Sunday, February 04, 2007

At Last: Muslims can be Guilty of Hate Speech too

A change from prosecuting Christians:

"A Muslim man has been found guilty of stirring up racial hatred at a London protest against newspaper cartoons that depicted the prophet Mohammed.

Abdul Saleem, 31, from east London, was found guilty of using threatening, abusive and insulting behaviour at a 300-strong demonstration outside the Danish embassy in central London in February last year.


Crunch time for the NHS - will it pull through?

Reform of the health service is slowing just as it needs to intensify. If we don't accelerate now, billions of pounds will have been wasted, warns the top cancer consultant Karol Sikora

This month saw a blast of more bad news about our beloved health service. Too few nurses, too many doctors, no money, operations cancelled, another radiotherapy scandal, staff threatened with redundancy and entire hospitals going bust or being bailed out. Many must be wondering where all the taxpayers money that's been poured into the service has gone. After all, if you increased the budget of any commercial organisation from 34 to 84 billion pounds a year you would expect to see some dramatic improvements. But car parking is impossible, the loos still dirty and people sit around endlessly clutching pieces of paper when you can travel the world with an invisible electronic ticket.

I have worked in the NHS for 34 years, so it comes as no surprise. It's a large monopoly provider employing 1.4 million people that sometimes seems more responsive to staff needs than to those of its customers. Buffeted by the winds of political and social change, assaulted by a barrage of new expensive technologies, faced with consumers who are more demanding than their parents, it is now struggling for survival. And in 2008, current increases in NHS funding of 7 per cent a year dry up. So what is the solution?

It has to be reform. Not tinkering at the edges but pushing quickly forward with the bold plans already in place. Increased pluralism with new players providing innovative services will lead to real competition and a market driven approach. Novel ways of working will lead to greater efficiency, better motivation and allow staff to work together to drive innovation rather than whinge about the lack of it. The key is to get the multiplicity of professionals working together in the best way for patients. This will need to close but not intrusive management.

We have nothing to fear from further implementation of payment by results (PBR) - which simply means paying hospitals and GP's for what they actually do. It is exactly what happens in any other service industry. Imagine a supermarket that gets paid the same wad of money each week regardless of how much it sold. PBR changes patients from being service users to welcome customers. Consider high-street opticians. The old lady with her shopping trolley living alone on her state pension is as welcome as the girl about town in Prada and pearls who wants Gucci frames. Both come out seeing better. Can we not apply the same model to cancer and hearing aids?

The trouble is, as the think tank Reform recently pointed out, the whole process of change has slowed down just when it needs to accelerate. Waiting times in some areas have actually risen and novel rationing systems have emerged. There was an outcry from both left and right when a Department of Health report on workforce numbers was leaked. But these were probably only the back of an envelope of doodles by civil servants, rather than a serious assessment of demand, technology improvement, patient preference and skill mix.

The real issue is that by 2008 we should have moved from central to devolved planning. Local, not central, management should be deciding what staff to hire, what they should be doing, how many of what grade are needed and how much to pay them just as in high street shops. Real incentives for productivity, completely omitted in the recent, very costly, doctors' pay award, are vital in a pluralistic marketplace.

Stripping away bureaucracy to reduce costs is an essential component of therapy for the NHS. One report suggests that we are heading for a 7 billion deficit in the NHS by 2010 and that's not allowing for step changes in technology. That represents a 2p in the pound increase in income tax for everybody unless we can make things more efficient.

Major new investment capital is available from City institutions subject to robust business plans. The usual emotional statements of need or woolly wish lists simply won't do. Doctors hold the key. They can carry the other health professionals by providing decisive leadership. Getting good rapport between local medical leaders and managers is vital as is delivering services to patients in convenient settings rather than city-centre teaching hospitals, while retaining access to technological advances.

The NHS staff that I have known over many decades, have the talent, skills and education to make the transition. Whether it's dealing with a child with a complex leukaemia, a coach crash on the M25 or managing an elderly man with cardiac failure, we can do it as well as the best in the world. But only by intensifying the current reform programme will the NHS reform ever be got out of intensive care and sufficiently revived to make the long transition to a consumer-driven marketplace of health. Whatever our political persuasions, we must all surely agree that a speedy recovery is in everyone's interests.


Freedom should not be for sale

Liberty is far too precious to sacrifice in the name of tackling hoodies, ASBO kids and cranky Islamists

According to the British Social Attitudes Survey, 81 per cent of British people now think that having the authorities follow terror suspects, tap their phones and open their mail is ‘a price worth paying’. A similar proportion endorses electronic tagging of suspects, and extended detention without charge, while 71 per cent think compulsory identity cards for all adults will be ‘a price worth paying’. The survey paints a picture of a society that does not hold personal freedom to be all that important in the face of the terror threat.

The study’s authors write that there has been a decline in the ‘British public’s traditionally strong commitment to civil liberties’. But it is questionable whether this commitment has ever been especially strong in Britain, except in the context of particular political movements the like of which are conspicuous by their absence today. Certainly, freedom is part of the national narrative. From Magna Carta to the Glorious Revolution and latterly the fight against Nazi Germany and then communism, there is a powerful mythology around the notion that the good yeomen of England are jealous of their ‘ancient liberties’. The fact that, unlike most Europeans, we have traditionally had neither identity cards nor routinely armed police to inspect them, does suggest a certain ingrained respect for individual liberty.

But of course, these are the very things that are now changing, and the indecent haste with which this is happening – without dramatic social change – must call into question the depth of the putative British love of liberty. Rather than showing a shift in deeply held convictions, the survey perhaps shows the fickleness of received opinion today. Indeed, the survey authors dismiss the idea that the public’s weakened attachment to civil liberties is simply a response to the threat of terrorism since 9/11 – the change of attitude predates 2001. They suggest instead that changes in political rhetoric are responsible.

The proportion of Labour supporters opposed to identity cards fell from 45 per cent in 1990 to just 15 per cent in 2005, a period during which Labour developed increasingly authoritarian policies on crime and disorder. Whereas identity cards still seemed sinister at the end of the Cold War, they fit far more comfortably into today’s political rhetoric, which is all about practical fixes to whatever new threat to society happens to be exercising the headline writers, be it hoodies, illegal immigrants, or bona fide terrorists. There is no mention in the survey of anti-social behaviour orders (ASBOs) or other less glamorous threats to civil liberties, but these are surely as much part of the picture as is terrorism.

One of the study’s authors is Professor Conor Gearty, also the author of several books on human rights. He argues that, ‘It is as though society is in the process of forgetting why past generations thought those freedoms to be so very important.’ This is a familiar point, but there is a danger here, as often in this discussion, that civil liberties begin to be valued as a kind of heritage rather than as urgent political priorities in their own right. Past generations in Britain and elsewhere fought for freedom from overbearing state power when they wanted more control over their own lives, and saw that without civil liberties the authorities could simply ride roughshod over them. Freedom from arbitrary arrest and detention – like a free press, freedom of association and the right to strike – was a practical necessity, not an airy-fairy principle dreamt up by some long-haired human rights lawyer.

It still is a practical necessity if we want to control our own lives. It is not civil liberties that are unworldly, but the notion that we can do without them and stay a democracy. The fact that politicians are able to get away with presenting civil liberties as expendable is testament to the extent of popular disengagement from politics. Instead of the ‘us and them’ of political struggle, we have the much vaguer ‘them and them’ of the benevolent authorities versus those frightening and mysterious individuals who might be out to get us. This is very different even from the patriotic idea of uniting to fight a common enemy. The idea that sacrificing civil liberties is ‘a price worth paying’ expresses a desire just to let the authorities get on with it. What we are paying for is not security, but rather the illusion that everything is under control. We can ‘do our bit’ simply by cheerfully complying with bizarre rituals involving plastic bags as we queue at the airport. None of this has anything to do with hardheaded political realism; it is a product of political exhaustion.

It is telling that the survey also shows ‘overwhelming public support’ for euthanasia for the terminally ill, with 80 per cent agreeing that a doctor should end a life at that person’s request. Whatever the merits or otherwise of this position, it is clearly not motivated by libertarian sentiment, a belief in every individual’s inalienable right to self-determination even unto death. Rather, it perhaps expresses a diminished lust for life, a weary ambivalence about the whole business. The British public is not up for it, it seems.

Love of liberty has never been entrenched in the British ‘national character’, but it is an essential component in any political movement worth the name. There is no reason to believe that the British public is dead set against liberty; it just doesn’t see the point. If civil liberties are to survive, what is desperately needed is an injection of political imagination.


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