Though Cowards Flinch

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)

Sign the petition

From January 2001, the rate of VAT for eligible sanitary protection products was lowered from the full rate of 17.5% to the “reduced rate” of 5%. Now we must pick up the campaign to see all sanitary products (including sanitary towels; sanitary pads; panty liners; tampons; keepers and maternity pads) be reduced to the zero rate (0%) alongside most food items, books, newspapers, magazines and children’s clothes.

They are very necessary items and rates on them disproportionately hit women the most. Some common sense on behalf of the government is needed.

Sign it

Emma Burnell, who puts together conferences and events, is understandably angry that men dominate conference platforms.  She offers a challenge:

Find me an all male panel – in fact, find me any topic on which you could reasonably hold an informed public debate – and I’ll give you the names of five women who could hold their own on the panel.

I think it’s the wrong challenge.

The problem is not primarily that men dominate platforms.  The primary problem is that there are platforms for them to dominate. Platforms are reflections of patriarchal domination in the first place, and simply reinforce patriarchal power structures.

 The real challenge is not to change the gender of who gets to dominate the rest of us from the platform, but to get rid of the platform entirely, and in so doing create the ‘informed public debate’ which is actually so lacking from the usual event format.

I don’t go to many conferences or events.  Partly this is because I live miles away from most of them, but mostly it’s because they’re generally shite.

When I do go I quickly get sick of the high-profile types – mostly men - who swan from conference to conference on conference-type fees.  Generally, they tell me what I already know and/or agree with, and expect me to sit and listen to their advice on what I/the movement/the party should do next.  I might get to ask a polite question which they then answer with varying levels of condescension (or flannel about if they don’t know).  Then I get to  go home again, none the wiser, but a bit more deflated. 

The more radical, power-reversing approach, is not to ask the important people what they think the less important people in the room should think and/or do, but to develop ‘bottom-up’ formats (more here), whereby the less important people can make demands of the more important people, with these demands focused on how the latter can take action themselves in support of the grassroots.  Of course the important people should have the freedom to express their opinion based on their expertise in the subject area – that’s why they’re there –  but in the end the focus should be on how they can help take the ’cause’ forward.

The Left should therefore seek to alter the structure of political conferences, making the high-profile (remunerated) participants work for their money, by briefing them pre-conference on their obligation to agree actions in support of whatever cause the conference is about.  If they fail to deliver on the commitments agreed at the conference (and if they are too onerous they shouldn’t agree to them), they won’t get invited back the next year;  the message will soon spread that they are just windbags, who need to be replaced on the circuit.

Then, I suspect, you’ll start to get gender equality amongst paid participants, no longer ‘platform speakers’ in the traditional sense, but something like ‘expert facilitators’.  The male windbags (and a few female) will fall off the conference gravy train, to be replaced by women committed not just to the display of their supposed expertise, but to using it for the common good.

Apparently in panic about falling polls amongst women voters, the government has ‘found’ £300 million for childcare support.  According to the Department for Work and Pensions press release:

Currently, childcare support is only available if you work 16 hours or more, but the Government is removing the minimum hours rule so that all families receiving Universal Credit will be eligible for financial help. This means that families on low incomes will receive more support to keep them in work.

As now families will be able to recover childcare costs at 70 per cent – up to £175 for one child or £300 for two or more children per week. The money will be paid through Universal Credit from 2013 and will mean that around 80,000 more families with children will be able to work the hours they choose.

Let’s set aside quickly two more obvious matters already widely commented upon -  first, that this support doesn’t start for another 18 months, and second, that this move does nothing for those working/wanting to work 16 hours or more per week, who suffered big cuts in April 2011 when 500,000 people, mostly women, lost an average £436 a year, and up to £1,300 a year”.

What other commenters don’t appear to have noticed is that for the most women who work or want to work for less than 16 hours per week, all of that childcare is already free, and has been for some time now.

Yes, that’s right. The government is offering to pay up to 70% of childcare costs on hours of childcare which, for most parents, are 100% free anyway.

This 100% free care comes under the longstanding Nursery Education Grant programme, under which all children 3 years and over get 15 hours per week free provision. The programme is also already being extended,  plans, to provide the same free care for children 2 years and over.

So in fact the only group who will benefit properly under the new scheme are parents of 0-2 year old children.  This would be fine, except that we already know that the number of parents seeking care for this younger age group is proportionately much smaller than  for the 2-4 year age group. (For example, the most recent Lancashire Childcare Sufficiency Assessment (p.40) found only 4,344 childcare places for 0-2 year olds, compared with 24, 206 places for 2-4 year olds.)

The 100% free care does currently cover only 38 weeks of the year (effectively a 50 week year because pretty well all childcare ceases for two weeks over Christmas).  It might be argued therefore that the new 70% support announced could help with holiday care costs, but surely if this had been the intention the government could simply have topped up funding specifically around holiday provision.

Similarly, there might be an argument that this move is in some way targeted at parents of school-age children so that they can work outside of school hours (for example, in a 8am to 11am job which means they need to use a breakfast club), but there would be much more effective ways of doing this (not least given the lack of breakfast clubs in most schools).

All in all, while there will be some benefit around the margins, it’s difficult to see this move by the government as anything other than a short-term panic measure, whether or not backed by some cunning plan to ‘unspend’ some of the £300 million once everything settles down. 

DWP officials MUST surely understand that the government is largely announcing 70% support for a group already being 100% supported, although there may be some confusion caused by the fact that DWP implements the former, while the Department for Education is responsible for the Nursery Education Grant system.

Whatever the case, it does look a little like Labour’s initial reaction – that this is nothing more than a ‘smoke and mirrors’ announcement – has some justification, and there must be some suspicion about whether this £300 million will be effectively spent or later sucked into existing budgets. 

And certainly, the Spectator’s view that the announcement “owes more to politics than policy” rings true, when the detail of the actual policy is examined in the context of existing arrangements.

The BBC reports:

Six-year-olds in England will face a new reading test next summer, after trials this year.

They will be tested on how they read using phonics, where children learn the sound of letters and groups of letters.

Currently, children face their first exam at the end of their third year in school (Reception, Year 1, Year 2).  These exams are called Standard Assessment Tests (SATs).   The new exams will be a year earlier, towards the end of Year 1, when in fact around a third of the children are still 5.

Let’s leave aside the issue of whether a sole focus on phonics as a method of teaching children to read is valid. I am not qualified to comment, though there are concerns at that it may lead to the exclusion of other teaching methods.

What I do know is that when SATs were introduced in the 1990s, sceptics were reassured that these really, really, weren’t exams for children, and that there was nothing to worry about.  

As time went on, SATs results became ever more important to the school’s reputation, as Ofsted reviews began to focus more and more heavily on the hard data they provided, to the expense of qualitative evaluation of whether children were happy, caring to others, communicative, and other increasingly unimportant issues. 

As a consequence, schools started to prep the children for these tests, and the pressure built both on children and staff. 

Lots of people my age will be able to tell you stories about the pressures put on children to perform – my own favourite is a friend in London being begged by a teacher to send her clever, but sick, daughter in for SATs as the school needed her scores to up the average.

Now the government, which we’re led to believe doesn’t believe in soul-destroying managerialism but in something called ‘free schools’,  is going through exactly the same process.  

But this time it will be imposed on children who, if they lived in other parts of Europe, would not yet have been anywhere near a school.  (Strangely, I don’t see mass illiteracy coming up as a problem in Sweden or Finland, where children only start school by the age of seven.)

But there’s no need to believe me.  Here’s Professor Greg Brooks, emeritus professor at Sheffield University, who knows a thing or two:

What they are proposing is horrendous. It is a vast waste of money. Even though I’m an advocate for synthetic phonics, I completely disagree with this test. It will inevitably cause teaching to the test, deflecting attention away from more valuable areas of the curriculum.

Never mind though, the government is planning to find extra curriculum time as part of its entirely thought-through plans to woo women voters.  

They’re planning to slash school holidays. 

You remember holidays, don’t you?  Those times when children used to get to be children, and do things like playing and growing up and stuff.  

But perhaps I’m just old-fashioned about what children are for.

Polly Toynbee is doing a live Q&A on the Guardian on whether class still matters. Copied below is TCF’s question to Polly, based on an earlier blog post:

The wealth gap, as you will attest, is far too wide – in 2010 it was at a point unseen since the second world war, and with the incoming cuts it is of grave concern to all those who believe everyone in society should be allowed the best possible chances to achieve the most they are capable of.

My question is, since you recognise that contractors in the private sector, not bound by any pay rates (as you’ve written before here) haven’t always got the public sector’s best interest at heart (and therefore that of public sector workers, many of whom are from a working class background), why in 2009 did you write in ‘Ethos’, the in-house magazine of multi-national outsourcing firm, Serco:

‘There is no doubt that putting some services out to tender has vastly improved certain standards over the years, broken the power of vested interests and brought in competition that has sharpened up results.’

(Link for that article is here)

*

Bash the Left, from the Left, to save the Left

The Guardian is usually pretty good at the detail of welfare policy, so it’s a bit disappointing to see this article on childcare, ‘Childcare costs stopping mothers going to work, says study’. 

The article focuses solely on the upfront costs of childcare as an obstacle to employment.  As such, it appears to be based on a single press release from insurance firm Aviva, and the author/editor don’t even seem to have bothered to read the report the press release is advertising. 

In that report, the Chief Executive of the Daycare Trust is quoted:

Parents in the UK contribute more towards childcare costs than any other country in Europe, and costs have risen every year for the last ten years.

At Daycare Trust we are particularly concerned about the recent cuts to the childcare element of working tax credits. Too many parents are already making the tough decision to give up their jobs because the extortionate costs of childcare do not make it worth their while. We fear that these tax credits cuts will mean that many more parents could also be priced out of the job market.

That is, while costs may be an issue (though I actually think this a simplistic argument which is bad for quality childcare in the long run), an expert in the field suggests that the government’s cutting of tax credits (from April 2011) is the bigger problem. (To be scrupulously fair, the press release focuses on data from the last year, before the main impact of the WTC changes, but it still seems odd for the Guardian to have left the new developments out, especially when the report highlights them.)

As a social enterprise childcare provider, I have plenty of evidence that Daycare Trust is correct in its assessment.  Based on my experience I commented on the Guardian piece as follows (slightly tidied here):

So, another International Women’s Day has been and gone.

What a pile of shite that was.

 Let me explain this somewhat controversial assessment.

International Women’s has largely become a celebration/statment of what it is to be a woman in capitalist society – commodified sexuality and all -  as opposed to a celebration of what the solidarity of women might achieve. 

The day has largely turned drifted from its socialist roots, and is the worse for it.

Here are two quick examples.

First, there’s one of the main international website for International Women’s Day, run on what looks at first sight like a philanthropic basis by Aurora GCM Ltd.  In its historical overview of the day, it pays brief attention to its socialist roots in 1908:

15,000 women marched through New York City demanding shorter hours, better pay and voting rights.

and then to what happened in 1917:

On the last Sunday of February, Russian women began a strike for “bread and peace” in response to the death over 2 million Russian soldiers in war. Opposed by political leaders the women continued to strike until four days later the Czar was forced to abdicate and the provisional Government granted women the right to vote.

But then the socialism is gone.  It’s done its job, and the link between ideals of solidarity and feminism is no longer needed:

Since its birth in the socialist movement, International Women’s Day has grown to become a global day of recognition and celebration across developed and developing countries alike.

Such a stance is hardly surprising, when you look a little more closely at what Aurora stands for:

Aurora is a niche marketing company founded in 2000 by Glenda Stone. Aurora is based in the City of London, serving over 100 corporate clients globally across sectors. The majority of Aurora’s clients are from the professional services, finance and technology sectors, however Aurora also has many clients in energy & utilities, pharmaceutical, FMCG, property, engineering, retail and travel sectors as well as many public sector clients in government and academia.

Nowhere on this whole publicity webpage is there any mention of women, never mind feminism.

 Within its own value system, Aurora is doing nothing wrong.  It’s seen a marketing opportunity in the sponsorship/hosting of a major website about International Women’s Day, and it’s gone for it;  Ms Stone’s and her colleagues’ may even have a real commitment to their understanding of feminism.  (Then again, maybe not.)

464 International Women’s Day events in the UK are advertised on the Aurora.  It does make you wonder what the day has become, when it is tied like this to the capitalist dream for its infrastructural support. 

As a second example, there’s last year’s Million Women Rise rally, perhaps THE major event in the UK marking International Women’s Day in 2010 (don’t think it’s happened this year).

Here’s what the blog said about the reason for the rally:

The women organising the march say that “enough is enough”.  Never has the rape of a woman’s right and dignity been so systematic and coordinated, the health and lives of women have never faced such peril.

The women’s march has been organised by ordinary women fed up with violence against women in all its forms.

Now don’t get me wrong.  I am in no way trying to suggest that challenging sexual violence, or any violence, against women is anything other than of huge importance, and it is great that so many women should come together to confront it in all its forms.

But in the end, is that what International Women’s Day is for?  Is it solely to remain a recognition of women’s position in an overwhelmingly patriarchal world?

Does it solely seek to define women’s position in relation to men and male violence, but stop short of confronting other issues that confront women?

Does it simply define women as they live under capitalism, or should it seek to celebrate and agitate for what they might achieve together – just as the Russian women of 1917 did?

Last year when Though Cowards Flinch did its best to mark International Women’s Day, Louise and Kat had their say on the relationship between socialism and feminsim in the 2010s.

Here’s Kat:

Every day there is another young person waking up, taking a look around and seeing the injustices the capitalist system perpetuates.

And even if they do not all become die-hard Trots, it’s good that there are young people who are conscious of injustice and will only become more so. Whether they choose to stand against capitalism as a whole, racism, homophobia, transphobia, ableism or sexism, the future is looking fine for the left and the fight for women’s rights. Socialism hasn’t got old, and neither has feminism.

And here’s another socialist feminist, Laurie Penny, blogging about the stuff she’s really very good at blogging about:

‘I am asking for an analysis that is more rigorous, more grounded in an understanding of the gendered basis of capital, an analysis that is less focused on recalcitrant sexual morality……….Today’s young women are neither soulless slags nor tragic victims: we are real people with real desires and real agency, trying to negotiate our personal and sexual identities in a culture whose socio-economic misogyny runs far deeper than conservative commentators would have us believe.’

Women as active agents, struggling to determine a destiny in which they are equal partners.  That’s more like it.

Yes, there is hope for International Socialist Women’s Day.



Roger Helmer MEP for the East Midlands region asked on his twitter feed today:

Why is it OK for a surgeon to perform a sex-change operation, but not OK for a psychiatrist to try to “turn” a consenting homosexual?

At first the question seems stupid – what’s the connection between homosexuality and gender reassignment? Isn’t this blatant homophobia? As David Allen Green has put it, has Helmer not confused “the distinct issues of gender identity and sexual preference”?

Then you read it again.

It’s still stupid.

For a longer discussion on the issue read Heresy Corner, I’m going to keep this brief. Gender reassignment is, as it is well known, the process of altering the sexual characteristics of an individual. That means a therapeutic measure of hormone replacement, replacement of organs, and other secondary sexual characteristics that aren’t reproductive organs (such as facial hair or breasts). As far as is physically possible an individual reflects the gender they have been reassinged to – nowhere in the surgery is there any attempt to mentally reassign a person, to make him/her feel like a man/woman (perhaps because there is no such feeling at all).

The notion that Helmer is comparing this with is the attempt to change, not a set of physical characteristics, but the complex psychosexual structure of an individual, which is far trickier in many ways to reassign, some would say impossible.

I’m of this latter opinion; you can’t try and “turn” a consenting homosexual, you can only try and make a person forget he or she is homosexual, or do things contrary to his or her sexuality (like be attracted to, or enjoy sexual practices with, a person from the opposite sex). And it ought not to be available by national health services like gender reassignment is. However if you want a homophobe to rub you with salts and tell you that you’re really attracted to people of the opposite sex, and that homosexuality is a myth or a lie one tells themselves, then what people get up to in their spare time is up to them – like with homeopathy it will be incumbent upon sane people to promote the truth of such ridiculous practices.,

Once again therefore, Helmer is way off the mark.We can add this to the list of other gaffes and witless opinions such as:

• Homophobia doesn’t exist

• Beating “dumb” cubs over the head was “humane” and that they deserved to die because they were “guilty” of eating too many fish.

Green climate policies are probably unnecessary

Margaret Thatcher’s handbag took £61,000 at auction in 2004?

Fair enough. It did create a verb where there was none:

“She cannot see an institution without hitting it with her handbag,” Julian Critchley, a backbench Tory critic, once said.

And the term “to handbag” entered the political lexicon.

The only other Conservative politician to manage that is Michael Gove.

So there’s no wonder that her handbag still has a hold on the popular imagination.  But what does it actually mean?

For Laurie Penny, it’s a symbol of fradulent feminsism:

Thatcher was no more a feminist than Bradley from S Club 7 was ghetto, but she created a brand of female empowerment – all heels, warmongering and expensive handbags – striking enough to replace the erstwhile aspiration of real woman-power.

For Najlaa Zorgui, a 17 year old Thatcher admirer, it’s a symbol of her housewife-wisdoms and her “femininity”

Well, for one thing, she was definitely a woman, and she made sure people knew, particularly early on in her political career. She shared her housewife-wisdoms with the nation, and even used a handbag. Given the timing of these displays of femininity, however, it’s certainly not improbable that these gestures were more geared towards helping her shrug off the “Iron Lady” image and adopt a more human-looking form.

And for me, it’s a symbol of monetary flat-earthism:

When John McFall refers to Thatcher’s notion of household income as erroneous, the image that comes forth in my mind is of Thatcher herself, standing in front of a door – a door that may be in Downing Street or may be that of a 1950 grocery store – arm folded half defensively across her wait, and a handbag dangling from it. 

It is an image that takes us backwards to a time when money was easy to understand, when you couldn’t spend more than you earned because you simply didn’t have access to the cash, when household budgeting meant stocking up judiciously on tins of beans if you could afford it one week.  It is a pictorial representation of [Stuart] Hall’s articulation of the new monetarism to an older tradition, ultimately a pre-capitalist tradition in which money still represents goods and labour. 

Surely Thatcher’s handbag can’t mean all these things simultaneously.

The scary thing is that it can. That’s the power of the Thatcher inconography, and the Left needs a counter-image.

Any ideas?