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Archive for May, 2012

Labour’s National Policy Forum: the continuing case for its abolition

Labour NEC candidate Pete Willsman has some proposals for internal party reform. These include changes to the National Policy Forum (NPF) to give members greater information on what’s being developed e.g. by shadow cabinet working groups, and power to the NPF to decide what goes to conference for approval.

Pete’s a good guy, properly devoted to democratising the party, but he’s in cloud cuckoo land here.

 The NPF does not need amending. It needs abolishing.

It was one of those initiatives that may have seemed like a good idea at the time but it is clear enough now that it and its (willing and often competent members) are more likely to used as a mechanism to fob the membership off with some notion of ‘being in office’ than to provide input into actual Labour party policy.

The stark reality is that the Parliamentary Labour Party and its advisers set policy, often in reaction to political opportunity, sometimes at short notice, always behind closed doors.  Anyone notice the idea of an EU referendum discussed by the NPF (not that I’m against it)?

Members and CLPs will be better off without the NPF deflecting their energies, and better served engaging with their MP/PPC to demand the policies they want, and holding the same properly to account if they don’t get them.

Of course, I’m no help to the abolitionist cause.  I sought nomination to the NPF ballot paper on just this agenda, but my own CLP declined to nominate me (although others did), instead preferring someone perhaps less likely to rock the boat.

But I’ll be back.

Why Greece will do just about anything to stay in the Euro (part 2)

May 29, 2012 10 comments

Two weeks ago I was told I was a) economically illiterate; b) talking defeatist ‘cobblers’ for arguing, against the leftie consensus, that the Left should get right behind SYRZIA and other anti-austerity parties as they do what they must do to stay in the euro. 

I argued that the pain would be just too much to bear, and that far from being a decisive act for socialism, leaving the euro could simply tear the country apart, with untold consequences.

Now the National Bank of Greece has set out in numbers what will happen to ordinary Greeks if Greece is forced out:

Per-capita income would drop by at least 55 percent in euro terms as a new currency would depreciate by about 65 percent, according to the report, emailed from the bank today. The recession would deepen by about 22 percent at stable prices, adding to the 14 percent recorded in the 2009 to 2011 period, National said, while unemployment would jump to 34 percent and inflation rise to above 30 percent, pushed up by the higher cost of imported goods.

Greeks know this.  This is why SYRZIA may not win the elections, despite being front runners.  People may feel it’s simply too dangerous.

I repeat

Better for SYRZIA to talk up the ‘nuclear option, in the knowledge that Merkel and co will most likely blink first, but to have some form of compromise lined up if need be. 

Greece will and must do what it can stay in the euro, though capital flight and bank withdrawals might just mean it’s already too late.

And we should support them in that.

Murdoch’s part in the downfall of capitalism

Am writing a piece of moderate length about Leveson for Thursday, but I just wanted to run something by this blog (and apologies for the title – nobody wins without bombast).

Before the Leveson enquiry, Ed Miliband the leader of the Labour party talked about reforming capitalism. Even Zac Goldmsith agreed, but it was largely scoffed at as unworkable. Philip Aldrick for the Telegraph said:

Reforming capitalism will be the lasting legacy of the crisis, but Miliband – for all his famed intelligence – offers nothing more than platitudes and petty politicking … Given the right incentives, the free market would put responsibility back into capitalism all on its own.

Pitching Predator against Producer capitalism was not mocked because it wasn’t necessary. Indeed the banking crisis proved it was necessary. It was chewed up and spat out because it could not be done by a moderate politician.

But perhaps the banking crisis was not the fork in the road moment, like it should have been. Perhaps Leveson is.

I heard Chris Bryant MP speak on Monday about the enquiry and about Murdoch in particular. He shared a story about how in an earlier contact with Murdoch he’d never seen staff so scared of their boss. The reason being is that he usually wears big rings on his fingers to really grab people’s attention when he is speaking.

Indeed as Mr Murdoch addressed the Commons Culture, Media and Sport Committee, James Murdoch had to take control of his Father’s hand a few times, instinctively inclined – as the elder Murdoch is – to beat his fist on the table to demand authority.

Murdoch, it is said, runs a tight ship. Or at least that’s how it appears. Of course when it comes to answering many of the questions from Robert Jay QC, the stock answer received is “I cannot recall” (or indeed the now-famous retort “it was not top-of-mind” from James Murdoch).

Murdoch’s only fall-back is incompetence.

So perhaps we should take pity on him.

Tom Watson MP, at the same event as the one Chris Bryant MP spoke at, said that the Labour party will be returning to debate the question of ownership. This must be on the grounds that one person or group can own too much.

This will be a very interesting debate, one I think which reaches into the producer/predator debate and renthuses it in light of Leveson.

Ed Miliband wasn’t simply in the right place at the right time, what he has been talking about for a while now on capitalism directly squares with a problem that has seen an unprecedented reemergence – on which the Labour party has to, and is, acting upon.

Categories: General Politics

Really, Ms Brierley

May 29, 2012 2 comments

This is an open letter to Sally Brierley, the Chair of the Nursing & Care Quality Forum, the creation of which was announced by David Cameron in January. 

It concerns her letter of ‘initial recommendations’ sent to Cameron on 18th May.

Dear Ms Brierley

I wish to offer my comments on nursing and care quality to the forum, and I do so in the context of your letter of initial recommendations to the Prime Minister of 18th May.  I will cover three specific issues: membership of the forum; staffing levels; and intentional rounding.

Membership of the forum

In your opening preamble you say:

When you announced your intention to set up the Forum, this was against a backdrop of high-profile failures in the quality of care, from isolated cases reported in the media, to systemic problems at Mid Staffordshire NHS Foundation Trust and Winterbourne View. These cases have demonstrated that there are problems with the quality of some nursing care, and some of these problems are very serious.

Given your concern about Winterbourne View, it seems odd that your forum contains no members from the private care industry. 

While you might wish to argue that some quality of care issues are generic to both the NHS and private sector, it would surely be remiss of the Forum not to examine whether there are any factors specific to private care which create the risk of patient abuse of the type seen at Winterbourne View.  Surely, therefore, the Forum needs someone on it with an understanding of the private care industry.

I recommend that you take early action on this point, so that issues relating to private sector care are adequately addressed by your forum.

Staffing levels

The professional press has picked up quickly on your initial finding that:

We heard overwhelmingly that staff are concerned about staffing levels and skill mix within their teams and the subsequent impact that this has on the quality and safety of care, and people’s overall experience of the care they receive.

You go on to make the central recommendation that Boards or their equivalent should conduct bi-annual reviews of staffing levels and skill mixes, and that the Care Quality Commission should seek assurances that these are being conducted.

This is fine in itself, but it is not enough.  Managerialism is fine when there are sufficient resources to manage; managerialism becomes part of the problem when there are not.

I am therefore most concerned that you feel able to say to the Prime Minister, in your opening statement:

Of course, more money and more staff would always help, but we need to ensure we use the resources we have available to deliver more effective and efficient high quality care. Nurses need to rise to this challenge, backed by strong leadership at every level.

This reads to me like an early abdication of responsibility on the part of the forum, and yourself as its chairperson. 

I see nothing in the remit of the forum which requires that it offer recommendations only within the constraints of existing funding to NHS Trusts and private sector organisations.  If it transpires that, ultimately, there are simply not enough resources being made available to ensure good quality care – and this is what your early findings do suggest – then it your forum’s responsibility to bring this to the attention of the Prime Minister (assuming you keep up your correspondence to him), and argue for more resources.

You will, I am sure, have seen Monitor’s most recent set of financial assumptions, setting out the eye-watering level of ‘savings’ that Trusts in both the acute and non-acute sector are being expected to make over the next five years, and further to the massive reductions in resources they have already suffered.    The staffing level/skill mix problem is only going to get worse, and if your forum chooses not to engage with this reality, then I am afraid it will become part of the problem itself, rather than part of the solution that both you and I hope it will be.

I recommend therefore that at your next forum meeting your lead agenda item should be a revisiting the parameters you have set yourself for your work, in light of your key early findings of resources constraints, and that subsequently you write to the Prime Minister to inform him of the outcome of your decisions.

Intentional rounding

I note that the forum wants to:

accelerate the implementation of person centred approaches such as ‘rounding with intention to care’ – where every individual receiving care knows they will have at least hourly contact with staff – and we believe that wherever possible, handovers should be done alongside and involving those we care for. Therefore, we will identify and work with demonstrator sites in a range of care settings (including hospitals, care homes, mental health and community settings) and use the lessons learnt to support others on their implementation.

Clearly you will be aware of the issues relating to patient confidentiality with bedside handovers, and I am sure you will be addressing those. 

However, I wish to raise a much more fundamental concern about ‘intentional rounding’ which I feel has been insufficiently explored to date, and which governmental/prime ministerial pressure to be seen ‘to do something’ about care quality risks being wholly set to one side, with serious negative impacts on that care quality in the medium to longer term.

At his visit to a Salford Hospital on 6th January, the Prime Minister announced the creation of the forum you now lead.  At the same time he made the pronouncement that he was in favour of ‘hourly intentional rounding’ and that he wanted to see it rolled out across hospitals nationwide.

This was, frankly, an insult to the nursing profession.  Imagine, by way of comparison. if the Prime Minister had visited an operating theatre on the same day, heard from an anaesthetist that he was now using a new anaesthetic drug which appeared to offer less post-operative  side effects, and then announced on the spur of the moment that he [the PM] now wished to see the use of this drug rolled out nationwide.  Imagine, then, the uproar that would have ensued from the medical profession.

Yet the nursing profession appears to be expected simply to say ‘Yes, Prime Minister’, and get on with ‘rolling out’ a method of nursing which is a) unproven in terms of its medium-to-longterm effectiveness;  b) despite the addition of ‘intention to care’, still bears some of the hallmarks of the ‘back round’ that both you and I were  subjected to as young nurses, and which a newly confident nursing profession moved on from in the 1970s and 1980s towards models of care which did not depend on mindless routines, but which took individual patient needs into account.

I note that the forum is wary of intentional rounding becoming an exercise in box-ticking.  Yet I fail to see how it can realistically be anything other than that (though it will be box initialling rather than ticking). Daily rounding sheets that I have seen have between 120 and 150 different boxes where an initial must be placed to prove that the care has been provided, or the question asked.   That is 120 boxes every 24 hours for every patient. How can that not become an exercise in itself?

There is a rich body of research literature – sadly apparently  untouched by the nursing profession – known as implementation studies, which looks at the way in which policy is implemented ‘on the ground’, largely beginning with the groundbreaking work by Michael Lipksy in the 1970s (Street Level Bureaucrats: Dilemmas of the Individual in Public Services).

This research studies the way in which policy imposed from above is inevitably interpreted by those tasked with implementing it, and how in situations where both resources are constrained AND worker initiative is restricted, the outcome is often one of  ‘alienation’ and degraded public service.

You can see this process of alienation and degraded service on hospital wards today. Where resources are scarce, and staff are undervalued, you get the inevitable result of staff  ‘shutting down’ their empathy as a coping mechanism, and the results are all too clear: nurses ignoring patient needs, huddling at the desk in a mixture of resentment and guilt, unwittingly part of a downward spiral of the type seen at Mid-Staffordshire.

The introduction of intentional  nurse rounding will – I can guarantee – lead, perhaps after initial improvements, to worse care in settings which are already under staffing pressure.  Excellent nurse leadership may slow up the downward spiral in some cases, but in most cases even that will not help. From there, mangerialism will again kick in, with the blame attached to staff when it turns out that intentional rounding did in fact become a giant, cynical box-ticking exercise, and that patients in their care become even more dehumanized.

 I urge the forum to get a grip of the implementation studies literature to which I refer, and to look back in history to see why routinised care was dispensed with by the nursing profession first time round.

The forum should then think again about its ‘demonstrator sites'; the evidence base for intentional rounding simply does not exist, especially in terms of its longer term effects, to justify ‘demonstration’ over ‘pilot’, and as noted the move towards national rollout in compliance with the Prime Minister’s uninformed wishes will not just be dangerous for patient care; it will be an expression of abject acquiescence on the part of the nursing profession, with your forum as key representatives, and a massive step back for the profession in terms both of its credibility and self-confidence.

Yours sincerely

 

Paul Cotterill, ex-RGN (registration now lapsed as result of ubiquitous 1980s nursing back injury)

 

 

 

 

Policy rubbish

Sadly, I must inform TCF readers that I did not make it to the ballot paper for the National Policy Forum.  This is because I was not nominated by my home CLP, although I did receive nominations from other places.

I must assume this is because I have a very weak grasp of policy matters and how they pertain to the Labour party’s development of a coherent programme.

In other news, here’s an interesting post from Mark Ferguson at Labour list, suggesting that the Labour party may be addicted to ‘fixing’.

Categories: Labour Party News

Why are Labour MPs letting ‘Open Europe’ set the anti-Europe agenda?

May 28, 2012 1 comment

Matthew Barrett has an interesting piece up at Conservative Home introducing the work of Fresh Start, the initiative of three Eurosceptic Tory MPs, including one Chris Heaton-Harris:

The Fresh Start Project is in the process of comprehensively researching the different options for renegotiating and reforming – ie taking back – the areas of competency Britain currently cedes to the EU.

So far, so normal. Studying how best the UK can freeload on Europe as-it-is-now, rather than contribute to ‘research’ into how European institutions might be reformed/renegotiated so it benefits the whole of Europe, is a traditional Tory stance.

But then we get this :

The wider campaign for a new relationship with the EU takes the form of the All-Party Parliamentary Group (APPG) for European Reform, which is open to all MPs, and which was set up in order to ensure that pro-reform voices from across the parties could be heard…… The pro-reform European think tank Open Europe acts as the APPG’s secretariat (my emphasis).

Regular TCF readers will remember Open Europe, and its relationship to Chris Heaton-Harris:

He [Chris H-H] doesn’t like regulation.  Especially EU regulation.  Especially things to do with workers’ rights.  His main source of evidence is the not-entirely-unbiased Open Europe:

“Based on over 2,300 of the government’s own impact assessments, an Open Europe study (2010) found that regulation has cost the UK economy £176 billion since 1998, a sum roughly equivalent to the UK’s entire budget deficit.”

It looks like Chris H-H may have got as far as the press release on this report. Otherwise he might have seen that this is a study of benefits/costs, not just costs:

“We estimate the benefit/cost ratio of the regulations we studied at 1.58. In other words, for every £1 of cost introduced by a regulation since 1998, it has delivered £1.58 of benefits” (p. 1).

Put simply, Open Europe is a rightwing attack job, happy to send out misleading press releases on the basis of twisted reports.   Just look at the website.

Why, then, would a solid leftwing MP like Kelvin Hopkins agree not just to sit on this All Parliamentary Working Group (alongside the odious Frank Field, naturally), but also accede to Open Europe as its ‘secretariat';  surely Labour MPs sitting on this group simply legitimises Open Europe’s pernicious policy influence within Westminster.

There is a whole leftwing rationale out there for the reform of the European Union: rebalancing power between the Council of Ministers and Parliament, challenging neoliberal assumptions built in the EU treaties, ensuring that free trade development takes human rights into account, and so on.  In advance of any EU Referendum, it is vital that the left rises to this challenge.  

Unless I’m missing something, allowing Open Europe free reign in parliament is the opposite of seeking to achieve this.

 

 

 

The real Lisbon Treaty: Tsipras, May and Eurogeddon realpolitik

May 26, 2012 7 comments

A short while ago, I mentioned the possibility of a Greek ‘fix’ involving artificial devaluation via (temporary) import duties and export subsidies, and noted:

Of course there is a reluctance even to think about tinkering with the fundamentals of the Single Market in this way, but as ‘eurogeddon’ approaches for both Greece and the rest of Europe, a temporary fix like this may start to seem an awful lot more attractive.

I was, as expected, pilloried for such left-field (borrowed) thinking , especially in the comments on the Liberal Conspiracy Sunny horror-edit, which failed to notice that I’d already acknowledged the issue, e.g.:

Providing subsidies for exports to the EU would be clearly illegal also as there’s no realistic prospect of it being approved by the EU Commission under the State Aid rules.

This is of course, true.  Up to a point…….

Article 30 of the Lisbon Treaty does indeed say:

Customs duties on imports and exports and charges having equivalent effect shall be prohibited between Member States. This prohibition shall also apply to customs duties of a fiscal nature.

But then Article 32 goes on to say:

In carrying out the tasks entrusted to it under this Chapter the Commission shall be guided by………(d) the need to avoid serious disturbances in the economies of Member States and to ensure rational development of production and an expansion of consumption within the Union.

This might easily enough be interpreted, if the political will is there, as meaning the Commission doesn’t have to enforce Article 30 if it’s going to create havoc, which then opens the door to precisely what I/Duncan have in mind.

 We’ll see.  It is only one option. 

In any event, the SYRZIA leader seems to be adopting a strategy of brinkmanship on pretty well exactly the same lines as I was supporting in that piece – refusing externally imposed austerity while at the same time refusing the option of leaving the Euro,  in the knowledge that both side have the ‘nuclear option’, and that it’s Merkel who will most likely blink first; that’s why IMF boss Lagarde has been sent in to play tough cop; SYRZIA will, I hope, see that as a demonstration of increasing desperation rather than one of bargaining strength. 

Cleverly, Alexis Tsipras also refers to the “structural reforms” that a SYRZIA-led government would undertake.  This might include some kind of unilateral export subsidy (import duties will of course be much harder to implement effectively, and a holidaymaker-focused sales tax may be another partial route). I suspect ‘structural reform’ is more code for reforming the tax system so that taxes from the wealthy are a) increased; b) actually collected.  The code may be about dampening capital flight for the time being.

Alongside this,  it’s interesting to see the Tories now in the UK making plans to restrict intra-EU immigration.  This is, like duties/subvention, apparently outside the spirit of the Single Market, as set out in Article 21 of the Lisbon Treaty, but open to exception:

Every citizen of the Union shall have the right to move and reside freely within the territory of the Member States, subject to the limitations and conditions laid down in the Treaties and by the measures adopted to give them effect.

It will be interesting to see, if Sunny decides to hack this article up and post random excerpts of it at Liberal Conspiracy, whether those accusing me of crass stupidity in understanding the fundamentals of the Single Market also think Theresa May’s plans are beyond the pale.

For myself, I suspect Alexis Tsipiras and his comrades understand the real politik of the European crisis rather better than Theresa May, though I may be wrong – May might be on to an incredibly cunning way for the UK to leave the EU without the bother of a referendum, thus outflanking Labour from so far to the right that even Ed’s brilliant Euro-team won’t see it coming.

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