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      We’d All Be Dead Another Secretary of State pushes determinedly, blindly on with NHS reforms, deluded in the notion that they alone can solve the great mystery of health. My message is: no matter how well intentioned, your policy making is doomed to fail, as others have failed before you. May I humbly suggest another solution? The NHS is now into its 30th year of perpetual reform (perhaps we should hold an anniversary party?). Yet it is still in need of reform. At what point do the politicians wake up and conclude that, in the way they go about […]
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    It had to come sooner or later, and it has come sooner. Christopher Smallwood, chair of St. George’s University Hospitals NHS Foundation Trust, writing in the Guardian on Monday February 8th, claimed that the “free at the point of use” mantra has had its day. It is time to allow insurance to play a part in funding the NHS, he said. This is no dodgy dossier from a right-wing think-tank, picked up briefly by the Tory press. It is a serious view from a senior NHS figure, published in a centre-left newspaper and included in a Guardian-sponsored public debate. And […]
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    All the gains and achievements following the boom years between 2002 and 2008, when the NHS enjoyed a significant injection of new resources, are under assault and unravelling fast. The need for a health debate involving the public is urgent and to understand the forces that have led the NHS to where it is today requires taking the long view. Crucially, this means seeing that the problems are not merely technical or managerial. At the centre of any analysis has to be an acknowledgement of the politics of health. Conceptualising health as political and as the product of political action is integral to […]
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    If Labour wants to go beyond opposing austerity and thereby appeal beyond the 25% of voters  affected directly, then it needs to propose policies that are relevant to the fears and dreams of specific sectors.  However, this needs to go beyond promising to do the same thing as the Tories only better, and policies should neither look like mere electoral opportunism nor be reducible to it: there needs to be a good reason for such promises.  And while it is important to defend the good in Labour’s record, new ground will need to be broken if there is to be […]
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    The Cities and Local Government Devolution Bill, slowly making its way through Parliament, feels like a background presence in conversations about the future of the NHS. With just five months left to fill huge provider deficits, by any means necessary, and with the near certainty of junior doctors going on strike, worries about constitutional tinkering seem almost frivolous. The healthcare devolution plans emerging from Manchester don’t immediately seem to take us into the unknown. In one light, the new NHS-led regional structure, with its emphasis on settling disputes and coordinating plans, looks not so very different to a good old regional […]
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    Representative democracy depends on politicians exiting office. It is part and parcel of our democratic system. There is considerable interest in who stands for and gains office, but curiously little about the leaving of political office: What is the experience like? What happens to politicians as they make the transition from office? What is the impact on their partners and family? Does it matter to anyone other than those immediately affected? Are there any wider implications? A detailed and systematic study was conducted to examine these questions. A sample was constructed of former council leaders and former MPs (to cover both local and national elected politicians), and, […]
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    The Coalition agreement promised no top down reorganisation of the NHS and the White Paper had lots of nice sounding stuff about patients at the centre, doctors in charge and less bureaucracy.  After lots of consultation making everyone feel important, the Bill was published and signed off by the LibDem leadership.  “Labour attacks Tories on NHS changes” was not a story of any interest. In the Commons the Bill sailed through on coalition votes without any LibDem disquiet and no great outcry from anyone in the professions – just Labour and the Trade Unions in opposition – so again no […]
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    In retrospect it is clear that those who fought Nye Bevan’s plans for setting up the National Health Service were right in at least one important respect. The setting up in 1948 marked a revolution in the relation between the state and the medical profession. But it was not quite the revolution that the critics had anticipated and prophesied. It did not mean the triumph of bureaucracy over professionalism or the subordination of doctoring to ministerial diktat. Instead, it created a situation of mutual dependency. On the one hand the state became a monopoly employer: effectively members of the medical […]
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    These are the key points taken from Chris Ham’s very interesting  Reforming  the NHS  from within Beyond hierarchy, inspection and markets: It is time to bring about a fundamental shift in how the NHS is reformed, learning from what has and has not worked in England and elsewhere. Politics and policy work on different cycles, which results in short-term political initiatives getting in the way of the long-term policy commitments needed to deliver transformational change. Large-scale structural reforms under successive governments have proved a major distraction and should be avoided in future. Transforming the NHS depends much less on bold strokes and […]
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    I went  to see an interesting play, This May Hurt a Bit, about the NHS in Bolton three weeks ago and thoroughly enjoyed it.  It is mostly about the politics of the NHS in England. I especially enjoyed the appearances of Nye Bevan, Winston Churchill and the Grim Reaper.  It’s on at the St James Theatre in London from 14 May – 21 June 2014 The producers, Out of Joint,  have kindly sent me a copy of the script.  There are 26 characters.  They produce it with a cast of 8, doubling up.  The set isn’t complicated.  It would be perfectly possible […]
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    The excellent Clare Gerada, Chair of the Royal College of GPs is calling for a brave and honest debate about rationing medicine.  According to GP magasine two thirds of GPs think that the NHS should stop providing free prescriptions for drugs that are available over the counter.  Generally stuff like Calpol which you can buy without a prescription is cheap, less than the £7.65 prescription charge we have to pay in England.  So it seems unlikely that requests for this stuff are coming from the people who have to pay charges.  Only a small minority of prescriptions attract a charge  – and […]
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    The collection of articles in the book NHS SoS edited by Jacky Davis & Raymond Tallis adds to our understanding of the Health & Social Care Act saga provided by the journalism of Nicholas Timmins in Never Again.  The articles from Jacky Davies & David Wrigley and Charles West in Chapters 4 and 5 were particularly interesting. However, one of the opening paragraphs almost put me off the rest. “Without the active collusion, passive acquiescence or incompetence of all these players (politicians, journalists, the unions and the leaders of the medical professions) it would hardly have been possible for the Tories […]
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