time in you for the Graduate Diploma in Law, Legal Practice Course and/or training contract? This may seem an obvious question but do you really know why you want to be a solicitor or barrister – think hard about it, this may be asked at interview.
If you can produce a convincing answer to this question you’re one step ahead. Think about what first sparked your interest in law, or what you like most about it. Maybe being a solicitor was your childhood dream, or maybe it runs in the family. Whatever the case, you need to show that you are passionate about the law. With all the academic requirements and vocational training, becoming a solicitor is a long-term project. To be offered a law training contract you need to show that you have the passion and the drive to see it through to the end.
Be specific in your reasons for choosing a legal career. Have you had any relevant work experience that has helped you to see first hand what a lawyer actually does? Have you had any personal experience of the work of a lawyer – perhaps through family or friends? Even if you have done pro bono in a law centre or a CAB, has this experience been useful in you understanding generic skills such as teamwork, communication or meeting deadlines? Has your law course or degree furthered your interest and commitment to law? Have you developed a substantial interest in access-to-justice? Have you had any relevant experience that has developed skills that would be easily transferable to a career as a lawyer?
The work of solicitors is more varied than you might think. There are a number of different settings in which solicitors work, for example commercial, private or in-house practice. You should be aware of the differences between the various settings, but if you’re not, do some research. Find out about the kind of role you might find yourself in if you were to go for commercial practice, for example. Is this what you hoped for when you embarked upon your law studies? If not, look into the other options. Being aware of your preferences is vital when choosing a firm with whom you want to carry out your training. Not only will it make what you learn more worthwhile, but you will find it easier to choose a firm. The firm will also find it easier to choose you.
For most training contract applicants, the choice boils down to the simple question: “Do I work in London, or do I work for a local regional firm? This is something of a personal choice, with implications that will affect your quality of life and your career. The largest firms are based in London and the legal market which circles the capital’s financial services industry is one of the most lucrative in the world. This translates into higher average pay packets for London solicitors. Aside from the careers benefits to choosing London, trainees can enjoy all the social and cultural activities that the cosmopolitan city has to offer. However, the cost of living is higher in London and you will have to content with the traffic and rush hour crushes on the tube. Working hours are often longer at London firms and you may find a more attractive work-life balance at firms outside of the capital. The choice, as always, is yours.
? Commercial awareness
Identify a current commercial article that you read or a recent event from the business world which has attracted your attention recently. Why do you consider it to be significant? Who are the key stakeholders in this situation and what are the implications for those concerned?
Business acumen and commercial awareness are important elements to becoming a successful solicitor. Please outline, in your opinion, why you think this would be important and tell us about a time when you’ve demonstrated your abilities in this area. What was the occasion and what impact did possessing this awareness have over the final outcome?
Choose a sector group of the firm and summarise the biggest challenges and opportunities they will face in the future.
Commercial awareness is something that firms almost without exception mention as a desirable quality. Commercial awareness is generally defined as a candidate’?s general knowledge of business. It can be summed up as an interest in business and an understanding of the wider environment in which an organisation operates: its customers and competitors. For corporates, this is about establishing “competitive advantage”, and it’s often interesting to work out how companies enter new markets (especially the BRIC emerging economies), and what barriers there might be for companies competing effectively in critical markets.
Commercial awareness generally means an understanding of a client’?s business and the industry or sector in which it operates. It is a key competency for applicants. It involves not only keeping up to date with commercial issues and it is also about being able to demonstrate commercial awareness through any business/work experience and, specifically, the applicant’s understanding of the type of firm to which they are applying. Clients seek business solutions, presented in a way that makes sense. An understanding that a law firm operates in a competitive industry is also considered as being commercially aware.
As a result you may be expected to demonstrate an understanding as to how the firm or chambers markets itself to its clients. To know who the firm’s main competitors are. To explain how you would attract a potential client by explaining the unique selling points of the firm (USPs). For example, if you’re applying to a foreign firm, it’s not inconceivable you could be asked who the major players are in that particular market (e.g. the US market). In addition to this you will be expected to know about the practice areas in which the firm or chambers operate and to be aware of key changes in legislation and the economic market which may affect the way in which they operate.
Have you done a LL.M. in international commercial law where you might have gained important experience in drafting or case analysis in this particular field of law? Have you even done a M.B.A. where you have studied business management in great detail? You could also think about participating in any student societies where you are doing the GDL or LPC – these are very active the vast majority of “learning providers”.
Mention any business/commercial experience you have had, including non-legal work and/or roles which involve dealing with clients or members of the public. Have you ever been a Director of a private limited company yourself? This can highlight your awareness of customer needs and expectations. Were you ever given the task of improving a current service or product? Did you add value to it? If so, how did you go about it, what factors did you have to take into consideration? Are you able to identify the long term and short term goals of an organisation or a project?
Thinking in terms of a SWOT (the strengths, weaknesses, opportunities and threats) analysis of the firm or legal sector can be helpful.
Did you have a key role in any society committees at school or university? Were you given a financial role? Any of these can be good indicators that you have had to think about different perspectives in the market place.
Have you ever raised money for a charity, secured sponsorship for an event? What process did you go through to secure the funds? Read the business press regularly. Try to know something about current leading stories/issues, and how they might have an impact on the firm’s clients. Look out for stories that will affect the firm to which you are applying, or its clients, directly or indirectly.
Look at the BBC news and business website. Read also publications like the Financial Times, the Economist, and The Lawyer. There are business related programmes on BBC Radio which are also available to listen again on-??line and as podcasts such as:
The Bottom Line (with @EvanHD) http://www.bbc.co.uk/podcasts/series/bottomline “Insight into business from the people at the top. Evan Davis meets influential business leaders for a round table conversation about the issues that matter to their companies and their customers.”
? Proactivity
Describe an occasion when you spotted an opportunity to make an improvement in ‘going the extra mile’, and took action without being asked to do so. What steps did you take? What was the outcome? Explain why you think this attribute is relevant for a solicitor.
This question is testing your problem solving ability. Detail what the issue was, why it was difficult and then what you did to resolve it. If you are talking about a group activity, do not put ‘?we‘? - they are interested in what you did. As with all your answers use this question to differentiate yourself i.e. make it personal and substantiate what you say with specific examples.
Aspects of a good answer might be as follows.
- Use initiative to act on opportunities. Become a leader before other people view you as one. Healthy organisations often reward those who take the lead, not just those with formal management roles.
- Take responsibility for own objectives: set priorities. Display a “?can do“? attitude even in demanding situations. Try to solve problems, rather than to pass them on to other people.
- ?Go the extra mile? when asked to do tasks. Go beyond your job description. Do work that gets you noticed. Show enthusiasm: this will be noticed and you will eventually be rewarded.
- Take ownership of problems: anticipate potential problems, take pre-emptive action and act quickly to resolve problems. Develop innovative practices. Value innovative thinking.
- Learn new skills that will enhance capability.
? Flexibility
Describe a time that you have had to change your approach to a project or task halfway through. What changes did you have to make? Why did you need to make these changes? What was the outcome?
This means that you are able to modify your approach to achieve a goal, and you are open to change and new information; you can rapidly adapt to new information, changing conditions, or unexpected obstacles. Legal recuiters are often looking for the following aspects.
1. Values need for flexibility:
- Accepts that other people’s points of view are reasonable or valid.
- Acknowledges that people are entitled to their opinions, and accepts that they are different.
- Steps into colleagues’ tasks when needed or required.
2. Demonstrates flexibility:
- Works creatively within standard procedures to fit a specific situation.
- Understands policies and can work within them to meet office, work group, team or individual goals.
3. Adapts approach:
- Changes one’s approach as required to achieve intended outcomes.
- Prioritises actions effectively in order to respond to numerous, diverse challenges and demands.
4. Adapts strategy:
- Changes the overall service plan and implements new practices when original approach and assumptions are no longer valid.
- Able to shift strategic focus and activities quickly in response to changing organisational priorities.
? Teamwork
Teamwork is considered crucial to functioning well as a trainee/junior in a corporate law firm.
Please give an example of a situation where you were required to work in a team to accomplish an important objective and describe your role in achieving this objective.
A law student who is good at teamwork might:
- Believe that working together with others or in teams gives higher synergies to self and the teams, and therefore is positive and enthusiastic about teamwork and team building.
- Contributes significantly when working as a member of a team or when working as a team leader to build a strong team; respects all the members of the team and cooperates with every team member and the team leader.
- Provides help and support to those team members who are in need of help and support, and shares relevant knowledge and information with all the team members including the team leader.
- Maintains the required level of communication in terms of quality, quantity and timeliness with the team members and the team leader.
- When working as a team leader, facilitates developing team goals with team members’ participation.
- Motivates the team members while working as a leader of the team or even when working as a member of the team, building up high team morale; creates a sense or feeling of cohesiveness among the fellow members.
- Is good at resolving the conflicts that might arise due to diverse personalities of various team members.
- When the members seem to err from the shared mission, goals and priorities, brings them back on the desired focus.
- Seeks for each and every member’?s active and enthusiastic participation all the time and accordingly motivates the members who seem to be getting disinterested or tuned out from time to time.
- Makes every member feel that each one’?s work or contribution is equally important.
- Shares credit for success of team with all the others in the team.
- Celebrates the team’?s success together with all the others in the team.
- Makes sure that the various teams do not become islands in themselves and form unnecessary boundaries around them.
? Defining qualities of the candidate
What can you tell us about yourself that sets you apart from other applicants, and which are convincing reasons why we should recruit you?
In a sense, your answer to this question is to some extent governed by your personal qualities not covered elsewhere in the form. Here are some further competences which might be relevant here.
Integrity
A trainee will be expected to upholds the principles of the current SRA Code of Conduct. Some aspects might include:
- Holds to a laudable value structure all the time and in all the situations.
- Practices integrity while dealing with everyone and therefore is regarded as trustworthy person.
- Does not turn and twist the information to gain something or to score a point in an underhand manner.
- Uses confidential information confidentially. Does not divulge the confidential information even under any pressure.
- Does not indulge in any kind of corruption or corrupt practices.
- Motivates others to practice integrity by being an example to others.
Leadership
Some aspects might include:
- Can envision the advancement and growth opportunities.
- Possesses abilities for high degree of conceptualization, strategising and analysis.
- Demonstrates high achievement orientation. Therefore, emphasises commitment, accountability, action orientation and results.
- Adept at interpersonal relationships and puts emotional intelligence in action.
- Excellent communicator.
- Uses his excellent influencing skills for bringing out the desired consensus, decisions and actions.
- Very good at decision making processes and once decisions are reached, displays firmness and decisiveness in implementation.
- Displays required flexibility and adaptability in different situations and times.
- Is great team builder and team player. Provides necessary support and cooperativeness.
- Possesses high commercial awareness and business acumen.
- Develops many next line leaders.
? Communication skills
All solicitors at [X] work with a wide range of people so need to be able to persuade, influence and display effective communication skills. Describe a situation when you have had to communicate effectively.
You should think of various forms of effective communications, e.g. oral presentations, written papers, written papers, drafting, interviewing or advising (on the LPC), practical legal research (on the LPC), blogging, participating in podcasts, and how you have adapted your method of communication according to the target audience. Your answer is bound to be more compelling if you can give concrete examples. Some related specific competences are given as below.
Persuasion
One scenario where persuading skills can be important is the job interview, but the following tips are valuable in many other settings.
- Focus on the needs of the other party. Take time to listen to them carefully and find out about their interests and expectations. This shows that you are really interested in them and they are then more likely to trust and respect you. It will also make it easier for you to outline the benefits of your proposal in terms they understand.
- Argue your case with logic. Do careful research on your ideas and those of your competitors (if there are any) and make sure that any claims you make can be verified.
- Use positive rather than negative language: instead of saying “?You’?re wrong about this”?, say “?That’?s true but ….”?, “?That’?s an excellent idea, but if we look more deeply …..”? or “?I agree with what you say but have you considered ….”?.
Listening
Some aspects might include:
- Believes that listening strengthens the quality of communication, interpersonal relations, human relations, emotional intelligence, conflict management and team management.
- Every interaction requires one to respond and since the quality of response depends on the quality of listening, tries to improve quality of his listening constantly.
- Thus, listens to understand the other person and not just to react, reply, control or manipulate the other person. By understanding the other person properly, can respond or act in the best possible manner.
- Generally respects other people and demonstrates openness and trust through his body language and spoken words.
- Then, paves way to influencing the people in right directions by diagnosing the issues and concerns of others in a better way for effective problem solving.
- Promotes a more participative style of managing by involving people.
? Conflict and pressure
The success of [X] is built on the self-motivation and applied effort of all its employees, as demonstrated by their ability to work through setbacks coping effectively with conflict and pressure. Describe a situation when you have had to deal with conflict and pressure. Which other people involved? What did you learn about yourself?
Some aspects might include the observations that the law student:
- Recognises the fact that conflicts are quite natural in any organization and yet these need appropriate redressing to move on with apt solutions, thereforeis willing to take up the responsibility of managing and resolving the conflict.
- Can think through clearly in a conflicting situation.
- Keeps his eyes constantly on the desired goals and therefore, does not drift away from them despite conflicting arguments and points of views.
- Listens well and patiently all the conflicting arguments and presentations.
- Controls the people and their communication patterns in the discussions that takes place when resolving a conflict.
- Facilitates the innovative and creative thinking of the people caught up in the conflict.
- Does not take sides of any particular set of people or their thinking. Rather, tries to facilitate working out genuinely appropriate and optimal solutions.
- Contributes his own inputs, ideas, creativity and analysis to supplement the missing or erroneous information and thus uncover the real issues and reasons that led to the conflict. Then proceeds to help find the answers.
- Gains agreements without leaving behind any bitter taste or disrupting the human relationships.
- Is proactive and as far as possible anticipates the conflicting situations and dissolves them well before they turn into conflicts.
? Commitment to excellence
Describe an occasion when you have demonstrated commitment to a task or project that resulted in you exceeding expectations either for yourself or others. What steps did you take? What was the outcome?
You will be able to achieve the excellence in any skill or competency only if you rehearse or practice the learned skill a large number of times. Knowledge alone is no guarantee for achieving great levels in skills or competencies. For example, only if you start swimming, you will become a swimmer; mere knowledge of swimming or great theories of swimming will not automatically make you even an ordinary swimmer. Knowledge surely helps and is a must but without doing, it is of no use to you. Implementation of knowledge is the name of the game. Wisdom is in knowing what to do and how to do but the virtue is doing it.
It’s said that you should become both consciously and unconsciously competent in your strive for excellence. Consciously competent means gaining the knowledge about the skill to be mastered and begin practicing the knowledge gained (example: gaining knowledge on how to swim using proper styles of swimming and start swimming using the right styles of swimming). On the other hand, unconsciously competent means keep practicing the knowledge gained till you gain mastery in the skill (example: you have now become an expert swimmer since you have been swimming using the proper styles of swimming over number of hours and you can now give yourself 9 on 10 or even 10 on 10). For greater success in life, you should try to reach the unconsciously competent level in the skills required by you for your professional, personal, family and social activities/tasks/projects.
? Personal challenge
Describe a significant challenge that you have faced outside of your academic studies ideally from the last 2 years. How did you initially analyse the challenge? What approach did you take to solving it? What did you learn from this challenge?
- Successful answers to these sorts of questions need to be as concrete as possible. Supply specific detail on the situation, the actions taken and the results achieved. Figures can be particularly useful in this context.
- Your example need not be very “significant”. Go for something you genuinely believe to be a real achievement rather than give them something you think they want to hear - it’ll be more convincing. The important thing is to set it in context. Explain why it was significant to you - if you’re unsporty, uncoordinated and broke your leg six months previously, learning to stay upright while sliding a few hundred metres downhill may well have been a major achievement.
- A useful device is the Trojan horse technique, which allows you to smuggle in other examples as in “ I considered selecting one of several achievements, including x and y. However I have chosen z because…....”
Aspects of a convincing answer might include the following.
1. Recognises Lack of Success:
Acknowledges areas where expectations are not met, and provides reasons which may or may not involve self.
2. Remains Positive:
Re-energises after loss or failure or after encountering a significant hurdle to readdress the situation and to overcome it; approaches new situations with continuing positive outlook, despite previous disappointments.
3. Takes Responsibility:
Acknowledges personal responsibility for outcomes, even when not all elements of a situation are within direct control but could have been personally managed.
4. Learns from Mistakes and Successes:
Analyses situations on an ongoing basis to improve own performance; designs a personal action plan to address own issues constructively and decisively.
5. Shares Learning with Team:
Deals openly with failure by bringing team together to define specific problems and present solutions; may involve team in diagnosis and in developing solutions to effectively transfer knowledge into the organisation.
? Mitigating circumstances
Are there any important mitigating circumstances why you feel the exam results you have listed do not fully reflect your abilities?
There may be good reasons why you ‘underperformed’, due to recent bereavement, or illness and disease, and these should be set out with reference to documentary evidence where possible.
Additional information
If applicable, please state any additional information which you think is relevant and supportive to your application or which you think has not been covered adequately in this form.
This is a good opportunity to do precisely that!
I did at least predict the winner of the Eurovision Song Contest 2013
This was the final results scorecard for last night’s Eurovision Song Contest:
- Denmark: Emmelie de Forest, Only Teardrops – 281 points
- Azerbaijan: Farid Mammadov, Hold Me – 234 points
- Ukraine: Zlata Ognevich, Gravity – 214 points
- Norway: Margaret Berger, I Feed You My Love – 191 points
- Russia: Dina Garipova, What If – 174 points
- Greece: Koza Mostra feat. Agathon Iakovidis, Alcohol Is Free – 152 points
- Italy: Marco Mengoni, L’Essenziale – 126 points
- Malta: Gianluca, Tomorrow – 120 points
- Netherlands: Anouk, Birds – 114 points
- Hungary: ByeAlex, Kedvesem – 84 points
- Moldova: Aliona Moon, O mie – 71 points
- Belgium: Roberto Bellarosa, Love Kills – 71 points
- Romania: Cezar, It’s My Life – 65 points
- Sweden: Robin Stjernberg, You – 62 points
- Georgia: Nodi Tatishvili and Sophie Gelovani, Waterfall – 50 points
- Belarus: Alyona Lanskaya, Solayoh – 48 points
- Iceland: Eythor Ingi, Eg a lif – 47 points
- Armenia: Dorians, Lonely Planet – 41 points
- UK: Bonnie Tyler, Believe In Me – 23 points
- Estonia: Birgit, Et uus saaks alguse – 19 points
- Germany: Cascada, Glorious – 18 points
- Lithuania: Andrius Pojavis, Something – 17 points
- France: Amandine Bourgeois, L’enfer et moi – 14 points
- Finland: Krista Siegfrids, Marry Me – 13 points
- Spain: ESDM, Contigo hasta el final – 8 points
- Ireland: Ryan Dolan, Only Love Survives – 5 points
And here’s how I voted, only on the basis of listening to 10 seconds of each:
1 Denmark 12
2 Iceland 10
3 Germany 8
4 Azerbaijan 7
5 Finland 6
6 Russia 5
7 Latvia 4
8 Malta 3
9 Austria 2
10 Belarus 1
11 Switzerland
12 Ireland
13 Georgia
14 United Kingdom
15 Norway
16 Sweden
17 Italy
18 Moldova
19 Spain
20 Lithuania
21 Albania
22 France
23 San Marino
24 Croatia
25 Israel
26 The Netherlands
Outsourcing, NHS, and the “modern anomie”
Jon Cruddas recently gave a progress report on how the evolution of ‘One Nation’ policy was going, In an article by Patrick Wintour published yesterday, Cruddas describes a ‘modern anomie’, a breakdown between an individual and his or her community, and alludes to the challenge of institutions mediating globalisation. Cruddas also describes something which I have heard elsewhere, from Lord Stewart Wood, of a more ‘even’ creation of wealth, whatever this means about the even ‘distribution’ of wealth. One of the lasting legacies of the first global financial crisis is how some people have done extremely well, possibly due to their resilience in economic terms. For example, it has not been unusual for large corporate law firms to maintain a high standard of revenues, while high street law has come close to total implosion in some parts of the country. In a way, this reflects a shift from pooling resources in the State to a neoliberal free market model.
The global financial crash did not see a widespread rejection of capitalism, although the Occupy movement did gather some momentum (especially locally here in St. Paul’s Cathedral). It produced glimpses of nostalgia for ‘the spirit of ’45”, but was used effectively by Conservative and libertarian political proponents are causing greater efficiencies. Indeed, Marks and Spencer laid off employees, in its bid to decrease the decrease in its profits, and this corporate restructuring was not unusual. A conservative and a libertarian have several things in common, the most important is the need for people to take care of themselves for the most part. Libertarians want to abolish as much government as they practically can. It is thought that the majority of libertarians are “minarchists” who favour stripping government of most of its accumulated power to meddle, leaving only the police and courts for law enforcement and a sharply reduced military for national defence. A minority are possibly card-carrying anarchists who believe that “limited government” is a delusion, and the free market can provide better law, order, and security than any goverment monopoly.
Essentially a libertarian would fund public services by privatising them. In this ‘brave new world’, insurance companies could use the free market to spread most of the risks we now “socialise” through government, and make a profit doing so. That of course would be the ideal for many in reducing the spend on the NHS, to produce a rock-bottom service with minimal cost for the masses. And to give them credit, the Health and Social Care Act was the biggest Act of parliament, that nobody voted for, to outsource the operations of the NHS to the private sector, which falls under the rubric of privatisation. Outsourcing is an arrangement in which one company provides services for another company that could also be or usually have been provided in-house. Outsourcing is a trend that is becoming more common in information technology and other industries for services that have usually been regarded as intrinsic to managing a business, or indeed the public sector.
Many expected the election of the present government to herald a more determined approach to outsourcing public services to the private sector. Initially came the idea of the “big society”, with its emphasis on creating and using more social enterprises to deliver public services, but the backers for this new era of venture philanthropism were not particularly forthcoming. The PR of it, through Steve Hilton and colleagues, was disastrous, and even Lord Wei, one of its chief architects, left. No one in the UK likes the idea of domestic jobs moving overseas. But in recent years, the U.K. has accepted the outsourcing of tens of thousands of jobs, and many prominent corporate executives, politicians, and academics have argued that we have no choice, that with globalisation it is critical to tap the lower costs and unique skills of labor abroad to remain competitive. They argue that Government should stay out of the way and let markets determine where companies hire their employees. But is this debate ever held in public? No, there was always a problem with reconciling the need for cuts with an ideological thirst for cutting the State. Unfortunately, cutting the State was cognitively dissonant with cutting the ‘safety net’ of welfare, which is why the rhetoric on scroungers had to be ‘upped’ in recent years by the UK media (please see original source in ‘Left Foot Forward’). And so it came to be, the Compassionate era of Conservatism came to pass.
Here in the UK, in 2010, the government indicated that it wanted to see new entrants into the outsourcing market, and the prime minister visited Bangalore, the heart of India’s IT and outsourcing industry, for high profile meetings with chief executives of companies such as TCS, Infosys, HCL and Wipro. Nobody ever bothers to ask the public what they think about outsourcing, but if Gillian Duffy’s interaction with Gordon Brown is anything to go by, or Nigel Farage’s baptism in the local elections has proved, the public is still resistant to a concept of ‘British jobs for foreign workers’. However, it is still possible that the general public are somewhat indifferent to screw-ups of outsourcing from corporates, in the same way they learn to cope with excessive salaries of CEOs in the FTSE100. The media have trained us to believe that unemployment rights do not matter, and this indeed has been a successful policy pursued by the Conservatives and Liberal Democrats. People do not appear to blame the Government for making outsourcing decisions, for example despite the fact that the ATOS delivery of welfare benefits claims processing has been regarded by many as poor, the previous Labour government does not seem to be blamed much for the current fiasco, and the current fiasco has not become a major electoral issue yet.
And the list of screw-ups is substantial. G4S – the firm behind the Olympic security fiasco – has nowbeen selected to support the Police Service of Northern Ireland at the G8 Summit next month. Despite the company’s botched handling of the Olympics Games contract last summer, G4S has been chosen to supply 450 security staff for the event at Lough Erne, County Fermanagh The leaders of the world’s eight wealthiest countries are expected in Fermanagh on June 17 and 18. Meanwhile, medical assessments of benefit applicants at Atos Healthcare were designed to incorrectly assess claimants as being fit for work, according to an allegation of one of the company’s former senior doctors has claimed. Greg Wood, a GP who worked at the company as a senior adviser on mental health issues, said claimants were not assessed in an “even-handed way”, that evidence for claims was never put forward by the company for doctors to use, and that medical staff were told to change reports if they were too favourable to claimants. Elsewhere, Scotland’s hospitals were banned from contracting out cleaning and catering services to private firms as part of a new drive towards cutting the spread of deadly superbugs in the NHS. There were 6,430 cases of C. difficile infections in Scotland in one year recently, of which 597 proved fatal. The problem was highlighted by an outbreak of the infection earlier this year at the Vale of Leven hospital in Dunbartonshire which affected 55 people. The infection was identified as either the cause of, or a contributory factor in, the death of 18 patients.
Whatever our perception of the public perception, the impact on transparency and strong democracy merit consideration. As we outsource any public service, we appear to risk removing it from the checks and balances of good governance that we expect to have in place. Expensive corporate lawyers can easily outmanoeuvre under-resourced government departments, who often appear to be unaware of the consequences, and this of course is the nightmare scenario of the implementation of the section 75 NHS regulations. Even talking domestically, Where contracts privilege commercial sensitivities over public rights, they can be used to exclude the provision of open data or to exempt the outsourcer from freedom of information requests. Talking globally, “competing in the global race” has become the buzzword for allowing UK companies to outsource to countries that do not have laws (or do not enforce laws) for environmental protection, worker safety, and/or child labour. However, all of this is to be expected from a society that we are told wants ‘less for more’, but then again we never have this debate. Are the major political parties afraid to talk to us about outsourcing? Yes, and it could be related to that other ‘elephant in the room’, about whether people would be willing to pay their taxes for a well-run National Health Service, where you would not be worried about your local A&E closing in the name of QUIPP (see this blogpost by Dr Éoin Clarke). Either way, Jon Cruddas is right, I feel; the ‘modern anomie’ is the schism between the individual and the community, and maybe what Margaret Thatcher in fact meant was ‘There is no such thing as community’. If this means that Tony Blair feels that ‘it doesn’t matter who supplies your NHS services’, and we then get invasion of the corporates into the NHS, you can see where thinking like this ultimately ends up.
A response to Tony Blair's "advice" this morning
This is a response to “Labour must search for answers and not merely aspire to be a repository for people’s anger”, by Tony Blair, published in the New Statesman on 11 April 2013.
Fundamentally, Blair is right in that Labour cannot merely be a conduit for ‘the protest vote’, but the issues raised by heir to Thatcher are much more than that to me. Blair argues that, “the paradox of the financial crisis is that, despite being widely held to have been caused by under-regulated markets, it has not brought a decisive shift to the left.” I am not so sure about that. Whilst I have always felt the taxonomy of ‘left’ versus ‘right’ largely unhelpful in British politics, I think most people in the country today share views about bankers and the financial services ‘holding the country to ransom’ (like the Union Barons used to be accused of), the failures of privatisation, the failures in financial regulation (PPIs), for example, which might have been seen as ‘on the left’. Tony Blair had a good chance of coming to power in 1997, and ‘the pig with a Labour rosette might have won at the 1997 General Election’ is not an insubstantial one. To ignore that there has been no shift in public opinion is to deny that the political and social landscape has changed to some degree. Whilst ‘South Shields man’ is still living with the remants of the ‘socially divisive’ Thatcherite government, what Michael Meacher MP politely called yesterday “a scorched earth approach”, voters are indeed challenging flagship Thatcherite policies even now.
Some Labour councillors and MPs did indeed embrace the ‘right to buy’ policy, but likewise many MPs of diverse political aetiology warn about the currentcrisis in social housing. Blair is right to argue, “But what might happen is that the left believes such a shift has occurred and behaves accordingly”, in the sense that Ed Miliband does not wish to disenfranchise those voters who did happen to embrace New Labour pursuant to a long stretch of the Conservative sentence, but we have a very strong danger now of disenfranchise the core voters of Labour. They are rightly concerned about workers’ and employees’ rights, a minimum wage (a Blair achievement), and a living wage (possibly a 2015 manifesto pledge by Ed Miliband.) Nobody wants to re-fight the battle of ‘left’ and ‘right’ of those terms, but merely ‘building on’ the purported achievements of Margaret Thatcher has to be handled with care.
Blair further remarks: “The Conservative Party is back clothing itself in the mantle of fiscal responsibility, buttressed by moves against “benefit scroungers”, immigrants squeezing out British workers and – of course – Labour profligacy.” Of course, Blair does not address the growth of the welfare dependency culture under Margaret Thatcher, but this is essential. Blair has also airbrushed the core of the actual welfare debate, about ensuring that disabled citizens have a ‘fair deal’ about their benefits, but to his credit addresses the issue of pensions in his fourth question. However, Blair falls into the trap also of not joining up thinking in various arms of policy, in other words how immigrants have in fact contributed to the economy of the UK, or contributed essential skills to public services such as the National Health Service. This is indeed a disproportionate approach to immigration that was permeating through the language of Labour ministers in immigration towards the end of their period of government. Blair fundamentally wishes to fight this war – indeed battle – on his terms and Thatcher’s terms. This is not on – this debate is fundamentally about the divisive and destructive nature of policy, of pitting the unemployed against the employed, the disabled against the non-disabled, the immigrant versus the non-immigrant, and so on. Part of the reason that Thatcher’s entire hagiography cannot be a bed of roses is that there exists physical evidence today of this ‘divide-and-rule’ approach to leadership.
Blair, rather provocatively at this stage, refers to the ‘getting the house in order’, which is accepting the highly toxic meme of ‘A Conservative government always has to come in to repair the mess of a Labour government spending public money it doesn’t have.’ However, the economy is in a worse state than bequeathed by Labour in 2010, and therein lies the problem that the house that the Tories ‘is getting in order’ is in fact getting worse. Acknowledgement of this simple economic fact by Blair at this juncture would be helpful. Blair’s most potent comment in the whole passage is: “The ease with which it can settle back into its old territory of defending the status quo, allying itself, even anchoring itself, to the interests that will passionately and often justly oppose what the government is doing, is so apparently rewarding, that the exercise of political will lies not in going there, but in resisting the temptation to go there.” Like all good undergraduates, even at Oxford, this depends on what exactly Blair means by the “status quo” – the “status quo” is in Thatcherism, and the “greatest achievement” of Conservatism, “New Labour”, so a return to listening to the views of Union members, ahead of say the handful of wealth creators in the City, is in fact a radical shift back to where we were. In other words, a U-turn after a U-turn gets you back to the same spot.
Blair then has a rather sudden, but important, shift in gear. He writes, “The guiding principle should be that we are the seekers after answers, not the repository for people’s anger.” This is to some extent true from the law, as we know from the views from LJ Laws who has described the challenges of making dispassionate legal decisions even if the issues are of enormous significance in social justice. Blair, consistent with an approach from a senior lawyer remarks, “In the first case, we have to be dispassionate even when the issues arouse great passion.” But then he follows, “In the second case, we are simple fellow-travellers in sympathy; we are not leaders. And in these times, above all, people want leadership.” Bingo. This is what. Whatever Ed Miliband’s ultimate ideology, which appears to be an inclusive form of social democracy encouraging corporate as well as personal citizenship, people ultimately want a very clear roadmap of where he is heading. The infamous articulation of policy under Cruddas will help here, but, as Ed Miliband finds his feet, Miliband will be judged on how he responds to challenges, like Thatcher had to respond to the Falklands’ dispute or the Miners’ Strike.
Blair fundamentally is right to set out the challenges. In as much as the financial crisis has not created the need for change per se, to say that it has not created a need for a financial response is ludicrous. The ultimate failure in Keynesian policy from Blair and Brown is that the UK did not invest adequately in a period of growth, put tritely by the Conservatives as “not mending the roof while the sun was shining”. Mending the roof, to accept this awful image, is best done when the sun is shining. Therefore, Labour producing a policy now is to some extent not the best time to do it. Blair had a great opportunity to formulate a culture in the UK which reflected Labour’s roots in protecting the rights and welfare of workers, but it decided not to do so. Tarred with the ‘unions holding the country to ransom’ tag, it decided to Brown-nose the City quite literally, leading to an exacerbation of the inequality commenced under Thatcher. Blair skirts round the issue of globalisation and technology in a rather trite manner, one assumes for brevity, but the wider debate necessarily includes the effects of globalisation and technology on actual communities in the UK, and the effect of multi-national corporates on life in the UK. Even Thatcher might have balked at the power of the corporates in 2013 in the same way she was critical of the power of the Unions throughout all of her time in government.
Whilst “Labour should be very robust in knocking down the notion that it “created” the crisis”, there is no doubt that Labour has a ‘debate to be had’ about how the Conservatives did not oppose the legislation of the City at the time by New Labour (and even advanced further under-regulation), why George Osborne wished to meet the comprehensive spending review demands of the last Labour government, and how the Conservatives would not have reacted any differently in injecting £1 TN into bank recapitalisation at the time of the crisis. The idea of spending money at the time of a recession has been compared to supporters of FA Hayek as ‘hair of the dog after a big binge’, but unfortunately is directly relevant to Blair’s first question: “What is driving the rise in housing benefit spending, and if it is the absence of housing, how do we build more?” Kickstarting the economy and solving the housing crisis would indeed be a populist measure, but the arguments against such a policy remain thoroughly unconvincing. The second question, “How do we improve the skillset of those who are unemployed when the shortage of skills is the clearest barrier to employment?”, is helpful to some extent, but Blair again shows that he is stuck in a mysterious time-warp; two of the biggest challenges in employment, aside from the onslaught in unfair dismissal, are the excessive salaries of CEOs (necessitating a debate about redistribution, given Labour’s phobia of the ‘tax and spend’ criticism), and how to help the underemployed. The third question is, course, hugely potent: “How do we take the health and education reforms of the last Labour government to a new level, given the huge improvement in results they brought about?” Fair enough, but the immediate problem now is how to slow down this latest advance in the privatisation of the NHS through the Health and Social Care Act (2012), and for Labour to tackle real issues about whether it really wishes to pit hospital versus hospital, school versus school, CCG against CCG, etc. (and to allow certain entities, such as NHS Foundation Trusts, “fail” in what is supposed to be a “comprehensive service”). The other questions which Blair raises are excellent, and indeed I am extremely happy to see that Blair calls for a prioritisation of certain planks of policy, such as how to produce an industrial strategy or a ‘strategy for growth’, and how to deal with a crisis in social justice? There is no doubt that the funding of access-to-justice on the high street, for example in immigration, housing or welfare benefits, has hit a crisis, but Blair is right if he is arguing that operational tactics are not good enough. Sadiq Khan obviously cannot ‘underachieve and overpromise’ about reversing legal aid cuts, but Labour in due course will have to set out an architecture of what it wishes to do about this issue.
Ed Miliband knows that this is a marathon, not a sprint. He has the problem of shooting at a goal, which some days looks like an open goal, other days where the size of the goal appears to have changed, and, on other days, where he looks as if he runs a real risk of scoring an ‘own goal’. It is of course very good to have advice from somebody so senior as Tony Blair, who will be a Lord in the upper chamber in due course, and Miliband does not know yet if he will ‘squeak through’ in the hung parliament, win with a massive landslide, or lose. Labour will clearly not wish to say anything dangerous at the risk of losing, through perhaps offending Basildon Man, and, whilst it is very likely that South Shields Man will remain loyal, nothing can be taken for granted for Ed Miliband unfortunately. Like Baroness Thatcher’s death, Tony Blair’s advice at this stage was likely to rouse huge emotions, and, whilst the dangers of ignoring the advice might not be as costly as Thatcher’s funeral, it would be unwise to ignore his views which, many will argue, has some support within Labour. However, it is clearly the case that some of the faultlines in the Thatcher society and economy have not been healed by the New Labour approach, and Ed Miliband, many hope, will ultimately forge his own successful destiny.
What will a Miliband-Thatcher brand achieve?
Characterising the leadership of Margaret Thatcher is difficult. The problem is that, despite the perceived ‘successes’ of her tenure of government, her administration is generally accepted to have been very socially divisive. For many, she is the complete opposite of ‘inspirational’, and yet listening to current Conservative MPs talk there is a genuine nostalgia and affection for her period of government.
What can Ed Miliband possibly hope to emulate from the leadership style of Margaret Thatcher? Thatcher’s early leadership can definitely be characterised as a ‘crisis’ one, in that full bin liners were not being collected from the streets, there were power blackouts, Britain was going to the IMF to seek a loan, for example. However, the crisis now is one which does not have such visible effects. Miliband can hope to point to falling living standards, or increasing prices due to privatised industries making a profit through collusive pricing, but this is an altogether more subtle argument. A key difference is that people can only blame the business models of the privatised industries, not government directly. Whether this will also be the case as an increasing proportion of NHS gets done by private providers is yet to be seen.
It is perhaps more likely that Thatcher’s leadership, in the early stages at least, migth be described as “charismatic”, involving both charisma and vision. Conger and Karungo famously described five behavioural attributes of charismatic leadership. They are: vision and articulation, sensitivity to the environment, sensitivity to member needs, personal risk taking, and performing unconventional behaviour. In a weird way, Thatcher in her period of government can claim to have provided examples of many of these, but it is the period of social destruction at the time of closure of coal mines which will cause doubt on sensitivity to the environment. While ‘Basildon man’ and ‘Ford mondeo’ man might have been looked after, apparently, ‘Easington man’ was clearly not. A ‘One Nation’ philosophy promoting one economy and one society might not be a trite construct for this, after all. The problem is that ‘Basildon man’ has himself moved on; the ‘right to buy’ is the flagship Tory policy epitomising independence, aspiration and choice for the modern Tory, as resumed by Robert Halfon, but there is ultimately a problem if Basildon man is not able to maintain mortgage payments, or there is a general dearth of social housing.
In a way, looking at the failures of Thatcher’s leadership style is a bit academic now, but still highly relevant in reminding Miliband that his ‘political class’ cannot be aloof from the voters. It is a testament to the huge ‘brand loyalty’ of the Thatcher brand that there are so many eulogies, and one enduring hagimony from the BBC, to Thatcher. Jay Conger provides a way of understanding how charismatic leadership is to be maintained, and the “Poll Tax” is symptomatic of Thatcher’s failure of these aspects. Conger identifies continual assessment of the environment, and an ability to build trust and commitment not through coercion. Miliband likewise needs to be mindful of his immediate environment too: his stance on Workfare disappointed many members of Labour, causing even 41 of his own MPs to rebel against the recent vote, and upset many disabled citizens who are members of Labour. What happens when charismatic leadership goes wrong can be identified clearly in the latter years of the Thatcher administration. These include relatively unchallenged leadership, a tendency to gather “yes men”, and a tendency to narcissism and losing touch with reality. I still remember now (and I am nearly 39), the classic, “We have become a grandmother” and that awful Mansion House spectacle when Mrs Thatcher proclaimed that ‘the batting had been tough of late’ whilst maintaining a quasi-regal ambience.
I personally disagree with the notion that elections are won from the ‘centre ground’, particularly because I conceptually do not find the classification of ‘left’ and ‘right’ helpful (especially if you, like me, wish to embrace “One Nation Labour” with genuine goodwill). To use the market analogy, I think it’s like making an offering which looks and functions like an iPod, but which has some of the features missing; you might as well buy the real thing. A more sensible strategy for a competitor to the incumbent is to offer something really disruptive; in other words, something which offers some of the good qualities of the current market leaders, but which adds useful value. Ironically, enough time has passed since the airbrushing of socialism from the mainstream UK political system occurred with the advent of New Labour for Ed Miliband to give this another go. You can argue until the cows come home, and many mere mortals who are management theorists have given it a go, about whether charismatic leadership needs both charisma and vision. Despite Denis Healey’s famous doubts about whether Ed Miliband has charisma, it seems that Fraser Nelson has latterly judged Ed Miliband to be quite personable. Certainly, Ed Miliband to come close to becoming a charismatic leader himself needs to have an extremely clear vision. He may have to “think the unthinkable”, and make an unrealistic promises such as a NHS which is ‘comprehensive, and free-at-the-point-of-use’ (still miraculously, though, in the current NHS constitution). However, to borrow George Osborne’s phrase, “there is a debate to be had”, about whether the deregulation of markets under the Conservatives and New Labour did lead to a climate which encouraged the global financial crash to spread to the London markets. There is also a debate to be had about the ‘market failures’ of privatised industries. Sure, nobody is wishing ‘Thomas Cook’ to become a state-owned travel agent, or you to wait a month to have a phone line fitted by the State. But this is to present outdated, prejudiced, ‘Aunt Sally’ arguments. There is a debate to be had instead about whether we wish certain national services, like utilities or railways, to be fragmented, at relatively high prices, and where there is clearly a substantial benefit to shareholders and corporate directors but little benefit to consumers. Nobody wants to see the Unions ‘holding the country to ransom’, but it is a triumphant failure of Tony Blair and New Labour that this demonising malicious memes have been allowed to remain alive almost forty years on. Nearly all people, instead, firmly believe in the idea of democratic representation, and this has now become vital in abuse of the workforce by certain employers. We hear stories all-the-time of powerful corporates using ‘zero hour contracts’, and it is this Government which has seen the dilution of employment rights of workers and employees (reduced eligibility for unfair dismissal claims, and a lower quantum of award.) And, finally, there is a debate to be had about what exactly underlies the ‘maximum number of people in employment’ claim; is it for example an increased number of part-time, flexible workers who are under-employed, or is it an artefact of migrant workers from Eastern Europe who are doing temporary jobs in the UK?
Ed Miliband has often many times remarked about his thoughts have been ‘shaped’ by Margaret Thatcher, despite the fact he is very clear he disagreed with many of the views of Thatcher. We need, however, a frank discussion of where Britain goes from here. Frankly, a pig with a rosette could have won certain Labour seats in Scotland, but those days are over. Labour’s membership started to go into decline from around 2002/3, long predating the fall in membership after the Iraqi war. The ‘paying of respects’ to the late Baroness Thatcher has allowed some Tory ideology to go unchallenged, such as the importance of the Unions in society, or the failure of privatised industries. However, what Ed Miliband can hope to emulate is a precise articulation of a vision. Miliband has to prove that he is the right person for the right times (2014/5), like Blair, Thatcher and Cameron/Clegg might have been. If Labour is to be given the honour of a mandate in 2015, it needs to have an extremely clear idea of what it hopes to achieve, and for whom.