Britology Watch: Deconstructing \’British Values\’

31 March 2009

Britain: The Self-Undermining Nation-State

Britain: the English Empire

While other countries formed nation-states, the English built an Empire. If all we English had been bothered about back then in the 18th and 19th centuries had been nation building, then I’ve no doubt we’d have had a unitary Nation of Britain long since: our little island fortress, with our sights and ambitions set merely on looking to our own affairs and keeping our European neighbours out of them.

But that sort of thing was for them, not us. So many of the European nations that emerged from smaller and larger entities alike during the 18th and particularly 19th centuries were landlocked or hemmed in by bigger powers. Not so we English. The open seas stretched out before us, and after we’d seen off first the Spanish Armada and then Napoleon’s navy, we ruled the waves as far as the Americas, Africa, India and Australia.

I’m not justifying all that our world-conquering ancestors did back then in a different world; but let’s not pretend either that our European rivals would not have done the same given half the chance. Indeed, the fact that they had to break out of a land lock helps to explain why the mid-20th-century Germans needed to fight for European domination first as stage one of their plan to rule the world.

The English Empire – what an achievement! Totally un-PC, of course, to speak in such terms – but our modern globalised world and, indeed, our multi-cultural Britain would simply not exist had our mercenary and missionary forebears not sailed off to drag half the world into the modern era. Un-PC, perhaps above all, to dub it the English Empire, not British. But it was the English that were the driving force and the power behind the imperial throne – albeit that many Scots, too, were happy to seize the opportunities for wealth, power and self-advancement that the Empire afforded them, for good or ill.

Should we English be proud of the Empire? To say simply ‘no’ is to conspire with the Britologists that would have everything that is great about ‘this country’ reflect back on ‘Britain’ and lay the blame for all that is bad on England and the English. For them, the English are essentially individualistic, aggressive, even violent; hostile and arrogantly contemptuous towards other cultures, which we supposedly blithely trampled over in the Empire; conservative, narrow-minded and insular. Yet in almost the same breath, they’d have us believe that the Empire in its British essence (as opposed to the ‘English’ aggression and opportunism that drove it) embodied the values that are still true, relevant and British for us today: tolerance, liberty, democracy, fairness and the rule of law. Values, in fact, which – according to Gordon Brown – could and should define a contemporary British ‘Nation’.

Well, I say ‘no’ to that British version of our history: that all-too simplistic dividing of the past into the English ‘black’ and the British ‘white’. You don’t get ‘greatness’ without it containing a little ‘grey’. The Roman Empire was great; its civilisation and technology were prodigies of its time; its law, literature and language, and later its conversion to Christianity, left an enduring legacy throughout Europe and the whole of Christendom. And yet, Rome was built on the back of military conquest, slavery and dictatorship. In the same way, our Empire spread English civilisation, industry, law, language, democracy and Christian faith throughout the world. And yes, it did so on the back of military conquest, slavery and imperial – though not dictatorial – rule. You can’t have one without the other; be proud of one without the other; have your British Empire without your England. You can’t say the ‘good’ values were and are all British but the ‘bad’ actions were all those of the English – because it was the actions and beliefs of the English that created the world in which those values stand today as our enduring legacy: our English legacy. And of that I am truly proud.

Others created nations; we English created the modern world. But as we rightly and democratically surrendered our imperial dominions to their own people, and as other global powers entered the stage, our horizons narrowed to our British island. Without the rationale of overwhelming mutual interest, and without the common enterprise of Empire, the marriage of convenience between England and Scotland that forms the bedrock of the United Kingdom finally looks set to be breaking down. Those who still cherish the ideal image of ‘Britain’s’ imperial greatness – conveniently forgetting the hard realities of domination and exploitation that were an integral part of that story, or ascribing them to England – now seek to build that Britain into a nation; rather than let it slide inexorably into the history books – the books telling the history of England, that is.

Britain never was, still is not and pray God never will be a ‘nation’ in its own right. For some of the Britologists, this is what it should have been from the beginning: from the time of the Acts of Union between England and Scotland in 1707. If this had happened – say, for instance, if Nelson had been defeated at Trafalgar and our energies had subsequently been turned in on ourselves instead of Empire – Britain would now be a European nation-state comparable to those of a similar scale, such as Germany and Italy, that were put together from a collection of kingdoms and principalities during the 19th century. This is how Brown and his ilk would like Britain to be today, fearful that a break-up of Britain into its constituent nations would diminish ‘this country’s’ standing among its European neighbours and weaken its ability to defend its interests within Europe and the international community – albeit peacefully in the present era, thank God.

Of course, logically, such a break-up would by definition diminish this country’s standing if ‘this country’ is defined as Britain: Britain – as a would-be nation-state – simply would be no more. But this would not lessen England’s standing. On the contrary, England would re-emerge from Britain’s shadows as the great nation it always has been, both before and through the period of Union with Scotland: comparable but superior in its past achievements to those other empire-building nations and former rivals France and Spain. England did not need to build a nation of Britain. It already was a great nation at the time of the Union, and the uncomfortable truth is that, from day one, ‘Great Britain’ was more the name of England’s Empire than that of a nation subsuming England. The Union with Scotland was in reality more of an annexation of Scotland – followed one century later by Ireland – into the English Empire, which was already beginning to expand across the globe by the beginning of the 18th century.

In fact, one way of thinking about it would be to say that ‘Britain’ itself was England’s ‘home Empire’ (hence, ‘Great Britain’) as opposed to the Empire ‘abroad’. Scotland and Ireland would then be described as having been originally English colonies, subsequently absorbed into the same political state as England: union within a common state (the English state, renamed ‘Britain’ / the UK to reflect its enlarged geographical extent) but not a common nation. Commonwealth of nations, not British Nation. Unlike a power such as France, whose colonies were all assimilated into France itself, each of the ‘British nations’ (both the other nations of the British Isles and those of the broader Empire) retained or developed distinct identities as nations: distinct from England, that is.

British ‘nationhood’: nothing if not England

So the ‘British’ designation of the other British nations in fact signifies their difference from England – in the past and in the present – as well as England’s enduring difference from Britain. At the same time, however, the British nations’ Britishness mediates a continuing union with England – politically, culturally, socially: a state (in both senses) that can persist so long as England, too, continues to see and describe itself as British. England is the central point of reference and underlying national identity of Britain. This latter term also denotes the commonality and ‘sameness’ of Britain, as well as the place of the ‘properly British’: where Britain is thought of as present to itself and in possession of itself, providing a centre of original and authentic Britishness that can be imagined as remaining present through its dispersion across multiple different British nations. But, because it serves this purpose, England cannot define itself as distinct from Britain; it cannot set itself apart from Britain, and / or see itself as superior to the ‘other’ British nations, because this would mean that it was not ‘one’ with – an equal partner to and the means for the unity of – the other nations: the guarantor and foundation of a common Britishness.

These mutually dependent pulls of shared identity / union and continuing difference help to explain why it is over against a distinct, ‘superior’ England that the ‘British nations’ both define their own difference and assert a shared Britishness: a Britishness shared with England, that is, but which is predicated on the suppression of an England that is itself distinct from Britain, since England has to serve as the place (literally) of a continuing Britain and ‘proper’ Britishness that those other nations can then both share and differentiate themselves from.

‘We are Scottish and British but not English’. This is still a view, I think, held by the majority of Scots. But it’s ironically connected with another common Scottish perception, which is that English people simply see themselves as ‘British’; that when they refer to England, they tend to mean Britain – and when they say Britain, they generally mean England. (For the moment, forget about the whole British government thing of saying ‘Britain’ rather than ‘England’ even when England is meant; I’m talking about the traditional Scottish assumptions, which are of course related to present British-government practice.) This is ironic because it exemplifies the conflicting pulls and ties of shared identity and difference with and from England that are mediated through ‘Britain’: Scotland is ‘one’ with England but only through Britain; but then again, an identification of England with Britain is asserted (which is what would in fact make that Union with England through Britain truly a union) but is itself framed as an ‘error’, and as the expression of ‘English’ arrogance, imperialism and will to dominate. So, through and as ‘Britain’, England is seen as both one with Scotland and different from it: an identification of England with Britain (and hence, a fundamental union between Scotland and England) is at once asserted and denied. Or putting it another way: Scotland sees itself as both ‘a part of’ Britain and ‘apart from England’ – but only if England and Britain are seen as both the same as each other and different from one another.

I think the same line of reasoning could be applied to the relationship between England and Wales; perhaps more so given the two countries’ much longer and deeper ties of shared and differentiated nationhood within ‘Britain’, which arguably go back to Roman times (or even earlier), when the actual colony of Britannia comprised roughly the territory of England and Wales today. The relationships are more complicated and painful in Northern Ireland. Here, I think the pulls are not so much between Ireland and England within Britain – on the analogy with Scotland and Wales – but between Ireland and Britain ‘as a whole’; although this structure still depends on England providing the ground and basis on which Britain can be viewed as a proper nation, as opposed to a collection of three or four nations. And hence, alongside the Union Jack, the Northern Irish Loyalists fly a flag that is essentially the Cross of St. George with the red hand of Ulster in the centre: as if to say that Ulster’s British centre is England.

So, in order for the other nations of Britain to be seen as nations that are distinct from England, on the one hand, and which are still fundamentally and authentically united with – one with – England in the Union, England itself has to be seen as (and see itself as) one with – identified with – Britain. This provides a core and foundation of ‘proper’ Britishness (British national identity) that the other British nations can then both share and ‘own’ (rather than having to share and own Englishness) at the same time as they can differentiate themselves from and within that Britishness insofar as it is also seen as a self-attributed (and self-defining) ‘property’ and national characteristic of England.

The denial of a distinct England (and England’s self-abnegation) is in this way the precondition for a ‘proper’ British nation to exist: England must be Britain for Britain to be – and for the other nations to be semi-detached parts of Britain not annexes of England. I have to say that I think it is this fundamental structure that allows a phrase such as ‘a Britain of nations and regions’ to make any sense at all. Analysed from a purely logical perspective, this is a complete non-sequitur if you presuppose a logical hierarchy whereby regions are smaller dependent subsets of nations. If Scotland and Wales are the ‘nations’ here, and the ‘regions’ are the sub-national territories formerly known as England, what does that make Britain? A nation or a ‘supra-nation’? Well, yes, perhaps the latter – another word for ‘supra-nation’ being ’empire’, which is what – in my contention – Britain always was: the core of England’s Empire. Or alternatively, if Britain is a / the nation in this phrase, then shouldn’t Scotland and Wales be described rather as regions on the same basis as the [formerly] English regions? Yes, of course they should. But the structure isn’t logical in this way, or rather it obeys a different logic: it is the identification of England with Britain that enables the ‘other’ nations of Britain to affirm a distinct national identity while remaining organic parts of Britain; while, if England has become Britain, the smaller sub-national units into which it has been divided are then aptly described as regions of a British nation.

This paradoxical structure results from the two conflicting pulls within New Labour’s attempt to fashion a new British Nation – integral Britishness, on the one hand, along with devolution for some of its parts, on the other. This leads to the need to assert a strong core of British national identity at the centre, allowing the smaller countries at the periphery to be both distinct nations and partakers of a shared British identity: the British identity of England, that is – turning the whole edifice into an integral British Nation. This is in contrast to what I describe as the original and historic character of Britain as essentially the core and name of England’s Empire, with the other British nations as dominions or ‘possessions’ of England. The two structures could be illustrated as follows:

 

Imperial Britain


 

Nation of Britain


 

Comparing the two diagrams, it is noteworthy that a former hierarchy of nations (England as the central sovereign national power within the United Kingdom both governing and ‘owning’ the other British nations) has been replaced by a hierarchy of governance: the central UK government exercising governance / sovereignty over the ‘nations and regions’ in some matters but devolving power in other areas. Or at least, that was the blueprint for the [English] regions until the electorate in the proposed North-East region scuppered the idea. But, as we know, the present government has continued with its regionalising agenda, although the Regional Authorities now are little more than unelected arms of central government. So a more accurate rendition of the present situation would perhaps have been to draw the above diagram with a thick arrow going one-way from the centre down to the regions.

This replacement of inter-national UK governance by inter-tier UK governance reflects the fact that devolution as implemented by New Labour did double duty as a process of delegating to the ‘nations’ certain aspects of governance previously handled by the England-dominated UK government alongside a process of developing a new regional tier and structure of governance. That’s to say, this is regional governance effectively within the context of a new integral Nation of Britain. To complete this structural transformation, ‘Britain’ is promoted from its position as England’s ‘dominion’ within the imperial set up (the territory over which England exercised sovereignty and which England ‘possessed’) to the position as the sovereign national power in its own right. Accordingly, England is demoted to the status of a mere territory over which the central British government exercises sovereignty and which it ‘possesses’ as its own; to the extent that it feels entitled to dispose over – indeed, dispose of – the English territory as it chooses by parcelling it up into smaller administrative units.

But this also means that ‘Britain’ governs the UK in England’s place. In other words, Britain both takes England’s place as the sovereign and central power within the structure, and represents (indeed, re-presents) England within the continuing inter-national aspects of the system. Or, putting it another way, ‘Britain’ in the new structure continues to also be effectively England: it rests on the British national identity of the English, or the identification of England with Britain; and it exercises and takes forward England’s historic role and responsibility of governance over itself (i.e., in this instance, over the ‘regions’) and over the other British nations. This is still effectively governance from the English centre, albeit that this cannot be acknowledged, as it is supposed to be a unitary system of British governance, with British nations and British regions standing in a relation of equality towards one another within an all-embracing Britishness.

Conclusion

So the Britishness is really just an overlay over a much more long-standing structure, with Britain taking over and taking forward England’s historic role as the power in the land. This system, as it stands, is dependent on ‘Britain’ both being and not being England. Firstly, for Britain to have a ‘national identity’ in its right requires that the people of England (continue to) identify as British / identify with Britain, providing a[n English] core of Britishness that the other nations of Britain can both see themselves as sharing and uniting with in a profound way (as it and they are both British), while differentiating themselves from it in a manner that defines their own national identities as being distinct from that of England / English Britishness.

This is the core problem with Brown’s Britishness agenda: the non-existence, precisely, of a core Britishness. ‘Britain’ is incapable of grounding its identity as a ‘nation’ within itself because it has always been, and continues to be, essentially a system of governance unifying a collection of distinct nations – now even more than ever, in fact, as the second of my above two diagrams illustrates: ‘Britain’ / the UK is just a hierarchical system of governance and a set of relationships between its constituent parts, not an integral nation in itself. This is why Brown and New Labour can define ‘core Britishness’ only in terms of a set of general moral and political values that themselves relate to the processes of governance and civic society: liberty, tolerance, democracy, justice, the rule of law, etc.

The reality is that the ‘core identity’ of Britain is the [only in part British] national identity of the English. And this is made up of a much deeper, broader, more concrete and personal set of characteristics, attitudes, beliefs and behaviours that can ever be encapsulated by a mere set of philosophical and political abstractions. It is of these things – the character, culture, society, history and traditions of a whole national community – that real ‘national identity’ is made. England has and is all of these things; Britain ‘of itself’ does and is not. So in order to be a nation, ‘Britain’ has to appropriate the national identity of England to itself (another way of saying it has to ensure that English people [continue to] see all of their English characteristics and values as essentially British). But Brown cannot engage with the question at this level, because if he did, he’d be forced to acknowledge that his British national identity is, at its core, none other than England’s by another name. And so, because he cannot acknowledge the concrete reality of the English people and identity as the real core of, and dominant culture and nation within, the UK (as it always has been), his Britishness can be articulated only at the level of abstract ‘shared British values’.

And secondly – and this is perhaps even more determining for the future of a continuing Britain – the other British nations also need this core Britishness and centre of Britain to be Britain-but-not-England and to still be England all the same. On the one hand, they need this, as I described above, to feel connected to a common Britishness (of which ‘England’ is the guarantor and foundation) that is the place of an authentic and equal Union between the nations of the UK, rather than being in fact just another name for a separate England of which they have historically been subordinate British-imperial ‘possessions’. And, on the other hand, the fact that this ‘British centre’ is also still England is necessary for them to define their own national identity as distinct [from England] through devolution.

In other words, the other British nations define themselves as nations through differentiation from the English centre of Britain; but they need that English centre to be British first and foremost in order to continue to feel anchored in a common Britishness. If, on the other hand, that Englishness of the British centre were somehow to be effaced altogether, then the other British nations would ironically lose the basis for their own distinct national identities, at least as contained within the British framework. They need England to exist in order not to be English; and they need England to be Britain in order to be British. Pull England out of the whole system – create a Britain ‘without England’ at its centre – and the national identities of the other British nations, and their sense of belonging to a ‘national-British’ community of any description, would be completely stripped of their present anchoring, and the constituent parts of what we now know as Britain would spin off into a chaotic existential abyss.

All of which doesn’t exactly make it easy to see what the way forward might be. But although the present system does shore up some sort of unitary structure for UK governance within the context of devolution – and while it does create a British anchor for the diverging and increasingly autonomous identities of Scotland, Wales and Northern Ireland – it is hardly a sustainable, rational or fair set up for England, which is condemned to a limbo land of being and not being a nation, and being the prop upon which the whole UK edifice and its other nations depend for their present existence.

And the point is, if this is not sustainable for England, then it cannot be a sustainable basis for a continuing United Kingdom, either. That is because England is the core national identity of the UK; but a UK that seeks both to deny that fact and yet relies on it is an edifice built on a foundation that undermines itself.

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11 March 2009

Shorts (4): Football Team GB – I’ve got a better idea

One of the things that’s truly ‘great’ about football in Britain (by which I actually mean all four nations of the UK, not just England) is the strength of the game at the grassroots. The literally thousands of amateur clubs that are kept going by the dedication of their coaches, the support of family members and the passions of their players; the vast structure of leagues and cup competitions at every level of the game, and for every age and, increasingly, gender. It’s these clubs that keep alive the true spirit of football, which provides a generally friendly way to fight out local rivalries, and a chance for young people to take out their aggression, keep fit and achieve a bit of glory.

The Olympics, too, was originally supposed to embody this spirit of amateur sport. It was supposed to be – and still is to some extent, even in Britain – about individuals who have a dream, and strive through sheer perseverance, skill and hard work to achieve it or at least give their all in the attempt. And it’s about friendly rivalry between nations – pointing the way to a world of peace in the more serious and vital affairs of life as well as in mere play.

All this trouble about a British Olympics football team is essentially because it’s got caught up in the turbulent national-identity politics of the present. Why not just cut through all of that and organise a mammoth all-UK amateur cup competition for the right to compete at the Olympics as ‘Team GB’ – pitching teams from all four corners of the UK against each other: little village sides from Kent journeying up to farthest John O’Groats, if necessary, in order to progress to the next round; with a team from County Antrim slugging it out in Merthyr Tydfil. If the clubs need help with their travelling and other expenses, then they could get support from the same Lotto fund that is being ploughed into the Olympic facilities – given that it’s going towards the same event.

This could be a real amateur sporting affair, in keeping with the original spirit of both football and the Olympics as I’ve described it. This means the top amateur clubs like those in the English Blue Square League, which are in reality semi-professional, would be excluded.

This would give a chance for talented amateur sportsmen and -women from across the UK to go in pursuit of an amazing once-in-a-lifetime opportunity: to represent not just ‘Great Britain’ but their community, village, town and, yes, nation (whether England, Scotland, Wales or Northern Ireland) at the greatest sporting tournament on earth – well, the second after the Football World Cup! This wouldn’t in fact be the British Olympic football team but merely a British football team. I say ‘merely’; but in reality, this would be more truly and profoundly a British team than any meaningless Team GB packed with overpaid professional players for whom the Olympics did not mean much compared with tournaments like the Premier or Champions’ Leagues. This would be something that passionate football enthusiasts from across Britain would have had to fight for.

A team comprising the ‘best’ amateur club (or clubs, including the women’s team) in Britain (or at least the winner of the All-UK Challenge Cup) wouldn’t in any way compromise the status of the four separate national Football Associations. This is precisely because it wouldn’t be a / the ‘national-British’ team, and because the separate national associations would all be engaged in organising the tournament and administering the participation of all ‘their’ affiliated amateur clubs that were interested in taking part. Indeed, the clubs themselves would doubtless regard their clashes with clubs from other national associations as their own small-scale version of full international matches. So this would be an international amateur contest to select one lucky (or two including the women) representative team(s): a team of Britain and not the Britain Team.

And the point of all this is that it would mobilise a huge amount of support and goodwill from what is known as the ‘British public’ – by which is meant the people of England, Scotland, Wales and Northern Ireland. The level of interest and enthusiasm would potentially be immense as local communities got behind their teams and the English / British love of the underdog was played out to the max. This really would be great and would truly bring to the fore the ‘best of British’ – if not the best British Team. And above all, it would exhibit the long-lost idea of sport: that it’s not about the winning but the taking part.

But the powers that be are interested only in winning: winning medals, winning prestige for ‘Britain’, and winning the fight for a Football Team GB as they see it, whether the people want it or not. But contrast the enthusiastic backing that a ‘Team GB’ selected the way I am proposing would generate to the devastation that could be wrought on the precious game of football by imposing a professional Team GB on us.

Football is, and could be even more, something that unites the different nations of the UK. If the government and the BOA get their way, it could become something that divides us, even to the extent of contributing to the eventual break-up of the UK if that is what is necessary to preserve our national teams and associations – because the demand for separation would surely grow enormously if the footballing heart of our four nations was ripped out and stuck to the badge of Britain, instead of being worn with pride on the shirtsleeves of amateur FCs from throughout our islands.

If you think this is a good idea, let me know – and I’ll suggest it to those said ‘powers that be’. How about the BOA, the (English) FA and 10 Downing Street for starters!

Shorts (3): Would a football Team GB be illegal?

I see another English government minister (the Sports Minister – for England only – Gerry Sutcliffe) has been sticking his oar in where he is neither qualified nor welcome to speak, insisting that: “A Great Britain football team will take part in the London 2012 Olympics even if it consists entirely of English players”.

I don’t know why Mr Sutcliffe feels he has any jurisdiction in the matter, as his governmental responsibilities for sport, and hence for football, are limited to England, not ‘Great Britain’ or the UK. But this sort of overstepping of legally defined areas of competency may be required to force through a football Team GB against the wishes of the Football Associations of Scotland, Wales and Northern Ireland, and the supporters of all four national UK teams, including those of England.

I’m wondering whether any decision to go ahead with an all-English Team GB would be open to legal challenge on at least two, possibly three grounds:

  1. The FA’s (that is, the English FA’s) constitution limits its responsibilities to “all regulatory aspects of the game of football in England”. I read this to mean that the FA is not legally entitled or even authorised by its own rules to select or regulate anything such as a ‘Great Britain’ football team.
  2. Team GB itself is selected by the British Olympic Association “in conjunction with the governing bodies, from the best sportsmen and women”. The reference to the ‘governing bodies’ means the governing bodies in the UK for the relevant sports. Those for football are listed as the FA and the associations for Scotland, Wales and Ireland. Therefore, if the BOA and the FA ignore the unwillingness of the SFA, FAW and IFA respectively to put forward names of their countrymen and -women for selection for Team GB – and even to recognise the validity of such a team – I would have thought this would be open to legal challenge on the grounds of flouting the established rules for selecting Team GB.
  3. This could also potentially be challenged on the grounds of discrimination: the BOA and FA could be accused of discrimination if they excluded Scots, Welsh and Northern Irish footballers from being selected. If, on the other hand, they did pick footballers from those countries who made it clear they wanted to be considered, this could be regarded as undermining the legally recognised authority of the national associations to regulate the game in their countries. Of course, accusing the BOA and the FA of discrimination in this way could backfire on the other associations, who could also be accused of discrimination for making their compatriots ineligible. However, such a legal challenge, if it were taken out by the BOA or FA, could also be viewed as questioning the authority of the associations to regulate the professional game in their countries. So the whole thing could get incredibly messy!

Maybe if the FA and the BOA persist in their offensive insistence on an unwanted football Team GB, legal action of the types I suggest might be the way to block it. The whole thing could drag on for years, making it impossible to proceed with plans, preparations and appointments for any eventual team.

Might be worth considering if the worst comes to the worst.

8 March 2009

Stillbirths and Neonatal Deaths: Ten Years of Devolution, Ten Years Of Failings

I first came across this story on the BBC News website on Wednesday morning last week. According to the report: “The number of stillbirths and deaths shortly after birth remains stubbornly high, claiming 17 babies every day on average in the UK, a report reveals. Every year in the UK nearly 4,000 babies are stillborn and another 2,500 die within four weeks. The stillbirth rate has not changed for a decade.”

The article then went on to quote a comment from the “Department of Health in England”, saying “there had been an increase in midwives and consultant obstetricians, and increased investment in the field”. This combination of statistics supposedly relating to ‘the UK’ and reaction from the DoH England [give them their due, the BBC do now more consistently make it clear when a UK government department has England-only responsibilities] immediately registered on my Britology radar: ‘are these UK figures actually England-only figures?’, I asked myself. Otherwise, why gauge reaction only from the English department concerned without any further comment relating to the rest of the UK? Such a practice usually is code for England-only information passing under the generic UK / Britain label.

The report about stillbirths and neonatal deaths was produced by the charitable society of the same name, the Stillbirths and Neonatal Deaths Society, or ‘Sands’. In fact, the document was due to be launched at the House of Commons later the same day, so it was not yet available for download. I scoured the Sands website in vain for information about whether the research and the activities of the charity were focused on England only or on the whole of the UK. The website talked only of UK-wide facts and figures, and in fact, it did not mention the word ‘England’ once anywhere. After more extended web research, I did manage to confirm that Sands is the established UK-wide charity organising emotional support and raising funds for research on the topic.

Later on in the day, I caught the BBC1 lunchtime news, where there was a more extended version of the report than had appeared on the BBC News website. This was an absolute masterpiece of ambiguity, which managed to completely avoid mentioning whether the Sands report related to England or to the whole of the UK, failing to (or perhaps succeeding in not) utter(ing) any of the words ‘England / English’, ‘Britain / Britain’ or ‘UK’. Any casual viewer would undoubtedly have been left with the impression that the information related to the whole of the UK; but this was never explicitly stated, even though Sands was calling for a ‘national’ [by implication, UK-wide] action plan to reduce the number of stillbirths and deaths in early infancy.

By now, I was getting really intrigued, and really frustrated. ‘Does the Sands report relate to England only or not; and if it does, why do they seem to want to suppress this fact rather than drawing comparisons between the situation in England and elsewhere in the UK, which would almost certainly be more embarrassing to the government?’, I wondered. I checked the Sands website in the evening – and still no report available to download. I was so irritated that I fired off the following email to the organisation:

“Dear Ms Duff [Sands’ Communications Officer],

“I followed with interest the press coverage today surrounding the launch of your Saving Babies’ Lives report. Will this report be available for download from your website soon?

“I am also interested to know whether its findings and recommendations relate to the whole of the UK or to England only, as the UK government and the Department of Health are responsible for healthcare and the NHS in England only. The media coverage (e.g. on the BBC1 lunchtime news) was somewhat unclear on this point. On your own website, you call for a nationally co-ordinated action plan (implying across the UK). But clearly, the government can only really co-ordinate all the measures required to reduce the number of stillbirths and neonatal deaths in England – unless your report recommends some sort of high-level, UK-wide co-ordination involving the participation of the governments of Scotland, Wales and Northern Ireland.

“I look forward to your reply.”

I don’t know whether this letter was viewed as a nuisance or irrelevance, or whether they were just plain too busy, but I haven’t yet received a response. In fact, it may well have been too close to the bone, as became evident when the report did finally appear on the website on Thursday and I was able to download it.

This is where I have to throw in a disclaimer. In some respects, I’m reluctant to critique this report, which is full of heart-breaking pictures of would-have-been parents cradling their stillborn infants, and desperate accounts of the devastating effect that stillbirths and neonatal deaths have on individuals and families. I’m not blaming Sands for the approach they’re taking, which is completely consistent and conscientious. I blame the UK-cum-de facto-English government and the effects of poorly managed, asymmetric devolution. So, as they say, the views expressed in this post are mine and do not necessarily reflect the opinions of Sands.

Apart from all the detailed data on stillbirths and mortality in early infancy, and the recommendations for alleviating the situation, a clear underlying message that emerges from the Sands report, for me, is that the failure to reduce the incidence of these traumatic events is closely connected with asymmetric devolution. Sands don’t spell this out because they want to encourage government to develop a co-ordinated cross-UK strategy and set of policies that strongly prioritise the issue. Hence, their tactic appears to be that of taking the moral high ground and arguing that this is such a critical social issue (responsible for far more deaths, for instance, than road accidents or cot death) that the government should rise above the political obstacles and start dealing with it.

But the political barriers are evidently key. As the report itself says:

“In the UK a combination of problems means we fail to identify many babies who are at risk, and to ensure their best possible chance of life:

• We lack knowledge, data and research into why babies die.

• We have no reliable way to predict which pregnancies are at risk of stillbirth or death early in life.

• There is little awareness of the extent of the problem or what the risks are.

• We don’t have the resources in maternity care to ensure optimal care for every baby.

Above all there is no political will to make things change [my emphasis].”

Why is there no political will to make things change? The problem, it seems to me, is twofold:

  1. The UK government – which is the primary intended audience for this report – lacks the political will and, more importantly, the political muscle and power to co-ordinate and implement a UK-wide strategy in this area. Post-devolution, the remit of the UK Department of Health stops at the borders between England and Scotland, and England and Wales. And there’s been a failure, precisely, to develop mechanisms to co-ordinate strategy, share knowledge and implement best practice in areas of social policy, including healthcare and the (four) NHS(‘s), across the four nations of the UK. (See my discussion of this elsewhere.) And this sort of co-ordination is especially critical with respect to stillbirths and neonatal deaths, according to the Sands report.
  2. The UK government has even been unwilling to own and embrace its responsibilities to formulate priorities and develop social policies for England as England, and has tended to wash its hands of its duties as the de facto English government by passing on or outsourcing the setting of healthcare priorities to Primary Care Trusts and an increasingly marketised healthcare sector. This has also resulted in a failure to set adequate priorities and co-ordinate measures to deal with stillbirths and deaths in early infancy, as emerges from the report; although Sands does not link this explicitly to the contrast between the situation in England and the devolved UK nations.

One area where the government could co-ordinate action at a UK-wide level, and which is vital according to Sands, is in research into the causes of stillbirths and neonatal deaths. As the report says, “A serious lack of direct funding for scientific research to understand and prevent stillbirths is holding back progress that could be made in reducing the numbers of deaths”. Scientific research is a reserved power, so the UK government could directly fund research in this area; and Sands is calling on the government to match the £3 million it is raising for this purpose. £3 million: absolute peanuts compared with the billions the government is pumping into the banking sector. But, as I said in that previous discussion, as the UK government has retained the responsibility for managing the economy but not the ability to formulate joined-up social policy throughout the UK, it tends to prioritise the economic over the social: in England, that is, as the devolved administrations do have a social vision for their respective nations.

Indeed, one of the problems about a direct-funded research programme is that it has to be underpinned by co-ordinated cross-UK data gathering. As the Sands report says in its next recommendation: “Data collection on pregnancies is limited in the UK, the exception being in Scotland. We need nationally collated, detailed and standardised data about all pregnancies and outcomes on which to base research”. Well, yes, that says it all, doesn’t it? In fact, before devolution, there was a ‘national’ (i.e. UK-wide) programme for gathering data on the issue, called CESDI: Confidential Enquiry into Stillbirth and Deaths in Infancy. But, as the report indicates, “these enquiries have stopped since the formation of the Confidential Enquiries into Maternal and Child Health (CEMACH) which has less funding to cover a far wider remit of work. We would like to see resources to enable a return to enquiries into all stillbirths, in particular those which are unexplained”.

The last CESDI report was published in 2001; and from 2003, its work was taken over by CEMACH, which looks into maternal and childhood deaths (up to the age of 16) alongside perinatal and neonatal mortality – and does in fact have a much smaller budget than did CESDI alone. In England, Wales and Northern Ireland, that is. In Scotland, on the other hand, as the report reiterates elsewhere, “detailed information about pregnancies and outcomes is available”. Why? Because the CEMACH work in Scotland is separately funded by a body known as NHS Quality Improvement Scotland (NHS QIS), which in fact will be taking over the whole CEMACH survey in Scotland from October of this year. (I add that this particular gem of information is not contained in the Sands report; I trawled it up from the CEMACH website.)

So let’s summarise. Research in Scotland is still focused on the specific problems of stillbirth and neonatal deaths; it enjoys superior funding to England, Wales and Northern Ireland, which are dependent on the CEMACH process; and until as recently as 2007, the CEMACH survey was also using a flawed methodology. As Sands informs us: “From 2007 CEMACH has adapted [the Wigglesworth] classification system to address its widely recognised limitations, particularly in gathering information about conditions associated with a death”. On top of this, the Scottish NHS is abandoning the CEMACH process altogether from later this year. And no political will exists to sort out these disparities and ensure that rigorous data gathering of the kind that still takes place in Scotland is co-ordinated across the UK. Surprise, surprise.

A similar lack of political will seems to prevail with respect to ensuring the dissemination of best clinical practice. For example, the report states: “The Royal College of Nursing and other stakeholders are currently working on a UK-wide framework for the education and training of neonatal nurses. But this framework must be adopted in order to be effective”. Well, clearly, there has to be the ‘political will’ to standardise processes and share knowledge across the four national NHS organisations. And there would have to be a commitment to make the necessary investments to raise standards, which would be particularly costly throughout England, whereas this is easier to achieve in Scotland owing to its smaller scale and higher per-capita level of public expenditure, guaranteed through the Barnett Formula. I’m reading between the lines here; but it stands to reason that if there were enough political will to introduce the improved training framework in England, then there would be no problem about standardising it across the other UK countries owing to their higher proportionate share of the public finances. So the issue must be that the government is unwilling to spend the extra money in England (with the Barnett consequential of even greater expenditure in the other countries), while the devolved administrations presently do have the financial and political latitude to roll out improvements in this area.

And evidently, to judge from the Sands report, these improvements are desperately needed. At times, the report reads like a catalogue of failure to learn from avoidable mistakes in antenatal care, childbirth and neonatal intensive care, resulting in babies continuing to die unnecessarily from the same causes. And there is not just a failure to disseminate best practice, share knowledge and prioritise the issue but also a lack of resources: insufficient antenatal healthcare personnel, such as midwives and other specialists, who might be able to help detect problems earlier on in pregnancy; inadequate staffing levels in intensive-care units for premature babies, such that only 14 out of 50 of such units ‘in the UK’ are able to provide the one-to-one nursing care that the British Association of Perinatal Medicine (BAPM) regards as a minimum standard.

The fact that the statistics are aggregated across the whole of the UK in this way is one of the shortcomings of the Sands report. This prevents one from being able to gauge whether the problems are significantly worse in England than in the other UK countries, which would be linked to the funding inequalities and strategic issues (lack of UK-government focus on this as a serious social issue in England) resulting from asymmetric devolution. I have no way of knowing how many of those 14 under-resourced intensive-care units are located in England; but I’d be willing to bet that none of them are in Scotland. It has to be said that all the specific examples of bad practice and inadequate resourcing, and all of the references in the body of the report to comments from clinical experts or to other reports on the issue, are drawn from England.

Another aspect of this topic that is exclusive to England is the way that the processes of funding the NHS contribute to the inadequate priority and insufficient resourcing that are given to stillbirths and neonatal deaths. These are described by the report as follows:

“Newly implemented commissioning structures between the Primary Care Trusts (PCTs) and hospital trusts have been evolving to meet new government structures. While this brings more focus to what is required from maternity services in each hospital, contracts may omit any proactive remit to reduce perinatal deaths. An issue that is not highlighted in a contract for funds is less likely to attract specific focus or resources.

“As the contracts come into place hospitals can negotiate additional funds for posts or for focus as they see fit. However, many hospitals see contract negotiations as being driven by the PCTs and only a few have seen the opportunities provided by being able to focus on local issues.

Tariffs

“It is unclear what is or is not included in the tariffs paid to trusts for obstetric services, with a great deal of room for interpretation on whether or not tariffs have been adjusted to allow for the funding of quality improvements. For neonatal care there is no nationally mandated funding system and health economies are left to make their own local arrangements which leads to an inevitable variability in the level of care provided.”

What the report doesn’t state explicitly at this point is that these funding mechanisms that have evolved to meet ‘new government structures’ and this lack of a ‘nationally mandated funding system’ for neonatal care exist in England only; as it is only in England that the government is still calling the shots when it comes to NHS funding and healthcare priorities. The system described above has been developed deliberately to allow a greater role for market forces, with individual hospital trusts competing for funding from PCTs based on their proven record to meet government targets and treat larger numbers of patients with different types of medical need. What this leads to is the creation of centres of excellence and a concentration of investment in particular ‘generic’ areas (such as maternity services, as described here), which can then more successfully bid for funding. But this means that certain specialisations within those generic areas (such as neonatal care) are not prioritised in a strategic way, as the focus is more on generating a critical mass in more ‘fashionable’, headline-grabbing areas of care that can attract funding in a bidding war, rather than on actual clinical and social need: in this case, more resources for preventing and dealing with stillbirths and neonatal deaths. By contrast, as is evident from the dedicated resources allocated to the issue at a national level through NHS Quality Improvement Scotland (referred to above), stillbirths and neonatal deaths are a nation-wide NHS priority in Scotland.

Conclusion

For me, one of the things that emerges clearly from the picture of failure painted by the Sands report is a demonstration of the harmful consequences of asymmetric devolution. No progress has been made in improving clinical outcomes in ten years: the ten years during which devolution of healthcare has been in place, with different systems, and levels and mechanisms of funding, in place in each of the UK’s four nations. This has led to an absence of strategic UK-wide focus on stillbirths and neonatal deaths, with the consequence that there has been inadequate funding of scientific research, and a failure to disseminate best practice and drive through better training of specialist nursing staff. This is clearly linked to the funding inequalities built in to the asymmetric devolution settlement. The report cites Scotland as the only example of adequate data gathering on the causes of stillbirths and neonatal deaths, after the successful pre-devolution information-gathering process (CESDI) was abandoned in favour of a more poorly funded and less specifically focused system (CEMACH) in England, Wales and Northern Ireland (but not Scotland) under the auspices of the infamous NICE (National – e.g. English – Institute for Clinical Excellence).

Meanwhile, there has been a lack of strategic focus on the issue in England, which in my view is linked to a general unwillingness on the part of the UK government to assume its responsibilities as the de facto English government in most areas of social policy, including the NHS. Instead, funding and prioritisation in England has been left in the hands of PCTs as part of a process designed to foster the development of a competitive healthcare market within the NHS. But, as we know, markets lead to winners and losers, and stillbirths and neonatal deaths have lost out to more market-friendly areas of obstetric and paediatric medicine where it is easier to demonstrate a return (improved patient outcomes) on investment, compared with the difficulties in making gains in stillbirths and neonatal deaths, where the causes of mortality are still often a mystery. But unless the resources are devoted to greater research and improved clinical care in this area, no improvements will ever take place.

Where I take issue with the Sands report is with its tactic of treating the issue purely at a UK-wide level, without differentiating between the nation-specific circumstances that are contributing to the ‘postcode lottery’ of varying standards of care and prioritisation throughout the UK. The report correctly identifies that the political dimension is key. And one absolutely fundamental aspect of this is that the UK government, in this area as in so many other aspects of healthcare, is unwilling to commit the levels of investment and to prioritise the issue at a national level (that is, an England- and hence UK-wide level) in the same way that it is prepared to enable the devolved governments to do so on a more limited scale. The pattern is: cut expenditure in England, and hand the thing over to the market as a supposedly more efficient way to deliver healthcare in line with patient customer demand, in order to release higher levels of funding on a smaller scale for Scotland, Wales and Northern Ireland.

Until these structural and national inequalities are removed, there can be no integrated UK-wide strategy for beginning to reduce the number of stillbirths and neonatal deaths. Perhaps we may never be able to reinstate a coherent UK-wide strategy in this area given the lack of political will to reform the present asymmetric devolution settlement. But the government at least has a duty to drive a strategy on stillbirths and neonatal deaths for England. However, I doubt this will ever happen until there is a proper elected English government, genuinely accountable to the English people.

5 March 2009

Shorts (2): Dominic Grieve and New Tory Britishness

Dominic Grieve, the Conservative Shadow Justice Secretary and an ‘original’ thinker on the English Question, has been setting out the blueprint for the prospective Tory government’s policies on promoting a more cohesive society, based on transcending the divisions created by New Labour multiculturalism and political correctness. Or should that be a more cohesive Britain?

While there is much to commend in Mr Grieve’s speech – and, indeed, I would commend it to anyone interested in gaining an insight into the direction Tory thinking and policy are heading in this area – parts of the text seem depressingly familiar:

“The laws and concepts underlying [multiculturalism] seem to me to drive people apart endangering our traditional sense of community based on shared values.  It is these values honed by history, that have created our legal and constitutional arrangements. But to the present government this historic sense of Britishness has been attacked as incompatible with modernity. . . .

“In schools, the dumbing down of history has resulted in a system where the teaching of a narrative of British history has all but vanished.  Instead of children being taught to take interest in and have respect for past events and individuals who have shaped their lives, they are encouraged to be contemptuous of people who in the past did not live up to the then unknown values of modern Britain.

“I am convinced that this approach has hindered more recent immigrants to this country developing a sense of belonging. Faced with a society that seems to be suffering an identity breakdown, should we be surprised that they find a common identity with their fellow countrymen hard to identify?”

So is the Tory prescription to the break-down of community cohesion through increasing cultural diversity more emphasis on ‘shared British values’; more teaching of ‘our country’s’ history as British history; and perseverance with engineering a modern British-national identity and even Nation of Britain, superseding Britain’s diverse ethnic communities’ originally discrete identities, such as that of Englishness? Plus ça change, as that traditional English saying goes!

There is one ray of hope, however. As Grieve says in his conclusion: “we will only succeed in developing  a community of values and a shared national identity if we allow all people the freedom to discover and to coalesce around their shared aspirations, arguing out areas of disagreement”. I take it from this that this ‘freedom’ includes the liberty to define one’s identity as English in the first instance, rather than British; and for this new Englishness to also provide an identity and set of values that other ethnic communities can embrace.

But the way Grieve describes the process again sounds depressingly similar to the present government’s orchestrated efforts to redefine the fundamental principles on which ‘this country”s governance and national identity should rest as British in the first instance, rather than English:

“This is why I believe that there is merit in looking to the creation of a Bill of Rights and Responsibilities to help better define ECHR [European Convention on Human Rights] prescriptions and ensure that the principles in the ECHR are expressed so as to be seen as being relevant to all people and not as at present an international obligation that seems on occasion to appear to privilege certain individuals over the rights of the law abiding majority.

“Preparing such a Bill would also provide us with an opportunity to engage in a national debate as to what aspects of our legal and constitutional framework constitute core values in the area of civil liberties that could merit better protection than the Human Rights Act itself currently affords.

“For example I believe that the right to trial by jury in indictable cases should be protected as a key feature of our participatory democracy. We may also wish to add to the right to freedom of expression in the ECHR and ensure that principles of equality under the law are spelt out-an important issue in countering the current lobbying for special privileges for different groups.

“There are also sound arguments for including the obligations of individuals to the wider community as well. While some rights are properly absolute, there is no reason under the ECHR, why the failure to act in a neighbourly and acceptable way should not be taken into account if an individual seeks to invoke rights.”

While I’m fully behind the goal of better defining and protecting principles such as trial by jury, freedom of expression and equality under the law, you can bet your bottom pound sterling that this ‘national debate’ about ‘core values’, and the ‘participatory democracy’ that enshrines and defends those core values, will be British and British only. For England, that is, of course: Scotland, as we know, is having its own national debate on these matters and may decide to go its own way. But no scope for a debate about English identity, values, freedoms and democracy under these Tories proposals. Not even if that’s what the people demand? And I especially dislike the last sentence of the passage quoted above, which seems no different from Gordon Brown’s attempts to make our ‘rights’ dependent on conforming to a prescriptive view of responsible, ‘acceptable’ behaviour. So long as we obey the law, and the laws themselves are reasonable, our rights are rights, whether we like the way people enjoying those rights conduct their lives or not.

But there’s just a glimmer – a little chink of ambiguity that could yet reveal itself as a chasm of differentiation between the suffocating embrace of New Labour’s Britishness and a future acknowledgement of England and Englishness. For is all this history that Grieve talks about British or English; indeed, are the values and identity of ‘Britain’ he talks about ultimately expressions of English culture and national identity? As I say, there’s just a hint of ambiguity here and there:

“From the Saxon moot court, through Magna Carta, the Glorious revolution of 1688 and onwards, freedom and equality under the law has been central to what English and with it British identity has been all about”.

“We have seen centuries old principles that a person’s home was inviolable to a bailiff seeking to carry out civil distress of goods overturned with impunity, so that the proud adage that ‘an Englishman’s home is his castle’ will soon be but an historic memory”.

“What message for instance does the case of Binyam Mohamed convey in terms of our values when we are faced with accusations that we colluded with the USA in interrogation practises that were outlawed by the English Parliament in the mid 17th century?”

What indeed? And maybe we need a new English parliament to make sure our fundamental English liberty is defined and reaffirmed anew for the 21st century. And maybe the way to uphold the Tory principle of the freedom of individuals and communities to be left to pursue their own path, and negotiate their own way to live and work together in peace and prosperity free from state interference, is to assert this as an English value over against the prescriptive collectivism, political orthodoxy and authoritarianism of New Labour Britishness. Because this is both a fundamental Tory principle and a ‘core value’ of England.

Perhaps the fact that, if the Tories are voted into power at the next election, this will be entirely due to the electorate in England (even if they won’t secure the majority of actual votes in England), will eventually give the Tories the courage to make a break from the New Labour mantra that only Britishness can provide a base of core values from which to build a cohesive society: a belief set that is still all-too evident throughout most of Grieve’s speech. And maybe the Tories will come to the realisation that the traditional Britishness (as opposed to New Labour’s neo-British nationalism) is actually an expression of Englishness, which alone can form the basis for a cohesive society and participatory democracy for and in England itself.

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