Category Archives: NHS

All together now…there are more than two types of production ownership

A fascinating YouGov poll entitled ‘Nationalisation vs Privatisation: the public view’ has been published, with results in brief accessible here: https://yougov.co.uk/news/2017/05/19/nationalisation-vs-privatisation-public-view/ and a more detailed, in-depth table here: https://d25d2506sfb94s.cloudfront.net/cumulus_uploads/document/uufxmyd8qm/InternalResults_170518_nationalisation_privatisation_W.pdf that showcase the country’s views on ownership of several of the country’s most important industries.

It is a relatively mixed bag produced by a cross-party sample of slightly fewer than 2,000 adults. Some results, such as the substantial support for renationalising the energy companies and privatisation of the telephone and internet providers, surprised me. Others, like the tiny percentage in favour of privatising the NHS, did not.

I like studying polls of this sort because they offer quite a clear picture of the economic consensus embedded in the population. I have a feeling that much of the growing support for state involvement in major sectors of the economy is down to a mistrust of the market; exacerbated by both the 2008 financial crash and other consequences of the neo-liberal period, such as the ripping apart of the middle class.

Admittedly, the sample is quite small, but I don’t think larger samples would suggest that this poll is especially anomalous. It appears to me that the country has steered slightly to the Left on the economy, but since most do not think in terms of ideology, it means very little for Jeremy Corbyn’s electoral prospects. A party breakdown of beliefs is provided and yields quite interesting results. Labour and Tory voters, more alike on policy issues than they will ever care to admit, are most sharply divided over rail ownership.

There is, though, something else about polling such as this that concerns me. The title of it and the options given to those who took part are very misleading and assume that only two different kinds of production ownership exist. It is crucial for the sake of informing political debate over public policy that people are reminded of the forgotten third option. The means of production in a society can be arranged through nationalisation, privatisation or worker control of industry; which can itself be described as the very core of socialism, where producers take control of production.

Omitting the third option in polling is to be understood, of course. Adding in ‘worker control of industry’ may create unnecessary confusion and boost the likelihood of a ‘don’t know’ response. But polling is not the only incentive for this post. This past week, the country’s major parties have all released their manifestos ahead of next month’s General Election.

Much of the commentary since particularly the Labour and Tory manifesto reveals has circulated around whether or not Britain can afford to renationalise certain sectors of the economy and whether it is a viable solution to the problems we are facing. Plans to bring the Royal Mail, railways and National Grid back under public ownership, as well as introducing a National Investment Bank and National Education Service, have prompted misleading newspaper headlines about the 1970s and the now conventional bashing of state socialism, which is less electable than it has ever been (in part due to the UK’s staggering levels of public debt).

Direct worker control of industry, therefore, ought not to be left out of public debate because it may represent the alternative to neoliberal capitalism that the Left has been searching for over the last forty years. The Labour Party of the last two years has openly referred to itself as a socialist party, so why doesn’t it support producers taking control of production instead of managing industry itself?

As long as the Left pushes for government programs which increase borrowing, public spending and taxes, it will not be able to formulate a constructive alternative to neoliberalism. It must recognise the value in low-tax, democratising policies like worker control of industry if it is to avoid further swelling of our national debt and more hits to its voter base.

I make no comment about whether worker control of industry is preferable in each individual sector or to the efficiency of production as a whole. To make judgement would be difficult at this stage. I also reaffirm that I am not a socialist. I merely think clarification is useful where it is not being applied by politicians or by the media.


The right to smoke does not equal the right to vote

It is striking to me that Theresa May has said something so straightforwardly sensible in reaffirming her wish for the voting age to remain at 18. I had always been under the impression that, given the dwindling interest in voting and sharp decline in participation over the years, politicians would be looking to 16 and 17 year olds to help beef up turnout by now.

She needn’t have bothered trying to rally the youth ahead of this election. Mrs May doesn’t exactly possess the charm that Nick Clegg displayed in attracting the youth vote during the 2010 General Election campaign, when he promised to scrap tuition fees upon getting into government.

The Tories would have just as much success rebranding themselves as the British Communist Party. Young people consistently show Left wing, liberal biases, and remain far more at home in the Labour Party or Liberal Democrats, at least until they enter the world of work and become taxpaying citizens.

I do enjoy the usual string of arguments deployed by those in favour of lowering the voting age. Especially humorous is the idea that because 16 and 17 year olds can smoke or drive they ought to be offered the vote in order to align rights with responsibilities.

Smoking and driving do not have anywhere near the impact upon public policy that voting can have, and 16 and 17 years by and large do not have the wisdom or knowledge that older voters do. Many will vote according to their parents’ biases, and not on the backs of independent thought or comparison.

It is at least a reminder that we don’t really have any coherent societal position on what exactly our ‘rights’ are. Of course, I appreciate the nuances in this argument. A 17 year old who turns 18 in July of this year might contend that he or she doesn’t lack the wisdom or knowledge of somebody a month older, and that person would probably be right.

But we need to draw lines somewhere. If we extend this argument, we can quite reasonably ask why 15 year olds ought not to be given the vote straight afterwards. It is a bottomless pit that creates nothing but problems and is never forwarded consistently.

The Prime Minister is, though, right when she claims that there are plenty of other ways to become active in politics, though the examples she gave (youth parliaments and councillors) were horrendously uninspiring. I myself used the lure of the summer’s referendum to do so, and with great personal benefits.

Most democratisation has absolutely nothing to do with government. It is arguably the workplace that is in most need of a little more democracy, since that is where adults spend most of their daily lives. I have been encouraged, for instance, by the slow growth in worker owned cooperatives in tiny pockets of the west.

Germany and Denmark operate thousands of successful, communal energy cooperatives, with many able to invest in renewable sources without the clouds of political forces hanging over their heads. A large network of worker owned enterprises has shielded Mondragon, in Spain’s Basque region, from the worst of the country’s economic hardship.

The vote often achieves very little in the way of democratisation. This is particularly so when a largely uncaring base are offered it. On the 11th November 2016, Darragh O’Reilly, a Northern Irish member of the UK’s Youth Parliament, laughably claimed in a parliamentary sitting:

“I tell you this: votes at 16 is no one-trick pony. It is nothing short of handing young people the freedom to achieve freedom. The freedom actually to fund the NHS. The freedom actually to have a decent transport system. The freedom to tackle racism.”

His statement was an enjoyable soundbite and I admire his genuine passion, but his view is baseless and most his age simply aren’t politically enfranchised. And of course no emotive political statement would be complete without a reference to the National Health Service.

Just like most other proponents of lowering the voting age, he dressed up its importance to be something other than what it actually is: a gimmick. If a genuine campaign were to emerge proposing to allow 16 and 17 year olds in the Armed Forces alone the vote, then I would be much more interested (and likely to agree).

Until then, Theresa May is correct to ensure that the voting age stays where it is. Britain is a one-party state and appears to have entered its second era of Tory dominance in the past forty years.

And 16 year olds aren’t about to change that.


I don’t dislike Labour, I pity them

I have a softer spot for the Labour Party than most on the Right. This is mainly because, through an expansionist welfare state, they were very helpful to my family throughout my upbringing.

I grew up in a single parent family, in the Kent/South East London overlap, with a younger brother and an older sister, and was on free school meals at school (I hope this is helpful for those in political circles who have misguided preconceptions about me or my background).

I mention this very quickly not to invoke any kind of unwanted sympathy, but to illustrate that the Labour Party actually did do good things for single mothers and dependent children. In an age of a one-party state, we prefer to forget any remnants of Labour’s successes.

In the days when my siblings and I were growing up (and I suspect the same is true today), single parents were better off financially if they did not seek work.

Jobseekers allowance simply did not compensate for the pressure that unemployment benefit alleviated. Housing and child allowances were larger and those affected were not forced into work once their children had reached the age of 3.

Recipients of benefit payments ought not to be demonised for this very reason. More often than not, they are pursuing a course of action that best fits the predicament that they have found themselves in.

In the case of my family, my father abandoned me when I was a baby, and I do not have any contact with him today. That is all I am comfortable revealing about my personal life, but it should help readers to understand why I am forced to sympathise with Labour more strongly than others on my side of the political spectrum (remember that I’m not referring to the Tories).

In general, I am supportive of a strong welfare state and oppose cuts to disability benefits. I think welfare should never out-compete the lure of work, but ought to be substantive enough to provide those who fall down the ladder with a sturdy rung from which to rebuild their lives.

The most fundamental reason for supporting a strong welfare state is to assist in the stimulation of production. I believe that a government hoping to create more jobs should present the poorest with a higher disposable income. It is at least a better use of public money than funding a bloated, nationalised health service.

My relatively low hostility towards the Labour Party thus has its roots in my own, subjective (past) circumstances. It is therefore saddening to me that it is not stronger.

Don’t misunderstand me. I am not yearning to become a member and would not do so if somebody more competent, like Yvette Cooper, was leading the party. Rather, it would be more accurate to say that I pity Her Majesty’s opposition.

I just feel that, especially during a period of landmark political change, Labour’s lack of bite and inability to provide the government with adequate opposition or scrutiny has had a harmful effect on the country’s Brexit debate.

To blame Jeremy Corbyn, too, seems a little too easy. His party’s problems, vast and not easily solved, most definitely stretch far wider than his critics are willing to acknowelege.

He isn’t to blame for lingering anti-Semitism (which I believe to be problematic but slightly overblown), he isn’t to blame for Tony Blair’s damaging legacy, and nor is he to blame for staunch internal divides over the result of Britain’s EU referendum.

It is true that his leadership has been slapdash. He resembles a small child who has just taken his first leap into the deep end of a swimming pool, only to find that it is difficult to navigate without armbands or a float.

He must also learn to take swift and decisive action against figures like Ken Livingstone, who I think has spent far too long in the political sphere and may well be showing signs of senility. I long for the day that both he and Lord Heseltine bow out from party politics.

Investigations are a step in the right direction, but the problem of prominent Labour figures making unpleasant or silly comments is so fully embedded within the party that they may well be futile.

And so we have a chronic credibility problem. It is worth noting that the Left all over Europe is experiencing unprecedented difficulty, but not all hope has been lost. The recent Dutch and Austrian elections show that leftist liberals still have places that they can call home.

If Labour is to regain its lost momentum, or at least pretend to be an electoral threat, it will need a new leader and to cease ignoring its voter base, particularly in the north of England and in Scotland, where the SNP’s legitimacy is beginning to wane.

I don’t hold out much hope. Not even our withdrawal from the European Union could breathe life into them.


Three steps British people must take before we address the NHS’ problems

My personal NHS experiences haven’t been so bad. Thankfully, either through conscious effort or sheer genetic luck, I haven’t had any serious medical concerns over the years, with a little bit of physiotherapy and a brief period of mental health treatment the only real blotches on my medical history. Each time I’ve had to use a clinic, GP surgery or hospital, procedure has been reasonably smooth and staff helpful and reassuring.

For the most part, those who work in our health service do a tremendous job. They work long hours, often far beyond what they are contracted to, and really do make a difference in people’s lives. I sometimes think that, given the NHS’ blatant inefficiencies, it is the efforts of staff alone that help to maintain strong public opinion of the organisation. Even when visiting my local surgery I get a pretty clear picture of the sheer magnitude of demand placed on the health service. I daren’t imagine what hospital winters are like.

Notice first and foremost that I make a distinction between the NHS and its staff. This is done so deliberately, not because I love one and hate the other, but because it makes debating the future of the service a little easier. We have, in the UK, a very real connection to a treasured institution, so any critique can often be dismissed as personal attack or Right-wing irrationality. Getting over this sacred cow treatment and attitude towards healthcare would be the national equivalent of an alcoholic admitting that he is so.

Dr Kristian Niemetz noted in a lengthy overview of the health service for the IEA on December 4th, 2015: “The NHS’ status as a sacrosanct institution promotes ‘groupthink’ and undermines the ability to detect and correct instances of failure, and adapt to changing circumstances.”[1] He is undoubtedly correct. The first step towards injecting the UK’s NHS debate comes from admitting that even something we love so dearly has its problems, and that the sacred cow treatment it receives is damaging and unjustified.

An intriguing report published by the BBC on the problems facing the National Health Service can be read in full here:

http://www.bbc.co.uk/news/health-38887694

It is unsurprising to me that our society has such an ingrained attachment towards the main entity in the healthcare sector. Most people alive in Britain today were born on the NHS, have been treated by the NHS and will die on the NHS. But what is bewildering is why, given this affection, we let politicians to this day use it as a political football. Healthcare, after all, is on its own terms a private affair. The NHS was set up in a silent, broken country still reeling from the effects of the Second World War. The idea (however inherently flawed) was that people would have access to care based not on ability to pay, but on clinical need.

So herein lays the second step towards providing the NHS debate with some much needed clarity: we must recognise that the society in which our health service was so proudly set up no longer exists. The country is very different now from the post-war era. Free movement of people has increased overall demand as well as introduced new, complex problems to an already over-burdened service. Health tourism, frequently earmarked by doctors as a major structural and financial problem, is one such issue. It is good that we look after those who need help, regardless of where they are from, but compassion can all too easily fall victim to corruption and exploitation.

The NHS is a public service, and thus is set up for public use. If public dynamics change, such as increases in how long we are living or how rapidly the population is growing, then pubic services must adapt in order to reflect those changes. A stale setup will not suffice in an age where British citizens are used as a cash cow (even those on low incomes pay hundreds in National Insurance) for a service that many now feel does not meet their needs. Public satisfaction is noticeably declining.[2]

A third change in social attitude that must prelude any reasonable proposals to address healthcare in Britain relates to the United States. In the UK, too often we conflate private, market-based healthcare with the widely-condemned American system. This, for two reasons, is an unhelpful conflation that only manages to worsen unwarranted support for maintaining nationalised healthcare.

Firstly, the notion that American healthcare is private is largely a flawed one. The World Bank notes that state spending on healthcare by 2014 had reached just over 17% as a proportion of GDP.[3] Back in July, the U.S government announced that they expected total state healthcare expenditure to rise to $10,365 per head.[4] There is clearly something to be said for the claim that the private sector is at fault for very real faults in American healthcare.

Secondly, using the United States as a projection for market and insurance-based models in the UK ignores the very tangible successes with similar systems in Europe. A BowGroup (respected Conservative think tank and research body) report summarised starkly:

“UK Healthcare continues to be much worse than in Europe. 323 lives are lost per day because we are not matching the best European standards in the three main killers – heart disease, respiratory disease and cancer. That’s 117,743 per year. 85 lives per day (or 30,965 per year) are being lost because we are not even matching EU average standards. Looking at trends over time, there has been no significant improvement over the last 7 years. Another good measure of the quality of healthcare is the survival rate once a disease has been diagnosed. On this measure, the UK is bottom of the league table of Western European countries for cancer survival rates. In fact, you have more chance of surviving lung cancer in Poland, Estonia or Slovakia than you do in the UK. In France, patients are twice as likely to survive lung cancer as they are in the UK. Significantly more money has recently been put into the NHS in the last seven years. But standards are still much lower than in Europe and activity (e.g. number of operations) has not increased. Money alone has not worked.”[5]

It is possibly due to the bureaucratic, centrally organised nature of the NHS that funding is not necessarily put to good use. Left-wing commentators and publications will, from time to time, refer to budgetary cuts as the source of these problems[6], but as studies frequently show, Britain’s successes in dealing with severe illnesses – of which cancer has emerged as a particular problem – have stagnated, likely due to the inevitability of longer waiting times in state-monopolised healthcare systems and irrespective of funding levels.

Europe has quietly managed to avoid the problems that we face by seeing and treating healthcare for what it actually is: a private concern, better organised efficiently than in a way that is necessarily universally liked. So the NHS zealots, which are also found on the Right in surprising numbers, would do well to concentrate on provision on the continent, and stop using America’s woes as a barometer for eternal market failure.

So, ditch the sacred cow treatment, acknowledge the many social changes that have taken place between now and the 1940s, and consider European templates before screeching about U.S healthcare. Only then, if we are to have a rational discussion, can we talk about what to do with the NHS.


Sources:

[1] https://iea.org.uk/publications/research/diagnosis-overrated-an-analysis-of-the-structural-flaws-in-the-nhs

[2] https://www.kingsfund.org.uk/sites/files/kf/BSA-public-satisfaction-NHS-Kings-Fund-2015.pdf

[3] http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS

[4] http://www.pbs.org/newshour/rundown/new-peak-us-health-care-spending-10345-per-person/

[5] https://www.bowgroup.org/sites/bowgroup.uat.pleasetest.co.uk/files/The%252085%2520A%2520Day%2520Who%2520Need%2520Not%2520Die%2520-%2520January%25202005.pdf

[6] https://www.theguardian.com/society/2016/jan/20/nhs-funding-falling-behind-european-neighbours-kings-fund-research

 


Sugar tax, stigma, Jamie Oliver and childhood obesity

There are three guarantees in this life: death, taxes and Jamie Oliver interfering in the dietary habits of the British public.

Mr Oliver, I suspect, would have been delighted by George Osborne’s introduction of a sugar levy on soft drinks yesterday, set to come into effect in 2018. His rallying for a penalty on teeth-eroding beverages took off late last year, and as I wrote here on my blog a few months ago, I was as unenthused by it then as I am now.

But unlike the UKs favourite celebrity chef, I’m not really a fan of the ‘Nanny State’ approach to modern societal behaviour. I find it to be an extraordinarily useless and condescending waste of time. Government interference in our personal lives and the economy is inevitable, but a punitive tax on sugary drinks will harm only the poorest in Britain.

How telling it is, too, that it was the Conservative Party, of all parties, to bring in the new measure. If anybody was in any doubt as to whether or not the Tories were New Labour in disguise, this decision should act as a wake-up call. Were the Tory Party in any way socially or morally conservative, no such interference would have been suggested.

In their surprisingly naive response to the announcement, the NHS declared that the measure is the “first step to tackling childhood obesity”, and that obesity “now affects one in five children, already costing the NHS £5bn per year. Obesity is the new smoking”. Well, forgive me, but seeing as taxation didn’t work with cigarettes, why on earth would such a policy be effective in countering our nation’s growing obesity problem?

Obesity is becoming rampant throughout Britain, without doubt. You only have to walk down the average high street for two minutes before you see the mouth-wateringly grotesque fat community, waddling in and out of fast food restaurants, concealing their lard rolls with appallingly baggy clothing and taking up entire seat rows on public transport. I may sound contemptuous and frustrated, but it is becoming a real problem.

When I was little, fat kids at school were called names. Those fat kids did not like to be called names, and in many cases (though often some years later in life), chose to lose weight as a means of pushing back against the bullies and dealing proactively with name-calling. In the age of hyperactive political correctness that we are now pretty much nestled into, advocates of social stigma are, of course, considered to be bigoted or extreme in some manner. But stigma works, and the process is far less damaging to those unaffected by obesity.

But, alas, Jamie Oliver has his way once more, and struggling parents and students will feel the strain of his agenda on their wallets and bank accounts. “Education, not tax”, too, is a commonly-propagated line which, to some extent, I agree with. It is a sensible proposition, but seems to fly over the heads of many parents who routinely fail to select healthier options for their children, or restrict the treats that they are permitted around the house.

If a little more parental responsibility was enacted, I’d suggest that many of the UK’s childhood obesity issues would begin to subside. Even children are fully aware that the more they eat and less active they are, the fatter they will become. It is a simple principle, which doesn’t seem to be registering as well as it used to. Education programmes have now been proven to be futile; taxation is a silly, penal measure which punishes everybody (to varying degrees), regardless of weight or dietary habits, leaving only a resurgence in social stigma as a plausible candidate to turn our woes around.

Schools, governments and parents can only do so much, though, and so it does seem to me to be time for society to play its role. But, whatever your opinion on the matter, Jamie Oliver certainly isn’t the answer.