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)

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’.

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.

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.

That’s true he did, but he didn’t say in the report that price caps were something he supported; instead he felt flooding the market with players would price out extortionate lenders, drive down costs and provide borrowers with value-for-money. In other words the market solution.

Elsewhere I have written about Shapps’ report:

In 2009 the then Shadow Housing Minister Grant Shapps opined that the lack of competition in the home credit market has meant that exorbitant rates of interest can be justified on the grounds that only very few businesses control the market. As Shapps puts it, 90 per cent of the Home Credit Market is dominated by just six companies.

So rather than through legislation, Shapps felt that six companies were keeping prices up, and that the real solution was to open up the Home Credit Market (which, actually, is also different from the payday loan market).

The problem of course is that this solution is bollocks. Shapps’ own, more considered, colleagues are only too aware of this. When I met Damian Hinds, MP for East Hampshire, he told me that even as a free-market economics advocate himself ‘Normal market rules do not apply here [in the Home Credit market]‘ – and that the rational consumer finds other motivations for paying over-the-odds for credit, such as being able to take out loans from their doorstep, which might otherwise look irrational to most.

Shapps has missed a trick with Stella Creasy’s amendment to the financial services bill, voting against her, but his naivety on the subject has been forthcoming.

Further, they know it is an issue among the public themselves, particularly those who are often left caring for elderly relatives and juggling employment as well. Or even those who have to leave employment altogether.

Though, even in the age of internet campaigns, which really do work, not much is coming through on this subject. This is perhaps reflected in the weak plans by government to draw up a mere draft bill, which is rumoured not to even touch upon the glaring issue of funding – something which even with a cost cap, through the Dilnot review, will still see people spending a lot of money on the care they or their relatives receive.

There is another implication, that so often gets forgotten. That of the cost implications to unpaid, full-time carers. Dr Linda Pickard of the LSE put it in the following way:

Providing unpaid care to older people and people with disabilities is costly. Many unpaid carers leave employment and experience costs to themselves in terms of foregone earnings. However, initial findings from a new study at the London School of Economics and Political Science (LSE) now show that carers leaving employment also involves high costs to the public purse. The study shows that the public expenditure costs of carers leaving employment in England amount to around £1.3 billion a year.

The implication thus being that if more money was put into social care, this would provide a counterbalance to the amount that is lost in tax receipts through people leaving their jobs to take up full-time care; not to mention the amount of money it costs employers to re-train other staff members on the back of this.

But sadly this is just another example of where short-term spending worries are given primacy over long-term savings and efficiency – or the spend to save model as it’s popularly known.

My ambitious appeal to readers is in tweeting this post to MPs, councillors and interested charities, social enterprises, private companies etc, to try and feed this issue back onto the desks of our elected senior representatives. Also it is an appeal to the Avaaz / 38 degrees-type campaigns that can engage the already-concerned public and raise this extremely important issue back to the top of the agenda again – before the problem only gets worse for social care.

All this would be, except that the research on which the legislation is singularly dependent doesn’t say what the legislators in England and Scotland say it does.  I do wonder if any of the legislators have actually bothered to read the research. If they had, and if they’d appraised it honestly, the legislation would not have been passed in Scotland, and would not be in hand in England.

The research both governments depend on is from the University of Sheffield Alchohol Research Group.  The Scottish Government commissioned research and “modelling” from the Group, with its most recent report delivered in January 2012, and research for England in 2009.  The England report contains a more detailed methodology, but both studies are similar in design and the data used.

Here the crucial bit of the England report:

The elasticity matrices [the method used in the research] on their own are not sufficient to reveal the likely behaviour of the population to price changes, since these also depend on the preferences for beverage, drinking location and price point that the different sub-groups exhibit. However they do form a useful starting point for analysis, and can be compared with existing results from the literature. (p. 50)

My rough (and I admit slightly mean-spirited) translation:

The researchers don’t know whether the results the legislators want will be achieved or not through a minimum unit price, but they’ve gone out of their way to provide some mathematical modelling which suggests it might because, after all, that’s what the legislators want and they paid for the research.

The research depends for its findings on a complex set of mathematical modelling, with log-log analysis of the relationship between price and consumption, changing over time, at the heart of this.  The data comes from five years of the annual Expenditure and Food Survey and, in the case of the more recent Scotland report, the Scottish Health Survey.  This is sample data based on respondent completing diaries of what they purchase and consume over a two week period.

The principal outcome of the modelling is a set of  ”elasticity matrices” in which the relationship between increase in minimum unit price and change in consumption is modelled for various population types, including moderate and heavy drinkers.  The model suggests that a 50p minimum unit might decrease overall consumption by 5.7% (Scotland research, Jan 2012).

It’s an impressive piece of work in its own terms, but it simply doesn’t find what those desperate to find a ‘solution’ to people drinking too much say it does.  Indeed, there is a strong indication that the real rationale for the mathematical modelling is to provide a fit with other research into the relationship between alcohol price/tax and consumption (not, note, minimum unit pricing):

Recent systematic reviews and meta-analyses by Gallet (2007) and Wagenaar et al (2008) found, respectively, a median elasticity for alcohol of -0.535 and a mean elasticity for alcohol of -0.51. By comparison, our elasticity matrix for all of England shows broadly similar results, with own-price elasticities ranging from a least elastic estimate of -0.2350 for on-trade higher-priced spirits to a most elastic estimate of -2.9386 for on-trade low-priced spirits.

The problem is that these meta-analyses don’t really show what the researchers and legislators want them to show either, even though they are meta-analyses of the general relationship between price and consumption (where you might well expect an inverse relationship)

 Take the Wagenaar et al. study:

Price/tax also affects heavy drinking significantly (mean reported elasticity = -0.28, individual-level r = -0.01, P < 0.01), but the magnitude of effect is smaller than effects on overall drinking.

This is the opposite of what the legislation is aimed at: heavy drinking leads to anti-social behaviour and increased health problems.

The Wagenaar report also recgonises that not all may be as it seems from the 112 studies it analyses:

[P]ublication bias(or, more generally, small-study bias) is always a threat to the validity of a meta-analysis. Statistically significant findings are more likely to be published than those that are not significant with one estimate suggesting that the odds of publication are 2–4 times greater when results are statistically significant. Thus, it is possible that a substantial number of studies with non-significant effects remain unpublished.

So what’s going on?  Why are the English and Scottish governments apparently so keen to push through legislation which is wholly based on wholly spurious evidence?

Why, on the other hand, is the Scottish government apparently so keen to overlook the research ‘findings’ that a 70p per unit price would lead (p.5 of report) to a 16.9% reduction in consumption, while the 50p price actually adopted will read to a 5.7% one? Does it not have the courage of its public health convictions? Or is is, perchance,  that a 70p unit price would put the price of ‘decent’ wine up, while the 50p one only affects the really cheap alcohol that the poor people drink?

The answer to these rhetorical questions is simple enough. 

There is a problem-drinking problem – that can’t and shouldn’t be denied.   The respective governments are desperate to be seen to be doing something. 

Doing something genuinely effective about it is beyond them, because that would mean putting in place policies (and government spending) which lead to people having realstic choices other than blotting out – at least for the night – what they have to live with.  That’s not a new, or British cultural problem – re-read the Paris bit of George Orwell’s Down and in London and Paris to remind yourself of that.

So the easy option is to put in place legislation aimed (almost certainly ineffectively) at a certain type of person most in the public eye.  Owen Jones calls them ‘chavs’. They’re probably called something else in Scotland.

And when the minimum price measure fails – and it will fail - at least the problem-drinking problem will be set out clearly in terms of the ‘target population’ (those chavs who got round the law by spending more on booze/buying it illegally), and the need to control it more effectively.  That’s even written into the ‘sunset clause’ provisions of the new Scottish Act.

The Scottish and UK governments perverting the role of science for short-term political ends at the expense of  social cohesion. Who’d have thought it?

I agree that Lansley’s new funding ‘rationale’ is very  likely to be politically driven, but Unity’s post doesn’t really get to the bottom of what exactly Lansley is up to with his “age is the principal determinant of health need” argument (by which I take Lansley to mean healthcare need).

Lansley is in fact correct to say that age is the principal determinant of healthcare need. That’s obvious. As people approach being dead, their call on health services increases dramatically.  A US study summary googled quickly illustrates this ’no-brainer’ point well enough:

From 1992 to 1996, mean annual medical expenditures (1996 dollars) for persons aged 65 and older were $37,581 during the last year of life versus $7,365 for nonterminal years.

What you can’t then do (unless you’re  Lansley, it seems) is argue that, because of this normal skewing of healthcare uptake to the point of life when people are nearly dead, the government should therefore skew the whole of the healthcare budget towards areas where there are higher concentrations of nearly dead people.

This is because most of the healthcare budget is NOT spent on those bits of care related to people being nearly dead; the biggest part of the budget is in fact spent on that percentage of the population which happens to need it at a point or points in their life before their nearly dead point.  

Take a look around any hospital.  It’s got people in it who are clearly not nearly dead, and who are receiving healthcare which is, on he whole, more expensive to provide than the care provided to the nearly dead.

But those not-nearly-dead people receiving the more expensive healthcare are only a smallish percentage of all of us not-nearly-deads. Just look at the graph on page 3 of this hospitalisation rate study and it’s easy to see you’ve got a statistically good chance of not ending up in hospital while you’re not-nearly-dead (hospitalisation is not the only use of healthcare, but it’s a decent enough indication of my general point)

So lots of people rarely or never need healthcare (at least until they’re nearly dead, and sometimes not even then).  The whole point of the NHS is that they  contribute anyway, so that the NHS exists if they do need it at some point.

Essentially then, Lansley seeks to use a fact that is true, and then extrapolate from it in a totally invalid manner.  In so doing, he seeks to bypass the incovenient fact that healthcare is needed more in poor areas by the not-nearly-dead-but-more-near-dead-than-teir-peers-in-richer-areas. 

It’s important to see the general pattern here, though.  It’s not just Lansley indulging in this type of devious behaviour.. 

Pickles did much the same with his spurious rationale for council cuts – arguing that Manchester is five times better financed than Wokingham because Manchester’s cash comes from central taxation rather than (notional) Council tax revenues. 

The problem for those opposed to such chicanery is that it can be an easy sell to compliant papers, precisely because the first part of his rationale is undeniable.

The challenge for the Left therefore, in addition to opposing the specifics of Lansley’s plan, is to set out how it forms part of a wider strategy of Tory deception.

As statistics from the Grio show, just 36 percent of black Democrats support legalizing gay marriage, compared to 61 percent of white Democrats”.

This brings up what Star Parker, the president of CURE (Center for Urban Renewal and Education), calls the Sunday-Tuesday problem – between the “biblical message the [black community] hears in church every Sunday or the big government liberalism they regularly vote for on Election Day Tuesday.”

Anthea Butler in the Religion Dispatches magazine recently sought to typify the reason why the issue of same-sex marriage is “so freighted for African Americans” – and to no surprise she says it isn’t simply about messages being relayed through the “Black Church”.

“Many enslaved African Americans”, Butler writes “were not allowed to marry, and after the Civil War, searched desperately to find their partners. Those who were lucky, married. Weddings were seen as a sign of prosperity, and joy for all in the community”.

So what’s the problem? Surely she knows black homosexuals were fighting in this struggle as well. She goes on:

when the black president says marriage is for everybody, straight or gay, and that it comes out of his faith, it elicits a visceral response from African-American Christians who have staked their spiritual and social lives on the institution of marriage… For them, hearing President Obama support same-sex marriage is sacrilege.

This for obvious reasons is not good enough. Butler is well-meaning, but she doesn’t even answer her own question. To be sure, this only explains why marriage is so important – we are simply to assume that its import is translated into hostility towards same-sex marriage through appeals to tradition. Something specifically formulated, if not reiterated, through the Black Church.

Another theory regarding the perceived cultural condemnation of anti-homosexuality in large parts of the black community concerns two things:

• that since black liberation theology and black cultural criticism concerns itself with what it perceives to be major problems within black life (namely the problem of white supremacy); and
• as Kelly Brown Douglas points out in her book Sexuality and the Black Church: A Womanist Perspective, “blacks cast homosexuality (as well as bisexuality, transgenderism, as well as other sexual practices) as a “white thing”, and not part of black sexual experience.

This notion that homosexuality is a “white thing” can even go all the way to the heart of the black male homosexual act itself. In Benoit Denizet-Lewis’ 2003 cover story for the New York Times Magazine about the so-called “Down Low” culture, he reveals:

Rejecting a gay culture they perceive as white and effeminate, many black men have settled on a new identity, with its own vocabulary and customs and its own name: Down Low (DL). There have always been men — black and white — who have had secret sexual lives with men. But the creation of an organized, underground subculture largely made up of black men who otherwise live straight lives is a phenomenon of the last decade … Most DL men identify themselves not as gay or bisexual but first and foremost as black. To them, as to many blacks, that equates to being inherently masculine.

Not only has there always been men engaging in secret sexual lives, in African communities there is evidence of homosexuality enjoying acceptance as a sexual alternative. Cary Alan Johnson in his book Hearing Voices: Unearthing Evidence of Homosexuality in Precolonial Africa, details the dynamics of accepted homosexuality in many African places, which can be typified as 1 of 4 types:

1-Type 1: between adults and youths (initiatory)

2-Type 2: between men and biological males who have “female“ or “feminine“ male status

3-Type 3: between men of different races or classes

4-Type 4: between mean of equal age, status and class.

As Johnson notes, “Type 2 behaviors were common among the Bara, Bitsileo and Tanala of Madagascar and transvestitism was usual, and in fact marriage to men provided instant status and an acceptable stake in the community for the homosexual male.”

Where these instances are forgotten, such as in the debates that are taking place between the so-called black community and President Obama, we might be as well to look towards Denizet-Lewis’ explanation that “the black community sees “homosexuality as a white man’s perversion”, even where that view is taken in the context of seemingly homosexual acts such as with the “Down Low” subculture.

But today, of course, this has gone far too far, and can certainly no longer legitimately be seen through the lens of slavery alone. Though there is no monolithic opinion, the black church and the black community is clearly, largely, condemning of all homosexuality.

What is clear is that their dismissal of Obama, and the fact they now feel let down by him, is in part due to the notion – which has been present for Obama’s whole presidency – that they feel like he is channeling white supremacist opinion, or even that he embodies this opinion himself.

Now of course with any other black male, accusing him of not only channeling white supremacist opinion but actually embodying it, would be silly – but let us not forget that Obama is of mixed origin. More than just fears of White definitions of sexuality, the issues that have arisen in black America this time have been compounded by an inability by some in the black community to accept Obama as a black person.

It’s good that the debate is now being had (I had first say on it a couple of weeks ago, but it does take other blogs a while to catch up), but I disagree wholly with Anthony when he advises the Labour leadership thus

Act irresponsibly and the consequences could be severe. This is one of the moments when indecision is justified. Don’t play political games with the national interest.

With this, he’s a bit too close for comfort to Alex Massie’s sneering rubbish at the Spectator:

The Better Off Outers at least have a respectable case for their beliefs and, rather importantly, actually believe Britain would be better off outside the EU…….That can’t be said of a party that so obviously makes a game of what might be thought quite an important issue.

The problem for both writers (and for Gabby Hinsliff/Mark Rusling) is that they fail to recognise that:

a) The European Union is not what it was pre-2008;

b) By consequence of a), it is perfectly admissible for the Labour party to adopt a wholly different stance to the EU from the one adopted in 1974, and that it does not need to be bound by its previous support for EU membership;

c) This would not be playing games with the national interest, the electorate, or anything else; it would be developing a coherent political position to put to the electorate.

So, I’m sure readers will be asking, if I had the Labour leadership’s ear like Anthony has the Labour leadership’s ear, what would I advise and why?

My advice to Ed and Jon would go something like this.

First, clarify why Labour thinks a referendum in 2018 or so would be a good idea.  This is because, in the wake of both the 2008 crash and the Lisbon Treaty (1), the European Union is markedly different from the one that British voters chose to join and then remain in.  

This is the opportunity to differentiate Labour from the Tories over Europe.   Labour should be openly critical of the way the institutions of the European Union has been hijacked by the Right to set disastrous neoliberal policies in law.  

Unless this can be changed in the 2014-18 period, Labour should say, then it may well be that Britain will be better off outside the EU.

Second, make clear that for the reasons set out above Labour has not yet decided what position it will take when it comes to a referendum.  

The reason Labour wants to defer a referendum to 2018 or so is not because it is ‘playing games’, but because it is developing a clear strategy to engage with other centre-left governments and parties in Europe to change what how the EU operates; only when it has had a chance to do this will it be in a position to decide whether in or out is in the national interest.

In short, Labour should be showing that it’s leading the charge to change European institutions for the better, not simply accept it for what the Right has made it.

Third, recognise that 2018 is a long way away for voters.  After all,  around 8-10% of people voting now will be dead by then.  

Thus, a 2018 referendum promise must be tied explicitly to the 2014 European parliamentary elections.  Labour should be stressing right now how important these elections are;  the national parties that make up the Party of European Socialists (PES) has  a real opportunity to take an overall majority in Strasbourg, and with that majority comes the opportunity to amend European law currently stacked against the working class/ordinary people/the poor. (2)

Fourth, the importance of the 2014 election should in turn be linked to Labour’s selection process for those elections, likely to take place later this year/early 2013. 

As a display of  strong leadership combined with evidence that Europe really, really matters to Labour now, Ed Miliband should take to conference plans to rejig the selection process in the way Jon Worth suggests i.e. by opening up the list to non-incumbents as part of  wider process to re-energize Labour’s team in Strasbourg for a parliamentary period when fundamental battles will be fought about the nature of Europe’s institutions.  

It is an indictment of the current system that someone like Jon, a socialist who has lived and breathed Europe for a decade, feels he has absolutely no chance of being selected, primarily because he’s actually spent his time in Europe rather than oiling the selection wheels in London.

In summary, Labour needs to be bold on Europe, and go much further, much sooner, than the first tentative steps it has taken in the right direction.  It needs to see itself as a pro-active force on Europe, aggressively differentiating its own pro-activity from the reactionary little-Englander nonsenses of the Tories. 

Labour (and the commentators who support it) need to stop worrying that an EU referendum will ‘define’ Labour’s first parliamentary term (assumed to be in some way for the worse), and instead be confident that it will be seen by voters as an integral part of strong Labour party project.

Labour needs to enunciate clearly that Europe is not currently working for working class people, because its institutions have been captured by the Right, and it needs to have a clear plan for their recapture by the Left.  This is not an anti-Europe stance. This is an anti-rightwing Europe stance.

Labour needs to be clear on what it means by European democracy, and it needs to put in place the right people to make European democracy work. 

Finally, Labour needs to ensure that what Europe does now, and what it can do, is understood by the electorate, primarily through the prism of the financial mess we’re in now.  People now ‘get’ Europe, in a way they didn’t in 2008.  Labour’s job is to build on that new consciousness.

(1) In particular, Labour should focus on the need for a (centre)-left led redrafting of the Lisbon Treaty. 

At the heart of the mush-that-is-now-Europe is the establishment of the Council of Ministers as a decision and law-making body in direct competition with the European parliament, as evidenced that we now have two sets of laws concerned with fiscal management of the Union – one an (unratified) intergovernmental treaty in the form of the Fiscal Compact, and the other the ‘six pack’ of regulations already made law by the European parliament.  Officially the European Commission says that these will work ‘in parallel’, but in reality they reflect a power struggle between two competing ideas of what European-level democracy is supposed to be.

Labour should therefore be clear that it favours the European Parliament as the supreme lawmaking body, while also making it clear that it is committed to ensuring that it has the best possible MEP team in there, rather than allowing the (strong) perception to continue that being a Labour MEP is a ‘gravy-train’ job for people who have served the party loyally. 

Part of this overall process should be a strong commitment – noticeably lacking to date – to the PES ‘fundamental programme’ review and ensuing manifesto development, such that all PES parties across Europe enter the 2014 election with a common manifesto for socialist change in a bold attempt to make the elections something other than a mid-term referendum on domestic government.

(2) I have already covered two areas of European law that I think should be subject to radical socialist amendment in the event of a PES majority in 2014.  Of course there are others (notably around sustainable agriculture and the CAP) but I’d want to see these at the top of my new-style MEP’s priority list.

First, and as noted above, the six-pack regulations on the implementation of the Stability & Growth Pact, which currently enshrine in law neoliberal economic orthodoxy, should be dismantled and replaced with a set of Keynesian prescriptions for management of the economic cycle (or the law simply annulled and macro-economic management handed back to national governments in the event of the end of the euro).

Second, PES should impose through its majority the amendments it failed to get through in 2011 on the human rights safeguards needed when it comes to the development of (free) trade with the developing world.