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BMA wrong to call for repeal of Health and Social Care Act

BMA wrong to call for repeal of Health and Social Care Act

BMA wrong to call for repeal of Health and Social Care Act

BMA wrong to call for repeal of Health and Social Care Act

BMA wrong to call for repeal of Health and Social Care Act

BMA wrong to call for repeal of Health and Social Care Act



by sjhoward

This is the 2,249th post. It was published at 16:38 on Friday, 13th June 2014.

Versions of this post also appear on the BMA website and Medium. It's like it's hunting you down wherever you look, begging to be read.

I took the photo at the top of this post at BMA House in September 2012.

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The BMA is asking members to sign a petition asking Government to repeal the Health and Social Care Act 2012. The leadership’s rationale is that the Act requires providers to compete, while the BMA believes that “collaboration and not competition is more likely to allow a greater integration of community and hospital services”.

I could not agree more: collaboration is more clearly in the interests of individual patients than competition, and collaboration seems at odds with competition. Yet I don’t think the BMA’s position should be to call solely for repeal of the Act: after all, the Act is not solely about competition. The legislation brought about many changes, some of which are working well.

For example, we are beginning to see the value of a new local authority perspective on influencing the wider determinants of health, as shown by the exemplary nominees for NICE’s local government public health award. This sort of progress can be found in many Local Authorities across England. To campaign for repeal of the Act is to surround this progress with a fog of uncertainty: repeal would reject this progress outright and move staff back into PCTs.

The Act limits the Secretary of State’s powers to intervene in the day-to-day running of the NHS. While the success of this has been questionable at best, we are beginning to see push-back against Government diktat. No one, except perhaps Lansley and Hunt, would argue that the NHS benefits from the Health Secretary holding operational control; yet repeal would reintroduce this.

The Act confers new responsibilities on NICE to support evidence-based social care. The Act provides the first (baby) steps towards regulation of healthcare support workers. The Act gives an unprecedented level of legislative support to research in the NHS. These may be small considerations in comparison to the problems of the Act, but outright repeal would (if I may mix metaphors) cast the baby and the bathwater both into uncertain territory.

How quickly the BMA seems to have forgotten the pain inflicted on our profession through restructure, job uncertainty, and redundancy. Excellent professionals left medicine — and especially public health — to pursue other careers, while others lived for years with the stress of the uncertainty of their positions. For the profession’s trade union to argue for yet another overnight reorganisation “so big, it can be seen from space” seems utterly perverse. Perhaps this is why, despite the BMA’s repeated urging, fewer than 4,000 people have signed the petition. Even if every signatory were a BMA member, this would represent less than 3% of the membership.

Repeal represents only a return to the past. It behoves professionals to put forward an alternative vision. For example, politicians refuse to discuss the threat to universal healthcare of having fewer taxpayers per patient as a result of an ageing population; yet the BMA is uniquely placed to devise a considered, collective, professional vision of the future of the NHS. To campaign only for repeal of what exists, and allow the next government propose and introduce yet another short-term model, seems to me to be a sure route to unhappiness.

The BMA should not call for repeal of the Act: this is opposition without a position. The BMA should identify the most insidious parts of the Act, and work tirelessly to scrap or rework them. But, more importantly, the BMA should thoughtfully advocate for the future health of the nation, not for a return to the systems of the past.

2D: Nigel Farage

2D: Nigel Farage



by sjhoward

This is the 2,022nd post. It was published at 12:30 on Wednesday, 22nd May 2013.

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Ukip’s increasing popularity has generated acres of news coverage in the past few months. I thought I’d use this 2D post to pick two of the more thoughtful articles about Ukip’s leader.

Nigel Farage

Writing in Prospect, the magazine for which he’s associate editor, Edward Docx describes Farage’s “relentless charm” in an article with several arresting revelations. Perhaps the most intriguing, if not the most insightful, is that “close up, he smells of tobacco, offset with a liberal application of aftershave”. I found it not a little strange how much that added to Docx’s characterisation of the man. Perhaps the scent of all party leaders should become a regular feature of all political reporting.

Docx mentions Farage’s deft handling of a lack of policy detail, but in The Telegraph, Allister Heath goes a little further in taking Farage to task on the lack of coherent policy: he claims that “there are huge black holes at the heart of Ukip’s proposals”.

While these are two rather different articles in terms of tone, form and content, they do identify much the same traits in Farage, at least from the grand political point of view. Despite this, they come to utterly different conclusions: Heath argues that Ukip essentially doesn’t “stand up to detailed scrutiny”, while Docx argues that Farage can “make politics feel personally relevant again” and “show our parliament a way to recover its dignity”.

Both arguments are well worth reading.

2D posts appear on alternate Wednesdays. For 2D, I pick two interesting articles that look at an issue from two different – though not necessarily opposing – perspectives. I hope you enjoy them! The photo at the top of this post was posted to Flickr by the Euro Realist Newsletter and has been modified and used under Creative Commons Licence.

Review: Live from Downing Street by Nick Robinson

Review: Live from Downing Street by Nick Robinson



by sjhoward

This is the 1,976th post. It was published at 12:30 on Wednesday, 16th January 2013.

I publish a book review every other Wednesday. You can browse all previous reviews here.

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Nick Robinson’s Live from Downing Street is a thoroughly enjoyable romp through the history of the relationship between politicians and the media, from the very beginnings of Parliament to the present day. It’s part historical and part autobiographical, with the latter part in particular including lots of amusing anecdotes about Robinson’s time as a political journalist. Some of these genuinely made me laugh out loud. It also has a lengthy “last word”, in which Robinson muses on the future of political journalism, and the opportunities and threats offered by introducing to the UK biased broadcasting in the mould of Fox News.

He has an easy writing style making this an easy relaxed read. He sometimes has a slightly peculiar reliance on turns of phrase which fail to accurately communicate what he means to say: for example, there’s a passage where he introduces Gordon Brown’s disastrous flirtations with YouTube by saying that politicians have always been keen to embrace technology to communicate their message – something which he’s spent most of the first two-thirds of the book disproving.

He gives a very eloquent account of the effect of the plurality of media in the broadest sense meaning that people surround themselves with messages that support their world viewpoint, and the effect this in turn has on perceptions of bias at the BBC. This is something I’ve been banging on about on Twitter for ages, in a far less coherent manner, and it was interesting to see that the same thoughts have occurred to that organisation’s Political Editor. He also gives an interesting discussion of the nature of bias and impartiality, which I very much enjoyed.

There isn’t an awful lot of new stuff in this book. I think many people who follow politics in detail are probably aware of the history of the BBC and the historic developments in the relationship between journalists and the press. But Robinson presents all of this with such a clear narrative and in such a clear way that I still found myself very engaged with the content even when he was describing events I knew well.

The lengthy discussion of recent events and media figures – phone hacking being perhaps the most notable example – will probably make this book date quite quickly. Indeed, the mentions of Leveson “whose report has not been published at the time of writing” already make it feel a little behind the times, particularly since Leveson’s report covers much of the same ground discussed by Robinson.

Either way, this is well worth a read, and comes highly recommended.



Live from Downing Street is available now from amazon.co.uk in hardback and on Kindle.

Review: My Trade by Andrew Marr

Review: My Trade by Andrew Marr

Review: My Trade by Andrew Marr



by sjhoward

This is the 1,898th post. It was published at 09:30 on Wednesday, 21st November 2012.

I publish a book review every other Wednesday. You can browse all previous reviews here.

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This is a thoroughly enjoyable personal history of journalism, written by the then BBC Political Editor, and former editor of the Independent, Andrew Marr.

My Trade certainly delivers on its promise to provide ”A Short History of British Journalism”, but rather than delivering a dry journalistic history, Marr injects copious amounts of humour and panache. He provides many personal anecdotes – some longer and more developed than others, but all entertaining – and passes judgement on developments in the media world, rather than merely reporting their occurence. The personal touch makes the copy much more engaging, and prevents it descending into a super-extended newspaper feature, like so many other books by journalists.

Anybody interested in British journalism would be well advised to read a copy of this book. It provides much background on how newspapers are put together, and how this has changed over the years. It even provides some history on the rivalries between newspapers, looking at (as an example) how The Mirror’s sales declined at the hands of The Sun, and how Marr’s own Independent set out to be different from everyone else, but ended up being much the same.

This is not intended to be – and nor is it – a detailed history of the development of the British media. Instead, it’s an enjoyable romp through the subject, stopping off at points of interest – particularly recent ones, and many of which you’d have thought he may have liked to avoid. He goes into some detail about Hutton and the problems of modern journalism, making convincing arguments for his point of view – which is, in part, critical of his BBC paymaster. It’s very clear from his writing that he’s experienced as a journalist, not just because he lists his many and varied jobs, but also because of the detailed insight he is able to deliver, and the apparent wisdom of some of his comments.

Certainly, this is a very easy-going enjoyable read, from a political editor who comes across as an affable kind of chap, and a book which I must highly recommended.

My Trade is available now from amazon.co.uk in paperback and on Kindle.

Jesus, the jungle and Nadine Dorries

Jesus, the jungle and Nadine Dorries

Jesus, the jungle and Nadine Dorries

Jesus, the jungle and Nadine Dorries



by sjhoward

This is the 1,877th post. It was published at 15:58 on Tuesday, 6th November 2012.

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I am not an MP for any reason other than because God wants me to be. I constantly try to do what Jesus would do.

So said Nadine Dorries in 2007. Obviously, Jesus has now recommended that Dorries abandons her constituents and takes a month off her regular job (while retaining a full £65,738 salary) to earn about £40,000 appearing on a tacky reality television show. God certainly works in mysterious ways!

Review: A Journey by Tony Blair

Review: A Journey by Tony Blair



by sjhoward

This is the 1,795th post. It was published at 09:30 on Wednesday, 5th September 2012.

I publish a book review every other Wednesday. You can browse all previous reviews here.

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Tony Blair’s autobiography gives a real and detailed insight into what it’s like to be Prime Minister: the stresses and how he coped with them, the challenges and how he tried to overcome them, the successes, the failures, the balancing of family life with political life and statesmanship. It really is quite fascinating.

Politically, there’s little in here that we haven’t heard before, but the detail and explanation of how and why decisions were reached seemed interesting to me. The “behind the scenes” detail of the huge events that occurred under Tony Blair’s leadership provided genuine insight, if not new information – Diana’s death, 9/11, 7/7, the Hutton Inquiry, and Iraq to name just a few.

Yet, it’s taken me the best part of two years to plough through this tome. That’s mainly due to what Ben MacIntire of The Times described as a “congenial style peppered with slang and gossipy asides”. I’d describe it as a style resembling transcribed speech, and it frequently becomes very thick and frustrating.

Let me pepper this review with some examples. When talking about the themes underpinning his leadership (something he does frequently, citing different themes each time), the following sentence appears: “Perhaps above all, an emphasis bordering on the religious on what counts to be what works.”

It’s not a crime against humanity, but it is a verbless sentence that doesn’t really scan very well. It’s the sort of sentence you have to re-read a couple of times to get the message. In a paragraph of prose, it’s a frustrating sentence that should have been edited. And these are little throughout the book.

Here’s another example. Read this sentence aloud: “I wondered – as did some of the newer and more radical faces in my Policy Unit, although this was still heresy in the party, not least among most of my ministers – whether we had been right to dismantle wholesale GP commissioning in the NHS and grant-maintained schools in education, instead of adapting these concepts of local self-govenment to spread decentralised management across the state health and education systems, but without the inequity inherent in the underfunded Tory reforms we inherited.”

Again, the message is clear, but it isn’t an easy read. A decent editor would surely have added some more punctuation, or cut this down into several sentences.

And, since we’re on a roll, let’s play “count the subclauses” in this example: “Precisely because the roots of this wider struggle were deep, precisely because it was a visceral life-or-death battle between modernisers and reactionaries, precisely because what was – and is – at stake was no less than the whole future of Islam – the nature of its faith, its narrative about itself, and its sense of its place in the twenty-first century – precisely because of all this, there was no way the forces opposed to modernisation, and therefore to us, were going to relinquish their territory easily.”

I think these examples demonstrate the message that this book is not an easy bedtime read. Yet, within a few sentences of passages like those above, Blair tells us about Alistair Campbell’s “clanking great balls”, describes Iraq as “a basket case”, PMQs as “a girls’ school playground” and relates that “I like to have time and comfort in the loo.”

And then, occasionally, Blair becomes suddenly coy: he didn’t want to discuss his son’s vaccination status “for private reasons the family was sensitive about issues to do with.” Note, again, that this hardly scans well.

The constant juxtaposition of long badly written passages of political prose and puerile descriptions of characters and situations wore me out. I couldn’t read more than a couple of chapters of this at once.

I think this demonstrates that I found this book a difficult read, which makes it difficult to rate. On the one hand, much of the content is five-star – well worth reading, whichever side of the political fence one occupies. On the other, the form of expression is risible, bordering at times on unreadable. This is a book that badly needs a revised and edited edition under the guidance of a decent editor! Until then, I can’t in good conscience give it more than three stars.

A Journey is available now from amazon.co.uk in paperback and on Kindle.

Some interesting rail statistics (really!)

Some interesting rail statistics (really!)



by sjhoward

This is the 1,733rd post. It was published at 14:59 on Friday, 20th July 2012.

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Rail fares are going up again. Every time this happens, talking heads on the news suggest that a re-nationalised railway would be cheaper. Is this true?

That is, of course, an impossible question to answer. It is undeniable that private companies now take profits that would otherwise have been returned to the Treasury under a nationalised system. But there is some data to crunch – There’s some data I’ve located with the help of @jrothwell (he blogs here) and @welsh_lisa2 in the House of Commons library.

This sets out rail fare increases in real terms since the late 80s, using the contribution of rail fares to RPI. I don’t think it’s too erroneous to assume that this is an okay proxy for an inflation-corrected comparison of the average change in rail fares. Because it’s based on a comparison of contribution to RPI with a 1987 baseline, the data isn’t in intelligible units – it’s all comparative.

This data shows a 42% increase in the real cost of rail fares from 1987 to 2011: this seems like a bad thing. This graph shows how rail fares increased over time. It shows the percentage increase on the 1987 fare for each year (including the 42% increase over 1987 fares in 2011).

That looks fairly damning! But is it down to privatisation? Privatisation got underway in 1994. The average year-on-year increase in fares between 1987 and 1994 was 2.34%. If we assume that this level of increase would have continued had privatisation not happened, we can plot the new course of history (red) versus the old one (blue):

As the new red line shows, had fare increases continued at the pre-nationalisation level, they would’ve ended up higher: they would be 73% higher than the 1987 equivalent.

However, some people claim that between 1992, when the Conservatives were re-elected with a mandate to privatise the railways, and 1994, when this actually happened, fares were artificially inflated to make the franchises seem more desirable. So, perhaps it’s unfair to include 1993 and 1994 in our calculation of the pre-nationalisation average increase. If we exclude them, the average year-on-year increase drops to 1.73%. The graph then looks like this:

That is, fares still end up higher in real terms than they actually did: in this scenario, the 2011 fare is 53% higher than the 1987 equivalent.

It would be great to have some pre-1987 data to see if that suspicious looking flick up in 1991 is really unusual, or just part of the pattern of the background picture: certainly if the 1987-1990 trend had continued, fares would hardly have increased. Combined with the above data, this answer in Hansard from Norman Baker suggests that the change from 1980 to 1986 was of the order of 6%. If we assume a 1% year-on-year increase, as that figure suggests, then the predicated and actual fare increase from 1987 to 2011 are pretty much equal.

Bearing in mind all of the above, I’m not sure it’s fair to say that privatisation has driven up passenger fares, even if some of the revenue is now siphoned off to private profit rather than being invested in public services.

Add this decrease in the rate of increase of fares to the indisputable data showing that passenger numbers have risen, passengers satisfaction ratings with both trains and stations have risen, and delays have decreased considerably, and suddenly privatisation seems like it might not have been the disaster we’re often lead to believe it was.

Of course, this is an extremely simplified view of things. I’m ignoring the complexities of the timing of various changes, I’m ignoring the government subsidies that have happened even under the privatised system, I’m ignoring the added jeopardy of train operating companies handing back franchises and leaving the government to pick up the pieces, and I’m ignoring the potentially dubious morality of selling off national infrastructure.

I’m not left with an overwhelming sense that privatisation is the best thing since sliced bread – or even that it was the right move – but I think that perhaps the waters are a little muddier than some would have us believe. And I’m going to stop being geeky now, and resume normal service…!

Andrew Lansley’s bad day

Andrew Lansley’s bad day

Andrew Lansley’s bad day

Andrew Lansley’s bad day



by sjhoward

This is the 1,668th post. It was published at 11:16 on Wednesday, 30th May 2012.

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If people could actually see inside my brain, all the things I was thinking, it really would be a very bad day.

So said Andrew Lansley, the Health Secretary, in an interview with Amber Elliott for Total Politics published today. This may be a slightly ill-advised soundbite given that there’s a perception that he’s duping the public with his plans for the NHS.

As it turns out, he’s having a pretty bad day anyway, as doctors have voted to take industrial action over pensions.

Nine years of blogging, and the permanence of it all

Nine years of blogging, and the permanence of it all

Nine years of blogging, and the permanence of it all

Nine years of blogging, and the permanence of it all



by sjhoward

This is the 1,638th post. It was published at 18:40 on Monday, 7th May 2012.

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Today marks nine years since I started blogging. Nine years. Increasingly, people are becoming concerned about the permanence of stuff posted the internet. Rick Santorum’s presidential campaign was hampered by the web, and the fact that for almost everything he said, he’d previously given an equal and opposite quote to some other source at some point in the past. And, of course, there’s many other less prominent examples of people’s online history coming back to haunt them.

Anyone with a blog, like me, can essentially make a choice. I could delete a load of old stuff. It wouldn’t make it completely unavailable online, as content from this site is cached all over the place; I guess it might make it slightly more difficult to find. But I’ve chosen not to do that. I’ve chosen to keep the complete sjhoward.co.uk blog intact. And I’m sure many people wonder why.

Firstly, let me say that it’s not because I think everything on here is great. It’s not. There’s some terrible stuff. There’s stuff that’s just plain dross. I’ve written things that I’m a ashamed of, like using “gay” almost as a punchline, or referring to the entire French population as “crazy frogs”. There’s positions I’ve asserted that, at best, are altogether blunter than I’d ever express now, like saying “I’m very anti-smoking”. And that’s before we even open the can of worms labelled “unnecessarily base humour”.

So why, you might ask, do I keep this stuff online, with my name written at the top of the page in a massive font size?

This is something I’ve thought a lot about. In the end, my reasoning was fairly simple. What I wrote in 2003 might have been unprofessional, but I wasn’t a professional then. It might have been immature, but so was I. The date is clearly and prominently shown on all the posts I’ve written. Of course I don’t hold all the same opinions I did when I was 18 – does anybody? We grow, we develop, our viewpoints and opinions change.

One of the more remarkable things about this little site is that you can how it happened. You can see the softening of my opinion on Tony Blair, from barely concealed hatred, to grudging admiration, to actual respect. My changing interests are reflected, from the 2005 election, during which I published daily “swing updates” based on a complex formula weighting different polls, to the 2012 local elections which were only mentioned in passing beneath a pretty picture of a bus stop.

All of this history, and all of these changing opinions, set out the path to where my politics and opinions lie today. And, of course, both will continue to shift over time.

In the end, I guess I came to the conclusion that if someone chooses to judge me on a personal opinion I held a decade ago, then so be it. Though I’d suggest that a far more interesting and intelligent approach is to ask questions: “You once said you thought x: do you still believe that?” or “Your position used to be y, now it’s z. What changed your mind?”

I don’t know exactly when the meaning of the term “flip-flopping” in political discourse changed from being about presenting different views to suit different audiences to being about actually changing your mind on a given issue, but I don’t think it’s a helpful change. I’m vaguely suspicious of people who claim to have “always believed” something – it has a slight whiff of valuing dogma above thoughtful and reiterative consideration of the issues. I can only speculate that the increasingly tribal nature of politics has led to increasing institutional derision of free thought: we must all toe the party line.

If you ask me, the sooner we lose the vogue notion that a change of opinion or reconsideration of position represents a weakness, the better off we all will be.

David Cameron doesn’t know how many houses he owns

David Cameron doesn’t know how many houses he owns

David Cameron doesn’t know how many houses he owns



by sjhoward

This is the 1,600th post. It was published at 11:55 on Thursday, 12th April 2012.

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I own a house in North Kensington and my house in the constituency in Oxfordshire and that is, as far as I know, all I have. Do not make me sound like a prat for not knowing how many houses I’ve got.

David Cameron, talking to Ginny Dougary for The Times, in 2009. I missed this first time round, but have just found it via David Eaton in the New Statesman.

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