And the Misjudged Comment of the Month Award goes to...

As the press is wearily reporting this morning, Royal Bank of Scotland, recipient of taxpayer's largesse, has reported the following:

• It lost £1.1bn in 2010
• Nevertheless, it paid out just shy of £1bn in bonuses
• 100 of its bankers got more than £1M in the last year

And what does Chief Executive Stephen Hester have to say about all of this? Well, he said the following [and please, if you are holding a mug of coffee or have anything potentially dangerous if it's lobbed across a room, do put it down now]:

"It can feel pretty beleaguered working at RBS with external and internal pressures, that's one of the handicaps we work with"

He also said that the bank was a 'political football' and that things were 'tough'.

You see, what the story of the last few years tells us, is that these people don't do contrition. They are the living, breathing embodiment of everything that is wrong with 21st century capitalism. And there is, apparently, nothing we can do about it.

Anyone else think that Brown might have made the wrong call when he threw vast amounts of taxpayers' cash at the system? We've been left with a neo-liberal government intent on slashing the public sector into little pieces in the name of 'deficit reduction', and a banking system that is, in effect, almost completely unreformed.

But, let's face it, not many in 2008 - including the then-Prime Minister - could have predicted that greatest collapse in market capitalism would end a few years later with a resurgent political Right launching a concerted attack on the public realm in countries across the western world.

Are the Lib Dems about to put a brake on public service outsourcing plans?

As the government's White Paper on public service reform looms, an (unusually high) level of resistance appears to be stirring from amongst the ranks of the Liberal Democrats.

The Green Paper on Public Service Commissioning, published last year, outlined how the government will open up whole swathes of the public service to 'mutuals, co-operatives, charities and social enterprises'. Crucially, it also included this caveat:

"The Government recognises that that many mutuals and co-operatives are profit-making businesses, which operate for primarily commercial objectives. However, they are included in this definition owing to their role in public service provision".

Large private companies will, of course, have the resources and influence to dominate proceedings from here on in. In effect, this opens up core public services to privatisation.

The government's arguments for this are twofold. First, that it will represent a power shift from the government to the people. Second, that it will improve efficiency.

This first argument is heavily flawed. Our current democratic processes may have its detractors, but, as many opposed to the government's NHS reforms have argued, how does allowing unelected special interest groups, or US-based corporations to control service increase democratic accountability? How is it more empowering to service users? Ask a room full of people whether they believe privately-run railway services have improved accountability or the influence of users and you won't find many hands raised. It is precisely these concerns that prompted the head of the civil service to launch an inquiry into these reforms.

The second argument is potentially even more misleading. A fragmented service, or one operating on market principles, can cause back-room bureaucracy, so regularly attacked by the political right to balloon... as the experience of the market-led US model of health care illustrates.

Doctors' strike on the cards as BMA calls emergency meeting on NHS reforms

The British Medical Association has called an emergency meeting on 15 March to discuss a wholesale re-assessment of its current tactic of critical engagement with the government over its NHS reforms (or decimation, if you prefer).

There is huge disquiet in the profession, both with the way in which the government appears to have ignored all criticism (constructive or otherwise) over the Health and Social Care Bill and also with the lack of robust public reaction from the BMA leadership.

Dr Steve Hajioff, who will chair the special meeting, has said that "absolutely everything about our response and the way we engage could change, with the bill as a whole and sub-sections... That could vary from welcoming something, to doing nothing, to organising a strike ballot".


FURTHER WORRIES

Meanwhile, to compound existing warnings regarding the impact of the Bill on accountability, on the potential for service privatisation and on fragmentation of provision, there have been a slew of further criticisms from members of the BMA.

Tom Dolphin, representing junior doctors, described the Bill in its current form as being a ‘disaster’ for education and training, arguing that the changes will fragment the service and make training far more difficult. The chair of the Conference of Postgraduate Medical Deans was equally uncharitable: ‘The structural changes are huge but, with the greatest respect, hardly thought through at all.’

In the area of public health the government's programme is under attack, from its hands off approach to dealing with the alcohol and food industry to its proposals to devolve power to local councils for public health provision.


Here's hoping that the government can be persuaded do to the Health and Social Care Bill what has just been done to its forestry proposals... 38 Degrees have their petition up and running already. For, as a GP wrote powerfully to the Guardian recently:

"Why, if thousands are prepared to march against the privatisation of forests, do we not have millions out on the street marching against the privatisation of the NHS?"

Government's weak justifications for NHS privatisation plans

The government has deployed a couple of justifications for their NHS reforms ('reforms' being such a light phrase for a demolition job) but numerous commentators, including the crusading science journalist Ben Goldacre, have helped demolish these, aided by some of the very researchers that government ministers have (mis)quoted.

Two of the government's key arguments are summarised below - the first of which can be best described as misleading; the second of which is quite frankly duplicitous.

ARGUMENT 1: SURVIVAL RATES ARE BETTER IN FRANCE THAN IN THE UK

The main argument that government ministers have used most often in recent months is that health care outcomes are better amongst continental health care systems than in the UK. Leaving aside the fact that this ignores the chronic underfunding of the NHS over decades compared to its continental cousins and ignores different attitudes to public health and diet, it is not strictly true.

Paul Burstow, the MP or Care Services, has repeatedly pointed to research showing that the UK has poorer survival rates for heart disease and cancer than France. He cites research by Martin McKee, from the London School of Hygiene and Tropical Medicine, and Ellen Nolte from Rand to support this claim.

In reality, of course, he has quoted this research totally out of context. The very same researchers wrote to the Guardian to say the following:

"Paul Burstow MP... seems to have misunderstood....the findings of our research that he cites... We showed that, in the years between 1997-98 and 2002-03, the UK had high death rates from conditions amenable to healthcare, but these were falling faster than in all but one of 18 other industrialised countries. Crucially, we also showed how deaths amenable to healthcare in the US, with its much more competitive system of healthcare provision, were improving at a much lower rate, despite spending vastly more on healthcare than the UK. This, we would suggest, is the most important message of our research".


The British Medical Journal has produced this graph, below, that shows this striking trend: that improvements in UK outcomes means that, by 2012, Britain should have lower death rates for the disease than France, despite the latter spending considerably more on its health system. For cancer, trends are similar.
 

BMJ, 27 January 2011


ARGUMENT 2: GP CONSORTIA WILL LEAD TO LOWER WAITING TIMES 

A cynic would suggest that the government's desire for shifting the budget for the NHS down to GP consortia would firstly allow rationing to happen at a local level (thus allowing ministers to avoid being the focus of blame) and would enable them to open the door for the rapid privatisation of the system.

The government, of course, has a different argument: that GP consortia - being run by 'front line professionals' rather than the pen-pushing, faceless, politically-correct and probably Labour-voting bureaucrats that currently have the audacity to exist - will be more efficient and better equipped to understand patient need. Oh, and waiting lists will be lower.

The evidence?

Meic Goodyear, Public Health Intelligence Specialist working at Lewisham PCT, has argues that evidence to support the view that lower waiting times at GP consortia is not there - by studying GP fundholding practices that proliferated under the last Tory government:

"Following the election of the Labour government in 1997, I used survival analysis techniques to compare waiting times for patients from fundholding and non-fundholding GP practices for all waiting-list admissions in the South West Thames region in a year. With the exception of orthopaedic surgery, patients from fundholding practices waited significantly longer; in the case of cancer patients in particular, the average wait was 12.5% longer if their GP was a fundholder".

Ben Goldacre has gone further:

"I have never heard one politician use the word “evidence” so persistently, and so misleadingly, as Andrew Lansley".

He cites the lack of evidence for GP consortia being better at commissioning than Primary Care Trusts, as well as pointing to the dangers (as many other informed commentators have) of Lansley's proposed introduction of price-based competition. It's worth a read, as is his more recent critique of Paul Burstow's claims, which points to the irony of a Tory minister drawing attention to an academic study that demonstrates the rapid improvement of health care outcomes under Labour's period in power.

There is, of course, another reason for these NHS reforms, and it isn't about affordability (the US healthcare system, for example, is increasingly expensive and financially unsustainable). It's about neo-liberal politics: that private is always 'good' and public 'bad'. That, in fact, is that.

Public faith in government's economic competence on the wane

Labour's rising position in the polls has led to them moving ahead of both coalition partners in terms of voting intention in the latest YouGov poll, with a predicted vote share of 45%, against a combined 44% for the two parties currently in government.

However, most worryingly for the Conservatives is the detail of the poll, which shows changing public attitudes to Cameron as a leader (increasingly negative) and to the government's approach to the economy.

The views of the public towards the ability of a government to run the economy is a well-established driver of voting intentions, and on this measure the figures don't look good for Cameron. In this latest poll, more than half of voters now think that the government is doing a bad job of running the economy:


YouGov Poll 11 Feb: economic competence


In terms of the approach to public spending, public opinion has now definitively swung against the approach taken by George Osborne, with almost 60% of the public believing the cuts are being undertaken too fast:

YouGov Poll 11 Feb: public spending

The detail of responses to both of these questions help illustrate how much Clegg has alienated himself from many of those who voted for his party at the last general election. Only 30% of those who voted Lib Dem in 2010 now endorse the economic record of the government, according to the poll, and less than a quarter support spending cuts being undertaken at such speed.

Meanwhile, the latest poll from ComRes shows a very similar picture.

Here is a report that Cameron won't mention

"Baseline performance across hospitals was already high on many criteria relating to quality, leaving little room for improvement... Where scope for improvement existed, we found many examples of improved, and none of worsening, practice"

Yes, that quote above is talking about the NHS. It's from the British Medical Journal, and, unsurprisingly, most of the British press chose not to report it (although some US websites have picked up the story).

Whilst government ministers have spent the last year (ever since Andrew Lansley's rabbit-out-of-a-hat announcement on NHS reforms) doing their best to tell everyone who will listen how desperately terrible the NHS is, they forgot to mention a few things that independent reports have demonstrated:

• That it is one of the more efficient health care systems in the developed world.
• That health care quality and safety provided by the NHS is good and getting better.

NHS reforms: the wave of criticism grows ever larger

It is a striking that this government has so far escaped widespread criticism amongst the general public for attempting to implement a drastic and potentially disastrous NHS reform programme in England, having won absolutely no electoral mandate whatsoever to undertake such changes.

There was no hint, even prior to the election, about such reforms, something that even the Daily Mail isn't altogether happy about. From those working in health care, though, it's a different story.
Criticism from within the health professions, from patient groups and from health think tanks has been almost uniformly negative - the Health and Social Care Bill seen variously as ideologically driven, ill-timed and potentially vastly damaging to accountability.

GP groups have been joined by trade unions and even a Tory MP (and ex-GP) in expressing significant concerns that care standards may decline, fragmentation increase and that they pave the way for a privatisation of the National Health Service.

Here is just a tast of how widespread opposition to these reforms have spread, encompassing groups not associated with centre-left politics:
 
The Royal College of General Practitioners has said that "these reforms could cause irreparable and irreversible damage to the NHS." This view has been vindicated by a poll of GPs that showed barely more than a fifth of GPs viewed the reforms as likely to improve patient care.

The Chair of the BMA's GPs Committee has warned in strongly worded terms that the Bill is likely to damage the prospects of 'the poor, elderly, infirm and terminally ill'. Like so many other critics of the reforms, he goes on to warn about privatisation:
"We will quite quickly see failed consortia bought up on the cheap by foreign companies and see bits of the NHS run from abroad. This really is just the beginning. Parts of this government want to see all NHS management in private hands." The BMA itself has now threatened that a strike is not off the table if the government continues to dismiss doctors' concerns.

The respected health journal, The Lancet, has gone even further in its criticisms, calling these reforms "the end of the NHS as we know it". The equally renowned British Medical Journal has expressed similar concerns.

The Royal College of Surgeons, has warned that price-competition may lead to lower standards of care, in what they describe as a 'race to the bottom'.
The Royal College of Physicians, in a similar vein, has expressed concerns about service fragmentation and damaging competition based on price, not quality.

The Kings fund has warned not only of the possible damage the reforms cause, but also criticised justification deployed by Andrew Lansley - that health outcomes in the UK are noticeably worse than in other European countries as a result of its structure.

The Royal College of Midwives has attacked the timing and nature of the reforms:
'This is a bureaucratic exercise that is about reorganising and restructuring, not about the quality of care for women...maternity care could suffer as trusts struggle to make efficiency saving and as the NHS itself struggles to cope with this profound shift in its structure.'

Professor Colin Talbot, from Manchester Business School, has queried whether the glaring lack of public accountability for the proposed GP consortia will lead to inefficiency or even worse:
"Now I am sure most GPs are good and honest folk with only the best interests of their patients and the taxpayers at heart. But some might not be, and the temptation could be very great indeed to cream off a little of that £80bn, could it not? Especially as it could almost certainly be justified as providing better local care for patients"

The Nuffield Trust has criticised the apparent lack of accountability that the reforms might create:
"Governance arrangements for GP consortiums, with respect to the accountability to the enrolled population served, are weak and need to be developed [because] the government has chosen not to mandate public involvement in the governance of GP consortiums".

Dr Kailash Chand OBE, Chair of Tameside and Glossop NHS echoed fears of privatisation:
"At the heart of Lansley's agenda may be the complete privatisation of the NHS – a process that has deep roots in Thatcherite ideology. We may be witnessing the end of the NHS as a publicly provided, publicly financed body."

It is ironic in the extreme that David Cameron, forever arguing that the government should trust 'front line' professionals, seems deaf to criticisms from almost all parts of the medical profession.

New cuts to universities leads to 13% reduction in funding from April

Universities and colleges in England are to lose 13% of their funding immediately, following confirmation from the funding body HEFCE on 2 February.

Total funding for teaching and research will fall by £940 million in 2011/12, once changes to various funding streams are incorporated.

As usual, the government has massaged the figures somewhat to produce a headline figure (in this case 9.5%) that appears lower. In fact, once inflation is factored in, the sector is staring at immediate cuts in excess of 15%.

Total funding for capital projects will fall by huge amount - over 50% - whilst the science budget and research are also hit.

Tory cuts to end Britain's status as world's leading news provider

The Conservative Party, and its allies in the media, like to portray themselves as patriots. The truth is that for the modern political Right all considerations are subservient to a slavish commitment to the free market - the cultural heritage of a nation state included.

It is thus of little surprise that thanks to the heavy cuts imposed on the BBC and in particular its World Service (arising  from a large cut in its Foreign Office grant ), Britain is set to lose its position as the number one international news broadcaster to Voice of America.

The BBC World Service currently has a global audience of 188 million, accounting for a large slice of the 238 million worldwide audience of all of BBC Global News. Significant reductions in the former figure are likely arise from the closures of a number of foreign language stations (in Africa, the Caribbean and the Balkans) and cuts to some English services.

If any positives are to come from these cuts, they are that the Tories should lose the right to claim to be the most 'patriotic' of the main three political parties, and all the political advantages that brings.  Their legacy will now include surrendering possibly the last area in which Britain enjoys global dominance.