Saturday, August 30, 2014
Thursday, August 28, 2014
“I don’t know how much any of you realise that with the Lansley act we pretty much gave away control of the NHS… we don’t really have day-to-day control.”
Jane Ellison, Public Health Minister (June 2014)
In Scotland and Wales, car parking charges at hospitals have been largely abolished. That’s one of the consequences of devolution.
In England, car parking charges at hospitals still exist because the NHS in England is a network of property companies run on behalf of bankers. That’s one of the consequences of Andrew Lansley’s £3 billion reorganisation that was in nobody’s manifesto.
It’s also what became clear last week when ministers published new guidelines on parking charges that sought to address the chief complaints about the system, especially from folk with disabilities and from staff whose shifts mean they can’t use public transport. These guidelines are just that. Guidelines. The Health Secretary has no power to compel NHS providers to comply.
That would be fine if the NHS providers were accountable in some way to a democratic institution locally that did possess the power to compel. It’s not fine at all that they appear to be simply unaccountable. The warming-up of the English NHS for privatisation has been presented as a hands-off policy freeing clinicians to make their own judgements on patient needs and the best way to meet them. They will be held accountable for clinical outcomes but nothing more. So the management of publicly-owned assets built up over many decades passes out of democratic sight. Unelected bodies are handed huge amounts of public money that is to be used to achieve specified objectives, yes, but with the ability to adhere to or to ignore other objectives at will. Objectives that might seem peripheral to the core aim of the NHS but which nevertheless have an impact on our lives.
The united aim of the London parties is to take the NHS further down the privatisation road. They really will do anything to avoid direct responsibility for the well-being of those who elect them. So we can expect to hear more about empowering the unelected managers of trusts and foundations and commissioning groups to make their own decisions. Decisions about what to do with our assets and our money. But these are not our decisions. And if they’re decisions we don’t like, then we have no redress.
It’s so very easy to cheer-on the stripping-out of democracy. ‘Good thing too. Get the politicians out of decision-making. Put the experts in charge.’ Then again, if you find yourself at the hospital, visiting a dying relative, and without the right change for the parking, the penny must drop even for the densest of Daily Mail readers.
The boundary between what is debatable as policy and what is to be delegated as mere administration is being pushed further and further in the direction of empowering an inaccessible oligarchy. Inevitably, the more centralised the system, the more pressure on its rulers’ time and so the smaller the realm of policy and the larger the realm left exclusively to the bureaucrats. Eventually, something big goes wrong at the sharp end; the politicians say ‘nothing to do with us’ and present privatisation as the answer to the ‘lack of accountability’ inherent in a system that they designed to fail.
In 1948 the NHS was deliberately set-up within a Government department – and not as a public corporation, like the nationalised industries – because it was seen as a service and not as an industry. It was to be run on lines of Parliamentary scrutiny and ministerial accountability, not commercial performance or independent access to the capital markets. It has since fallen victim to a cross-party consensus that is far from unique (since education and the fire service are going the same way), one that combines long-term guile on the part of its promoters with short-term stupidity on the part of its receptors in a currently winning formula. One that views turning all caring into a profit-seeking business as the only means of motivating staff to do better with increasingly constrained resources.
Patients can expect more respect as customers, surely? Why? The contract isn’t with them personally and the ultimate truth is it’s then the money that motivates, not them at all. Going the extra mile won’t happen if it wasn’t allowed for in the bid. Costs increase as the moral hazard is to order more stuff that can be charged for, even when not really needed. Nobody is transparent about their costs any more, because that becomes a matter of commercial confidentiality.
In Somerset, NHS Trusts are in the process of being reorganised, not on the basis of what they can do for patients but on the basis of their financial prospects. This is a requirement of the Lansley act, which forces every NHS Trust either to become a full-blown Foundation Trust or to give up, for example by handing over to a private contractor. Weston Area Health NHS Trust is England’s smallest Acute Trust (someone has to be), yet ranks as one of its top six for clinical efficiency, and has the smallest percentage of patients readmitted to hospital within seven days. So it’s not surprising to see it being destroyed. As with academies, the new language is that of mergers and acquisitions, of chains and groups; soon it will be the language of share options and directors’ bonuses. Public money, private pockets.
We need to be abundantly clear that our own aim is democratic decentralisation. Democratic institutions without the decentralisation of real power are a facade behind which centralist interference in local affairs continues unabated. Decentralisation without democracy is a sell-out (often literally) to a managerialist form of tyranny that is no improvement.
Monday, August 25, 2014
“‘Fighting’ was one of the most honourable words in the vocabulary, ‘the real, highest, honestest business of every son of man’, as Thomas Hughes put it… Of course, the fight had to be for a good cause. But one of the effects of imperialism had been to imbue very large numbers of people with a religious belief in Britain as the great force for good in the world… That England could be in the wrong was almost inconceivable.”
Mark Girouard, The Return to Camelot: Chivalry and the English Gentleman (1981)
One of the key arguments in the debate on Scottish independence is that a splintering UK would lose the ability to throw its weight around in the world. Is that an argument against independence, or one of many strong moral arguments in favour, one of the instances where Scotland’s gain is also a gain for others, here and abroad?
When David Cameron writes, as he did in the Sunday Telegraph last week, about Britain’s ‘military prowess’, he hopes the lack of connection with other issues won’t show through. He heads the government of a country that is supposedly bankrupt (though, as we’ve noted, in no hurry to pay down its debts). Local services are being more than decimated, while food banks proliferate. Never mind ‘charity begins at home’. What about ‘competence begins at home’?
The incompetence of the London regime explains why our energy security has been outsourced. It’s why the next nuclear power station in Wessex will be built by two rogue states if ever there were, the French and the Chinese. The French, whose position on minorities is 200 years out-of-date. So much so that if France applied to join the EU today it would risk a refusal on human rights grounds. And the Chinese? China is an economic giant and emerging superpower but arguably has the worst human rights record of all. Just 25 years ago in June, troops of the People’s ‘Liberation’ Army mowed down students demanding reforms before the Gate of Heavenly Peace in Beijing. Justice is still awaited. France and China share an image of themselves as modern, enlightened states that in fact carries forward the contemptuous centralism of absolute monarchy at its worst.
In 1969, following the crushing of the Prague Spring, two young Czech students burned themselves to death in Wenceslas Square. Their example has been widely repeated, notably by autonomists in India and by victims of the European sovereign-debt crisis. But nowhere do the figures equal those in Tibet, where 35 cases were reported in 2011/12.
Do we hear about these deaths? No, we do not. Gaza, yes, Lhasa, no. Whole editions of Newsnight are devoted to every little flare-up in the Middle East. China might as well be another planet. That can’t just be because there are fewer Tibetan Buddhists at the BBC than Jews, Arabs and Maoists. Acute oppression makes news headlines; chronic oppression does not. Those who have rockets to lob at their neighbours are, from a relative perspective, the lucky ones. The unlucky are those whose oppression is so total, whose fear of reprisals is so great, that their voices are never heard.
The United Nations should be standing up for the oppressed everywhere, without favouritism. It faces huge difficulties in doing so. It is composed of the winners, the states that exist and not the unrepresented peoples who are still in the queue. The least that British diplomacy can do is nudge it in the right direction. Can British diplomacy do that? Or is the shadow of empire cast too long? Are we too busy doing our own thing, exercising our military prowess? Bombing other countries, then sanctimoniously patching-up the injured and welcoming (or not) the refugees whose homelands our actions have disrupted.
Most of the time, over 95% of the world is at peace. It shouldn’t be beyond the wit of man, acting collectively, to treat violence and the causes of violence, problems no more inevitable than smallpox or polio. Unilateral action may be swift but it’s rarely decisive and it effectively absolves the rest of the world of its responsibility for collective security. We need to confront the fear that if we aren’t acting as the world’s deputy sheriff, someone else will fill the vacuum. The UN’s job is to prevent the vacuum emerging. The sad fact is that our own efforts seem to have created far more vacuums than we’ve filled.
Look around the world for hotspots and you’ll see the Union Jack disappearing over the horizon, its mischief-making done. Kashmir. Palestine. Iraq. The Libya operation cost around £1 billion and only succeeded in replacing a crazy but competent dictator with a bunch of bandits. While spreading conflict across the central Saharan states in its wake. Leaving well alone was always a sensible alternative. Now, when last week’s evil enemies are proposed as this week’s necessary allies, it makes even more sense.
The best intentions can go awry. The 1916 Sykes-Picot accord is now viewed as a shameless example of European colonialists carving up territory that was none of their business. Yet Mark Sykes, the British half of the deal, was a Yorkshire squire who fell in love with the Middle East. He had his doubts about imperialism, thinking that "the White Man’s burden is a bag of gold". He hated cities and their inhabitants (he was, after all, MP for central Hull) and greatly admired the nomadic life of the desert. It was his deepest wish to protect the area’s ancient civilisation from corruption, "the smearing of the east" with the "slime of the west". He hoped Sykes-Picot would provide the focus for emergent Arab nationalism. Which in a much less predictable sense it now has.
In a globalised economy, actions have unexpected consequences. The idea that Islamist fundamentalism was deliberately promoted by the British Empire in order to weaken Ottoman rule – and strengthen London’s influence in its place – is about as believable as The Protocols of the Elders of Zion. The Brits backed fighters, not theologians. But successful fundamentalism never lacks funding. Oil is oil and if the Islamic State is financed by the oil wealth it now controls and by donations from others whose wealth also comes from oil, then we may indirectly be funding terrorism every time we top up the tank.
Muscular humanitarianism has been the subject of debate ever since Disraeli and Gladstone locked horns over the Eastern Question of their day. But whatever its achievements, crusader-style chivalry starts to look insincere once we consider how cramped its priorities are by realpolitik. In the 21st century, 19th century multi-national empires like the UK are not the best means of doing good and they only get in the way of other institutions better placed to deliver. At the 2005 G8 Summit in Scotland, Tony Blair told the world’s press that “we are trying to do good”. Might it not be far, far better for states like ours to stop trying to do good and simply be good?
Tuesday, August 5, 2014
It takes a lot of planning to fit the First World War in between Sunday’s closing ceremony for the Stolenwealth Games and tonight’s televised independence debate between Alex Salmond and Alistair Darling.
The juxtaposition may give cause for thought. Scotland’s choice seems to lie between two visions of Europe. On the one hand, it can become a modern, pragmatic, Nordic-style social democracy whose guiding light is the common weal and not the enrichment of the slyest. On the other, it can remain part of the one centralised monarchical empire in Europe that was not toppled by the events that began a century ago. Choose well: the same class of inbred twits whose inept diplomacy launched that war is still at the helm.
That much is evident from the handling of the anniversary. The focus is on British and colonial casualties, with little attempt at reaching out to understand realities shared with the ‘enemy’. Tactics and trauma will be the thing, not the bigger picture, which is way too much of an embarrassment. But gloriously, needlessly dead is gloriously, needlessly dead: what does nationality have to do with it? The silo mentality is what wins, loaded to overflowing with our selective remembering.
What do we remember? And why? Yes, you, small child with no memory of the last century, let alone of its wars. What must you never forget of the experiences you never had? The lessons of history? We mark the centenary of the war to end war with yet more war. The sacrifices that must never be thought to have been in vain? Heresy it may be to say but was the post-war world a better world? Was it all ‘homes fit for heroes’? How many of the social and political changes that did occur were going to occur anyway? Was it all for nothing then? Quite possibly, but you won’t hear the twits admitting it.
One huge consequence of 1914-18 was to militarise the anti-London struggle in Ireland to an unprecedented degree. Should Scotland vote ‘Yes’ it will be worth watching the Scottish reaction to any dirty tricks or delaying tactics from Westminster, now that a new generation of Scots soldiers have battle experience in Iraq and Afghanistan. A worried establishment this week finally conceded ‘devo-max’, the option they wouldn’t allow on the ballot paper. Can any but a fool trust the London parties’ final desperate offer of further powers? Too little, too vague and far, far too late to make any difference. But presumably requiring another confirmatory referendum before implementation – since no-one will announce the details – and so to be kicked into the long grass in the meantime. No SNP gains at Westminster next May? Oh well, it’s a changed world, so never mind what we promised. It wasn’t exactly binding, was it?
In Wessex, we have our own regional recollections of service in the First World War. The 43rd (Wessex) Infantry Division spent the war in India and the Middle East (as apparently did the duplicate 45th (2nd Wessex)). The Wessex county regiments saw action both on the Western Front and across the Mediterranean and Middle East. Military leaders seemingly understand the motivating power of the Wessex name rather better than their civilian counterparts who struggle to breathe life into ‘The South West’ and ‘The South East’. Or is that an over-simplification? Do the civilians know exactly what they’re up to? The Wessex name has been well-used by the military: for the Wessex Brigade, the Wessex Division, the Wessex Regiment, the Royal Wessex Yeomanry, even HMS Wessex. But the British Army is not a democracy: Wessex patriotism is fine when confined to cap-badges but not so fine when it gets political. That’s when it becomes less of an asset and more of a threat. To take a Welsh analogy: a male voice choir at the Albert Hall singing ‘God Bless The Prince of Wales’ is one thing; Plaid Cymru is another; the Free Wales Army something else again.
In 1997 we held a strategy conference in Reading. One of the questions we sought to answer was: where should we look for allies? The Army’s record on Wessex looked promising but even in terms of Wessex as a purely cultural project it would be self-limiting. It’s not a pride of place that comes from below but from above. At its heart is loyalty to the Crown, not loyalty to the land. Since it’s ‘their’ army, not ‘ours’, it’s more likely to end up part of the problem, not of the solution. A London fist in a Wessex glove. A sustainable future won’t lie with yet more wars for global domination beneath the Union Jack or Le Tricolore but in a Europe at peace with itself and the world, the Europe of a Hundred Flags. Are we closer to it than we were in 1914? Only time will tell.