Other democracies should beware taking pleasure in the UK’s travails

Voters in most developed countries feel that their contract with the state is fraying writes Bronwen Maddox in the FT 

I can barely think of a meeting I’ve had since September that didn’t begin with jokes about Britain’s newfound instability. I started a job a few days before Liz Truss became prime minister, and the “lasted longer than the lettuce” one has been inescapable. “Three prime ministers in a year!” (Ambassadors from European countries still incredulous at Brexit particularly like this one.) Now, there are the strikes — although the meltdown of the NHS’s emergency services is no joke at all. 

But these are rash quips if coming from other democracies. The joke may be on them, too. Older democratic countries share many of the same problems and are struggling to show that they have a system that can solve them. “If you don’t have a political system that can make short-term sacrifices for the long-term good of the country, how can you expect your system of government to survive?” asked one senior Chinese official of a distinguished British former minister. 

It’s a good question. In Britain, the NHS is a symbol of these problems above all others. The stand-off with the government by nurses and ambulance workers is of course about worker pay, but is also about how much the government wants to pay for the health service at all. 

Much of the problem stems from the demands of an ageing population, and that is something that many older democracies share. Even if other countries may no longer envy the NHS, they share some of the same troubles. On many fronts, the contract that voters thought they had with their governments — over them paying for healthcare, education, pensions — is being rewritten, and not in their favour. Perhaps the best-known saying of Jean Claude Juncker, when prime minister of Luxembourg, was: “We know what to do, we just don’t know how to get re-elected once we have done it.” 

Those sceptical of democracy have prophesied that this is how it consumes itself. It is easier to make promises than to keep them, so the temptation is for politicians to make extravagant commitments to get into office, and then try somehow to stay there. Following this recipe, democracy decays into populism and then autocracy. 

To some degree, yes. Boris Johnson and the unfulfillable Brexit promises were a symptom of the need to assemble an expansive coalition, built on impossibilities. The antidote — the “grown-up conversation with the nation” that politicians sometimes desperately invoke — seems pitifully weak. 

All the same, that is what is needed. The pandemic does offer some encouragement, showing that people are prepared to give up an extraordinary amount if persuaded it is necessary. But there are also more practical things that governments could do to help. 

First, they need to make the case for growth and the steps required to bring it about. Truss was not wrong in her ambition, just in recklessly ignoring the constraints on any country seeking to borrow money. For Britain, that means closer relations with Europe. A US trade deal is not coming any time soon; the only alternative of a large market is China, and Rishi Sunak’s government has chosen not to lean that way. It also means telling people that more legal immigration is needed. It means championing the creativity in science and culture that are themselves the product of the intellectual freedom at the heart of democracies. 

The second thing to do is change voting systems and improve legislatures. In the UK, the House of Lords is indefensible, as former prime minister Gordon Brown has pointed out. He is right that regions need more representation, too. And first past the post is increasingly hard to defend in a country of many different kinds of people and views. 

Third, is to stand up for the values that underpin liberal democracy but not try to couple them with all the other deals on the world stage. Insisting on a human rights agenda in every diplomatic relationship can jeopardise the pursuit of environmental and security accords that are desperately needed on their own account. It can lead to accusations of double standards — as shown by the controversy over Qatar’s hosting of the World Cup despite its treatment of LGBTQ people. 

It is right, though, to pursue those liberal principles, while acknowledging that not all countries share them. They are, along with economic prospects, one of the reasons people risk their lives in small boats trying to come to the UK — one of the best arguments that liberal democracy has a future.

John Pilger on Journalists, BBC, NHS, Amnesty and State Murder

 

Goodhart’s law comes back to haunt the UK’s Covid strategy

Chris Giles in The Financial Times 


Every so often, public policy provides a reason to discover or remember the value of Goodhart’s law. The UK’s response to coronavirus is a powerful and tragic example.  

Named after Charles Goodhart, a financial guru, former chief economist of the Bank of England and a sheep farmer, the maxim is about the dangers of setting targets. When a useful measure becomes a target, the law states, it often ceases to be a good measure.  

Mr Goodhart developed the law after observing how Margaret Thatcher’s government in the 1980s targeted the supply of money to control inflation but then found the monetary aggregates lost their previously strong relationship with inflation. Inflation ran out of control even when the government held a tight grip on the money supply.  

What was true in 1980s UK economic policy is regularly experienced in the private sector. Far too often companies hit their top-down targets without improving underlying performance.  

In the current crisis, target-setting is altogether more important. Early in March, Italy’s government strove to protect the nation’s health by locking down the Lombardy region. Initially, this led to a mini exodus that probably increased the spread of the disease to other parts of the country.  

But it is in the UK where Goodhart’s law was most obviously overlooked. Throughout the crisis, “protect the NHS” has been the government’s core target. Along with “stay at home” it was the slogan repeated daily to “save lives”.  

At first sight, nothing seemed amiss. Ensuring hospitals would not be overwhelmed seems so obviously necessary. Who would have wanted to see them starved of funds in a public health crisis? And their staff needed to be given all necessary equipment to battle the pandemic. With many weeks of experience, however, the slogan and associated numerical targets for making hospital beds available have been nothing short of a disaster. The evidence is overwhelming that instead of saving lives, they have cost them. 

While the government focused on hospitals, care homes were given much less priority. Over the past five years between mid-March and the end of April, an average of 17,700 people have died in England and Wales’s care homes. This year, the total is just above 37,600. There is a debate over whether coronavirus was recklessly seeded into care homes when patients were moved there from hospitals. But there can be no doubt that relegating care homes to second division status contributed to the 19,900 excess deaths in the care sector.  

Far more people than normal have also been dying at home and most of the excess deaths have not been classified as related to Covid-19 on death certificates. We do not yet know precisely why, but at the height of the crisis local doctors were asking their elderly patients to think hard about whether they really wanted to go to hospital or use the emergency services. A fit and sharp relative of mine received two of these calls.  

The exact causal links will take time to establish. But 29,874 people have died at home since mid-March in England and Wales, 10,800 more than normal. 

No one should think the government’s ambitions deliberately cost lives. But it was a deadly example of Goodhart’s law. The moment “protect the NHS” became the mantra, people dying elsewhere or without being tested didn’t count. 

By comparison, the much criticised target of performing 100,000 coronavirus tests a day by the end of April was better conceived. Although the health department fiddled definitions to hit the goal for one day, earning a rebuke from the statistical regulator, the effort has left the UK better positioned for its ultimate objective of testing, tracking and isolating those with the virus. 

Goodhart’s law always pops up in unexpected places. The failure in this crisis to think through the incentives created by the “protect the NHS” slogan will haunt Britain for many years.

NHS ‘score’ tool to decide which patients receive critical care

Doctors will use three metrics: age, frailty and underlying conditions write Peter Foster, Bethan Staton and Naomi Rovnick in The FT

Doctors coping with the coming peak of the coronavirus outbreak will have to “score” thousands of patients to decide who is suitable for intensive care treatment using a Covid-19 decision tool developed by the National Health Service.

With about 5,000 coronavirus cases presenting every day and some intensive care wards already approaching capacity, doctors will score patients on three metrics — their age, frailty and underlying conditions — according to a chart circulated to clinicians.

Patients with a combined score of more than eight points across the three categories should probably not be admitted to intensive care, according to the Covid-19 Decision Support Tool, although clinical discretion could override that decision.

The UK is set to exceed 80,000 coronavirus cases on Sunday and 10,000 deaths in hospital with government models showing the peak of the outbreak is now expected to be reached over the next two weeks, leaving the healthcare system facing arguably its toughest challenge since its inception. 

The scale of the pandemic and the speed at which Covid-19 can affect patients, has forced community care workers, GPs and palliative carers to accelerate difficult conversations about death and end-of-life planning among vulnerable groups.

The NHS scoring system reveals that any patient over 70 years old will be a borderline candidate for intensive care treatment, with a patient aged 71-75 automatically scoring four points for their age and a likely three on the “frailty index”, taking their total base score to seven points.

Any additional “comorbidity”, such as dementia, or recent heart or lung disease, or high blood pressure will add one or two points to the score, tipping them into the category suitable for “ward-based care”, rather than intensive care, and a trial of non-invasive ventilation.

Although doctors and care workers stress that no patient is simply a number, the chart nonetheless codifies the process for the life-and-death choices that thousands of NHS doctors will make in the coming weeks.

A frontline NHS consultant triaging Covid-19 patients said the “game-changer” for assessment of patients with coronavirus was that there is no available treatment, meaning doctors can only provide organ support and hope the patient recovers.

“If this was a bacterial pneumonia or a bad asthma attack, then that is treatable and you might send that older patient to intensive care,” the consultant said, adding that decisions on patients were “art not science” and there would be exceptions for patients who were fit enough.

“The scoring system is just a guide; we make the judgment taking into account a lot of information about the current ‘nick’ of the patient — oxygenation, kidney function, heart rate, blood pressure — which all adds into the decision making,” he said.

But it is not just hospital doctors who must make tough decisions. GPs, hospice workers and families with vulnerable members are also involved.

Last week NHS England wrote to all GPs asking them to contact vulnerable patients to ensure that care plans and prescriptions were in place for end of life decisions, leading to many difficult conversations. These have been made harder by the need to conduct them on the phone or via Skype to observe social distancing rules. 

Ruthe Isden, head of health and care at Age UK, the charity, said the need for haste had unsettled many elderly patients, who have felt under pressure to sign “Do Not Resuscitate”, or DNR, forms. 

"Clinicians are trying to do the right thing and these are very important conversations to have, but there’s no justification in doing them in a blanket way,” she said. “It is such a personal conversation and it’s being approached in a very impersonal way.” 

The subject of DNR notices is particularly unsettling for individuals and families who want the best care for their loved ones, but often feel the choices have not been fully explained.

The data clearly show that resuscitation often does not work for elderly patients and can often cause more suffering — including broken ribs and brain damage — while extending life only by a matter of days.

John Pilger - What Govts Aren't Telling You About the COVID-19 Pandemic

We're not all in coronavirus together

‘The virus does not discriminate,” suggested Michael Gove after both Boris Johnson and the health secretary, Matt Hancock, were struck down by Covid-19. But societies do. And in so doing, they ensure that the devastation wreaked by the virus is not equally shared writes Kenan Malik in The Guardian

We can see this in the way that the low paid both disproportionately have to continue to work and are more likely to be laid off; in the sacking of an Amazon worker for leading a protest against unsafe conditions; in the rich having access to coronavirus tests denied to even most NHS workers.

But to see most clearly how societies allow the virus to discriminate, look not at London or Rome or New York but at Delhi and Johannesburg and Lagos. Here, “social distancing” means something very different than it does to Europeans or Americans. It is less about the physical space between people than the social space between the rich and poor that means only the privileged can maintain any kind of social isolation.

In the Johannesburg township of Alexandra, somewhere between 180,000 and 750,000 people live in an estimated 20,000 shacks. Through it runs South Africa’s most polluted river, the Jukskei, whose water has tested positive for cholera and has run black from sewage. Makoko is often called Lagos’s “floating slum” because a third of the shacks are built on stilts over a fetid lagoon. No one is sure how many people live there, but it could be up to 300,000. Dharavi, in Mumbai, is the word’s largest slum. Like Makoko and Alexandra, it nestles next to fabulously rich areas, but the million people estimated to live there are squashed into less than a square mile of land that was once a rubbish tip.

In such neighbourhoods, what can social distancing mean? Extended families often live in one- or two-room shacks. The houses may be scrubbed and well kept but many don’t have lavatories, electricity or running water. Communal latrines and water points are often shared by thousands. Diseases from diarrhoea to typhoid stalked such neighbourhoods well before coronavirus.

FacebookTwitterPinterest People in their shanties at Dharavi during the coronavirus lockdown in Mumbai. Photograph: Rajanish Kakade/AP

South Africa, Nigeria and India have all imposed lockdowns. Alexandra and Dharavi have both reported their first cases of coronavirus. But in these neighbourhoods, the idea of protecting oneself from coronavirus must seem as miraculous as clean water.

Last week, tens of thousands of Indian workers, suddenly deprived of the possibility of pay, and with most public transport having been shut down, decided to walk back to their home villages, often hundreds of miles away, in the greatest mass exodus since partition. Four out of five Indians work in the informal sector. Almost 140 million, more than a quarter of India’s working population, are migrants from elsewhere in the country. Yet their needs had barely figured in the thinking of policymakers, who seemed shocked by the actions of the workers.

India’s great exodus shows that “migration” is not, as we imagine in the west, merely external migration, but internal migration, too. Internal migrants, whether in India, Nigeria or South Africa, are often treated as poorly as external ones and often for the same reason – they are not seen as “one of us” and so denied basic rights and dignities. In one particularly shocking incident, hundreds of migrants returning to the town of Bareilly, in the northern Indian state of Uttar Pradesh, were sprayed by officials with chemicals usually used to sanitise buses. They might as well have been vermin, not just metaphorically but physically, too.

All this should make us think harder about what we mean by “community”. In Britain, the pandemic has led to a flowering of social-mindedness and community solidarity. Where I live in south London, a mutual aid group has sprung up to help self-isolating older people. The food bank has gained a new throng of volunteers. Such welcome developments have been replicated in hundreds of places around the country.

FacebookTwitterPinterest South African National Defence Force soldiers enforce lockdown in Johannesburg’s Alexandra township on 28 March 2020. Photograph: Luca Sola/AFP via Getty Images
But the idea of a community is neither as straightforward nor as straightforwardly good as we might imagine. When Donald Trump reportedly offers billions of dollars to a German company to create a vaccine to be used exclusively for Americans, when Germany blocks the export of medical equipment to Italy, when Britain, unlike Portugal, refuses to extend to asylum seekers the right to access benefits and healthcare during the coronavirus crisis, each does so in the name of protecting a particular community or nation.
The rhetoric of community and nation can become a means not just to discount those deemed not to belong but also to obscure divisions within. In India, Narendra Modi’s BJP government constantly plays to nationalist themes, eulogising Mother India, or Bhārat Mata. But it’s a nationalism that excludes many groups, from Muslims to the poor. In Dharavi and Alexandra and Makoko, and many similar places, it will not simply be coronavirus but also the willingness of the rich, both in poor countries and in wealthier nations, to ignore gross inequalities that will kill.

In Britain in recent weeks, there has been a welcome, belated recognition of the importance of low-paid workers. Yet in the decade before that, their needs were sacrificed to the demands of austerity, under the mantra of “we’re all in it together”. We need to beware of the same happening after the pandemic, too, of the rhetoric of community and nation being deployed to protect the interests of privileged groups. We need to beware, too, that in a world that many insist will be more nationalist, and less global, we don’t simply ignore what exists in places such as Alexandra and Makoko and Dharavi.

“We’re all at risk from the virus,” observed Gove. That’s true. It is also true that societies, both nationally and globally, are structured in ways that ensure that some face far more risk than others – and not just from coronavirus.

America is not the land of the free but one of monopolies so predatory they imperil the nation

Its growing economic crisis is in contrast to a thriving and newly innovative Europe writes Will Hutton in The Guardian


  

Illustration by Dom McKenzie


Tomorrow, President Trump arrives in London for the annual Nato summit. Despite the boasting and the trappings of superpower status, he is an emissary from a country whose economy and society are in increasing difficulty, and whose global leadership is under challenge not just from the usual suspect, China, but from Europe. With the unerring capacity to be wrong that defines the Brexit right, Britain is about to decouple itself from a continental economy beginning to get things right, and hook up with one that is palpably beginning to fail.

This is not the conventional wisdom. The EU is sclerotic, undynamic, stifled by quasi-socialist red tape, and hostile to insurgent startups. It is so degenerate it cannot even defend itself – as Trump will undoubtedly remind its leaders over the next two days. The US is the mirror opposite. A free trade agreement post 31 January with the US is the number one strategic policy aim for Brexit Britain – unshackling the UK from the declining old, and embracing the English-speaking, dynamic new. Best be nice to “the Donald”.

Except the latest research demonstrates the reverse is true. Britain is about to make a vast mistake. In the recently published The Great Reversal, leading economist Thomas Philippon of New York University and member of the advisory panel of the New York Federal Reserve, mounts a devastating attack on the conventional wisdom, so perfectly embodied by the witless Boris Johnson. The news is that over the last 20 years per capita EU incomes have grown by 25% while the US’s have grown 21%, with the US growth rate decelerating while Europe’s has held steady – indeed accelerating in parts of Europe. What is going on?

Philippon’s answer is simple. The US economy is becoming increasingly harmed by ever less competition, with fewer and fewer companies dominating sector after sector – from airlines to mobile phones. Market power is the most important concept in economics, he says. When firms dominate a sector, they invest and innovate less, they peg or raise prices, and they make super-normal profits by just existing (what economists call “economic rent”). So it is that mobile phone bills in the US are on average $100 a month, twice that of France and Germany, with the same story in broadband. Profits per passenger airline mile in the US are twice those in Europe. US healthcare is impossibly expensive, with drug companies fixing prices twice as high or even higher than those in Europe; health spending is 18% of GDP. Google, Amazon and Facebook have been allowed to become supermonopolies, buying up smaller challengers with no obstruction.

This monopolising process gums up everything. Investment in the US has been falling for 20 years. Because prices stay high, wages buy less, so workers’ lifestyles, unless they borrow, get squeezed in real terms while those at the top get paid ever more with impunity. Inequality escalates to unsupportable levels. Even life expectancy is now falling across the US.

But why has this happened now? Philippon has a deadly answer. A US political campaign costs 50 times more than one in Europe in terms of money spent for every vote cast. But this doesn’t just distort the political process. It is the chief cause of the US economic crisis.

Corporations want a return on their money, and the payback is protection from any kind of regulation, investigation or anti-monopoly policy that might strike at their ever-growing market power. Boeing, for example, ensured – as one of the US’s biggest lobbyists – that regulation was friendly to its plans to shoehorn heavier engines on to a plane not designed for them – the fatal shortcut behind the two crashes of the 737 Max 8. Philippon shows this is systemic; how both at federal and state level ever higher campaign donations are correlated with ever fewer actions against monopoly, price fixing and bad corporate behaviour.

In Europe, the reverse is true. It is much harder for companies to buy friendly regulators. The EU’s competition authorities are much more genuinely politically independent than those in the US – witness the extraordinary fines levied on Google or the refusal this February to allow Siemens to merge with the French giant Alstom. As a result, it is Europe, albeit with one or two laggards such as Italy, that is bit by bit developing more competitive markets, more innovation and more challenge to incumbents while at the same time sustaining education and social spending so important to ordinary people’s lives.

Even starting up businesses is now easier. France is generating multiple hi-tech startups, with unemployment falling. Parts of Paris, Barcelona, Amsterdam or even Milan are now rivalling San Francisco’s Bay area.

The EU’s regulations are better thought out, so in industry after industry it is becoming the global standard setter. Its corporate governance structures are better. And last week, to complete the picture, Christine Lagarde, the incoming president of the European Central Bank, in the most important pronouncement of the year, said the environment would be at the heart of European monetary policy. In other words, the ECB is to underwrite a multitrillion-euro green revolution. In short – bet on Europe not the US.

Thus Jeremy Corbyn, seizing on leaked documents showing how US trade negotiators want UK drug prices to rise to US levels, is on to something much bigger than the threat to the NHS, fatal though that is. Any trade deal with the US will require the UK to accept the protections that are making US capitalism so sclerotic, predatory and high priced – while dissociating itself from a European capitalism that is not only beginning to outperform America’s, but so much better reflects our values.

This election is set to seal not just the geopolitical but geo-economic mistake of Britain’s recent history. The tragedy is that our national conversation is hardly aware of how high the stakes have become.

As a doctor, I say it’s time to nationalise GP surgeries

Practices refuse to take on work that benefits patients because it isn’t in their business interest. Let’s bring them into the NHS writes Dr Paul Williams, a GP and the Labour MP for Stockton South, in the Guardian

  

‘Public satisfaction with general practice remains relatively high, but not all practices work as well as they should for their patients.’ A receptionist at a GP surgery. Photograph: Anthony Devlin/PA


General practices support patients through every stage of their life. They are the heart of their communities and the gateway to our NHS. Every day, around a million GP consultations take place in English practices. We should rightly be very proud of our system of primary care.

But it isn’t perfect. As data published this week shows, patient demand for general practice services is increasing while the number of GPs is actually falling – according to the survey, one in 10 GPs are in contact with 60 or more patients a day, which is double the safe limit. At a time when people are living longer, and health problems are becoming more complex, the government has spectacularly failed to deliver its promise of an extra 5,000 GPs. Not enough medics want to be GPs, and too many doctors leave general practice too early.

Simple changes might make things better for staff working in primary care, and for patients. When the NHS was founded in 1948, hospitals were brought into public ownership and general practice was left in the private sector, where, mostly, it has remained. Most of the time your GP doesn’t get a salary. They have contracts with the NHS and local authority for a variety of services and they take home the “profit” that they make.

While some think the partnership model is more productive than being employed like hospital colleagues, it is not right for everyone. Increasingly, GPs do not want to become partners because of the levels of responsibility and financial risk involved. Evidence suggests that many GPs would be open to moving to a salaried model. At the same time, there are many other staff who work in primary care who would like more influence over the organisation they work for.

Public satisfaction with general practice remains relatively high, but not all practices work as well as they should for their patients. In many practices you can see a doctor on the same day, but in the area I represent as an MP, in March 4,437 people had to wait more than 28 days between making an appointment and having a consultation. In some parts of my constituency, poor access to a GP is the biggest issue that people contact me about.

 ‘Evidence suggests that many GPs would be open to moving to a salaried model.’ Photograph: Alamy Stock Photo

As a health service leader, I was astounded by the number of times practices wouldn’t take on work that was clearly beneficial to their patients, because it wasn’t in their business interest. I have battled with GPs who told me that they weren’t paid enough to do annual health checks for adults with learning disabilities (they get more than £100 per check), wouldn’t take student nurses on placement because the profits weren’t large enough, and wouldn’t offer appointments in early mornings or evenings because it was “optional”. That clearly isn’t right or fair to their patients.

Our health services should be designed around need. The places with the oldest people and the highest levels of deprivation should get the greatest resources. The inverse care law tells us that in the real world the opposite happens. Practices emerge where doctors want them to be, rather than where public health needs assessment tells us they should be.

Culture and leadership are always more important than organisational structure, but a new ownership model for primary care would create an environment that facilitates happy staff and healthier patients.

Employee-led mutuals should be created within the NHS with nurses, doctors, pharmacists, therapists, managers and patients all having a say in how the organisation is run. These new organisations – instilled with a progressive and innovative culture – would be much better working environments for staff, with improved career pathways for nurses and more incentives to invest in people. As they would be within the NHS, there would be no profit motive. Crucially, they wouldn’t be able to pick and choose which services to offer to their patients. Struggling practices could receive investment to bring them up to the level of the best.

This model would enable a strategic shift from reactive and hospital-based care to preventive community care – without the NHS having to pay a premium price that includes GP profit. All existing GPs should be offered salaried employment within these organisations. Those that wish to retain their existing contractual arrangements should be allowed to do so. This is likely to be particularly important in rural communities.

Groups of general practices are already coming together into primary care networks. This is a step in the right direction. Why not give them the option to go one step further, become NHS primary and community care organisations, and complete Nye Bevan’s NHS?

Protect the NHS – but don’t protect it to death

Harry Quilter-Pinner in The Guardian

 

The NHS, as portrayed at the opening of the 2012 London Olympics. Photograph: Julian Simmonds/REX/Shutterstock




Dancing doctors, uniform-clad nurses and children jumping on hospital beds. There are very few countries that would include a celebration of their healthcare system in the opening ceremony of the Olympic Games. But this was the sight that greeted the millions who tuned in at the start of London 2012. After all, as former chancellor Nigel Lawson said: “The NHS is the closest thing the English people have to a religion.”

Now the country will once again celebrate the NHS, as it turns 70. And so we should. Across the globe, 400 million people still don’t have access to essential healthcare services. Thanks to the NHS, no one in the UK faces this injustice. It is there for us all – regardless of race, sexuality, gender or financial means – at our times of greatest need.

But we must also take this opportunity to stop and reflect. How good is the NHS? What do we want for its future? And what do we need to do to make it better?

A new report attempts to answer some of these tricky questions. It shows that, despite the rhetoric, in many ways the NHS is deeply average. In the authors’ words “the NHS performs neither as well as its supporters sometimes claim nor as badly as its critics often allege”. Shockingly, it finds that if you suffer from cancer, a heart attack or a stroke in the UK, you are more likely to die early than in other developed countries. 

This reality jars with a national perception of the NHS as world leading. Some will jump on this as an opportunity to call for radical change: perhaps a shift to a social – or even a private – insurance model. This would be a mistake. Fundamentally, the NHS is sound: its “free at the point of need” principle ensures that getting ill doesn’t mean getting poor. Moreover, there is strong evidence that it is more efficient than its marketised equivalents in the US and Switzerland.

Money is part of the answer as to why the NHS underperforms, compared with other systems. We spend less on healthcare than most other countries of a similar size and income level: just 9.7% of GDP compared with around 11% in both Germany and France. It should not come as a surprise that with average levels of funding come average levels of care. Theresa May’s recent “birthday present” – a long-term funding settlement for the NHS worth an additional £20bn a year by 2023 – will start to address this, though many predict that it will not be enough in the context of a growing and ageing population.

But money alone is not the solution: the NHS also suffers from a lack of reform. In places where the NHS has embraced best practice it is undoubtedly world leading. Stroke care is a good example. In 2010, London went from 34 hospitals treating stroke sufferers to just eight new centres of excellence. This has resulted in 400 lives saved per year across the capital. There have been attempts to replicate this nationwide. But in too many areas these changes, which involve consolidating services into fewer, more specialist centres, have been opposed by both the public and politicians. 

There are similar debates about moves to embrace new technologies in the NHS. The evidence is clear that artificial intelligence and robotics could fundamentally transform health and care. The government recently announced funding to help save 30,000 lives a year through technology-enabled diagnosis of cancers. But all too often, people see data-sharing as a breach of privacy and the rise of robotics in the NHS as an attempt to cut costs.

In some ways, this reluctance to embrace change is unsurprising. We all have a strong emotional and cultural attachment to the NHS. We are understandably protective of it. And many see the NHS as the last vestige of an endangered postwar consensus. They are fearful that it will go the same way as the rest of the welfare state, becoming watered down, outsourced and underfunded.

But in looking to protect the NHS there is a real risk that we end up “killing it with kindness”. All change is not bad change. As Lord Darzi’s recent review of the NHS has made clear, “high-quality care is a constantly moving target: to stand still is to fall back”. This would not only be a travesty for those who suffer as a result; it would also fuel the arguments its critics. When the great reformer, William Beveridge, proposed the creation of the NHS during the second world war, he was focused not on protecting existing achievements but on embracing the future. On its 70th birthday, it is vital that we do the same again.

Dead Cats - Fatal attraction of fake facts sours political debate

Tim Harford in The Financial Times


He did it again: Boris Johnson, UK foreign secretary, exhumed the old referendum-campaign lie that leaving the EU would free up £350m a week for the National Health Service. I think we can skip the well-worn details, because while the claim is misleading, its main purpose is not to mislead but to distract. The growing popularity of this tactic should alarm anyone who thinks that the truth still matters. 

You don’t need to take my word for it that distraction is the goal. A few years ago, a cynical commentator described the “dead cat” strategy, to be deployed when losing an argument at a dinner party: throw a dead cat on the table. The awkward argument will instantly cease, and everyone will start losing their minds about the cat. The cynic’s name was Boris Johnson. 

The tactic worked perfectly in the Brexit referendum campaign. Instead of a discussion of the merits and disadvantages of EU membership, we had a frenzied dead-cat debate over the true scale of EU membership fees. Without the steady repetition of a demonstrably false claim, the debate would have run out of oxygen and we might have enjoyed a discussion of the issues instead. 

My point is not to refight the referendum campaign. (Mr Johnson would like to, which itself is telling.) There’s more at stake here than Brexit: bold lies have become the dead cat of modern politics on both sides of the Atlantic. Too many politicians have discovered the attractions of the flamboyant falsehood — and why not? The most prominent of them sits in the White House. Dramatic lies do not always persuade, but they do tend to change the subject — and that is often enough. 

It is hard to overstate how corrosive this development is. Reasoned conversation becomes impossible; the debaters hardly have time to clear their throats before a fly-blown moggie hits the table with a rancid thud. 

Nor is it easy to neutralise a big, politicised lie. Trustworthy nerds can refute it, of course: the fact-checkers, the independent think-tanks, or statutory bodies such as the UK Statistics Authority. But a politician who is unafraid to lie is also unafraid to smear these organisations with claims of bias or corruption — and then one problem has become two. The Statistics Authority and other watchdogs need to guard jealously their reputation for truthfulness; the politicians they contradict often have no such reputation to worry about. 

Researchers have been studying the problem for years, after noting how easily charlatans could debase the discussion of smoking, vaccination and climate change. A good starting point is The Debunking Handbook by John Cook and Stephan Lewandowsky, which summarises a dispiriting set of discoveries. 

One problem that fact-checkers face is the “familiarity effect”: the endless arguments over the £350m-a-week lie (or Barack Obama’s birthplace, or the number of New Jersey residents who celebrated the destruction of the World Trade Center) is that the very process of rebutting the falsehood ensures that it is repeated over and over again. Even someone who accepts that the lie is a lie would find it much easier to remember than the truth. 

A second obstacle is the “backfire effect”. My son is due to get a flu vaccine this week, and some parents at his school are concerned that the flu vaccine may cause flu. It doesn’t. But in explaining that I risk triggering other concerns: who can trust Big Pharma these days? Shouldn’t kids be a bit older before being exposed to these strange chemicals? Some (not all) studies suggest that the process of refuting the narrow concern can actually harden the broader worldview behind it. 

Dan Kahan, professor of law and psychology at Yale, points out that issues such as vaccination or climate change — or for that matter, the independence of the UK Statistics Authority — do not become politicised by accident. They are dragged into the realm of polarised politics because it suits some political entrepreneur to do so. For a fleeting partisan advantage, Donald Trump has falsely claimed that vaccines cause autism. Children will die as a result. And once the intellectual environment has become polluted and polarised in this way, it’s extraordinarily difficult to draw the poison out again. 

This is a damaging game indeed. All of us tend to think tribally about politics: we absorb the opinions of those around us. But tribal thinking pushes us to be not only a Republican but also a Republican and a vaccine sceptic. One cannot be just for Brexit; one must be for Brexit and against the UK Statistics Authority. Of course it is possible to resist such all-encompassing polarisation, and many people do. But the pull of tribal thinking on all of us is strong. 

There are defences against the dead cat strategy. With skill, a fact-check may debunk a false claim without accidentally reinforcing it. But the strongest defence is an electorate that cares, that has more curiosity about the way the world really works than about cartoonish populists. If we let politicians drag facts into their swamp, we are letting them tug at democracy’s foundations.

PFI is bankrupting Britain's public services

The plight of my local hospital trust in Walthamstow shows just how debt is holding our country back. Could this be the time for a windfall tax?


Stella Creasey in The Guardian

Next time you have an appointment cancelled at hospital, or a headteacher tells you their school will be losing staff because of budget cuts, ask how much PFI debt they have – the answer may surprise you. My hospital trust, in north-east London, spends nearly £150m a year repaying its PFI debt – nearly half of which is on interest payments. If Theresa May is serious about taking on the unacceptable face of capitalism, she could save Britain a fortune if she goes after the legal loan sharks of the public sector.

New research from the Centre for Health and the Public Interest (CHPI) shows just how much these debts are hurting our NHS. Over the next five years, almost £1bn of taxpayer funds will go to PFI companies in the form of pre-tax profits. That’s 22% of the extra £4.5bn given to the Department of Health in the 2015 spending review, and money that would otherwise have been available for patient care.

The company that holds the contract for University College London hospital has made pre-tax profits of £190m over the past decade, out of the £725m the NHS has paid out. This alone could have built a whole new hospital as 80% of PFI hospitals cost less than this to construct. This is not just about poor financial control in the NHS – UK PFI debt now stands at over £300bn for projects with an original capital cost of £55bn.


It’s time to grasp the nettle and get Britain a better line of credit

Private finance initiatives are like hire-purchase agreements – superficially a cheap way to buy something, but the costs quickly add up, and before you know it the debt is crippling.

For decades, governments of both main parties have used them for the simple but ultimately short-sighted view that it keeps borrowing off the books – helping reduce the amount of debt the country appears to have, but at great longer-term expense. Its now painfully clear that the intended benefits of private sector skills to help manage projects have been subsumed in the one-sided nature of these contracts, to devastating effect on budgets.

No political party can claim the moral high ground. The Tories conveniently ignore the fact that these contracts started under the John Major government – and are expanding again under Theresa May, with the PF2 scheme. Labour veers between defensive rhetoric that PFI was the best way to fund the investment our public sector so desperately needed during its last government, and angrily demanding such contracts be cancelled outright, wilfully ignoring what damage this would do to any government’s ability to ever borrow again.

It’s time to grasp the nettle and get Britain a better line of credit. That requires both tough action on the existing contracts to protect taxpayers’ interests, and getting a better deal on future borrowing. Some have already bought out contracts – Northumbria council took out a loan to buy out Hexham hospital’s PFI, and in doing so saved £3.5m every year over the remaining 19-year term. But as the National Audit Office has shown, gains from renegotiating individual contracts are likely to be minimal – what is saved in costs is paid out in fees to arrange.

However, the CHPI research also shows up another interesting facet of PFI. Just eight companies own or appear to have equity stakes in 92% of all the PFI companies in the NHS. Renegotiating not the individual deals done for hospitals or schools, but across the portfolios of the companies themselves could realise substantial gains. Innisfree, which manages my local hospital’s PFI and others across the country and has just 25 staff, stands to make £18bn alone over the coming years. If these companies are resistant to consolidating these loans into a more realistic cost, then it’s time to look again at their tax reliefs, or – given the evidence of excessive profits in this industry that shareholders have received – resurrect one of New Labour’s early hits with a windfall tax on the returns made.

Longer term, we need to ensure there is much more competition for the business of the state. Despite interest rates being low for over a decade, these loans have stayed stubbornly expensive. The lack of viable alternatives – whether public borrowing or bonds – gives these companies a captive market. If the government wants better rates, it needs to ensure there are more options to choose between, whether by allowing local authorities to issue bonds, or reforming Treasury rules that penalise public sector borrowing in the first place.

As our public services struggle under the pressure of PFI, Labour must lead this debate to show how we can not only learn from our past, but also provide answers for the future too. The government has already spent £100bn buying the debt of banks through quantitative easing. With Brexit expected not only to add £60bn to our country’s debt but also affect our access to European central bank funds, taking on our expensive creditors is a battle no prime minister can ignore in the fight to stop Britain going bust.

The Corbyn Effect

Part 1 Andrew Murray interviewed byTariq Ali

Part 2

We need the state now more than ever. But our belief in it has gone

Aditya Chakrabortty in The Guardian



 

Illustration by Nicola Jennings


I left the Royal Court theatre a few days ago, feeling as though the writer had been rifling through my and other reporters’ notebooks. In Wish List, Katherine Soper has pinned down a theme central to today’s politics – but one I’ve yet to see in print or hear from an MP. To grasp it is to understand much of what drives support for both Brexit and Trump – and just why this is such a hostile climate for the left, be it in the form of Ed Miliband or Jeremy Corbyn, Bernie Sanders or Hillary Clinton.

Zero-hours workers '£1,000 worse off a year' than employees



At the centre of the play is a 19-year-old whose life is already over. Tamsin Carmody’s mother has died, leaving her in charge of the family. That means looking after her brother, Dean, who has been almost broken by poor mental health. When things get too much, he’ll press his hand on to a burning hob.

To scrape by, Tamsin works on zero hours in a giant distribution warehouse, packing strawberry lube, Meat Loaf albums, bottles of gin. The grim details of how the 21st-century British labourer has been reduced to cheap commodity are all here: the work boots that leave Tamsin’s feet clenched balls of pain, the countless paper cuts from folding cardboard that never get time to heal, the pleading for more work each morning. Some of this derives from Soper’s own experience. The 25-year-old has done her own zero-hours stint in a packing plant where, after calling in sick for a shift, she turned up the next day only to be ordered home: she had already been replaced.

Then there’s Dean. The government reckons he’s fit for work, despite his inability to face strangers or venture out in daylight. He loses his disability benefits, and has to enact the farce of assembling a CV and applying over and over again for jobs he won’t get and could never hold down.

And here is where a play does what a newspaper can’t and a politician won’t: the siblings’ lives are laid side by side, and the state is revealed to be just as callous, unanswerable and punitive as the employer.

FacebookTwitterPinterest Erin Doherty (Tamsin Carmody) and Joseph Quinn (Dean Carmody) in Wish List. Photograph: Tristram Kenton for the Guardian

Tamsin can’t meet her impossible targets of packing 400 items an hour; Dean is in no state to fill in all his job applications. Tamsin’s boss shrugs that he’s following orders: “They just get the numbers in the red and they work out how to put them in the black.” Dean’s health assessor and welfare adviser are in the pay of a government following a busted austerity strategy that relies on cutting off money to the poor.

Both have to struggle through tick-boxes, euphemistic nonsense (Tamsin’s warehouse is a “fulfilment centre”; Dean’s disabilities make him “fit for work”) and a system that grabs a lot while giving a pittance.

We’re often told that the state and the market have entirely different roles. But meet any number of the people paying the price for Britain’s crash, and you’ll see that they play almost identical parts using similar language and similar bureaucracy. And far from protecting low-paid workers from the depredations of the market, the state wants to hurl more people into it under the pretence that they are shirkers.

None of this fits with how social democrats view the state. Having attended my fair share of Labour and other leftwing political meetings, I know that a staple feature is that some grey-haired man in a jumper will leap up towards the end and launch into a good-hearted defence of the state. Public investment, social security, industrial strategy: all will circle back to the state; all will be met with murmurs of approval.


This has happened without the pundits and politicians noticing

And all are a million miles away from the experiences I regularly hear while reporting. I think about Lisa Chapman in Northamptonshire frantically searching the internet in the small hours to protect the benefits of her husband, who has Parkinson’s. A few days after my trip to the theatre I saw a presentation from the head of a local Citizens Advice. One of the PowerPoint slides read: “For some people, there is no safety net any more.” There was a time, she explained, when if someone walked in penniless she could get on the blower and shout, and scream and get them some money from somewhere. Now? That was almost impossible.

And I think of the valleys of south Wales, and the replies I got when asking what would make things better in one of the poorest parts of western Europe. No one mentioned the government, either in Cardiff or in Westminster. When I mentioned the G-word – in this place, where Thatcher shut the mines while Labour just relied on its voters to carry on being good little sheep – the response was usually laughter.

At the end of 2015, a team of academics held a series of two-day discussions with small groups of members of the public across Europe. They were asked only one big question: what should the government do for your children’s generation? Of all the countries, the British were easily the most pessimistic about what could be done – behind even Slovenia.

The British liked the NHS and pensions, but thought both would be gone in a generation. They didn’t talk about the good things that could be done by government. Trade unions came up just once in the entire two days. “I found it quite shocking,” recalls Peter Taylor-Gooby, of the University of Kent. “Of all the groups we interviewed, the British had this mood of resigned, reluctant individualism.”

Thirty years ago, Ronald Reagan claimed the nine most terrifying in the English language were: “I’m from the government and I’m here to help.” He said it was a joke; it turned out to be a prophecy. Three decades of both right and left privatising, outsourcing and deregulating have shrunk the public imagination about what their representatives in government can achieve. Put that alongside the shattering of the working class, the smashing of trade unions, and the diminishment of so many other social institutions.

The need for the state and collective action hasn’t diminished, but the public belief in it has gone. The state is now either invisible or hostile. This has happened without the pundits and politicians noticing, but its consequences could shape politics for decades.

After Dean has received his latest brown envelope, Tamsin turns to him and begins a vow. “We’re gonna make it without them. OK? Fuck them … we can do this ourselves. We can – I can work, and …” Her voice breaks. “This isn’t fucking fair. I can’t keep doing this. I can’t.

“I’m so fucking tired.”

I'm a junior doctor in the NHS, and I'm terrified for this winter

Aislinn Macklin-Doherty in The Guardian


Widespread concerns that the NHS will face the “toughest winter ever” are not exaggerated or unfounded – just look at the terrible news today from Worcestershire. We really should be worried for ourselves and our relatives. As a junior doctor and a researcher looking after cancer patients in the NHS, I am terrified by the prospect of what the next few months will bring. But we must not forget this is entirely preventable.

Three patients die at Worcestershire hospital amid NHS winter crisis


Our current crisis is down to the almost clockwork-like series of reshuffling, rebranding and top-down disorganisation of the services by government. It’s led to an inexorable decline in the quality of care.

I have also become aware of an insidious “takeover” by the private sector. It is both literal – in the provision of services – and ideological, with an overwhelming prevalence of business-speak being absorbed into our collective psyche. But the British public (and even many staff) remain largely unaware that this is happening.

Where the consultant physician or surgeon was once general, they now increasingly play second fiddle to chief executives and clinical business unit managers. Junior doctors such as myself (many of whom have spent 10-15 years practising medicine and have completed PhDs) must also fall in line to comply with business models and corporate strategy put forward by those with no clinical training or experience with patients.

It is this type of decision-making (based on little evidence) and seemingly unaccountable policymaking that means patient care is suffering. Blame cannot be laid at the feet of a population of demanding and ageing patients, nor the “health tourists” who are too often scapegoated.

The epitome of such changes is known as the “sustainability and transformation plans”. These will bring about some of the biggest shifts in how NHS frontline service are funded and run in recent history, and yet, worryingly, most of my own colleagues have not even heard of them. Even fewer feel able to influence them.

Sustainability and transformation plans will see almost a third of regions having an A&E closed or downgraded, and nearly half will see numbers of inpatient bed reductions. This is all part of the overarching five-year plan to drive through £22bn in efficiency savings in the NHS. But with overwhelming cuts in social services and community care and with GPs under immense pressure, people are forced to go to A&E because they quite simply do not have any other options.

I have been on the phone with patients with cancer who need to come into hospital with life-threatening conditions such as sepsis, and I have been forced to tell them, “We have no beds here you need to go to another local A&E.” Responses such as, “Please doctor don’t make me go there – last time there were people backed up down the corridors,” break my heart.

According to the Kings Fund, our NHS leaders are choosing to spend less year-on-year on healthcare (as a proportion of GDP) than at any other time in NHS history and yet we are the fifth richest economy in the world. Simultaneously private sector involvement increases and astronomical interest rates from private finance initiatives must be paid, with hospitals such as St Bartholomew’s in London having to pay up to £2m per week in interest alone. No wonder nearly all hospitals are now in dire straits.

This is all the result of intentional policies being made at the top with minimal consultation of those on the frontline. With such policies accumulating over the years we are now seeing the crisis come to a climax. The UK has fewer beds per person and fewer doctors per person than most countries in Europe. Fewer ambulances are now able to reach the highest-category emergencies, which means people having asthma attacks, heart attacks and traffic accidents are being left to wait longer in situations where minutes really matter.

The sustainability and transformation plans for my local area in south-west London show that they plan to cut 44% of inpatient bed stays over the next four years . This is dangerous. It is likely that St Helier hospital in Sutton, which takes many emergencies in the area, will close and patients will then not only have access to critically reduced services, they will then have to travel longer to hospital, having waited longer for the ambulance to get to them.

This will be the straw that broke the camel’s back. I cannot stand by while patients’ lives are put at unnecessary risk this winter. And neither should you.

Jeremy's Anthem for 2017

by Girish Menon

I’m not afraid of  Brexit

I’m not worried about Trump

I’m not scared of boundary changes

Don’t care about opinion polls

I don’t bother with Tony

Nor his many cronies

Half a million volunteers

Are my army

Largest party in the EU

I won’t let you down

I believe in socialism

Universal basic income

World class NHS

Pure air, water and food

A safe place to live

For all who live here

Half a million volunteers

Will each bring thirty new voters

Largest party in the UK

I won’t let you down

I said don’t go to Iraq

I did not fudge my bills

I do not hate the wealthy
The media hate me

But the youth relate to me

And I am full of energy

Half a million members

Will spread the good word

A fair government in the UK

I won’t let you down.

-----

Universal Basic Income explained

Whatever you think of him, Donald Trump is right on TPP and TTIP

Youssef El-Gingihy in The Independent

In a YouTube video of policy proposals released this week, President-elect Trump announced that the US would withdraw from the Trans-Pacific Partnership. This trade agreement encompasses the major economies of the Pacific Rim with the notable exclusion of China. Other policies included a hodge-podge of climate change denial through promoting fracking and coal, deregulation, infrastructure spending and measures against corporate lobbying.

There are mounting concerns about xenophobia following Trump's victory. The appointments of Breitbart's Stephen Bannon as chief strategist, the anti-immigration Jeff Sessions as attorney general, Mike Pompeo as CIA director (in favour of bulk data collection) and General Michael Flynn as national security advisor would appear to reinforce Trump's targeting of Hispanics, Muslims and other minorities.

Yet amid all this soul-searching, the key question liberals should be asking is why authoritarian nationalism is spreading across the West. The answer is relatively simple. Neoliberal globalisation has left millions behind both in the advanced economies and the global south over several decades. Wealth has been siphoned to the top. The economic fallout post-2008 has seen inequality widening, with many falling into poverty. The effects of austerity on southern Europe are a social catastrophe.

The liberal and social democratic parties previously representing working-class constituents have abandoned them and are captured by corporate power. The Democratic party under the Clintons and Obama as well as New Labour under Blair and Brown were emblematic of this process. The result has seen millions of voters turn to candidates positioning themselves as anti-establishment. Hence the success of the SNP, Ukip, Brexit and now Trump.

Free trade agreements are at the heart of the matter. Negotiations have taken place behind closed doors with corporate lobbyists. Transparency has been minimal. It is exactly this kind of undemocratic, technocratic managerialism which is prompting a backlash against elites. It is the same technocratic managerialism that saw the troika of the European Central Bank, the European Commission and the IMF impose unrelenting misery on southern Europe, rendering Greece as expendable. The troika even issued memoranda to be rubber-stamped by national parliaments.

Both the EU-US trade agreement, or Transatlantic Trade and Investment Partnership (TTIP), and the Trans-Pacific Partnership (TPP) are sold as reducing barriers to trade through harmonisation of regulations thus increasing growth. But harmonisation effectively means a race to the bottom with the lowest common denominator regulations being adopted. In fact, there are not many barriers left and the question is more of how growth is distributed. It is now clear that trickle-down economics is a myth.

Trump has stated that he is against TTIP and TPP, and may even reverse the North American Free Trade Agreement (Nafta). Many people do not understand what these trade agreements mean so let me spell it out. They promote trade liberalisation. This essentially means opening up public services to corporate takeover. They would likely make public or state ownership difficult. They would restrict the financial tools available to countries to regulate banks. They would also limit their ability to impose capital controls.

They would lock in privatisation through Investor-State Dispute Settlement clauses. This means that multinational corporations could sue governments if they took steps that harm their profits or even the future expectation of profits. This would take place through private, secretive courts rather than the normal law courts. In fact, precedents have already seen tens of countries sued by corporations for measures taken in the public interest.

The NHS is a good example. It is currently being privatised, paving the way for a private health insurance system. TTIP would mean that if a future UK government took steps to reverse this then they might well be sued. In effect, this acts as a deterrent against government actions harming corporate interests. This would apply not just to healthcare but to all public services, from education and broadcasters such as the BBC to public transport and utilities.

These trade agreements would also enforce enclosure of the commons through intellectual property rights. So drug patents would be extended to combat cheaper generic medicines. Patenting of the human genome would be enforced. Farmers might have to buy seeds from corporations. I don’t know about you, but that sounds like a dystopian world to me.

Neoliberal globalisation is not some irresistible force of nature. Economic protectionism may not exactly be progressive but the current status quo of wage stagnation and falling living standards is unsustainable. If steps are not taken to remedy the damaging effects of neoliberalism then the backlash will only intensify, likely leading to rising nationalism, fascism and global conflict.

In his victory speech Jeremy Corbyn spelled out exactly why the establishment hates him so much

Youssef El Gingihy in The Independent

Jeremy Corbyn's conference speech yesterday underlined exactly why he has been subjected to a ferocious smear campaign. We have heard an endless catalogue of critiques: That Corbyn lacks leadership; that he is not electable; that Labour has become a protest party infiltrated by the far left. Yet the real reason behind these attacks is that Corbyn is a clear and present danger to powerful, vested interests.

For the first time in a generation, a Labour leader is truly challenging the cosy political consensus extending through the Thatcher-Blair-Cameron axis. The policies taking shape represent a clean break from several decades of deregulated free market economics.

Corbyn has positioned Labour as an anti-austerity party. He emphasised that the financial sector caused the 2008 crisis not public spending. This is important as Miliband and Balls mystifyingly failed to make this argument. One can only surmise that they were eager not to offend the City of London.

Corbyn promised to reverse privatisation of public services. This would mean renationalisation of the railways. It would mean restoring a public NHS reversing its privatisation and conversion into a private health insurance system.

It would mean an end to the outsourcing of council services. It would mean returning public services into public hands. And none of this is radical. Polling shows the majority of the public, including Conservative voters, is in favour.

It is no surprise that Richard Branson and Virgin seemingly used Traingate in an attempt to discredit Corbyn. Virgin would stand to lose billions in contracts if such policies went ahead. As would many other corporate interests - the likes of Serco, G4S, Capita and Unitedhealth to name a few.

Corbyn promised Labour will build enough social housing and regulate the housing market. Again, property developers, investors and construction firms would stand to lose from the restoration of housing as a social good rather than a financial instrument.

Corbyn vowed that bankers and financial speculators cannot be allowed to wreak havoc again. Regulation of the financial sector will have the City running scared - the party may well be truly over for them. Deregulated finance has resulted in industrial scale corruption profiting a tiny elite at the expense of ordinary people. This was evident not only during the crash but in the raft of scandals since, including LIBOR and PPI.

Corbyn added that the wealthy must pay their fair share of taxes. Labour would take effective steps to end tax avoidance and evasion. This would need to start with winding down the offshore empire much of which comes under the influence of the UK and the City of London.

Corbyn highlighted the grotesque inequalities driven by neoliberalism. The result has seen millions of ordinary people abandoned by a system that does not work for them. Here, Corbyn again broke with the consensus pointing out that immigration is not to blame. Scapegoating of migrants is convenient for elites keen to distract from the damage that they are causing. Corbyn emphasised that it is exploitative corporations, which are to blame for low wages not migrants. Over-stretched public services are down to Conservative cuts not immigration. However, after years of xenophobic anti-migrant rhetoric, winning this argument will require plenty of hard work.

On the economy, Corbyn promised investment with £500bn of public spending and a national investment bank. He also promised investment in research and development, education and skilling up of the workforce.

Yet none of this is especially controversial. Much of it is increasingly accepted as common sense amongst economists.

It is Corbyn's reset on foreign policy, which is truly intolerable for the establishment.

Corbyn spoke of a peaceful and just foreign policy. There would be no more imperial wars destroying the lives of millions; generating terrorism and migration crises. Arms sales to countries committing war crimes would be banned starting with Saudi Arabia. This will have set alarm bells ringing amongst the nexus of intelligence agencies, defence contractors and corporates. Corbyn is directly challenging the Atlanticist relationship paramount to the US-UK establishment and its global hegemony, particularly in the Middle East.

It is no surprise that the Conservatives and their mainstream media cheerleaders have therefore attacked Corbyn. The most damaging attacks, though, have come from his parliamentary party. The process of disentangling from the New Labour machine captured by corporate interests may still generate more damage.

As Corbyn and McDonnell have both made abundantly clear, socialism is no longer a dirty word. Corbyn's Labour - the largest party in Western Europe - is powering forward with a vision of forward-looking 21st century socialism.

Am I a socialist?

Zoe Williams in The Guardian


Every day millions of internet users ask Google life’s most difficult questions, big and small. Our writers answer some of the commonest queries

 

‘There is nothing unsocialist – indeed, nothing more socialist – than to have been involved in the miners’ strike.’ Photograph: Steve Eason/Getty Images
 

This question has gained extra piquancy this week, with two investigations – one, Dispatches, undercover and rather underhand – into Momentum, the grassroots organisation that sprang up in support of Jeremy Corbyn. The question put, insistently, is: are Corbyn’s supporters real socialists or hard-left entryists? If we accept that some of them are real socialists, are they having their arms twisted by Trotskyists?

I know from the ferocity of the debate that it will be taken for insincerity when I say this, but nevertheless, I mean it: I find it difficult to identify the concrete principles that separate the acceptable socialist from the unacceptable outrider. Often the criteria are quite loose and temporally free range: you are no longer a socialist if you’ve shared a platform with a revolutionary, or been involved with Stop the War (the jury is still out as to whether going on a Stop the War march counts), or ever espoused anything other than parliamentary democracy, even if it was the 90s and you were drunk.

Proxy issues – usually Trident and Palestine – are used as tests of the boundary between socialism and radicalism, even though neither issue could be rationally situated on the left or right, one being fundamentally a techno-military question of what modern warfare will look like, the other a foreign policy matter in which the supposedly “lefter” side has plenty of support among conservatives. There is nothing unsocialist – indeed, nothing more socialist – than to have been involved in the miners’ strike, yet if it put you in contact with the Alliance for Worker’s Liberty, which it probably did, that made you a communist.

  ‘In the early part of this decade, Ed Miliband called himself a socialist.’ Photograph: Oli Scarff/AFP/Getty Images

There is a school of thought that says, just as George Osborne would never call himself a free-market fundamentalist, rather, a man of good sense, so a socialist shouldn’t wrestle too much with self-definition. Yet I have the feeling, in the absence of clarity, of a taboo closing in, so that one day soon we will wake up unable to remember whether socialism is an acceptable position at all, or whether it opens you up for some abstruse historical reason to the accusation of “palling around with terrorists”. 

It is helpful to return to the pre-Corbyn consensus, by which I mean, any time up to last September; how could you describe yourself, before you made Andrew Neil even redder, or Evan Davis’s eyebrows shoot up, or in some other way put yourself beyond the pale of common sense?

You were a socialist if you believed in nationalising industries and/or utilities, if you believed in raising wages through collective pay bargaining rather than post-hoc redistribution, if you cleaved to a fair day’s pay for a fair day’s work – a living wage. Free healthcare at the point of use is properly understood as a socialist principle, and is described as such by American commentators, but has never counted because British opinion is united in support of it: a tacit understanding of our politics is that once something has majority support, it ceases to be socialistic – it’s an OK position so long as it remains niche, and it is easier to turn a blind eye to the socialism inherent in a popular position than it is to admit that socialism is often popular.

Likewise, a belief in equality has now reached the status of platitude, with politicians from every party espousing it, whereas in fact, it remains socialist rather than capitalist: only a creed that considers equality an actionable goal, rather than a utopian idea you scramble towards by giving extra nursery hours to insufficiently aspirational toddlers, can realistically claim to believe in it.

In the early part of this decade, Ed Miliband called himself a socialist, without much catcalling.

‘If you wanted to sound like a West Wing leftie you would call yourself a liberal egalitarian.’ Photograph: NBCUPhotobank/Rex Features

Those who wanted to signal their discontinuity with the Blair years, while not sounding too radical, would call themselves democratic socialists – that is, they believed in socialism but were happy to trust a sensible, non-socialist majority to democratically overrule them.

If you wanted to sound like a West Wing leftie – like a British leftie, only better looking, wearing cashmere, more likely to win, and even losing, less likely to be a crank – you would call yourself a liberal egalitarian.

There were questions to which Miliband-style socialism had no answers: it was not against private property, indeed, socialism has never been rigid on this point. So if you saw the growth of a landlord class and the return to a rentier society as the inevitable result of housing being priced as an asset (exchange value) rather than a necessity (use value), that would put you in Marxist territory, whereupon you would have to park a perfectly demonstrable economic theory while you quickly apologised for gulags.

It is fascinating, to me at least, to see a younger generation on the left reclaim “communism” – now in the shape of fully-automated luxury communism, which fuses the aims of egalitarianism with the inevitability of a robotised future. Lefties over 40 will never call themselves communists because the inevitable conversation about whether or not Stalin was evil is just too tedious. It is a glimpse of what it feels like to be seen, if a Muslim, as an apologist for Isis, but only a glimpse.

To get to the fundamental distinctions between socialism and communism, without going via Stalin, Mao and Kim Jong-un, it is useful to return to the source of both terms – Paris in the 1830s – when secret political societies sprang up to finish what the revolution had left undone. These groups were mainly discursive, though occasionally spilled out into street protest, dismissed at the time – this will be familiar – as mainly middle-class intellectuals. It’s a bizarre and, even more bizarrely, effective rightwing accusation: “Your movement is stupid because its proponents are too clever.”

It was often hard to disentangle one belief from the other since the words waxed and waned in popularity, were often used interchangeably, and both believed in revolution. However, very broadly, the socialists wanted central direction of industry but weren’t opposed to markets, while communists wanted to see an end of markets and money, with all endeavour freely chosen and paid for by coupon. Socialists weren’t against private property, though they were in favour of the common ownership of goods, and obviously there’s space in there to quibble about what can and can’t be legitimately held in common.

Communists believed in universal free education, and so did some socialists. There were societies fusing socialism and communism that preached class war, on the basis that the aristocracy was a cancer on the body politic and as dangerous to man as was the tiger to other animals; and thought, furthermore, the aristocracy of money was as bad as the aristocracy of blood.

However, by a process of self-sorting and vigorous infighting, the communists ended up the more trenchant on this killing-enemies point, while socialism by the mid-1800s was shot through with a much softer vision, in which science and the best of humanity would unite to create paradise on Earth through peaceful means. The Comtean Positivist Religion of Humanity, resting on the twin blessings of brotherly love and the natural goodness of mankind, was probably what finally did it for the socialists’ allegiance with the communists, who found them saccharine.

‘Karl Marx would roll in his grave.’ Photograph: Popperfoto

To put that in perspective, even by 1846, the first two items on the agenda of the Communist Correspondence Committee were: “1. An examination must be made of the Communist party. 2. This can be achieved by criticising the incompetent and separating them from the sources of money.” If you know you’re a socialist because it takes a lot of evenings, you know you’re communist when you hate the other people at your meeting worse than the devil (this is no longer the case with fully automated luxury communists, FYI).

Just as a new technological context has allowed a generation to re-imagine communism, so the tectonic movements in democracy, energy, climate, land, finance, money and work throw up questions to which the socialism of the 1830s, 1930s or 1980s could not possibly have the answers. How do you reconnect a socialist party to a grassroots movement in the absence of mass trade union membership? How do you bring energy back into common ownership? Is there any point in nationalising fossil fuels, or is the right to a common stake in a viable future more important? (In that case, only renewables are socialist). How do you arrest the concentration of land into the hands of the few, when it’s moving so fast? Is profit un-socialist by definition, or is it the legitimate result of a good decision, so long as the investment is accessible and pro-social? Indeed, is finance inherently capitalistic or can it be democratised and thereby socialised? (Mark Davis at the Bauman Institute releases a report on this on Thursday).

Come to that, now we understand money as a social resource – a marker of trust between people and institutions, with no innate value – should we socialise its creation? How do you build solidarity that doesn’t rely on work or a workplace? Probably the only solid socialist answer to any of these questions is that it’s within the wit of science and the innate goodness of the species to figure them all out. There are certainly no fixed lines, here, no spaces where a classic socialist could not possibly be flexible to the demands of the future, where a would-be socialist finds him or herself confronted with an idée fixe. Marx would roll in his grave.

You could question the value in using old principles to solve new problems: I would counter that those principles – common ownership, equality, fellowship, innovation, a belief that everyone’s welfare is everyone else’s business and that a better future for the next generation is the sine qua non – are universal and need no updating, for all that they don’t point in one obvious direction.

Finally, you could argue about the wisdom of returning to an old term when it risks derailing the quest for new answers. Yet the stigma around it is lifting. In the 90s and noughties, it was a shorthand for a person who didn’t understand modernity and couldn’t find political energy with a canary and a pit helmet. The fact that it’s being reclaimed, with pride, is probably the beginning of a very short answer: if you can ask, “Am I a socialist?” and not mind getting a “Yes”, then you probably are one, or at the very least, know some.