Tuesday, March 31, 2015 

Labour stupidity cancelled out by the Lib Dems' lack of credibility.

Having set out where my vote's going this early, I'm obviously going to be spending the next 37 days grinding my teeth at every stupid, ignorant, counter-productive and downright indefensible leaflet and argument from the Labour campaign, all whilst still trying to convince myself I've made the right decision.  For instance, a sensible position for Labour to take on law and order would be to recognise crime has continued to fall in spite of the state of the economy and the cuts to the police.  It should therefore follow it is absurdly wasteful for the prison population to continue to be at a record level, and one of the very first things you could do to alleviate the pressures on the system would be to make clear no one should serve a short sentence for mere possession of drugs for personal use.

Except, of course, Labour remains anything but sensible on law and order, especially around election time.  THE LIB DEMS: SOFT ON CRIME, DRUGS AND THUGS screams a leaflet, the yellow peril having "made it harder" for the police to use DNA evidence, sent Anjem Choudary a pallet of hydrogen peroxide and given out crack to schoolchildren.  I exaggerate, but not by much.  You'd also mind less if the leaflet was clearer on where the Lib Dems have gone so wrong, only for the solutions apparently to be to scrap police and crime commissioners, which is fair enough but has nothing to do with the above, put "more bobbies on the beat", and "strengthen professional standards".  Jesus wept.  Responding to the complaints from among others the Transform charity, which quite rightly branded Labour's defence of jailing people for simple possession as "medieval", the party also said the Lib Dems "should explain why under this government drugs treatment has become much harder to access".  Or perhaps Labour can explain what help it is to a hard drug user to be sent to prison when they could instead be required to seek treatment.  That wouldn't be tough though, would it?

It's not even as though the Lib Dems aren't setting themselves up as a massive target elsewhere.  Their big promise today was to spend £3.5bn extra on mental health care should they be returned to government, only considering every single Lib Dem policy comes with a big question mark after it due to how we know they'll abandon a shedload of pledges for the slightest glimpse of power, who knows whether or not it would be a "red line".  To give the Lib Dems and Nick Clegg himself some credit, they have recognised mental health care has been underfunded for too long, whether you agree with their wider idea of a "zero" target for suicides or not.  £3.5bn, if it truly was extra spending, would be exactly the kind of money needed to help bring down the current waiting times for treatment, as well as help to address the chronic shortage of beds that has seen under-16s have to spend weekends in police cells rather than in hospital.

Only, as Kat explains in the video supposedly meant to support the party's commitment, the Lib Dems in coalition have presided over a NHS that has seen mental health become even less of a priority.  She was lucky in that her parents had private health insurance, so that on both occasions when she was overcome by her eating disorder she was able to get the treatment she needed on an inpatient ward.  On the second occasion this was only however after she had tried to get help via the NHS, which ended with the assessment deciding she wasn't sick enough to meet their criteria.  Predictably this led to Kat blaming herself for not being sick enough, leading to her starving herself further, to the point where she once again had to rely on private healthcare.  It doesn't exactly strike as an endorsement of the Lib Dem stewardship of the NHS, enlightened as they might be on mental health.  Why then should anyone trust them to put this right when they have made clear a vote for them is a vote for another coalition, with all that entails for the policies outlined in their manifesto? 

Answer came there none.

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3/31/2015 11:16:00 pm | |

Monday, November 14, 2011 

Stupid question, stupid answer.


Health secretary Andrew Lansley is to announce that he is prepared to sack NHS bosses who attempt to save money by rationing treatment or making patients wait longer for operations.

So when exactly is Lansley going to sack himself?

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11/14/2011 03:01:00 pm | |

Tuesday, June 14, 2011 

Pause? Repeat.

There are times when you can't help but marvel at the amazing feats of rhetorical dexterity achieved by politicians. It's even more remarkable when the modern media, that supposed cynical, feral beast which always manages to cut through the bullshit to the truth takes on the main role of convincing the nation that their leaders aren't in fact men with feet of clay.

The government's success in turning its "pause" on their proposed NHS reforms into a substantial victory will probably become a case study in how to rescue presumed lost causes. Just two months ago Andrew Lansley stood up in the Commons and announced that his seemingly well-laid plans were in fact causing such disquiet that they needed to be brought to an immediate halt. Never mind that the consultation period on his initial white paper,which the Department of Health had presented as giving overwhelming support to his proposals had long since passed. There now needed to be more scrutiny, more thinking done on something so major.

Those of us who imagined that this was another example of the government attempting to legislate too quickly and not being able to see the wood for the trees couldn't have been more wrong. Everything had been sown up in advance. In was brought Prof. Steve Field, a practising GP, not an outright critic of Lansley's plans but in fact a keen supporter, albeit it one with some reservations. He and his future forum would review everything, and make recommendations in due course. Out would go the worst excesses, those parts which would have always been politically unacceptable once it was actually noticed they had been proposed in the first place, such as the opening up of the NHS to any outside provider who could offer a better deal and the role of Monitor in actively promoting such competition, and in would come ever so slight changes which most likely would have been inserted during further readings or forced by the Lords. Hence now the commissioning boards which would have been purely made up of GPs must have at least two lay members, as well as a nurse and a consultant on them, while the 2013 deadline for the abolition of primary care trusts will be "relaxed".

Everyone then has either had their personal objections somewhat pandered to, or can claim victory for their part in either ordering or demanding the "pause", with the exception of Lansley himself. GPs concerned they were going to be left holding the blame if things went wrong can point to the others on their boards, not to mention the health secretary, who takes on ultimate responsibility for the NHS and its continuation as a "comprehensive service". Managers, hospital consultants and nurses have all been told their views have been taken on board and will have representatives at various points of the commissioning process. Those healthcare firms looking to cream off the easy jobs might be perturbed at first, but nothing has actually substantially changed from the initial plan: their opportunities will just be "slowly phased" in. The Liberal Democrats can claim it was down to their sudden discovery of how disastrous the bill was that the "pause" took place, as they did at the weekend, despite Clegg and friends having initially signed off and voted for it, while Cameron has had a smashing time over the past few weeks making the same speech over and over again about how much he loves the NHS, just to drill it in to anyone who thinks the fact he's a Tory means he secretly wants to privatise the whole damn thing as soon as he can. The Tory backbenchers, ever wary of the Lib Dems gaining the upper hand, looked like mutinying until they saw the actual changes and decided quite reasonably that they're fairly minor. Potential banana skin sighted, the Conservatives have deftly skipped over it.

As for the media, the majority still can't get enough of Cameron's shiny bonce. The novelty effect of having another party leader alongside him also hasn't yet worn off, and everyone's written Lansley's obituary already anyway, so it was only natural to portray this as another great success for this new Teflon leader. Oh, and there was a shouty doctor too, always helpful when going into actual details is as mundane as it is on this topic. This whole nauseating stunt had it been attempted by Labour would have resulted in those involved being pilloried for resorting to such spin, a word it seems which has mysteriously fallen out of favour now the Tory-supporting press have their one true loves back in power. Only a few naysayers are pointing out that this top-down reorganisation, the exact thing the coalition promised they wouldn't do is now going to take place just as the NHS needs to be making massive efficiency savings. Cameron after all made his one great promise that he'd cut the deficit rather than the NHS, while Labour for once being both realistic and honest declined to ringfence the health budget, knowing that savings have got to come from somewhere.

This isn't by any means the end of the matter; it's just another temporary sticking plaster on reforms that haven't been anywhere near properly thought through, where it's still not clear that GPs are ready to take on a commissioning role despite have signed up to the pathfinder consortia, and where if the waiting lists continue to increase real, open, discontent with the coalition's promises and policies will begin to develop. A highly embarrassing political mess though, one of the coalition's own making, has been turned into a shining example of Cameron's leadership abilities and the Liberal Democrats' influence within the government, with all the blame shifted onto the unfortunate Lansley. Everyone wins, except for us plebs in the long term. And isn't that what modern politics sets out to achieve?

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6/14/2011 11:44:00 pm | |

Tuesday, April 05, 2011 

An accident prone coalition.

For a government less than a year into its first term, the coalition is already becoming remarkably accident prone. All governments through initial hubris or power of will tend to implement reforms which they either later regret or have to put right; others become so addicted to legislation that they either manage to bore or overwhelm those potentially opposed into submission: just witness New Labour's astonishing 21 criminal justice acts, a figure which itself can't be properly verified so prolific were the additions to the statute book.

The key difference with the coalition is that the policy u-turns and clarifications it's been forced to make ought to have been glaringly obvious to anyone even slightly in touch with the political mainstream. Caroline Spelman's crackpot scheme to sell off the nation's forests, regardless of the possible merits of reforming the Forestry Commission, was the kind of idea which should have been squashed when first proposed. Excepting banning the WI and riding roughshod over objections to new housing developments (which, oh, the coalition is also planning to do) nothing could be more seemingly calculated to rile up the Tory heartlands than the potential padlocking off of local woodland. Yet somehow it not only went through cabinet, all but three from the respective coalition parties also voted against an amendment urging the government to rethink the sell-off.

Once again proving the truism that politicians and indeed we as a species never learn anything from our mistakes, Andrew Lansley duly stood up in the Commons yesterday and channelled Spelman over his reforms to the NHS. While the changes are not being abandoned wholesale as the forest sell-off was, we are instead going to have a "pause" or a "natural break" in the proceedings as everyone is being urged to reconsider their respective positions. Lansley's gambit from the beginning in promoting his white paper was cunning, so cunning in fact that it was just too clever: his idea was through handing over commissioning to GPs, many of whom have long believed that they could do a much better of running the NHS if only they were given the chance, he could at the same time buy support for the work of building on Labour's introduction of the private sector, allowing or more accurately forcing the newly formed GP consortia to buy services from "any willing provider".

What's more, it almost worked. With most GPs so delighted at the prospect of wielding the knife as it were, with "pathfinder" consortia already representing 87% of England, it took a while for most to take notice of the other changes being introduced. It was only last month at an extraordinary special representative meeting that the British Medical Association called for the withdrawal of the entire Health and Social Care bill, while the Liberal Democrat spring conference, motivated by the opposition of Shirley Williams and Evan Harris called for major changes.

Quite why it took the Liberal Democrats so long to realise that they'd been duped is unfathomable. After all, the coalition agreement specifically called for an end to top down restructuring of the NHS, while the white paper proposed the abolition of both primary care trusts, which the Liberal Democrats had wanted to democratise, and strategic health authorities. It's the top down restructuring to end all top down restructuring, and yet without the disquiet at the speed of the reform rising they may well have voted for it regardless. Whether you go with Nigel Lawson's observation that the closest thing we have to a national religion is the NHS, or Tory MP David Ruffley admitting that it even makes them socialists, the only thing more popular than trees is our free at the point of use health care system, however much we complain about it and want to improve it. Once you get even close to suggesting that much of what it does can be farmed out, or that private firms can cherry pick what they want to do at a profit while the state is left with the hard cases, you have a problem on your hands.

And yet David Cameron, the man who said his priority was the NHS and that he'd protect it from cuts was up until very recently not only defending the bill but praising Lansley's work to everyone. Almost needless to say, along with everyone else in the cabinet who'd let Lansley get on with it, Cameron was nowhere to be seen as his health secretary was forced into his new strategy of delay. If Gordon Brown became known as Macavity, never being around when the shit hit the fan or when it was time to take responsibility, then Cameron is putting in a remarkably similar performance. This failure to pin the blame directly on the prime minister has been the biggest failure of the opposition to the coalition so far: Nick Clegg and the Liberal Democrats have rightly been targeted for propping up a Tory government intent on using however much time it has to embark on an economic and social experiment of slashing the state and hoping the private sector can fill in the gaps; unfortunately this has been to the detriment of properly nailing Cameron first and the Conservatives second for their aloofness at what they're about to unleash.

This ultimately is why Lansley's plans have had to be temporarily frozen. It's not that the Liberal Democrats are threatening to oppose the bill, or that the doctors themselves have become militant, it's that Cameron's image, carefully cultivated as the protector of the NHS, was in danger of being permanently sullied. Lansley instead is the one being left out in the cold, widely being described as dogmatic and unwilling to compromise, having only done what was asked of him regardless of it conflicting so obviously with both the coalition agreement and indeed with the manifestos of both parties. It could well be that this is a bluff, with only piecemeal changes to the bill made, as after all, Cameron himself is still fully behind plans which would see the entire public sector opened up to the private sector. More likely however is that the Liberal Democrats will be given enough compromises to claim that they've stopped Lansley's worst excesses, something they'll especially prize if the AV referendum fails, while the Conservatives will show themselves as being willing to listen to reasonable criticism. Even if this turns out to be the case, it shows once again that the coalition firstly isn't as clever as it thinks it is and secondly that through the right strategy and target it can be potentially defeated. Cameron, if it wasn't already clear enough, is the key.

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4/05/2011 11:59:00 pm | |

Wednesday, December 15, 2010 

Opaque consultations and Andrew Lansley's NHS reforms.

As political U-turns go, the Liberal Democrat about face on tuition fees has absolutely nothing on the promise made in the coalition agreement that the new government would not indulge in top-down reorganisations of the NHS. The full pact between the Lib Dems and the Conservatives was published on the 20th of May; on the 12th of July the government published the Liberating the NHS white paper, advocating the abolition of strategic health authorities and primary care trusts. If you were feeling cynical you might fall into the belief that the two parties had no intention whatsoever of honouring the pledge made in the agreement, and had been planning all along to do exactly the opposite. Appropriately enough, the website setting out the coalition's Programme for Government has already been closed down, and is now only available through the National Archives' cache.

Today the government published its response to the consultations launched by that previous health white paper. Considering how quick the coalition was to abandon its opposition to carrying out the kind of top-down reforms which had so angered and demoralised NHS staff during Labour's years in power, you'd expect it to at the least recognise or catalogue just how many responses were either in favour of their proposals and how many were against. While this would be time-consuming as there were over 6,000 submissions, it would not only signify this government's dedication to transparency but also enable us to ensure that they aren't misrepresenting the overall tone of those responding.

Instead the document cherry picks from this vast cache of opinions, and while it does provide a small amount of space for trenchant criticisms of the original plans (paragraph 1.15, page 10), it quotes at far greater length those who were supportive, which it describes as coming from "across the spectrum". It's impossible to know whether this is an accurate summary of the consultation submissions for the simple reason that the only thing we have apart from the tiny pieces directly lifted from them littered throughout the paper is the names of the organisations that took part. These are listed in this highly professional 58 page PDF file (original mirrored here in case it's replaced), 27 pages of which are either completely blank or have what may have been the remnants of earlier edits to the document strewn across them.

This wouldn't be so bad or so hilariously hypocritical if the document itself didn't propose an NHS "information revolution" (paragraph 2.23, page 22), the kind where "information can drive better and safer care, improve outcomes, support people to be more involved in decisions about their treatment and care, and, through extending opportunities for people to provide feedback on their service experience, improve service design and quality". Such as by perhaps asking whether those responding to consultations would mind having their submissions published alongside the official government paper, ensuring that their own objections and proposals can be used to hold the department to account? A further consultation was incidentally launched on this "Information Revolution", alongside another on greater choice and control, with very little fanfare back in October (an introduction to the "IR" on the DoH website has so far received only 18 comments). Most will only now be learning of them, with the consultations closing on the 14th of January, leaving little real time for many to respond.

It may well be the case that the responses to the consultation have somewhat altered the government's plans, as it sets out (paragraph 1.13, page 8), although you certainly wouldn't know if from the way it's presented the opposing submissions. For instance, while the summary of how the government has listened suggests that it's changed its view on the commissioning of maternity services due to the response, a look at the actual relevant section (paragraph 4.97, page 79) sees four different organisations quoted as supporting the original plan while another four, described as representing the majority view, differed. Here's where it would have been incredibly useful to have the full submissions to be able to see the real strength of opinion. Without them you're left to take the Department of Health's word for it, which judging by previous performance would be a very foolish thing to do indeed.

As with so much else the coalition is proposing, speed is being favoured over properly thinking through the possible consequences of such rapid and untested reform. The response given in the white paper to those arguing that the proposed changes are a "revolutionary" leap in the dark (paragraph 1.20, page 12) is that they would be better characterised as a logical evolution of the reforms put in place by the last government, with it commenting that practice-based commissioning and GP fundholding have been around for 20 years. This is despite Andrew Lansley previously arguing that comparing the former and GP commissioning is meaningless as they are completely different things. It also doesn't make clear that £80bn of NHS funding will be going straight to the new GP consortia to allocate and spend, a truly massive change, and one which the government is yet to prove the majority of GPs actually want. The cost of this reorganisation, yet to be revealed despite the health secretary apparently knowing the figures, comes as it seems unlikely the government will be able to keep its other promise of a real terms increase in spending on the NHS without making further cuts in other departmental budgets. If no one other than NHS staff originally cared about the breaking of the "no more top-down reforms" pledge, millions of voters will come to if it leads inexorably to Cameron's "cutting the deficit rather than the NHS" policy becoming just another election soundbite.

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12/15/2010 11:25:00 pm | |

Wednesday, August 27, 2008 

No excuses for being Andrew Lansley.

There are, according to Andrew Lansley, no excuses for being fat. Or to be slightly more specific, being obese. Apparently, the idea that biology or environment has any bearing on whether someone is overweight is simply making excuses. Making excuses is bad. As is nannying. Our government does both. That makes the government bad.

This is an extension of Cameron's speech a few weeks back that a lot of people's problems are self-inflicted. To a certain extent this is undeniably true; saying so is not something radically new, or something that has been actively discouraged, despite how the Conservatives have tried to portray it as doing so. It's more simply that somebody noticed that most bristle at being told that everything is entirely their fault; rather that doing so more subtly, not being quite so confrontational and being more feel-good tends to work far better. This isn't political correctness, this is simply being far more sensitive, which is more likely to work.

In fact, Lansley is actually taking it a step further than Cameron by rejecting the idea that there are any excuses. Cameron added:

"Of course, circumstances - where you are born, your neighbourhood, your school, and the choices your parents make - have a huge impact. But social problems are often the consequence of the choices that people make.

Cameron then does indeed believe that both biology and environment have their effect on obesity, which is wise, because they both obviously do.

Ignoring where you were born and what you are born into for half a second, would Lansley agree that there is an excuse for someone being overweight if the medication which they take has a side-effect of weight gain (Yes, bear with me, I'm being rhetorical, I'm sure he would)? After all, that is most certainly an excuse which some could make when they were overweight to begin with, but it could also be a valid one.

Like with Cameron, Lansley again isn't aiming this at the obese members of his own party. It's the nod and the wink - it's not the Fatty Soameses of this world that are the problem, obviously, but rather all those gigantic, wobbling, welded to the pushchair, acne-riddled layabouts that stuff their faces all day and then have the audacity to walk around our towns and cities where other members of the public might see them. Likewise, Lansley must surely agree that there are no excuses for the put upon single-mother, the kind that has to allocate every single penny of her income, the one that shops not at Waitrose or M&S or even Tesco or Sainsbury's, but at Netto, Farmfoods, Iceland, Lidl, etc. The one that doesn't have the time, or energy, to as this person on CiF says, "produce healthy food from basic ingredients". She could do that, if she wanted to be on her feet for another two hours of the day, but why bother when she can buy the economy pizzas, ready meals at however many for £5 and otherwise which can either be popped straight in the oven or straight in the microwave?

Now that we've agreed that there are no excuses whatsoever for being the size of a house, what then are Lansley's suggestions for altering the situation. Let's start with some cod-psychological behavioural theory:

If we are going to defuse the time-bomb of obesity-related ill-health, we must change the behaviour of adults today, as well as our children. Tell people that biology and the environment causes obesity and they are offered an excuse not to change their behaviour. As it is, people who see more fat people around them may themselves be more likely to gain weight. Young people who think many of their friends binge-drink are likely to do so themselves. Girls who think their peers engage in early sex are more likely to do so themselves. Peer pressure and social norms are powerful influences on behaviour and they are classic excuses. We have to take away the excuses.

Quite so. But isn't there also peer pressure not to be fat? Perhaps things have deteriorated still further since I left school, but I'm pretty certain that being overweight was not exactly a barrel of laughs, unless of course you happen to be the barrel and the laughs were directed at you and you laughed along in a feeble attempt to pretend you weren't the butt of the joke. In fact, let's not beat around the bush here: I called fat people fat. You called fat people fat (probably). I was an unpleasant little pustule (and still am) and on one occasion I told a girl that she should consider the Slim Fast plan, thinking this was devastatingly witty. She descended into floods of tears and I became enemy number one with her friends, quite rightly, for a good time afterwards. I felt like a shallow little twat and still do. I'm pretty certain that it's probably much the same in some of the more immature offices across the land, and that those especially overweight have to face up to a fair amount of abuse when they venture out. Do these things therefore balance out, or not? I don't know. I'm pretty sure that they can't simply be dismissed as "excuses", however.

For teenagers, I believe we also have to think specifically how we can deploy leadership, role models and social marketing approaches, not just to warn them about the harmful consequences of risky behaviour, but inspire them with what they can achieve by choosing healthy living. We must not constantly warn people about the negative effects of obesity – instead we must be positive – positive about the fun and benefits to be had from healthy living.

Again, perhaps I'm being a little simple here, but aren't there plenty of role models out there that are anything but overweight? Indeed, I'm struggling to honestly think of someone obese or overweight that's a positive role model, unless we perhaps count a few singers that have emerged recently, such as Adele or those two reality show debutantes, Rik Waller and Michelle McManus. Inspiring is a noble and obvious aim - but it's one that's a hell of a lot harder to do in practice than it is when making a speech.

Today, I propose that our second responsibility deal should be on public health. I have invited Dave Lewis, chairman of Unilever UK, to chair a working group of business representatives, voluntary groups and experts. Together, we will invite views on these proposals and hammer out the details of the deal. Our proposals for the responsibility deal include: supporting EU plans for a mandatory GDA-based front-of-pack food labelling system; industry-led reformulation initiatives and reduction of portion sizes; proportionate regulation on advertising and positive campaigns from the industry and government to promote better diets; a responsible drinking campaign matched by community action projects to address drug abuse, sexually transmitted infections and alcohol abuse, using a proportion of drinks industry advertising budgets and supported by the government; and incentives and a local structure, through business organisations, for small and medium-sized companies to improve the health of their employees, working with business organisations, NHS Plus and the Fitness Industry Association.

Ah, details. On the GDA front, I'm pretty certain that it's either already became law for firms to have similar details on the packaging or have rolled them out voluntarily; the Diet Coke bottle sitting in front of me has the exact scheme described on Lansley's link on the label. This is opposing the so-called traffic light scheme, which while simplistic was far easier to understand and which the Food Standards Agency set-up. Firms like Coke, and supermarkets like Tesco opposed it. On the reformulation initatives and reduction of portion sizes, again, I think most manufacturers have already been responding to that, reducing salt and fat levels, etc. They've probably not done as much as they could, but I can't see how the Conservatives rather than Labour are going to be any more successful in persuading them to do so. On positive campaigns from industry and government, it's not as if the government has not already been doing so: there's a whole Choosing Health section on the Department of Health website, and there's been a White Paper on the subject. There's currently a responsible drinking campaign being run by the government, one which I think is actually rather good, but whether such things ever have any effect is open to question, and the community action project again seems to be the Tories deciding that the voluntary and private sector will pick up the slack, whilst the last proposal just seems to be in there to make up the numbers.

In other words, Lansley seems to be more or less siding with some of the less reputable sides of the food industry in blocking the traffic lights scheme, proposing pretty much all that the government is already doing, and not a lot else. All while being slightly more in your face, less open to the idea that there are reasons for being overweight not just limited to eating too much and not exercising enough, and not offering anything approaching new except a harsher line in rhetoric. Do I really need to keep repeating the bit about the new Blairites, except with a slightly less kind face?

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8/27/2008 11:55:00 pm | |

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