Look Left – “A mess… unnecessary… setting the NHS back”: Another attack on the health bill

Another day, another week, and another stinging rebuke over the health and social care bill - this time from a former Department of Health permanent secretary.


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• Another day, another week, and another stinging rebuke over the government’s health and social care bill – this time from a former Department of Health permanent secretary.

Lord Crisp, who is also a former NHS chief executive, told Radio 4’s World This Weekend today:

“I think it is a mess, is my straight forward view of it. I think it is unnecessary in many ways, and I think it misses the point.

“The point is that it should be setting out the direction of travel of the NHS, which is more community, more prevention based and it should identify the sort of mechanisms for using that which would obviously include some competition, some use of the private sector, but much greater emphasis I would have seen on integration and on planning and getting the balance right.

“I think it is confused and confusing and I think it is unfortunately setting the NHS back.”

This week, the bill returns to the Lords for key votes, with Ed Miliband calling on Lib Dem peers to “join with Labour to hole David Cameron’s health plans below the water line”, saying if they don’t, the “betrayal” will be “bigger than the row over university tuition fees”.

In a column in today’s Sunday Mirror, he writes:

“They will betray not only the people who rely on today’s NHS but also generations to come. It will strike at the heart of Britain’s proudest institution.

“The choice is not reform or no reform. But what kind of reform and whether it makes our NHS better or worse.

“Go to any hospital just now and you will hear the opposition from doctors and nurses about this bill, their worry about how much harder it will make their jobs. I think they’re right.

“Even members of his own cabinet are telling David Cameron to think again. He cannot just plough on. Labour will fight to stop him and finish off this bill.”

Adding of Mr Cameron:

“The reality is on his watch, the NHS is getting worse. The bad old days of long queues for some operations, longer waiting times in A&E and fewer nurses are coming back.

“The number of NHS nurses has now fallen by 3,500 since the general election. By the time of the next election there will be 6,000 fewer nurses. The billions spent on David Cameron’s unwanted reorganisation could save these jobs.

“His plans will distract staff who will have to cope with huge organisational change and they will put profits before patients and bring in creeping privatisation. That is why we are fighting against Cameron’s plans. Those plans can still be defeated.”

Earlier this week on Left Foot Forward, we revealed that even Tory voters don’t trust David Cameron and Andrew Lansley on the NHS, as Neil Foster of Progressive Polling blogged:

A new YouGov poll (pdf) commissioned by Progressive Polling and Unite illustrates the extent of the political fallout, with the prime minister facing a notable loss of trust. Downing Street advisors may have hoped David Cameron’s renewed support for the bill can make a difference to public support for the legislation. They are set to be disappointed.

On the issue of health reform a staggering six times as many people trust health professionals more than they do Mr Cameron and his health secretary.

When asked about the possible effects of the government’s NHS proposals, as Chart 1 (gif) shows, 60% of voters said they trusted the views of health professionals the most, 10% said David Cameron and Andrew Lansley, 16% said neither and 14% didn’t know.

What is quite remarkable is that even Conservative Party supporters say they trust NHS health professionals more than their leader and Mr Lansley on the health reforms, by 40% to 30%.

The findings show the PM’s decision to renew his support for the beleaguered bill is unlikely to help his government promote the legislation; instead, Mr Cameron’s association is already causing harm to his standing.

YouGov’s findings show voters feel David Cameron has not honoured his pre-election promises. Three times more people think he hasn’t delivered on his pre-election assurances over the NHS than those that do (59%-19%). The Labour Party has now opened up a 15-point lead over the Conservatives on health compared to eight points at the end of January (pdf).

And in another poll (pdf) this week, the monthly Guardian/ICM survey, Tory support was down four points on 36 per cent, with Labour up two to 37 per cent and the Lib Dems down two to 14 per cent, with the Tories’ standing on the NHS hit further.

As the Guardian reported:

There are signs that the Conservatives’ failure to persuade the public about its NHS reforms could contribute to a “retoxification” of the Tory brand.

Cameron – who once said his priorities could be summed up in the three letters “NHS” – initially invested a great deal of effort in overcoming the Conservatives’ historic difficulties on the terrain of health.

One year into his leadership, ICM found he had made progress – in October 2006 only 31% said they did not trust the Tories at all to run the health service, as against 32% who said the same of Labour. In the latest poll, however, 40% of respondents said they did not trust the Conservatives at all, against 25% who say the same about Labour [see Chart 1 (gif)].

Only a minority of voters trust either of the main parties “a lot” on the health service – 23% for Labour, and a mere 13% for the Conservatives. Labour is trusted “a little” by 46% of respondents, while 42% say the same of the Conservatives.

Also this week on Left Foot Forward, Ed Jacobs on how Welsh first minister Carwyn Jones has pledged to listen to NHS staff as David Cameron leaves them out in the cold; a report on how Mr Cameron got an “earful” from his choreographed ‘yes men’ health summit; a special report from David Taylor on how India is trying to build its own NHS; Welsh health minister Lesley Griffiths AM on the fight to save the NHS in Wales; and Jos Bell on the debate on the NHS Risk Register.

And tomorrow morning on Left Foot Forward, we’ll have a report on Scotland’s most senior civil servant, Sir Peter Houdson, attacking the health reforms as “enormously risky”.

• The controversy surrounding the government’s ‘workfare’ policy grew this week, with public unease increasing and more companies pulling out of the scheme.

On Left Foot Forward, the TUC’s Richard Exell looked at the question “when is it right and wrong to mandate labour”:

Workfare is wrong on four counts:

• It is unfair to unemployed people;

• It is unfair to employees;

• It doesn’t work;

• It is based on a mistaken understanding of unemployment.

Workfare is unfair to unemployed people because it makes them work in return for derisory wages. Working full-time in return for JSA of £67.50 a week (£53.45 if you’re under 25) can lead to pay rates under £2 an hour.

Even when an unemployed person is getting higher benefits (for children, partner, rent) it is very unlikely that the hourly rate will come near the minimum wage…

Four years ago the Department for Work and Pensions commissioned research into workfare in the USA, Canada and Australia, and found (pdf):

“There is little evidence that workfare increases the likelihood of finding work. It can even reduce employment chances by limiting the time available for job search and by failing to provide the skills and experience valued by employers.”


Is it always wrong to make work compulsory? Is work experience always a bad idea?

I don’t think so.

For one thing, the benefit rules that require unemployed people to be available for work go right back to the Lloyd George benefit system and have always had widespread support from trades unionists and the Left more generally. The case law that availability is “not a passive condition”, that there’s an obligation to try to get work, has also been widely accepted.

For another, positive work experience can help people get jobs if it is well-designed. Paul Gregg, who advised the last government on conditionality, draws a distinction (pdf) between two types of work experience programme.

On the one hand, there is the punitive approach exemplified by workfare, which he rejects.

But the other type is the “intermediate labour market” approach, which is aimed at long-term unemployed people and others with serious disadvantages, provide childcare and other necessary adjustments, include training and jobsearch support and ideally (crucially in my view) offer a wage rather than benefits…

The future jobs fund – in my view (pdf), the best employment programme for a generation (pdf) – embodied this approach. It was voluntary, it paid a wage rather than benefits and there were serious safeguards to stop it undermining the pay and conditions of other workers.

But would it have been unacceptable if it hadn’t been voluntary? Labour went into the last election with a promise to extend the FJF approach, but I doubt if it would have remained a voluntary programme and I think that would have been reasonable…

If we can achieve a programme that guarantees a job with a decent wage the same reciprocity says we should take it or lose the benefit. A job guarantee would be a huge advance; this is a responsibility we should demand.

The debate comes as more and more examples of corporate greed and undeserved bonuses emerge; as Left Foot Forward reported on Thursday:

A double dose of rewards for failure today: The failed bank RBS has given out so many bonuses that they went from profit to loss; and British Gas’ owner Centrica has announced profits of £2.4 billion despite – or perhaps because of – rocketing energy bills.

RBS announced that in 2011 it had made a pre-tax £766 million loss, and that it had given out a £785 million bonus pool. Yes, their bonus pool was bigger than the amount they lost.

Also this week on Left Foot Forward, Izzy Koksal on why Chris Grayling should respond to criticism of workfare, not smear critics; Alex Hern with the information you need to end workfare, and an explanation of how workfare is not voluntary; James Mills and Richard Darlington on the record NEETs numbers; and Amanda Ramsay on the need for job centres to undergo radical and urgent reform to bring down unemployment.

And tomorrow morning on Left Foot Forward, we’ll have an in depth look at ‘workfare youth’, revealing that despite the progress this week against workfare, the government has more in store for young people.

• Internationally, the world breathed a sigh of relief today at the news Nelson Mandela was back home following his weekend hospitalisation.

The Nobel Peace Prize winning former South African President was discharged from hospital after a diagnostic procedure for an abdominal problem, with Pretoria saying he was sent home after the checks “did not indicate anything seriously wrong”.

He had earlier undergone a laparoscopy – a procedure that involves inserting a tiny camera through the abdomen or pelvis – and was recovering well, defence minister Lindiwe Sisulu telling reporters he had been suffering from “ongoing discomfort” but was “as fine as can be at his age – and handsome”.

The BBC adds:

In 2004, he retired from public life – his age and declining health mean he has appeared in public only rarely since.

In January last year, he was treated in Johannesburg for a serious chest infection and his health remains a subject of huge public interest.

The BBC’s Karen Allen in Johannesburg says Mr Mandela is still considered by many South Africans to be the father of the nation.

Messages have been pouring in from well wishers hoping for a speedy recovery, says our correspondent.

As the Guardian reports, the mortality of Mabida is an ever-greater concern for South Africans:

The government has been at pains to provide timely reports on Mandela’s condition after the communications void surrounding his last hospitalisation prompted wild rumours about his health…

The government has not revealed where Mandela is being treated, although reporters were being kept at a distance from Pretoria’s 1 Military hospital, which is officially responsible for the health of sitting and former presidents.

Mandela last appeared in public before the football World Cup final in July 2010. Worries over his health intensified last year when he was hospitalised with an acute respiratory infection. He failed to attend, or even send a recorded message to, the centenary celebrations of the ANC last month.

Most South Africans recognise that the Nobel peace laureate, who spent 27 years in prison during the struggle against racial apartheid, may not live for much longer, even if they fear that day.

“We wish him well,” said a Soweto resident, Ronny Zondi. “But understanding his age, we’ve got to accept he might not be with us for long. We wish that God could keep him longer.”

Sentiments everyone will echo.

Progressives of the week:

Wycombe Wanderers FC, whose players wore special anti-homophobia t-shirts during the warm up ahead of their home League One game with Hartlepool United on Saturday, which they won 5-0. The display against prejudice followed the special Downing Street summit on Wednesday into how football tackles racism and homophobia.

As the Pink Paper reports, Wycombe have been leading the way in the battle against bigotry in the sport:

The players will warm-up in special t-shirts as part of the Football v Homophobia week of action which was organised by The Justin Campaign, set up in honour of Justin Fashanu – the world’s first openly gay footballer who committed suicide in 1998.

Wycombe were, of course, the first football club to sign the Government Charter for Action, tackling homophobia and transphobia in the sport.

Matt Bloomfield, the club’s representative for the Professional Footballers’ Association, signed the Charter on behalf of the Blues ahead of the clash with Charlton Athletic in October.

Bloomfield said: “It’s great to see the club are continuing their support in tackling all forms of discrimination in the game that we all love. Homophobia and transphobia have no place in society and everybody should be able to enjoy sport, regardless of who they are and where they’ve come from.”

A statement from the Justin Campaign read: “Whether we are the subject of the abuse or witness it, homophobia, prejudice and discrimination affect us all.”

It is to be hoped other, more high profile clubs, and all the home nations’ national teams, follow Wycombe’s lead and step up their efforts to pound prejudice into the ground.

Regressive of the week:

New columnist for the brand spanking new, super soaraway Sun on Sunday, Toby Young.

His column today was itself nothing too unexpected from the Toadmeister – essentially blaming immigration for the health service’s ills (with not a word said about the immigrants who keep the NHS alive; funny that) – but his Twitter ramblings last night, in which he described the Milly Dowler phone hacking scandal as “that murdered girl thing” and sought to rewrite history were, even for him, surprising, staggering and beyond the pale.

In case you missed it, here is Young’s exchange with Graham Linehan (@Glinner):

GL: “London’s village idiot, Toby Young, is taking a job at The Sun. A lucrative 3 or 4 months ahead of him! http://tinyurl.com/88turvt

TY: “@Glinner Never forgiven me for suggesting snooty movie wank-fest was form of snobbery, eh?”

TY: “@Glinner I’m pleased you’ve written a hit play. Well done. No more satisfying kind of success (see Act One). Much better than telly success”

TY: “@Glinner But don’t begrudge others’ success because you think it should be you and no one else rolling in money. That way madness lies”

GL: “@toadmeister a standard troll selling your mediocrity to a man who tried to cover up the hacking of a murdered girl’s phone. Begrudge you?”

GL: “@toadmeister and I don’t feel the need to to forgive you, because as soon as you did your piece on bad movie club, I exposed you as a liar”

GL: “@toadmeister so go away and start trolling and lying for the Sun. A marriage made in heaven”

GL: “@toadmeister oh,& what on earth makes you think you’re in a position to judge whether theatre success is better than telly success? So funny”

TY: “@Glinner That murdered girl thing? Check the Guardian story. turned out to be balls. Get off your high horse”

GL: “@toadmeister wow. Amazing take on the Milly Dowler story. I guess you tell yourself that so you can sleep? anyway, battery on phone is going”

GL: “@toadmeister …so I’ll say goodbye. If you would like your arse to be handed to you again, please do stay in touch”

Still, having taken the Murdoch Sun shilling, what else did we expect?

Evidence of the week:

Sustrans’s new briefing, “20mph: A snapshot of the evidence” (pdf), which revealed 70 per cent of British people want the speed limit reduced to 20mph in residential areas “to make them safer”.

Highlighting the benefits of a reduction to 20mph, the briefing notes:

There were 405 pedestrian and 111 cyclist deaths in Britain in 2010. Yet we know that reducing speeds saves lives. In fact a pedestrian struck at 20 mph has a 97% chance of survival whilst at 30 mph the figure is 80%, falling to 50% at 35 mph.

A recent British Medical Journal study showed that the introduction of 20mph zones was associated with 42% fewer road casualties. Younger children were the main beneficiaries in this reduction in causalities, and serious injuries and fatalities also dropped significantly.

Further pointing out:

• When 30km/h zones were introduced in Germany, car drivers changed gear 12% less often, braked 14% less often and required 12% less fuel. Research also showed that driving at a steady 30 kph reduces vehicle emissions as braking and accelerating between junctions and other obstacles decreases.

• Heavy traffic damages communities – and the speed of traffic plays a key role. A study from the Commission for Integrated Transport found that where cities have 20 mph speed limits covering between 65% and 85% of the street network, they are transformed “from being noisy, polluted places into vibrant, people-centred environments”.

• There are clear financial benefits to 20mph. In 2010, the estimated cost to the economy of collisions in Britain was around £15 billion. Conversely, area-wide 20mph limits are low cost and high benefit. For example, Portsmouth converted 1200 streets in the city to 20mph for a cost of just over half a million pounds whilst Transport for London (TfL) estimates that the 20mph London’s zones are already estimated to be saving the city more than £20 million every year by preventing crashes.

• Claims that 20mph is expensive to enforce are misleading. The police are required to enforce the speed limit whatever it is – this is no different with 20mph. A recent meeting with ACPO8 underlined their support for 20mph and highlighted the need for more resource to enforce speed limits on all roads and streets.

A reduction in the speed limit should also lead to an increase in the number of cyclists, the briefing adds:

High vehicle speeds are the greatest deterrent to walking and cycling. Reviews show that reducing speeds to 20 mph (30 km/h) encourages more people to walk and cycle. A 20 mph speed limit in built-up areas allows for the safe mixing of motorised and non-motorised modes of transport, and makes it easier for pedestrians and cyclists to enjoy the same direct and safe routes for their journeys as motorists.

As Sustrans’s Eleanor Besley wrote on Left Foot Forward:

The health benefits of cycling far outweigh the risks, but as the number of cyclists rise, so have the number of people killed and seriously injured. Instead of accepting this as an inevitable, we must make sure the approach from national and local government will give everyone the best possible chance of a safe journey.

This weekend on Left Foot Forward:


• Jos Bell on the debate on the NHS Risk Register – read it here.

• The Week Outside Westminster – read it here and sign up to receive it by email here.


• Carl Packman on how the next credit crisis will hit consumers, not banks – read it here.

• The World Outside Westminster – read it here and sign up to receive it by email here.

This week’s most read:

1. Rangers FC: How a market leader went bustStephen Henderson

2. Greece is a smokescreen to hide the mother of all bank bailoutsNick Dearden, Jubilee Debt Campaign

3. The information you need to end workfareAlex Hern

4. Chris Grayling should respond to criticism of workfare, not smear the criticsIzzy Koksal

5. Tory voters trust BMA and co. over Cameron and Lansley on the NHSNeil Foster, Progressive Polling

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