Health Reform

Deputy PM Mr Nick Clegg and the Liberal Democrats have been claiming victory in the struggle to make NHS reform more progressive. The party certainly seems to have won much of what it wanted (BBC, 12 June 2011).

In order for Liberal Democrats to get what they wanted, their Tory coalition partners are being forced to back down from long-time promises to introduce more competition to the NHS (BBC, 14 June 2011). The focus on competition has had to be relaxed as the NHS listening exercise says slow down, increase accountability to elected officials, increase the involvement of professional opinions and to only use competition where it can clearly 'secure greater choice and better value for patients' (DoH, 2011).

Furthermore, the Tory part of the coalition has been less than impressed with Liberal Democrat celebrations (Watt, 2011). On the opposition benches the Liberal fight for a more progressive policy has met a lukewarm response at best.

There are concerns and suggestions that the listening exercise has led to proposals that PM Mr Cameron ought to show far more favour to 'protectionism' in the health market than either of the previous Labour Premiers did (BBC, 16 June 2011{1}). A particular critic is former Labour health secretary Mr Alan Milburn. Mr Milburn has been vocal in his criticism, but not just of reform plans.

While Mr Milburn levelled criticism at the government for its attempt at the 'biggest nationalisation' in NHS history, he also pursued Mr E Miliband's Labour Party for its willingness to back away from what he called 'radical territory'. In this case the 'radical' is allowing the market access to the British healthcare system to end what Mr Milburn calls 'public sector producer-interest protectionism'.

All of this debate about public funded health is occurring  with a background of public sector reforms that are sparking talks of mass union action (BBC, 16 June 2011{2}). Shadow Chancellor Mr Ed Balls has responded on behalf of Labour's current frontbench team, urging all sides to towards calm in matters ahead (Stratton, 2011). Mr Balls warns against falling into a 'strike trap' which will only benefit the Tory Chancellor against whose measures strikes would be aimed.

The Shadow Chancellor's calls for the sides to get back around the table to find a smarter solution will be good news for those in the coalition who wish for less confrontation, such as Chief Secretary to the Treasury, Liberal Democrat Mr Danny Alexander who said he believed there was a 'huge amount of room for dialogue'.

So this is the deadlock that faces the future of the NHS. With it, a few questions come to mind:

+ Firstly, to what purpose where National Insurance & the NHS set up initially?

+ Secondly, how progressive are these reforms proposed by the listening exercise?

+ Thirdly, how do these two match up and what can still be done?

Well the ball was set rolling by the National Insurance Act of 1911, brought in on the back of the People's Budget of 1909 which was described by its champion and Liberal Chancellor David Lloyd George as:

'a war Budget. It is for raising money to wage implacable warfare against poverty and squalidness. I cannot help hoping and believing that before this generation has passed away, we shall have advanced a great step towards that good time, when poverty, and the wretchedness and human degradation which always follows in its camp, will be as remote to the people of this country as the wolves which once infested its forests'
       - David Lloyd George, Announcing the People's Budget, 29 April 1909

This purpose has been refined & reformed over time; Atlee & Bevan passed the NHS Act in 1946, expanding the means at Britain's disposal for tackling Beveridge's Giants; that is Want, Disease, Ignorance, Squalor & Idleness (Taylor, 2009).

Amongst the new proposals is a recommendation that the Secretary of State for Health 'should remain accountable for the NHS' which, combined with the call to limit competition to where it can improve choice & quality of services; is certainly a progressive suggestion. To assure a democratic say in the running and consumer's say in the service, as a means to promote the best quality and affordable access is surely within the scope of those original aims.  There are however, some who are not so sure that these proposals are the end of the story, with Dr Meldrum of the BMA suggesting that they 'don't think the privatisation genie is back in the bottle' (Triggle, 2011).

The initial implementation of National Insurance took much work, compromise (dropping Land Tax proposals) & even constitutional reform (Parliament Act 1911) before it came into being. There is no reason then not to think of these reforms as anything other than part of an ongoing process. The reforms offer a way of striking the balance between the cost-effectiveness the market can bring, something that is suggested to be key in assuring the NHS can be funded adequately in the future; and the need to insure that the UK maintains its health service that is nothing short of a wonder of the world. A system where everyone has access to free services at the point-of-use, which prevents one of the 'poverty traps' present in other parts of the world.

There is of course a fourth and final question. How far will the Tories be willing to meet the proposed adjustments to their healthcare policies?

==========
References:
==========
+ BBC's 'Nick Clegg to claim NHS changes victory for Lib Dems'; 12 June 2011;

 Nick Clegg's 'How we’re protecting our NHS'; Listening Exercise Statement from Guy's Hospital; 14 Jun 2011;

+ BBC's 'Cameron backs wholesale changes to NHS plans'; 14 June 2011;

+ Department of Health's 'NHS Future Forum publishes recommendations to Government'; 13 June 2011;

 NHS Future Forum recommendations to Government; Downloads;

+ Nicholas Watt's 'Nick Clegg under fire over health reform 'victory''; 12 June 2011;

+ BBC's 'Milburn calls amended NHS plans 'a car crash''; 16 June 2011{1};

+ BBC's 'Coalition 'losing its way' on public sector reforms'; 16 June 2011{2};1

+ Allegra Stratton's 'Ed Balls warns unions of George Osborne's 'strike trap''; 19 June 2011;

+ Nick Triggle's 'Analysis: Why the NHS wants to move on'; 14 June 2011;

+ Matthew Taylor's 'Global Giants'; in Duncan Brack, Richard S. Grayson & David Howarth's 'Reinventing the State: Social Liberalism for the 21st Century;  Politicos, 2009.

Lords Reform

Plans are set and work is underway towards a reform of the House of Lords. The reforms advocated are very firmly democratic, seeking to ensure a representative elected upper chamber in the UK parliament. The main aspects of the proposals so far as put forward by Deputy PM Mr Clegg (2011) are:

+ to reduce the number of members in the lords to 300;
+ to be composed of at least 80% elected members;
+ and for members to sit for a single term of three parliaments (or 15 years), with a third to be elected every five years;

For any supporters of democracy it is a move to be welcomed. However there have been some legitimate issues raised in opposition to creating a second elected chamber, pointing to constitutional issues that may arise as a result (BBC, 2011). Particularly there is a concern that reform of the Lords could renew constitutional struggles that where settled by the Parliament Acts in 1911 & 1949.

The 1975 Australian constitutional crisis was demonstrative of the kind of issues some worry may arise from neither house being definitively more accountable to the people than the other. In a two-chamber system like that of Germany, this wouldn't be an issue. However in our Westminster System, we use Responsible Government. That means that the government is chosen from and sits in the most representative chamber and is accountable to that chamber. If the Lords is no longer less accountable than the commons, the supremacy of the commons enshrined in the Parliament Acts can be called into question.

There is no indication thus far though that there are plans to alter either the Parliament Acts of 1911 & 1949, which enshrined the supremacy of the Commons and prevents the upper house from unduly blocking so-called 'money bills'; or the Salisbury Convention. So fear for a struggle over which house the government is called from seems to be unfounded. This does not address concerns however that reforms may just to create an elected upper chamber that is still as powerless as before.

That's not just a British issue either. In another parallel between Canadian & British politics, Canada finds itself in the midst of a related debate. In Canada the options are between reform of its upper house, the Senate, or the abolition of it (Payton, 2011). From senior politicians (CBC, 2011), to the media (Hepburn, 2011), to bloggers (Canada, eh?, 2009) the matter is one that has dragged on over several years with a swell of support for abolishing an institution seen as powerless that reform will not reinvigorate.

Whatever the solution Lords reform will not be easy. It is a sore issue that has long plagued the UK parliament. At the Diamond Jubilee Naval Review in 1897, while on board the colossal ship 'Campania' which carried the commons members in the wake of the much smaller 'Danube' carrying the Lords (Massie, 1992); Radical MP Mr John Burns suggested with a smile that if the Master of the 'Campania' would only:

'increase speed, many constitutional questions between commons and lords would be settled permanently'

It might be hoped that a more peaceable solution can be arrived at. The key thoughts in developing reform of the Lords are:

+ that the upper house must have a clear purpose & powers;
+ that it must have a clear relationship to the government;
+ and that it must be democratic & representative.

If these stipulations are met, a revamped Lords could add a useful new dynamic to British politics. If not we could well be better of just removing it all together and saving the nation some money.

==========
References:
==========
+ Nick Clegg's 'Green government, reforming government: the liberal influence'; 17th May 2011;

+ BBC's 'Clegg unveils plans for elected House of Lords'; 17th May 2011;

+ Parliament Act 1911;

+ Laura Payton's 'Hold referendum on Senate's fate: NDP'; 1st March 2011;

+ CBC's 'Don't reform Senate, abolish it: Ontario premier'; 31st May 2011;

+ Bob Hepburn's 'Abolish the Senate instead of trying to reform it'; 28th January 2011;

+ Canada, eh?'s 'Why not abolish the Canadian Senate?'; 28th August 2009;

+ Robert K Massie's 'Dreadnought: Britain, Germany & the Coming of the Great War'; Jonathan Cape, 1992.

Miliband strikes back

Mr E Miliband showed better form in yesterday's PMQs, taking the Prime Minister to task over concerns raised about welfare reforms.

The issue on hand was the reduced financial support that will be available to cancer patients under the proposed reforms.

It was a much stronger performance from Mr Miliband today, bouncing back from a tough week to push Mr Cameron out of his comfort zone.

European Trends

In the past month this blog has covered Human Rights, the role of states & the balancing acts of Liberty. Now seems as good as any to look at the political situation in Europe, where these are all issues of consequence:

It seems that the coalition's favourite line that says 'the cuts are necessary and whoever had to make them would suffer politically' is bearing weight in Europe. In Spain, President Zapatero's long standing Socialist Worker's Party (PSOE) government has engaged in cuts much like the Conservative-Liberal Democrat government in the UK. And much like in the UK, Mr Zapatero's government has suffered protests against it's economic policies (Tremlett, 2011) and a great increase in support for the opposition in the polls.

The question is whether this confirms the necessity but unpopularity of cuts regardless of party; or confirms that the unpopularity of the policy is due to an underlying unfairness. Is it sensible policy advised by financial experts; or symptomatic of a system with undue focus on favouring the finance industry, an issue common to Britain & Spain?

Supporters of a Federal Europe will be enheartened by a European Parliament special committee's report on the financial crisis (Beres, 2011). The report isn't binding but is certainly informing, particularly when we consider that the negotiations about the future of EU funding are still ongoing. The decision to accept the report passed the committee stage with a majority of 32 to 9 and it faces a vote by the whole parliament in July. The main recommendations of the report are that a major increase to the EU's budget and much closer economic & political union present the best solution to the weaknesses exposed by the financial crisis (Beres et al, 2011).

Pervenche Beres, French Socialist MEP and author of the report, expressed a belief that its recommendations represent a lesson learned but also the means to compete with the giant economic superpowers of the future (The Record Europe, 2011). It certainly appears to signify an increase in support for Europe's institutions and the work they carry out; the work of elected judges at the ECHR is a highly publicised example.

Germany has taken the decision to close all seventeen of its Nuclear plants by 2022 (BBC, 2011). The decision has promised to cause something of a rift; in Germany due to the Merkel Government's move to accede to popular protests against nuclear power and throughout Europe as nations seek to address the hole left in the energy market and position themselves politically in light of this move.

And finally in the UK, Deputy Prime Minister and Liberal Democrat leader Mr Nick Clegg has been working hard to get the message out that Liberal Democrats are living up to their mandate. It is most certainly a difficult sell to a public that has set its mind firmly against the party. Mr Clegg has been promoting the work the party is doing on reforming the House of Lords (Clegg, 17th May 2011) and in negotiating a better deal on NHS reform (Pack, 2011).

The Liberal Democrats, beginning even as the results rolled in on local election night in May, are seeking to regain the confidence of voters (Clegg, 6th May 2011). It is an aggressive publicity campaign aimed at showing the Liberal Democrats to be the reforming government they were elected to be and furthermore one that gets results (BBC, 2011).

That's all for now, but we will be back next week with a look in detail at the House of Lords reform proposals.

==========
References:
==========
+ Giles Tremlett's 'Spanish voters head to the polls, as city square protests continue'; May 2011;

+ Europarl.europa.eu's 'Invest more at EU level to counter crises, says Financial Crisis Committee'; May 2011;

+ Europarl.europa.eu's 'Pervenche Beres: "To get out of this crisis we need to work together"'; March 2011;

+ The Record Europe, 4th June 2011;

+ Pervanches Beres & Special Committee's 'Draft report on the financial, economic and social crisis: recommendations concerning the measures and initiatives to be taken'; March 2011;

+ BBC's 'Germany: Nuclear power plants to close by 2022'; May 2011;

+ Nick Clegg's 'Green government, reforming government: the liberal influence'; 17th May 2011;

+ Mark Pack's 'Tamed and reshaped – Clegg on the NHS White Paper'; June 2011;

+ Nick Clegg's email on the election results; 6th May 2011;

+ BBC's 'Conservative Lib Dem coalition agreement facing renewal?'; May 2011;

Educating Arthur

In 'The Once and Future King' we see the unfolding of the relationship between the Wizard Merlin and his pupil, the future King Arthur. This relationship, of teacher & student, has been ever-present in our pop culture from Gandalf & Aragorn to Ben & Luke; from Frank & Rita to Morpheus & Neo.

The most recent example is the dynamic between River Song & The Doctor in BBC's 'Doctor Who'. The parallel to Merlin & Arthur is firmly highlighted by The Doctor's tendency to travel backwards along River's timeline; like to Merlin who was 'born at the wrong end of time'. There is a distinct contrast between the Merlin-Doctor and the Arthur-River characters.

The Doctor is a teacher, a person of thought who educates so as to see the world anew:

'Because I can't see it any more... That’s the problem, you make all of space and time your backyard and what do you have? A back yard.  But you, you can see it. And when you see it, I see it.'        - The Doctor in an unreleased Scene from Flesh and Stone and The Vampires of Venice ', BBC's 'Doctor Who'. [Youtube link]

Merlin seeks learning for learning's sake. In his world work is it's own reward. Truth is the purpose and result of both work and contemplation, with the belief that Truth is always the best thing:

'He was frightened of what he had done to the king, feeling as if he was trying to revive a drowned man with artificial respiration, who was nearly too far gone. But he was not ashamed. When you are a scientist you must press on without remorse, following the only thing of any importance, Truth.'       - Merlin in 'The Book of Merlyn', 'The Once and Future King'.

River is a student. She is a character of destiny; and her reward has time and again been the Doctor. Her studies and mastery have been for the achievement of her dreams and rewards. She gains wisdom and her mastery to produce affects:

'Not those times, not one line. Don't you dare!'.
- Dr River Song in 'Forest of the Dead', BBC's 'Doctor Who' in response to the Doctor's plea that time can be rewritten.

Arthur learns from his tutor in order to prepare for his future. The aim to meet his destiny, too gain at the end; working to get the reward, to complete the quest and reap the glory:

'Oh, sir... I have been on that quest you said for a tutor, and I have found him. Please, he is this gentleman here, and he is called Merlyn... He is a great magician, and can make things come out of the air.'      - Arthur in 'Sword in the Stone', 'The Once & Future King'.

This dynamic and the trials faced remind me of the alchemist's journey. In versions such as Paolo Coelho's 'The Alchemist' (1988) we see those who pursue destinies, the philosopher's stone or the elixir of life having to make a choice: will they pursue enlightenment or gold?

Education is struggling with this dynamic right now. Maybe because states are working so hard to be economically powerful, everyone feels under threat from this frantic drive toward economic supremacy. Maybe these fears are threatening our Liberty, as we throw our money behind the safety of one horse or the other. What was it Benjamin Franklin said about Liberty & Safety?

'They who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety.'

In any discussion of liberty this is an important matter to consider. To weigh the management of human productivity against human enlightenment. Yet the 'Vital Power' of John Stuart Mill (1859) speaks to both a humanity free to be enlightened and free to be productive.

We suspend liberty to grease the wheels of the machine, we limit the time and resources available to researchers, thinkers & teachers; all to speed up the process of churning out the research and the students. We limit the power of individual enterprise in order to make market places run more smoothly, more efficiently.

Yet studies into education, into motivation at work and even into the sheer potential options that our language offers us, suggest that these restraints only hold us back from our potential. The evidence suggests that rather than competing forces they are complementary; that a society which can provide space & time from distraction to pursue enlightenment and the freedom of enterprise can be more productive than either alone.

In 'Doctor Who' the TARDIS acts as this perfect social setting. It liberates the Doctor to teach and River Song to achieve astounding feats. It is the setting that allows the Doctor and his students to rise above the everyday issues that drag down other pairings, such as Merlin & Arthur. In doing so it demonstrates how we are at our best when we are free to think and free to act. Everything else is just a matter logistics.

==========
References:
==========
+ T.H. White's 'The Once & Future King'; Voyager, Reissue 1996.

+ Paolo Coelho's 'The Alchemist'; Thorsons, 1988.

+ Benjamin Franklin & William Temple Franklin's 'Memoirs of the Life and Writings of Benjamin Franklin'; 1818.

+ John Stuart Mill's 'On Liberty'; 1859.

The President's Address at Westminster Hall

Last week US President Barack Obama addressed a combined sitting of both houses of the UK parliament in Westminster Hall, an honour given to few visiting dignitaries.

President Obama was introduced by Speaker Bercow, who is once again working hard to improve parliament's image and reputation.

The President's speech touches strongly upon the importance of Human Rights and is well worth listening to.