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The NHS “reforms” break an implicit election promise – and do not go nearly far enough


Cast your minds back to the days of the last election. All the talk was of cuts and the campaign was curiously short on optimism. Nick Clegg rocketed to popularity because of his outsider status and a rare ability to sound slightly hopeful about the odd issue. Cameron and Brown battled over grim details, tainted by all that had gone before. One of the few rays of hilarity to shine out of the darkness was the very British ridicule of one of our current Prime Minister’s key policies and publicity stunts.

I’m referring, of course, to Cameron’s notorious airbrushed poster campaign. The abnormally clean image of the old Etonian presented on billboards everywhere to the entire nation, took the Tory drive for renewal to the laughable extreme. Dave was not wealthy and out of touch, merely handsome and approachable. As funny as the image and tactics themselves were however, it’s the snappy quoted message alongside his shiny face coming back to haunt the Prime Minister now.

I certainly do not pretend to even partially comprehend the reforms to the NHS this Conservative led government is proposing. Indeed the lack of understanding from its own ministers seems to be a large part of the problem. And it’s no secret the Conservatives have long planned a shake-up, fuelled by the steadfast belief of their long serving top dog on health, Andrew Lansley. However whilst the faults and flaws of the plans that are becoming clear are extremely important, in terms of political capital and strategy for Number 10, they are in many ways besides the point when it comes to that infamous election promise.

“I’ll cut the deficit-not the NHS” translated for voters to “This is a new kind of Tory party that treasures the NHS above all else. We will not mess with it anyway.” Cameron will argue his promise did not say he wouldn’t change the NHS and that it needs modernisation for the better. But he knew the implication of his promise and the votes it would win him. His protestations about the benefits of his reforms will therefore mean little to those his promise swayed.

It’s also especially hollow given that the Prime Minister has since watered down and diluted that concrete pledge, which formed the symbolic heart of his campaign, again and again and again. First it became merely a safeguard for frontline services and then promised improvements, like an increase in the number of midwives, were scaled back and ultimately scrapped altogether, with even plans to maintain current numbers reversed. Fears about privatisation which the reasonable man might have attributed to overzealous, sensational leftist press, are now emerging to have hard evidence behind them. 50,000 jobs are set to be cut. How exactly is this not cutting the NHS?

If the workers within the system themselves were in favour Cameron would have a much stronger argument. But countless GPs have written to newspapers, as well as other types of professional, warning against the changes as unnecessary and damaging. The Prime Minister continually insists that locals have the right to opt in our out, but what are those that oppose and don’t sign up to the scheme meant to do? Even in my quiet rural area GPs feel overworked and many local people distrust the vested interests of certain doctors. Is handing over the biggest budget in the country to them really a good idea and what people want? It’s doubtful if the new system will even be able to produce what the public need.

Another argument constantly wheeled out by the Tories is the pressing need for modernisation and reform, which make it necessary. There is nothing necessary about these plans though. Whilst the health service has its flaws, the current system leads to a mostly positive service. There are undoubted challenges in health care such as an ageing population and emerging drugs, which often seem insurmountable. Government proposals do not do enough to ease the burden and according to many that know, they actually complicate the fight. For a leadership so keen on cutting the deficit, you would think that such costly, ideological plans could wait for better times.

 It would also do more good in the long run, and reduce the deficit substantially, to work out some realistic spending priorities centrally. Vital areas and treatments need to be protected nationally and things the NHS can’t afford to provide should be phased out. The private sector does have a role but it should grow independently of the NHS and take up the slack for treatments it shouldn’t be wasting resources on. Taxes and other initiatives should encourage healthier living. Devolving decisions to GPs is no magic pill, no silver bullet and it doesn’t even equip the NHS for the critical, worsening challenges it will face in the future. It would be a far more sensible decision for the government to begin a nationwide debate about what we expect, want and need from our NHS now. It would fit with the “new politics” of plural cooperation and potentially produce actual solutions.

Perhaps the main reason the government looks less likely to bow to pressure from the public on this issue is the Prime Minister’s ego and pride. He’s been happy to recognise the weaknesses of coalition and concede on issues like the forests and sport in schools. But the NHS plans are too inextricably linked to Cameron’s personal brainchild; the Big Society. Its philosophy of localism and choice in the community over centralised solutions marries nicely with Lansley’s ideas for health. The health reforms open the way for the sort of community cohesion and interaction, fuelled by voluntary, charity involvement, that Cameron wants to see. He genuinely believes it’s the path to a social recovery for Britain that’s sustainable and empowers government to do what it does best, as well as liberating people from the state. He’ll continue to be blind to all the irreversible wounds the “reforms” will inflict on the NHS itself and his popularity with the people as long as it remains tied to his vision. His recent attempt to re-launch the initiative demonstrates his huge commitment; it cannot afford to fail.

The real shame for the country and even the Conservative party, is that Cameron’s election pledge could have been a clever way of dumping a responsibility and challenge for maximum political gain. His implicit promise of not touching the NHS meant it could have been left as it was, a gargantuan issue for a future administration to tackle, ticking over just fine for the time being. There are after all, enough problems for the coalition to face. If this government had done mostly nothing on health, the public would have thanked them for it, the Conservatives especially. But Cameron is so determined to be radical and appear to be so, that he will press on, regardless of the consequences. It may prove to be the well meaning project that took his remodelling of the state too far.

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Pray the Devil Back to Hell


Sitting in a luxurious hotel lobby in Spain last week I came across an article by the actor Hugh Bonneville in The Times which was part of their Christmas appeal. It was about Liberia and in particular a young mum, who claimed she was 21 but was in fact 17. She was having her third child. Even if it survived birth it would struggle to make it out of childhood, such are the overwhelming health risks for children in Africa. I wish I could quote the striking figures about infant mortality in the article but they are tied up behind Murdoch’s News International online paywall, although that is another matter entirely. The unsettling truth is that I would not have lingered over the article had I not known I would be writing a review on a documentary about Liberia’s turbulent recent political history on my return to British soil. I was holidaying in a country with 20% unemployment and an expanding prostitution industry, and the depressing fact is that we are all guilty of choosing to focus on these more manageable economic and moral woes of developed nations, than look with unblinking eyes at the seemingly insurmountable challenge of Africa. We need documentaries like Pray The Devil Back To Hell to jolt us out of our ignorance and indifference now and again and spark good souls into action.

Having said this, badly made documentaries can also turn an audience away from an issue, so it was an enormously important and difficult task that directors Abigail E. Disney and Gini Reticker took on. They were trying to summarise a long and bitter struggle and in particular distil the bravery and brilliance of ordinary women that formed a peace initiative that restored calm to their country. Liberia had once been envied as one of the few independent African republics, but just like other nations on the continent it encountered its terrible problems when the dream of a nation founded by free slaves on equality went sour over generations, leading to a sporadic civil war raging from 1989 to 2003. The conflict reached new and devastating heights at the beginning of the 21st century, so events remain chillingly fresh in the minds of those involved and are surely too close to be dismissed as mere history. Given the harrowing plight Liberians still face today according to The Times appeal, it’s clear this documentary had the potential to convince viewers why Liberia was as deserving of sympathy and aid as other better known African nations in crisis and poverty.

This is the story of an unlikely coalition of brilliant women, and given their brilliance the filmmakers are wise to let the women tell the story in their own words. From the beginning we are guided by the words of the charismatic leading light of the movement, and from then on the documentary is a painstaking fusion of moving interviews and dramatic archive footage. Initially the speakers set the scene of everyday life, then emotional interviews detail the atrocities carried out, both by the rebels supposedly fighting for democracy and the government forces commanded by President Charles Taylor, elected on the back of a campaign of fear. Having thus captivated the audience the film plunges into the remarkable story of the women that set out angrily to put a stop to the bloodshed in their villages of their friends and relatives. This story speaks for itself and is a tale of the power of peaceful protest that we in cynical developed nations may not think possible in the modern age.

Originating as a Christian movement the women’s plan for peace soon spread into the Muslim community and these two often divided groups of mothers proceeded to present a formidable and determined united front. Indeed the film is certainly a convincing advocate for the continuing good of religion in the modern world when its message is simplified to easily understandable, universal goods, namely peace in this case. Wisely the directors do not ram religion down the throat of the audience however; it is a key factor behind events but comes second to the sheer humanity of the story.

What’s especially extraordinary is that not only do the women force peace talks with their organised action, but they maintain the momentum to ensure the implementation of genuine democracy for their country, even after the ceasefire, to keep the widespread violence from making a comeback. As the momentum of the campaign builds so does that of the film and it’s easy to get swept up in the struggle. This is a story full of big and shocking ideas and issues but one with an ultimately idealistic message. There are rapes, murders and corruption, religion, race and reminders that our interconnected modern world means those in developed countries cannot afford to sit back and let the suffering play out (extracts from articles show that President Taylor had links to Al-Qaeda and other threats). In the end though the very real and authentic rhythms of African rhetoric, chanted by peaceful protestors clothed in harmless white, won the day. People power and perhaps as the Spice Girls said, girl power, conquers in a world where the odds are stacked against it. There is certainly something irresistibly inspiring about it all.

Despite the seriousness of the subject matter some atmospheric opening titles with colourful African images and music, along with a concise running time of 72 minutes and the powerful likeability of the women, avert a gloomy lecture of a film. In any case the drama of the story itself would make it hard to make a boring film about such stirring events. Even with the ongoing challenges suggested by the article that I read this story has a happy ending that makes it possible for help to reach those who need it most in Liberia. One would certainly hope that now heartfelt donations go directly towards the care of children and young mothers like those I mentioned at the beginning, rather than into the pockets of corrupt officials or towards the production of weapons. Watch this film over the festive season to see how deserving many Liberians are of our gifts and goodwill. Watch it to spare a moment for those less fortunate than ourselves. Watch it to be gripped by something real, not a contrived and fake blockbuster but a story with actual characters that personify a selfless Christmas spirit.