The PIP debacle exposes the folly of outsourcing key NHS services

The intransigence of a number of leading cosmetic surgery firms to Government requests for them to provide greater support for women who received breast implants from Poly Implant Prostheses (PIP) has led Andrew Lansley to criticise them on a number of levels, from providing poor data on the number of women that have undergone a procedure and for "not stepping up to their responsibilities at all" by failing in many cases to offer to replace or remove implants.

It is a combination of the clear powerlessness of the Health Secretary and the disregard for any moral duty on the part of a number of the private firms involved that demonstrates a key problem with fragmented and privatised health care.

And yet the government's Health and Social Care Bill, which will increase this fragmentation and privatisation, rolls on. The news that leading management firms are being rewarded for teaching GPs business knowledge that is already available in the soon to be dismantled Primary Care Trusts (a development criticised by the BMA's GPs committee) demonstrates the determination of Cameron and Lansley to force a restructuring through regardless of cost and without evidence that it will improve much beyond the balance sheets of a number of private companies. 

And as if to back up this view, the plans for the privatisation of the NHS compensation - a move that the chair of the consultants committee at the BMA argued would 'mimic the worst aspects of US healthcare' - referenced the Confederation of British Industry as identifying the authority as a "potential opportunity". It seems that for the modern Conservative Party, their key interest in the NHS is how much money its constituent parts can make for private corporations.

It even appears that the Government is reluctant to commit to the recommendations on the pro-reform task force that it set up, the NHS Future Forum. Chris Ham, Chief Executive of the Kings Find has commented that "there were very few, specific credible commitments on the department's part to actually do anything in making a reality of what the Future Forum has said", explicitly citing the need to include in the NHS constitution a commitment that patients who require joined up and integrated care from different parts of the system get the services they need.

It is instructive that one of the latest recommendations from the Future Forum is that the Government should address confusion around 'choice' and 'competition' in Lansley's Bill, stating that "Monitor and the NHS Commissioning Board should urgently support commissioners and providers to understand how competition, choice and integration can work together to improve services for patients and communities". 

It seems that in its haste to plow on with outsourcing as much as the NHS as possible, the government is willing to risk the creation of a fragmented, confused system that may be significantly more bureaucratic than the existing one.

Labour should concentrate on doing its job, not writing the 2015 budget

Let's face it, the last few hours aren't great if you are on the left or centre-left of British politics. A curious interview between Ed Balls - an intelligent MP with a good understanding of economics - with the Guardian has turned into a PR headache.

The aim, no doubt to some in Labour high command, was to try to counter the relatively disappointing poll position that Labour finds itself in with regards to questions of economic competence by convincing Balls - a proponent of Keynesian economics - to nuance his rhetoric with some soundbites on the economy designed to please the right-wing press.

Balls now appears to have backtracked on the interview somewhat. But there are three problems with the interview 24 hours earlier:

First, there is no point trying to write the 2015 budget in opposition, 3 years before the election. None. Yes, voters want to see what you believe in, but most aren't listening at this stage and, if they are, want to hear your response to current problems, not those of 3 years time.

Second, Ed Balls was right in his approach over the last 18 months. His assertions - and those of like-minded economists like Paul Krugman and David Blanchflower - that cutting deeply during a recession in the private sector would damage economic growth have come to pass. The downgrading of austerity-mad EU countries across the EU for pursuing deficit-cutting mania has served to justify this position. Confusing the message that he Balls been giving on these issues doesn't help.

Third, the right-wing press can't be won over. Never. And neither is there a future left in triangulation, in out-flanking the Tories on the right, despite what the likes of John Rentoul and Dan Hodges might argue. It's a route to electoral oblivion.

The real battle - opposing the attack on social democracy

What Labour should be doing is trying to defend some the cornerstones of British social democracy that are under attack in the name of 'defecit reduction'. The horrendous assault on the National Health Service is one. The government's Health and Social Care Bill will turn one of the fairest - and most efficient - health systems into a fragmented, bureaucratic, privatised mess that will emulate some of the worst aspects of the near-bankrupt US system.

MPs like Andy Burnham know this. Forging alliances with like-minded people and parties across the political spectrum to defend the NHS is crucial - and is popular.

Yes, many aspects of the polls at the moment don't look good for Labour. But it's worth bearing in mind that the last election was in 2010, which itself ended 13 years of Labour rule. Panic-driven interviews, hopelessly misguided press releases and confusing messages won't change it. Sticking to a principled, but realistic will.

Ken's new anti-Boris ad

The Livingstone team released their new ad backing up their 'Fare Deal' campaign. It is - rather like the recent video ad - effective and succinct. Unusual for a political advert... 

50% top rate of tax 'brings in hundreds of millions of pounds'

The Telegraph today covers a potentially politically awkward problem for Osborne and the endless numbers of right-wing commentators that are wedded to the Laffer curve: the forthcoming HMRC report on the revenues generated by the 50% top rate of tax appears to conclude that the tax rise generated far more revenue than many on the right argued would be the case.

Perhaps its about time that some of those commentators came clean and admitted that not even they believe their own propaganda on the 'wealth destroying' impact of higher taxation on richer members of society.

The modern right don't want to see work pay: they just say they do

One of the central planks of modern conservative thought is that taxes should be lower to make work pay. The government should get out the way and let people be rewarded for hard work.

However, this is also one of its biggest lies. Because, to a huge extent, hard work in the UK does not pay. Wealth is increasingly being horded; house price increases earned thousands of families more over the past few decades than their day jobs ever did and, crucially, success is increasingly determined by the family into which a child is born, not the decisions that they take afterwards.

Social mobility - low and getting worse

One of the key problems with the UK is its lack of social mobility. A number of academic studies have highlighted the problem and its scale.

In 2005, the LSE produced a detailed study that compared the income in adult life on sons born into families from different income groups. It found that there was a closer correlation between the income in adult life of a son and his parents' income in the UK than in all of the other countries they studied, bar the USA. Nordic countries, for example, had a weaker correlation.

http://cep.lse.ac.uk/about/news/IntergenerationalMobility.pdf

In essence this means that the son of rich parents in the UK is more likely to grow up to be rich, whilst the son of poor parents will be more likely to remain poor. Ironically this is little different from the US, despite the latter's myth of the 'American dream'.  Worse still, the study showed that in the UK mobility appears to be declining, not improving.

Fig 2: Report from Panel on Fair Access to the Professions

Meanwhile, in 2009, a report from the Panel on Fair Access to the Professions demonstrated the dominance of the upper echelons of many high status professions by public and private school educated people. In other words, the richest families are able to pay for the success of their children; buying them the success that they frequently attribute solely to themselves.

Unpaid Internships: the biggest barrier

The reasons for the strong link between the financial and professional success of the children of the wealthy are numerous - among them access to private education or well-regarded state schools, family networks and the relative stability of their families. However, one of the most powerful symbols of the ability of the wealthy to conserve and consolidate their position in society is one that is getting progressively worse - the unpaid internship.

Unpaid internships, particularly those that are full-time and long-term, have a pernicious impact on mobility. Whether they are in the industries  where these practices are more established (art galleries, the media, the music industry) or those where the problem is growing (for example in the charity and corporate sectors), the unpaid internship presents an almost impossible barrier for those without parental support to rely on.

Sure, a young person working 9-5, five days per week unpaid in central London may be able to find an evening or weekend job to earn some money, but will it pay London's increasingly extortionate rents? Of course not. And will it impact on their ability to do their day 'job' properly? Naturally.

So, what will tend to  happen is that the daughter or son of an ordinary family may be able to undertake such a position for a few weeks, perhaps slightly longer, but they will eventually need to drop out. Left in place are those with access to independent wealth - the proverbial bank of mum and dad. Hence those industries with established reputations for unpaid jobs end up being staffed by a suspiciously large number of people with double-barrelled names and plummy accents... plenty of Tarquins and not many Traceys.

The stories of those who have undertaken such schemes are numerous - and let's not even get into the scandal of charities and companies auctioning off unpaid intern positions for money. A number of sectors - not least the charity sector - argue that paying their staff is too expensive to countenance. A few, Oxfam included, are fiddling at the margins, arguing that 3 or 4 day per week positions are affordable for ordinary young people, ignoring the reality of the cost of living, particularly in the south east of England.

Meanwhile, the campaign against the practice of employing unpaid interns is growing - from Interns Anonymous, to Graduate Fog to Intern Aware. At the same time, however, the forces defending hese practices are powerful. It's not surprising that a Conservative MP is amongst those dismissing concerns of those that argue that work should be paid. It's never ceases to surprise that many will talk about meritocracy and the value of hard work, but will happily kick the ladder away when it suits.

Rewarding hard work: the myth created by the modern right

It is in their ambivalence towards unpaid internships that the true ideology of modern Conservatism rears its head. For despite the favourite myth the modern right likes to peddle - that it seeks to reduce the roll of government and lower taxation all to allow those that work hard to be rewarded accordingly - the truth is that all the modern Tory Party is really concerned about is ensuring the wealthy protect their position.

Hence, given a choice, income tax is judged 'fairer' than inheritance tax, even though inherited wealth is totally unearned. Witness too their visceral hatred of any attempt to increase taxes on property or assets. Finally, judge them by their attitude towards maintaining the charitable status of private schools: a surefire method by which those with the most income ensure that their children don't have to fight on a level playing field.

It is the latter that the Tory Party would never wish to see - a level playing field. But without one, the lie that those that those that do best in life are those that work hardest is laid bare. And the central plank of right-wing economic policies collapse beneath it.

Is the Standard going back to its old ways?

The Standard, whilst not quite back to the pretty shamefully one-sided coverage that it demonstrated during the run up to the 2008 mayoral elections (under its previous ownership), appears not to be able to kick the habit of acting as an unofficial cheerleader for Boris.

For those who need a reminder why the current owners of the newspaper deployed the 'Sorry' adverts across the underground in 2009 (and it wasn't only because of the embarrassment of having employed Andrew Gilligan for all that time), then this litany of embarrassingly one-sided articles (riddled with insinuations about how much he appears to love jonny foreigner) should provide a clue:

"Livingstone Backs Terrorist on the Tube's Job"
"London Need Fruit Trees Just Like Delhi, says Ken"
"My 10am tots are medicinal, says whisky-swilling Ken Livingstone"
"Islamic leaders back Livingstone re-election bid"

As one regular contributor to the Standard said at the time: "Readers outside the M25 may not be aware of the huge onslaught raining down on the mayor and his agencies from Northcliffe House".

Have things improved? Somewhat, but not hugely. Sure, the relentless stories designed to benefit the Tory Mayor have tailed off a little, and there is a bit more balance in their coverage. However, their selectivity demonstrates their political sympathies. Witness, for example the almost negligable coverage the paper gave to a Comres voting intention poll in March 2011 that showed Ken ahead of Boris, compared to the prominence it gave to polls from the same firm that showed Boris ahead in September 2010 and then later in November 2011.

This may be a very close race, and the Standard will, once again, play a role in its outcome. On the evidence so far of the Standard's election coverage, staff at Boris HQ can be forgiven for feeling rather pleased.

UPDATE
For those of you that still have the patience to follow some of Andrew Gilligan 'journalism' will note he certainly hasn't changed his tune... but in all honesty even regular Telegraph readers (judging from their comments section, hardly the most well-adjusted people themselves) must have tired of his obsessively regular articles on Livingstone.

In 2012 commuters are being given a false choice

Given a choice between short-term cuts in transport fares or longer term investment in networks, which do people prefer?

Polling in 2010, by YouGov, and in 2011, by ComRes, suggest it is very much the former. On this basis, Ken Livingstone's new campaign against the large rises in transport fares announced by Mayor Johnson, may have more weight than many in the media have appreciated. 

What is the real shame is that national Government policy forces this choice. Many other EU countries use greater taxpayer subsidies for transport systems. By subsidising transport through taxation, the burden of cost is spread more widely - this also avoids the false choice that is being presented in the London mayoral election of 2012. 

However, in order to accept this, political leaders have to be in a position to justify why those that don't commute every day by train, tube, tram or bus should subsidise those that do. Well, here are three arguments:

The first is an economic argument. Developing transport infrastructure provides benefits for the country as a whole, encouraging business investment. This works on numerous levels, from businesses in catering, hospitality and retail industries that rely on large numbers of lower-paid workers taking buses to work, to major multinationals based in the centres of large cities that can only function correctly with modern mass transit networks.

The second could be termed a 'knock-on effect' argument. Even regular drivers stand to benefit from better public transport, quite simply because where train or tube services are worse, more people turn to their cars. The net effect of poor public transport - as many in cities across America or Asia can testify - is more gridlock on the roads.

The third argument could be described as the safety net argument. By investing in sustainable mass transit, even those reliant on cars have the opportunity, should they need it, to use alternative forms of transport. So a driver who is unable to drive for whatever reason, or who has a change in personal or work circumstances, or even just needs to get to an airport to go on holiday, has the safety net of a viable alternative if they require it.

With Osborne in the treasury and Cameron at Number 10, these arguments aren't likely to be heard forcefully in the corridors of power for some time. But, as the roads become ever more gridlocked, the case for investing properly in transport will become ever more persuasive.