Category Archives: NHS

Ed Milliband: Schoolboy Politics

Labour supporters will be non-plussed by the performance of its leader. Any objective appraisal will come to some daunting conclusions. There are several policy and leadership issues where he has been found sadly wanting.

1. Libya. Labour’s policy support for the Libyan adventure is driven by emotion: the ‘we can’t stand aside while thousands are slaughtered’  argument. Maybe there would have been many deaths in Benghazi and maybe not. We shall never know. One thing is certain: by supporting the weaker side in a civil war  the conflict has been drawn out and will lead to many more deaths than not intervening. But the bigger objection is that Labour is buying into an Anglo-French strategy to use NATO to extend their influence in Africa and the Middle East. This is essentially a neo-colonial strategy that will lead to other interventions and a complex of economic and financial sanctions that will be injurious to everyone involved. The alternative is to patiently relate to the various situations as a friend and to allow the various civilian revolutions to work themselves out. The Anglo-French ambitions will divide NATO and lead to splits betwee northern and ‘Mediterranean’ states. The Libyan mis-adventure will work out badly for Britain and not to Labour’s advantage.

2. The AV Referendum and Constitutional  Changes. The electorate have rarely had any appetite for electoral and constitutional reform. Of course, the electorate distrust their MPs and Parliament itself. This is a healthy distrust and people have no wish to be deprived of it. Here Milliband had a judgement call. He got it wrong and labelled himself a loser. In practice he would have had no difficulty in finding a good reason not to seek to commit Labour to the preservation of Nick Clegg. And now Labour must be ruthless and sink Clegg’s constitutional proposals in the Lords. The time ‘to do’ constitutional reform is when you control the agenda.

3. Scotland

Labour got the issues badly wrong. Scots electors turned to the SNP as the best option to protect them from Coalition cuts. They were right in their judgement. This time the issue was not the menace of self rule as Labour supposed but which party can best be trusted most at this time to defend their interests. As with England, Labour has no convincing alternative narrative.

4 The NHS Reform Bill

Labour is getting this wrong. Today they should divide the House to defeat the NHS Bill. I believe that Cameron is willing to ditch the Bill in order to maintain the Coalition. There is no need for a Bill. The worthwhile reforms can be accomplished without one. If it is ditched the Lib Dems will be given the credit for it. Again this is a judgement call. Can Ed Milliband deliver on the NHS? I doubt it now.

5 And lastly a more basic point. Where is the evidence that Labour is working as a team and is the ‘team’ up to it. Precious ittle and ‘No’ are my answers and more to the ppint it may be the judgement of the country as a whole.


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Barnsley: Worse to Come

The Barnsley Parliamentary By Election humiliation for the Coalition parties does not come as a surprise. There is worse to come. A North-South divide  with Labour dominating the vote in Scotland, Wales and Northern England and the Tories, and to a certain extent the Lib Dems, in the South, South East and South West of England has been evident for decades. New Labour and the growth of Lib Dem support in the South has muddied this picture but the rift remains.

Even if an optimistic view is taken on economic recovery, the scale of Government cuts in expenditure and a lowering of household disposable incomes for years ahead is bound to alienate whole communities across Britain but especially in Labour areas of the country. The Lib Dems, in particular, will pay a heavy electoral price: Council and Assembly votes in May are likely to result in the virtual elimination of the Lib Dems in working class communities in huge swathes of the country. Both Coalition parties are likely to huddle together in what until recently has been the Tory south. Paradoxically, the Lib Dem vote in Council By Elections  in the South has held up and the party has gained some Tory seats. This is an historic pattern of Colaitions of the right and centre over more than 100 years of their temporary emergence and is likely to make more probable the eventual merger of them. While I do not wish to exagerate the similarities between the platforms of the Coalition partners, I do believe it to be true that there a few real differences between the radical economic liberals on  right of the Lib Dems and the social liberals of the Tories: they are cut from the same cloth.

Absurd comparisons between the political and social revolutions underway in the Middle East and Africa and the future we face  together in Britain are best avoided. However, there is a relevant question for we Britons. Are British people going to accept, will ordinary people up and down the country stomach, the destruction of the welfare state, a dramatic lowering of household disposable income and the loss of many jobs, Will the public go quietly when the NHS fails to hold on to many advances, in particular shorter waiting lists for hospital appointments, and the middle classes joining the dole queues?  Of course, of course, I hear you mutter. There will always be a stolid majority for social pain – so long as it doesn’t affect us and  others like us. But will this be true this time?

Well, the Coalition has been busy fixing the Constitutional rules so that it is more difficult to get rid of them. Five years of it and not a drop less has been their resolution. Political memories are short is their belief. But is there not a valid political question? What do people do when it becomes more difficult to throw out one Parliament and elect another. Do people up and down our orderly and responsible society take to the streets? If denied the one sure constitutional method will many people choose another? Surely not. But hold on.  After all we have seen the television pictures of peoples demanding change. This is the tele/internet age. If it works for them why not us? Don’t shoot we’re British is our shout. Of course, our needs are obvious.  Oblivion is what we need now, the bottle and the pills that is what happens in the TV soaps. Oh and throwing something as well. Come off it!

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NHS Reform By Threat

To those of us with some knowledge of the founding, funding and growth of the NHS, it is a source of wonder to see the Tory conversion from outright opposition to apparent support. Now, we are told,  it is the Tory ambition to produce an NHS second to none in Europe. And all this by spending less money and sweeping away an unloved bureaucracy. I rely in my continuing disbelief  in a Freudian slip. Yesterday David Cameron told us that a failure to reform the NHS along the lines the Coalition now proposes would make the NHS unaffordable and  the agreed NHS objective of ‘free at the point of need’ would become unsustainable. Where and when have we heard this before? I rely on my readers to tell me. But am I not right to say that we heard in 1948 when the NHS was formed, and  was rammed down our throats my the Blessed Margaret Thatcher in thirteen long years of starving the NHS of capital and finance. Under the Tories we can never afford it.

Is it possible to build a world class NHS without spending more and more money and increasing the proportion of GDP spent on the NHS. I suggest not. The NHS was firmly rooted at the bottom of most EU Health league tables when Margaret bowed out unwillingly from power. It required massive capital and revenue expenditure under Labour administrations to lift it to mid-table performance.

It has always seemed to the Tories that this expenditure was avoidable if the private sector was permitted to play a larger role in health provision. In recent years the private sector has played a significant role but always under the protection of a benificent state. Is there, just possibly is there, a way of surrendering to private interests, saving administrative costs while preserving the mantra of ‘free at the point of sale (sorry, need).’

And the solution, ‘Give the money to GPs’. Or as it was said in the distant days of ITMA and Tommy Handley, ‘Give them the money Barney.’ It never dawned on David Cameron in  all this bravura that perhaps the GPs did not want this money. Nor that any responsible professional health organisations agreed with his proposed reforms. This is not his style. ‘You disagree with me. That’s a pity. But that is not going to stop me pressing ahead. So it may not work out but I believe it will.’ You learn this sort of thing on the playing fields of Eton.

‘Oh well clever dick, what reforms do you support to get this massive and growing health care under control.’  Well, first I believe in evolutionary not radical change in the NHS. I am not against givng GPs control over their budgets where they wish to operate this way or to making compensatory reductions in central bureaucracy. I am in favour of compensatory savings in central bureaucracy if we proceed this way and not at the expense of the necessary protection NHS services enjoy and need. This is the not the Tory way. You do not learn this approach on the playing fields of Eton. ‘What a cissy. Press on lads.’

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Mandelson and the Millibands

Contrary to many comments, Labour members have a choice at the coming leadership election; between a long term commitment to  reassuring their members and erstwhile supporters or winning new adherents to an appealing alternative programme to  Coalition budget cuts and an immediate challenge to its authority.

There is a case for either. What do we think will happen? Can the Coalition be swept aside by public repuganance to its programme. If Boy George is stupid enought to press on with 25-40% public expenditure cuts when the economic recovery is stuttering to a halt, public repugnance may sweep the Coalition aside and the Labour Party might achieve a majority in its own right in an early election. If you believe that there is no space for genuflecting to a pre-New Labour past, teeth-gnashing and confession. If you believe the first, you should  vote for David Milliband. As the person with the most serious, senior experience of Government, he is your man for a snap General Election. It is said that David Cameron’s nightmares are focussed on the possibility of a quick and bloodless Labour transition to David Milliband.

Labour voters have an alternative candidate in Ed Balls. If you believe that the issue of the economy will be the one and over-riding issue of this notional snap election then Ed Balls is your man. At his best Ed Balls has  Churchillian qualities: he is pugnacious, and combative and (with a little help on delivery)  the best equipped candidate to be convincing on the economy. But for the disasters of war, Churchill would not have found his way to power in 1940. Do we not have economic disasters of commensurate gravity now?

If you believe that the Coalition will last a full term, which remains the view of academic pundits and right-wing journalists, Labour does not need David Milliband or Ed Balls. Anyone will do. Why not the engaging and popular Ed Milliband. If the latter it is likely that good sense will disappear in a welter of apologies for the past and the party will cease to be relevant. Labour will risk being  out of power for a very long time.

I favour an endeavour to sweep the Coalition from power as soon as possible before too much damage has been done to British society. There is a military analogy. Can we summon up the blood and sinews (do we have the will and have we got enough money); can we few, when confronted by the many triumph, (although weak, do we have a winning  strategy and do our enemies have exploitable waeknesses), if we are prepared can we catch them unprepared (do not underestimate your enemy he has probably anticipated your coming).

The Coalition cannot be assured of the whole hearted support of its troops: there are weaknesses on the  left flank, some of who have deserted the field and others who are switching sides. After a period of negotiation a cavalry charge is required here.

So in the final issue the choice is clear. For Victory in an early battle choose one of two Generals David Milliband or Ed Balls; for a long and inconclusive guerilla campaign, select Captain Ed Milliband.

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For God’s Sake! Unplug the NHS.

I want to tell you a story. My friend Harry, a pensioner of modest means, developed a malignant growth in one of his eyes. To cut a long story short,  after many months of radiotherapy the growth had been reduced in size. The time had come to eliminate the source of the problem, in a place dangerously close to the optic nerve, by a non-invasive operative technique. It took up a large part of the time of a specialist doctor, a radiotherapist, two nurses  and a team of technicians , for a day. The operation saved Harry’s sight. At a rough reckoning the capital equipment used in Harry’s treatment cost over £250 million and the unit cost of his treatment, including pre-operative and post-operative care, must have run into a six figures. Harry was a life-long Tory voter. He did not thank me when I advanced the thought that if he had had his way, a prolonged period of Tory administration from the end of the war to the present day, the event he had so graphically described to me, would NEVER have taken place. For the Tory mantra throughout the period was that although the idea of a NHS was a nice one, it could NOT BE AFFORDED. Does that phrase ring any bells with you?

Now you are an agency worker earning £7 an hour. You have just been told that your production target has been increased from 18 to 28 cases a day  and those who did not reach the target would be sacked at the end of the week. You settle down to do your best and after four hours of looking at the screen you pause to take a breath,  nip ouside for a ciggy, that sort of thing. Did you know that in these four hours the NHS had spent £50 million pounds of your money. God almighty, you might think, unplug those machines! Hold on a moment. Just think. Harry today, you tomorrow? 

I can hear those Coalition Goverment supporters among my readers, say to themselves, there he goes again. The Coalition agreemenr is to lay-off the NHS and cut every other public service. So it does. But are you telling me that the strongly held Tory instinct to dismantle the NHS has suddenly disappeared. Was the change necessary to ‘win’ a General Election or is it genuine?

This is what you do my friends to unplug the NHS. You reorganise it cutting out centrally controlled costs, you shift some costs to the private sector, you distribute costs to local councils, charitable organisations and doctors bank accounts, you cut staff and  freeze their wages,  you abandon targets and increase waiting times and lists (but not in every geographic area), you talk a lot, obfuscate and throw scorn on think-tanks that suggest worsening standards and post-code lottery. You say,well naturally there is some disturbance because we are changing things for the better. Just you wait until our modernisation works its way through. What we are doing is eliminating waste. Does that ring any bells? Sorry Harry, we can fit you in towards the end of 2011. Keep your fingers crossed.

Now you there, in the courtyard stubbing out your cig. What do you think? Are going to bother to vote next May? No, perhaps not! My advice to you is to try and stay healthy. Should you be smoking at all? You bring these things upon yourself you know. In the Big Society we accept responsibility for ourselves. And, no hard feelings? Good luck, to you. We are all in this together.

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