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So far, Cameron is winning the TV debates debate

In the game of poker that is the planning process for General Election TV debates, Cameron—the player with most to lose—is currently playing best. The broadcasters have played worst, totally fumbling their hand.

exposure of a product

Cameron patently has the most to lose from taking part in the debates. Unlike Miliband and Clegg, he’s not all that unpopular as a leader. He has little to gain and much to lose from sharing a platform with Farage, and further legitimising UKIP’s candidacy.

Cameron’s demand for inclusion of the Green Party will not be met by the broadcasters. If it were, it would look like the participants had been chosen on Cameron’s recommendation alone—hardly a fair and impartial source—opening them to justifiable legal challenge from the other parties who want to take part.

So Cameron is faced with two possible outcomes: the broadcasters do not go ahead, in which case he comfortably sidesteps the problem; or—more likely in my view—the broadcasters go ahead and “empty chair” him.

In the latter case, all options remain open to Cameron. Changing his mind, if that’s the way the wind is blowing, is a one-day story at most. He could even duck the first debate, with Farage, on the grounds that he objects to UKIP’s inclusion without the Greens, take or leave the second (3-way) debate for much the same reason, and still face down Miliband in his preferred (and accepted) one-on-one format.

The debate including Farage will doubtless be a fiery occasion which will probably do damage on all fronts—but it’s likely to do more damage to those present than to an absent Cameron. Speeches criticising an absent leader don’t make for nearly such good TV as people yelling at each other. Clegg and Miliband’s commitments to “anyone, anytime” debates means that they can’t duck Farage; it might make sense for Cameron to let them demolish each other one-on-one in the second debate, too.

Cameron’s other advantage, which Miliband seems insistent on handing to him gift-wrapped, is that opponents are now calling for Cameron to debate in airtime they could be using to build a message or attack Cameron’s record. The media’s own obsession with the debates will likely trap them in this neutralised position until there is movement—which, clearly, Cameron will prefer to leave until the last moment. Cameron calculates—I guess accurately—that his apparent prevarication over taking part in TV debates damages him less than full-frontal attacks from his opponents.

The broadcasters bungled this process by announcing a plan rather than debates. The announcement of a plan implied room for negotiation and manoeuvre. Had they had the common sense to announce the invitees, the format, and the dates, making them fixed events to which leaders were invited, the landscape would now look very different—and I’d wager that all four leaders would be signed up.

The spanner in Cameron’s works could come from the “digital debate” proposed by The Guardian, The Telegraph and YouTube, and confirmed last week to include Cameron’s five preferred participants. Yet, despite being proposed a consortium which buys ink by the barrel, nobody seems to have noticed. If the two papers were to announce a date and invitation list on their front pages, along with assurance that they would “empty chair” those who didn’t turn up, all of those invited might find it difficult to graciously decline… and even more so if they could get a broadcaster to commit to covering (but, to ease the legal challenge, not producing) the event.

Unless the digital debate consortium make a move, it seems unlikely that anything will move in this story for a few weeks at least… but it will be fascinating to see how it plays out.

This post was filed under: Election 2015, News and Comment, Politics, , , , , , , .

Thoughts on the Serial podcast

Among my friends, not having an opinion about the Serial podcast is roughly as socially acceptable as not having an opinion on the Cereal Killer cafe. And as someone who listens to a lot of podcasts (most of them actually of radio shows), I feel particularly entitled to have a view.

For those who have been offline over the last few months, Serial was a weekly podcast with a new episode released each week. It was presented and produced by experienced American radio journalist Sarah Koenig. The podcast followed Koenig’s investigation into the 1999 murder of schoolgirl Hae Min Lee, for which her ex-boyfriend, Adnan Syed, had been convicted and imprisoned.

General life and busyness mean that I didn’t quite manage to keep up with the weekly pace of Sarah Koenig and Co’s Serial. A couple of week ago, though, I finally finished the first season; here follow a few jotted thoughts.

Serial-2

It was very addictive…

Serial displaced everything else on my podcast playlist. I listened to episode after episode, and couldn’t get enough. I thoroughly enjoyed it, and look forward with keen anticipation to the second season.

…but not as innovative as many people suggested.

Blog post after newspaper column after magazine review have suggested that Serial‘s format of a single story told over several weeks is novel, yet Radio 4 has used this structure for decades on hundreds (probably thousands) of dramas, and tens (probably hundreds) of documentary series. The combination of a sort of gonzo journalism and drama was, I concede, a little unusual—but not novel.

Sarah Koenig was the perfect host…

I’ve never listened to anything Koenig has done before. I don’t know if she’s a regular on This American Life because (heresy ahead) I don’t listen to that show. But for this, she was perfect. She has a brilliant radio voice and great way of writing text that pulls in the listener. This listener can’t praise her presentation highly enough.

…but the overall tone was odd.

Jonathan Rothwell wrote a few weeks ago about the weirdness of the show’s slightly jaunty ‘whodunnit’ tone and the way in which this jars with the reality of what is being described. This is a real life brutal murder case; the very existence of the journalist’s investigation implies a reasonable suspicion of a miscarriage of justice, with all the additional harm that carries; yet the story is often treated rather lightly. I found the cognitive dissonance of content and tone unsettling.

The production was fantastic…

The handoffs between Koenig’s presentation and clips of interviews and archive material were seamless. I think this owes much to the writing and the presentation, but also the production and compilation of clips that demonstrated each point was impressive. This is something a lot of Radio 4 productions do really badly, so it’s a joy to hear it done well.

…except for the use of music.

Music is powerful, and especially so in radio drama where the only stimulus is auditory. If you add in music underneath a witness’s recorded testimony, it will change my perception of that testimony. If you are trying to make a balanced review of a case to allow me to reach my own conclusions, then your music is likely to be prejudicial. If you are trying to make drama and argue for one side or another, you probably shouldn’t be playing with people’s lives through a podcast.

I worried about the narration overstating facts…

There were a few episodes in which the characterisations of events in the narration extended beyond the described facts of the case. It is difficult to describe exactly what I mean without giving an example – apologies if this counts as a spoiler.

In episode six, there is a lot of discussion of the ‘neighour-boy’. He is reported as having once said that he had been shown the body, but he did not testify at the trial. This is repeatedly characterised Koenig as the ‘neighbour-boy’ being a witness to the murder. This is evidently false: seeing a body is not equivalent to seeing a murder.

There are a few similar incidents through the series, and I can’t quite decide whether they are mere slips of the tongue, or whether there is a conscious decision to refer to the events in these terms to heighten the drama. Either way, given the import of the situation, it seems plainly to be wrong, and unfair to interviewees as much as to the accused.

…and got a bit claustrophobic in parts.

This may be the public health physician coming out in me, but I felt that the series was very narrowly focused on the case at hand—with a couple of notable exceptions. The series would have benefited from drawing more on similar cases and from aggregated data about many cases. I wanted stats!

I don’t know why it aired before completion…

It isn’t clear to me why Serial started airing before the series was complete. It seems a curious decision, and one with which I’m not entirely comfortable. Hypothetically, if someone had confessed, would the series have continued? Would it have been fair to air a recorded confession prior proper investigation? Would it be fair even to report such a confession? Starting a story which has such a big impact on the lives of all involved without clear knowledge of where it might end strikes me as mildly irresponsible.

I think this changed the nature of the podcast, too—the tone and focus seemed to shift as the podcast went on, in a way which might well be attributable to the media coverage it generated. It started out as an exploration of the limits of reasonable doubt, and ended as an unsolved whodunnit. The former was a more interesting concept, with more interesting stuff to explore, than the latter.

…nor why there were strange gaps in the story.

Relevant questions seemed to go undiscussed in Serial – though it’s possible I just missed them. (Possible spoilers ahead.) It’s not clear to me whether Jay knew where the body was. It’s repeatedly said that Jay was able to show where the victim’s car was, but there’s no discussion of whether he knew the location of the body. This is a bizarre omission given that his story is that he helped to bury the body.

And don’t get me started about that conclusion.

I felt like the podcast got a bit wrapped up in itself by the end. My impression throughout was that the intention was to explore the nature of reasonable doubt. It seemed as though the show caved to externally generated expectation to ‘solve’ the crime in the final episode – an unrealistic expectation which wasn’t met, but was sort of pointed at and talked around. This was a shame. I would’ve liked a much more strident ending that pointed out (spoilers ahead) that – no – we don’t know who committed the murder but – yes – the trial outcome was wrong because of the gulf of doubt. I wanted Koenig to come out fighting about ‘innocent until proven guilty’, not giving a personal reflection on her own personal theories about Syed’s guilt or innocence.

But overall—I can’t wait for Season Two.

There were problems, but—all things considered—I enjoyed Serial. It’s great to hear speech radio done really, really well. I donated towards a second season and will look forward to listening to it. In the meantime, I’m now totally hooked on another This American Life alumnus’s podcast: Alex Blumberg’s Startup (and Reply All, which I actually discovered first). Oh, and This Week in Google, of course. Not forgetting my preferred alarm clock, The Globalist. And More or Less. And… well… all the good stuff.

This post was filed under: Media, Reviews, , .

The private sector will always be involved in the NHS

A number of politicians have recently made absurd statements about the role of the market and profit in healthcare, and specifically in the NHS. In political terms, the two worst culprits are the Labour Party and the National Health Action Party.

When the Labour Party left office in 2010, data1 showed that roughly 5% of NHS procedures were carried out in the private sector. Under the current Government, as of the most recent set of statistics, this is roughly 6%. It’s just worth bearing those proportions in mind whenever you hear Labour pontificate on the role of the private sector in the NHS. But I digress.

In his Party Conference speech, Andy Burnham asked:

And for how much longer, in this the century of the ageing society, will we allow a care system in England to be run as a race to the bottom, making profits off the backs of our most vulnerable?

I’ll answer that question in a moment. But to illustrate that Burnham is not alone, let us turn to the National Health Action Party.

You may not have heard of the National Health Action Party: it is a well-meaning but misguided Party whose platform—to defend and improve the NHS—is as vague as it is logically flawed. Dr Richard Taylor, co-leader of the party, was previously an MP; he signed an Early Day Motion in support of homeopathy, and praised the use of acupuncture and reflexology in cancer treatment. To date, the party has contested and lost nine elections2 with their best result being a 9.9% share of the vote for a single council seat in Liverpool. Again, I digress.

In The BMJ, in reaction to the news that Circle Health plans to withdraw from its contract to run the Hitchingbrooke Hospital in Cambridgeshire, a National Health Action Party representative said:

This perfectly illustrates the difference between the private sector, which seeks profits, and public NHS Trusts … This shows exactly why the market has no place in healthcare.

So, you ask me, what’s wrong with those quotes? They seem like perfectly sensible sentiments to me!

Both of these quotes are simply nonsense. Neither the Labour Party nor the National Health Action Party are campaigning for the removal of profits and the market from the NHS—and nor is anyone else.

health care industry

Any modern business, be it a hospital or fishmonger, is reliant on suppliers who will draw a profit. The NHS doesn’t manufacture its own light bulbs and baths, nor generate it’s own electricity,3 so people will draw profit from supplying them.

Alright, you might be saying, but that’s not really medicine, is it?

But of course, profits are made on medicine too. Sure, the NHS could manufacture all the medicines it needs—it already manufactures some.4 But many medications are under patent. Are NHS patients to be prevented from accessing patented drugs? Of course not: so companies will draw a profit. And the more sick people there are, the bigger the profit there is to draw.

OK, you say, but medicines are a special case.

Except they’re not. Almost every product used to deliver healthcare—from syringes to catheters to implants to surgical tools—will generate a profit, as it is almost all bought in from commercial manufacturers.

Come now, you say, supplies are a red herring. I’m interested in healthcare—a human caring for another human. There’s no profit to be made there!

Oh, but there is. Management of human resources is a tricky business. Often, Trusts will hire in external experts to help with training, planning or management, many of whom will work for consultancies which make a tidy profit.

Everyone knows human resources officers aren’t human, you intone—though I couldn’t possibly comment, I’m talking about a nurse looking after a patient at the bedside. Where’s the profit in that?

The scenario you describe is just dripping with profit—from the agency that recruited the nurse, to the profit on the manufacture of his uniform, to the cut of his pay which goes to the nursing agency he’s working for, to the cut of his car parking fee which is given to the private company managing the facility.

Ugh. You do go on a bit. What’s your point?

Suggesting that the NHS be removed from the commercial market and freed from the pursuit of profit is nonsense. Of course, the internal market in which NHS providers compete with one another could be reformed or removed, but the NHS is involved in a wider external market which is here to stay. The NHS is one of the country’s biggest purchases of goods and services, and each supplier will be doing the best they can to—effectively—profit from the sick.

Even if, for the sake of a thought experiment, we say that the NHS could be isolated totally from the battle for private profit, the end result in terms of the health service alone might not be that different: there would be continual pressure to reduce costs to the taxpayer, which is effectively the same financial pressure as increasing profits to shareholders.

The true argument is about the extent of involvement of the private sector.

Consider privately-employed doctors. Would we trust doctors to the same extent if we knew their interests balanced our interests with profit potential? This isn’t something we have to treat as a thought experiment: most GPs are small businesses and work on exactly this principal with little discernable effect on levels of trust. But, again, it feels icky.

Consider private sector management of whole NHS hospitals. This might look like a step too far: it takes a layer of previously publicly-funded management, who perhaps tried to balance the drive for profits with the best interests of patients, and moves them to the profit-hungry private sector. Yet, the management would always be accountable to commissioners, who would be looking out for the patients: so does it really matter? Perhaps not from the conceptual standpoint—but I’ll admit that it makes me more than a bit uncomfortable. And while a sample size of 1 makes for a poor trial, the fact that the first hospital so-run has become the first hospital to be rated as “inadequate” on patient care does not feel reassuring.

Consider public health campaigns teaming up with well-known brands. Is it okay if public healthcare money inflates Aardman Animations’s bottom line, if using Aardman characters is a good way to get health messages to children? I’m not sure: evidence about cost-effectiveness could sway me one way or the other.

Wouldn’t it be wonderful if we could have a debate on these issues that’s based in the real world, rather than the five-word soundbite world? Wouldn’t it be great if politicians would describe the extent of private involvement in the NHS that they believe to be appropriate, and we could then vote for the Party whose ideas most closely align with our own? Wouldn’t it be peachy if our politicians would stop patronising us all and treat us like adults?

As I said in my last post, the current model of delivery for the NHS is unsustainable. This is a problem that needs statesmanship, cross-party exploration, and—most importantly—tackling by adults.


  1. Hospital Episode Statistics: the set of data that describes what happens in hospitals across the NHS in England. They’re not perfect by any means, and lag quite a way behind real time, but they’re the best we’ve got. 
  2. The Eastleigh by-election, the London region in the European Parliament election, and seven local election seats. 
  3. Actually, I have worked in a hospital that generated a lot of its own heat and power. They had pages and pages of information about it on the hospital intranet. As a junior doctor, I never got time to read it.  
  4. The NHS manufacturers relatively tiny amounts of “special order” medication that isn’t available commercially. One of the units that does this work is based here in Newcastle, a stone’s throw from the site where William Owen first produced Glucozade as a special pharmaceutical product to aid recovery from common illnesses some 88 years ago. It was later sold to Beecham’s, renamed Lucozade, and is now everywhere, despite the fact that—to this blogger at least—it tastes vile. 

This post was filed under: Health, News and Comment, Politics, , , , .




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