Britology Watch: Deconstructing \’British Values\’

9 January 2013

Coalition Mid-Term Review: Sidelining England in the British-national interest

The UK coalition government published its mid-term review on Monday of this week. It is not the intention of this article to carry out a detailed analysis: I am interested mainly in the way England is treated, or rather is not, in the document.

At first sight, for a document produced by the UK government, it is remarkable how many times the words ‘England’ and ‘English’ actually appear: 15 and six respectively. However, most of the references to ‘England’ are of two related types: 1) where it is necessary to spell out that certain facts or policy proposals relate to England only in order to avoid misunderstanding, and to prevent people living in Scotland, Wales or Northern Ireland from thinking they are affected by them; and 2) to make sure that credit can be claimed for England-specific achievements for which the coalition parties hope to be rewarded by English voters at the next election.

Examples of the first type of reference occur on page 26, where the document refers to a number of policy proposals in the area of personal care as being specific to England, such as rules regarding eligibility for care and the introduction of a Deferred Payment Scheme designed to prevent people from having to sell their homes in order to pay for care. Clearly, these are important statutory and financial matters, and it is necessary to make it clear to non-English readers that they affect only people living in England.

Examples of the second type of reference are:

  • “We have provided the resources to help local authorities in England freeze their council tax for three years in a row” (page 14): Tory policy – please vote for us, England. (What are these ‘resources’, though? I thought local-authority funding in England was being cut, and the council-tax freeze was just a statutory, central government-imposed diktat. Do they mean local-authority funding is being cut by less than it would otherwise have been if authorities had been allowed to increase council tax willy nilly?)
  • “We have brought in the Protection of Freedoms Act to limit the retention of DNA samples in England and Wales in line with practice in Scotland” (page 37): Lib Dem policy – look, we actually do care about you, England, at least in the lofty area of British civil liberties if nothing else.

The first type of reference to England described above has the character of a legal declaration of ‘territorial extent’, along the lines of when cereal packets make it clear that a competition is limited to Great Britain and does not include Northern Ireland. And indeed, the whole document is circumscribed by a legal disclaimer of this sort covering territorial extent, which appears right at the end:

“As a result of devolution, many decisions made by UK Ministers or in the Westminster Parliament now apply to England only. The Northern Ireland Executive, the Scottish Government and the Welsh Government make their own policy on these devolved issues. This document therefore sets out the agreed priorities for the Coalition Government in Westminster.”

No clarification as to which policies “now apply to England only”, of course! Is the general public just supposed to know what they are, as the document certainly doesn’t make this clear to the reader as it goes through the different policy areas, apart from the few exceptions I have already mentioned? But throwing in a disclaimer like this means the government can essentially cop out of providing a detailed break-down and say: ‘look, we’ve acknowledged that some policies are England-only, and anyone interested in those particular policies will know whether they’re England-specific or not’.

This is simply not good enough, although it is par for the course. We’ve come to expect from Westminster politicians and the UK government that they will avoid referring explicitly to ‘England’ as much as they possibly can, and will do so only when it is necessary to avoid factual misunderstanding and harmful political consequences, in the ways outlined above. But their unwillingness to acknowledge a country called ‘England’ to which so many of their policies relate means that Westminster politicians cannot and do not hold themselves properly accountable to the ‘nation’ and people affected by those policies.

This fact is evident in the evasive manner in which many of the policy ‘achievements’ and remaining objectives of the coalition are described; and in many instances, the evasiveness relates directly to the suppression of references to ‘England’. For example, the document never makes it explicitly clear that when it discusses ‘the NHS’, it means only the NHS in England. This helps it gloss over the fact that the coalition has legislated for a massive reform to the NHS that will alter it – in England only – quite radically from the institution created by the post-war Labour government. And yet, the government still has the gall to refer to it as “one of our great national institutions”, as if the NHS it presides over is still fundamentally the same old British NHS, which it no longer is (at least not in England).

So suppression of the England-specific nature of the NHS reforms goes hand in hand with evasiveness about the scope and nature of those reforms. For example, the document says: “We have improved the NHS by . . . starting to devolve commissioning of most health services to GP-led clinical commissioning groups”. But what it doesn’t say is that these changes are limited to England and that the said commissioning groups are statutorily obliged to consider bids from private health-care providers even if the services they provide are initially more expensive than those of existing, public-sector NHS providers.

A more honest account of the government’s measures would be explicit about both their England-specific character and their ultimate guiding principles, and would be expressed something like this: “We have reformed the NHS in England in such a way as to create a competitive health-care market in which private companies will increasingly take over the provision of publicly funded services”. This is actually intended to be an ideologically neutral statement of what the government has done: it has marketised the health-care sector in England, whether you believe that’s the most effective way to deliver health care or not. So why should a Tory-led government not trumpet that achievement? Well, because it suspects, probably correctly, that if English people knew what had been done to ‘their NHS’ (but not to the NHS’s in Scotland, Wales and Northern Ireland), involving changes that were not set out in any manifesto or in the Coalition Agreement, they’d probably violently object. So instead, the coalition pretends that ‘the NHS’ remains fundamentally the same – a primarily public-sector and ‘British’ institution – neither of which is true any more: in England, that is.

The same analysis could be made of many, many other parts of the document that discuss England-specific policies and legislation while avoiding clarifying either that they relate to England only or that they are driven by an ideological bias in favour of private enterprise and markets at the expense of the public sector and, arguably, the public interest – in England. Another brief example – one among many – is where the document says: “We have introduced a presumption of sustainable development in the National Planning Policy Framework, which includes protection of the Green Belt, Areas of Outstanding Natural Beauty and Sites of Special Scientific Interest”. How disingenuous can they be? What this really means is: “We have prepared legislation to make it easier to obtain planning permission for major developments in England’s countryside, with only Green Belt, Areas of Outstanding Natural Beauty and Sites of Special Scientific Interest retaining the previous level of protection”. So England’s green and pleasant land can be concreted over under the pretext of driving economic growth, in the British national interest, regardless of the very passionate interest the English public has in protecting its countryside and natural heritage.

The identity of the ‘nation’ on which this concept of the ‘national interest’ is predicated is quite nebulous in the Mid-Term Review, as indeed it was in the original Coalition Agreement. This is quite simply because, in so many instances, the nation concerned is in reality England, but the government will not and cannot acknowledge this fact. This is rather damaging, as the very raison d’être of the coalition, then as now, is to govern in the ‘national interest’, as the title of the Mid-Term Review makes clear: “The Coalition: together in the national interest”. But whereas the phrase ‘national interest’ is adduced as justification for the coalition’s existence or for certain key decisions on five occasions in the document, the word ‘nation’ is used only once: “In 2012, the nation came together to celebrate the success of the London Olympic and Paralympic Games and the Diamond Jubilee”.

Three of the references to ‘national interest’ relate to the formation and continuance of the coalition, based on pulling the UK round from a dangerous financial and economic crisis; one to supporting the work of the Airports Commission, which could lead to controversial approval for, say, a new terminal at Heathrow or a new runway at Stansted (i.e. more environmental degradation in England “in the national interest”); and the other reference deals with the decision to opt out of, or in to, various EU police and criminal-justice measures. In other words, ‘national interest’ is very narrowly defined in terms of a small number of strategically important reserved policy areas – the economy, air transport, foreign policy and security – whereas large parts of the document deal with devolved policy areas, i.e. with those affecting England only or mainly.

Are these English measures also being introduced in the ‘national interest’? It’s hard to believe they are given the unwillingness of the government to connect the phrase ‘national interest’ with the specific nation, England, concerned? And if they’re not being carried out in the English-national interest, in whose interest are they being done? The interest of the government’s ideological, commercial and financial bedfellows (its corporate sponsors and partners, and its financial creditors)? The interests of the UK state and establishment, and their preservation from an economic meltdown that could have accelerated the centrifugal, nationalist forces challenging their  continuing existence? Or the interests of the coalition parties themselves, who want to come out of the five-year relationship claiming they have fought their corner and followed through on their manifesto pledges – irrespective of the fact that many of the measures they’ve introduced were never outlined in detail and in some instances were flatly contradicted by their manifestos and by the Coalition Agreement, such as the [English] NHS reforms or the Higher Education policies (especially the massive hike in tuition fees for English students)?

But these questions, as indeed the English Question itself, are completely sidelined by the Mid-Term Review. After all, the Coalition can hardly be expected to hold itself accountable to an entity such as ‘the English people’, can it, if its remit is to govern in the British national interest?

28 July 2012

Isles of Wonder, or a world left wondering?

So what are we to make of last night’s Olympics opening ceremony? Firstly, I would have to say that it was indeed spectacular and impressive, and many moments stood out that will doubtless linger on in the memory, such as the factory funnels emerging from [England’s] green and pleasant land; the Olympic rings being forged in the steel mills; and the magnificent solution they come up with for lighting the Olympic cauldron.

Now for the criticism. It would be easy to be churlish and run off a list of all the many aspects of British and English history that were glossed over or left out altogether. The ones that stuck out in my mind were the history of Empire and slavery, and the darker moments of our industrial past; although the ‘Satanic mills’ segment of last night’s show did allude to those in a gentle way. You could also mention Magna Carta; the long story of Christianity as a central pillar of the UK nations’ society and culture; the role of sports not included in the Olympics, such as rugby and cricket (or those which, from an English point of view, should not be represented by a British team, such as football); and the history of violence in English society, for which we are infamous throughout the world, as typified by football hooliganism and last summer’s riots.

Similarly, I thought that some of the history in the performance was a bit garbled and skewed, such as when there was a brief moment of remembrance for the victims of World Wars I and II, and the narrative then returned to 19th-century industrial scenes. How about remembering the victims of all wars Great Britain, and then the UK, has been involved in, including the American War of Independence, the Napoleonic Wars, and the Crimean and Boer Wars? Perhaps just a tad sensitive vis-à-vis our US, French, Russian and African guests – so the ceremony shied away from those out of political correctness.

Politically correct does really sum it up, although this was not always compatible with factually correct. I’m thinking, for example, of the celebration of the NHS, which pretended that there is still a ‘UK NHS’, true to its founding principles. The truth, as we know, is that there are now four NHS’s – one for each of the UK’s nations – and that the English one has just recently been opened up to private market forces. Of course, I suppose the creator of last night’s spectacular, Danny Boyle, could have been making another political point by making ‘the NHS’ such a centrepiece; although, if he was, this was again very subtle and indirect, and glossed over the fact that the NHS – the British one – is no more. Perhaps, rather, we should interpret the NHS bit as a celebration of ‘British times past’, of bygone Britain, like most of the rest of the show.

This was in fact a highly backward- and inward-looking, nostalgic and retro view of Britain, and will probably confirm to people of many other countries just how self-important, arrogant and insular ‘the British’ are. ‘Oh’, they might say, ‘so Britain invented the industrial revolution, unionism, women’s rights and suffrage, modern sport, popular music and the World Wide Web, did they?’ Apart from the fact that this is not strictly true, it’s all historical. What is its relevance to the present, and what sort of vision of its future does ‘Great Britain’ have today? And what is its relevance to the many other participating nations that are going through similar convulsions in the present? Has Britain learned something from its past that can help it to guide those other countries and help prepare a sustainable future for the community of nations going forward? What about a vision for a sustainable planet – post-industrial for countries like Britain but still very industrial for many developing nations – to present to all the nations gathered symbolically in the Olympic stadium and watching via the medium, TV, that was invented and first used in live broadcasts in Britain? And what were they to make of all of the ‘in’ cultural references that only British, and sometimes only English, people could really relate to? ‘God, these people are so damn introverted and up their own proverbials!’

The truth of the matter is that ‘Great Britain’ doesn’t actually have a vision of its future nor of its place in a rapidly evolving world. In no small measure, that’s because Great Britain is indeed a historical relic in itself: neither ever a proper, unified nation in its past; nor, certainly, a nation or polity in the present that is capable of expressing and mediating the hopes, aspirations, national sentiment or desire for deeper democracy on the part of its respective constituent nations.

So last night’s event was perhaps after all a fitting celebration of what it means to be British: a multifarious community with a strong sense of its past but no vision for the future. Isles of Wonder and historical reverie, indeed; but one that would have left the rest of the world wondering.

7 October 2011

National Health Service or national myth? Why UK Uncut’s ‘Block the Bridge’ protest is an empty gesture

In Norway, after the horrendous massacres carried out by Anders Breivik in July of this year, acts of remembrance were organised throughout the country in which people held aloft red roses: the symbol of Norway’s governing Labour Party, and once the symbol of Britain’s. By contrast, no red roses will be carried by the followers of UK Uncut, which is organising a ‘Block the Bridge’ protest this coming Sunday: a blockade of Westminster Bridge, just opposite the Houses of Parliament, to urge the Lords to throw out the government’s NHS Bill – the last chance of its being defeated or modified.

No, the red rose – international symbol of socialism, and incidentally also an iconic symbol for England in the form of the Tudor Rose – will not be in evidence. This is despite the fact that the protesters ostensibly wish to defend the socialist principles and legacy of the ‘British’ NHS, founded in the wake of the Second World War by Attlee’s Labour government. Instead, the plan is apparently to deck the bridge out in the blue and white colours of the NHS brand, or at least the NHS brand in England, which uses a lighter blue colour than the logos for NHS Scotland and NHS Wales, and a darker blue than the branding for Health and Social Care in Northern Ireland – the equivalent of the NHS in the Province.


The NHS (the one in England)

Darker blue for Scotland

Nice Celtic image and dark-blue font for GIG Cymru

‘NHS’ vanished altogether in this sky-blue logo for Northern Ireland

As these logos neatly illustrate, the ‘British’ NHS that UK Uncut’s valiant brigades will be standing up for is not the British NHS at all but the English NHS; and the Union government’s NHS Bill does not constitute a dismantling of the British NHS but a reorganisation of the English NHS along market principles. The British NHS as such was in fact dismantled by the last Labour government’s lop-sided implementation of devolution, which created four separate health services for each of the UK’s established nations (for the purposes of this discussion, Cornwall being assimilated to England). And it was that same Labour government that began the further dismantling of the English NHS that UK Uncut and its supporters are demonstrating against, as it was Labour that began the marketisation of the NHS that the Tory-Lib Dem coalition is finishing off. And of course, Labour’s marketisation was based on the support of its Scottish and Welsh MPs, with whose help the introduction of Foundation Hospitals – in England only – would not have been passed.

So it is perhaps no wonder that those Blocking the Bridge on Sunday will not be sporting socialist red roses. Maybe the protesters realise deep down that it was Labour that first sold out the founding principles of the NHS: that it was to be both a state-run and -owned service, and a national service, available free at the point of use to all in Britain in a uniform, consistent way. And perhaps they realise that the NHS is already neither of those things and will be even less so – in England, that is – if the Bill goes through.

But try telling UK Uncut that the NHS Bill relates only to the NHS in England – and believe me, I have tried this week, via tweets and email – and you might as well be threatening to try and march the massed ranks of the English Defence League across Westminster Bridge on Sunday: stunning silence and a complete lack of engagement with the critique of UK Uncut’s discourse, which refers constantly to ‘Britain’ and the ‘UK’ in relation to this and many other England-specific issues, and never to ‘England’. Nothing. In fact, one imagines that UK Uncut would view demonstrators bringing banners displaying the Tudor Red Rose and flags of St. George on to the Bridge on Sunday more as potential reincarnations of Anders Breivik himself – whose somewhat tenuous Facebook links with some EDL members were joyfully paraded about in some parts of the media and blogosphere in the wake of July’s massacres – rather than as being like the noble Norwegian public standing up for a national institution and values that are under threat, and mourning its young.

Indeed, Sunday’s demonstration really has more of the character of an act of mourning for an NHS that no longer exists than a political campaign that stands a realistic chance of influencing the government and bringing about meaningful change. In this sense, the absence of socialist and English symbols betrays the lack of any coherent blueprint – to continue the logo theme – for how a truly nationally owned and accountable NHS might be organised and funded in England now that it is no longer possible to go back to the Bevanite British NHS. Because that’s what the protesters will be defending on Sunday: the founding principles of the British NHS, not the actual one in England that the NHS Bill relates to, or the potential for a better English NHS, run by an English government, that puts the needs of English people first.

In this sense, it seems to me that the UK Uncut protesters are more interested in engaging in political myth than practical reality. The NHS – the idea of a unified, UK-wide health service free at the point of use to all UK citizens – is still widely proclaimed as one of Britain’s great national institutions. Indeed, it is one of the things, alongside the BBC, that symbolises Britain itself: its national unity and values. But if people finally wake up to the truth that the British NHS no longer exists, it might also dawn on them that a unitary Britain no longer exists. UK Uncut’s failure to engage with these realities is therefore an expression of its, and many other people’s, profound inability to emotionally separate themselves from a British nation that is no more.

For my part, UK Uncut doesn’t cut it. Maybe the almost inevitable passing of the NHS Bill, for all the doubtless harm it will do to universal health-care provision in England, will finally convince people that the old Britain is dead and only an English politics, accountable to the English people, will put their interests before those of UK plc. I won’t be helping to Block the Bridge on Sunday, because I’d rather stand up for an English future than be stuck in futile mourning for the British past.

24 January 2010

England: The Unspoken Other

“What we cannot speak of we must be silent about”. Ludwig Wittgenstein

I’ve received a reply from the BBC to my complaint about their failure to point out anywhere in their coverage that the Conservatives’ draft manifesto on health care related to England only. Here’s what they said:

Dear Mr Rickard

Thank you for your e-mail regarding a Radio 4 news broadcast on 2 January. Please accept our apologies for the delay in replying. We know our correspondents appreciate a quick response and are sorry you’ve had to wait on this occasion.

I understand you were unhappy with a report on the Conservatives’ manifesto for the National Health Service (NHS) and that you felt it failed to make it clear it related to England only. I note that you feel this was another example of an issue presented as relating to the whole of the UK and that it is a practice you continue to dislike.

We are aware that a report that is of great interest to one part of our audience may be of little interest to another. This issue of national and regional news is of great importance to BBC News and requires a balance which we are always striving to get just right.

While certain news items may be specific to one part of the country, and often reserved for coverage by our regional news, we also have to acknowledge and cater to the many listeners and viewers who express a clear interest in knowing what is happening in other parts of the UK. It is also the case that certain stories which at first appear geographically limited can ultimately have a wider impact on the country as a whole. [My emphasis.]

You may be interest in the following entry on The Editors blog by Mark Byford, the deputy director general, who looks at this issue and the recent review of the merits and challenges facing BBC News regionally and nationally by the BBC Trust. The Editors blog is availabe here:

http://www.bbc.co.uk/blogs/theeditors/2008/06/uk_news_coverage.html

I would also like to assure you that we’ve registered your comments on our audience log for the benefit of the news teams and senior management. The audience logs are important documents that can help shape future decisions about content and ensure that your points, and all other comments we receive, are circulated and considered across the BBC.

Thanks again for contacting us.

Regards

Stuart Webb
BBC Complaints
__________________________________________
www.bbc.co.uk/complaints

There’s something profoundly unsatisfactory about this response, over and above the plain fact that Mr Webb failed to address the substance of the complaint, which was that the BBC had failed in its duty to report on the news accurately and impartially. In this case, this would involve simply letting people know that the Tories’ proposed policies would be implemented only in England. Rather an important detail, one might think.

But let’s analyse what Mr Webb is saying here. I’m particularly interested in the section I’ve highlighted in italics. Mr Webb is comparing the coverage of the Tories’ draft NHS manifesto to the way ‘regional’ stories are reported on. In essence, he’s saying:

  1. The story in question did relate to just one ‘part of the country’ [a circumlocution for ‘England’: notice how, after the initial reference to my email, he can’t bring himself to use the ‘E’ word] but was nonetheless of interest to listeners outside of that ‘region’, and so was legitimately broadcast as a ‘national’ news story
  2. ‘Geographically limited’ [i.e. English] stories can have a significant impact on ‘the country as a whole’ [i.e. the UK], which thereby sets up a second reason why this particular story should have been broadcast on the national news: it’s not just ‘of interest to’ the whole of the UK (appealing to people who take an interest in current affairs), but it also affects the ‘interests’ of everyone in the UK. In other words, the Tories’ policies on the NHS could affect everyone in the UK materially in some way. Hence, though this was on one level just an ‘English matter’, it also matters to everyone in the UK – in both senses.

Well, yes, that’s all true: policy and expenditure decisions about the NHS in England are indeed of interest to many UK citizens living outside of England; and they do have a knock-on effect on the NHS’s outside of England, in that an overall increase or decrease in England-specific expenditure results in proportionally higher rises or cuts in expenditure in the other countries via the workings of the Barnett Formula.

But the relationship between spending in England and in the devolved countries is not straightforward or transparent. In this instance, Tory pledges not to cut the English NHS budget in real terms do not mean that the NHS budget won’t be cut in Scotland or Wales. If English spending declines overall despite the NHS budget being ring-fenced, then the Scottish and Welsh block grants will be smaller, and NHS spending in those countries may well have to be reduced. In order to understand how the Tories’ NHS policies will affect their interests – in the sense of ‘benefits’ – it is vital that Scottish and Welsh listeners understand the true relationship between England-specific policies and the corresponding policies in their own countries. And they can hardly come to this understanding if they’re not informed that the Tories’ policies are in fact only intended for England. To use Mr Webb’s analogy, this may have been a ‘regional’ story, relating to just one ‘part’ of the UK (England); but then, when genuine regional stories are covered at a ‘national’ level, the BBC does tend to take the trouble to spell out which region the story directly relates to.

So Mr Webb’s regional analogy completely falls over: a ‘regional’ story (e.g. one about Scottish politics or, say, an innovative private-public partnership being pioneered by a hospital Foundation Trust in one part of England) can well become a ‘national’ story (covered in the national news bulletins) if lots of people throughout the UK are interested in it and could be affected by it in some way. But that doesn’t make it a national story in the other sense: directly concerning the whole of the UK. But that’s precisely how the NHS story was covered: no attempt was made to make clear to listeners that it did relate just to one – albeit a highly influential – part of the UK. The word ‘England’ (the actual name for that ‘part’) simply wasn’t mentioned by the British Broadcasting Corporation; just as it was not referred to anywhere in the Tories draft NHS manifesto itself.

This illustrates a common observation: that while England is indeed formally ‘a part’ of the whole (Britain, the UK), it is generally referred to and thought of in British political discourse as if it were the whole (the UK) itself. In fact, there are two kinds of ‘parts’ of Britain from this point of view:

  1. England, which is a ‘geographically limited part’ of the UK but, as such, is politically and existentially (in terms of its official identity) indistinct from the UK and subsumed within it
  2. The ‘nations and regions’, both of which are really in effect thought of as regions of the UK / Britain (the ‘country’), the only difference being that three of those ‘regions’ have a distinct national character as recognised in the devolution settlement.

Such a structure does not reserve any place for England, which is where Mr Webb’s comparison of the Tory NHS story to a regional item is so disingenuous. On this model of the UK, the UK / Britain is ‘the country’ or ‘the nation’; and the nation is sub-divided into regions, three of which have their devolved, ‘nation-like’ systems of partial self-government. England (or ‘the regions’), on the other hand, is simply none other than the UK; just as Andalusia or Castile are regions of Spain (and are thereby also Spain), whereas the Basque Country, Catalonia and Galicia are national regions of Spain (and are by that token also still Spanish). On this analogy, England has become a ‘convenient’ (actually, inconvenient) name for the non-national regions of the UK; while Scotland, Wales and N. Ireland are the UK’s ‘national’ regions.

According to this understanding of the UK, then, England as such – as a nation – does not exist. This is a hard ‘truth’ whose implications are only beginning to dawn on me, despite the fact that I’ve voiced similar thoughts and discussed similar models for the relationship between England and the UK in numerous previous posts. In particular, thinking of things in these terms allows one to come to a deeper understanding of why the BBC won’t and can’t engage properly with complaints that they present ‘English’ stories as if they were British ones; and why the mainstream political parties resolutely persist in avoiding any reference to England when setting out their England-specific policies.

On an obvious level, this is of course done for political advantage: ultimately, because it maintains the whole British establishment and system of power, in and through which both the BBC and the parties seek to exercise their influence and prosper. But beyond these considerations of ‘interest’, the establishment won’t say ‘England’ because it can’t: how can you speak the name of something that does not exist? Both aspects are in play here:

  1. Because the establishment doesn’t want England to exist, in case this undermines its self-ascribed right to govern as Britain, it does not speak the name of England and thereby, in a sense, makes England not exist, at least within the formal discourse and self-understanding of British politics: ‘the Nation is Britain, and the parts of Britain are its nations and regions’. That’s it: no need to invoke an ‘England’ that is just not a distinct part of this whole.
  2. And because the word and name of England does not exist within the ‘politically correct’ language, it then becomes both inappropriate and irrelevant to mention it: language deals with things that exist, or that we believe to exist, not with what does not exist. ‘England’ has ceased to refer to anything in the present: it’s off the map of the British establishment’s mind, just as it’s off the physical map of the nations and regions. ‘England’, then, is a word that has served its time and is now redundant.

The BBC and the mainstream parties therefore do not say ‘England’, not just because they’d rather suppress all thought of England but because they’ve actually succeeded in removing the thought of it from the official and publicly ‘acceptable’ language of the British polity. They won’t say England because they can’t say England; and they can’t say England, not only because England officially doesn’t exist (it doesn’t refer to anything tangible within the polity) but because they actually don’t believe it exists any more, and they don’t know what ‘England’ means or should mean. In short, they’ve not only suppressed England from the apparatus of British governance, but they’ve repressed ‘England’ from their conscious minds and language.

This is the reason for my allusion to Wittgenstein at the start of this post: a foundational figure in what used to be referred to as the ‘English’, or at least ‘Anglo-Saxon’, school of analytical philosophy. The quote I used is my own translation from the original German that seeks to capture its ambiguity better than the classic translation: “Whereof one cannot speak, thereof one must be silent”. For me, my version (“What we cannot speak of we must be silent about”) perfectly encapsulates the combination of psychological repression and conceptual incapacity that characterises the British establishment’s silence with respect to ‘England’. First, out of political considerations of power, England was suppressed, both as a distinct national focus of politics and identity, and as something whose name – and in whose name – our political representatives could thereby speak. But then, once suppressed from the language, ‘England’ has become suppressed from the minds and understanding of reality of British politicians and media. England was first deliberately suppressed from political language and influence out of pure political motives; but now that language genuinely does not know it – so better not talk about it.

So on this view, England is no more. England is none other than the UK. And yet, England, as that which has been eliminated from British-political language, thinking and institutions – and as that which, in part for that reason, is beyond their reach and understanding – is also the Other of Britain. In psychological terms, if an individual represses a part of themselves and their history that they think of as unacceptable and inappropriate to express openly and socially, that part doesn’t in fact cease to exist, even if the individual’s conscious mind has succeeded in erasing all trace of it, and can no longer access the reality of that suppressed experience through deliberate thought and language. That part of themselves thereby becomes their ‘Other’: their repressed, unconscious selves that the conscious mind won’t and can’t recognise but sees as alien and unreal. The Other is the part of the individual that they have to suppress in order to think of themselves and to function as who they think they ‘are’. But in reality, those individuals cannot be whole persons until they are able to come to an understanding of and reconnect to the hidden parts of their selves and their histories.

So it is with England. The British establishment has suppressed its own deep roots in English identity and history because it projected onto England all the bad aspects of its own society, politics and history; and because it acted in the interests of redistributing power in a way that appeared more equitable than the England-dominated past, even while in fact continuing to exercise the same sovereign power that it previously wielded in England’s name. In other words, England had to die in order to be resurrected as Britain – but a Britain that, in order to be Britain, refuses and is incapable of acknowledging the England it still profoundly contains within it.

So England is Britain’s Other, whose name it cannot speak for fear that it might recognise itself in it. England is indeed both a ‘part’ and the whole of Britain: the part that in reality it needs to reaffirm as part of itself in order to be whole again. Otherwise, if the voice and identity of England cannot find expression within a Britain that would rather pass over it in silence, they will find expression in ways that could destroy the cohesion and survival of Britain itself as a political entity – just as, in an individual, unwanted traits and experiences end up being acted out in a more self-destructive manner if they are repressed indefinitely.

Well, this is a nice analytical model; but where does it leave us in practical terms? In particular, I’m wondering whether I should bother continuing to send off my complaint emails to the BBC every time they flagrantly ignore the England-specific nature of a story or policy announcement. If I do carry on, I certainly shouldn’t expect them to see reason, in the sense that, in my view, it is a simple case of reporting things in such a way that the public in different ‘parts’ of the UK know whether and how a story affects them. That’s what an ‘impartial’ public broadcaster is supposed to do, isn’t it?

But the responses I’ve received, as exemplified by Mr Webb’s email, reveal that the BBC appears not to see it that way. Perhaps they actually believe they’re carrying out their remit to report a story impartially by not making a point of saying ‘the Conservatives’ draft manifesto for the NHS in England’ or the ‘Liberal Democrats’ policy for childcare and education in England’ if the parties themselves choose not to spell this out.

More fundamentally, though, the BBC doesn’t see this as a serious enough issue, in my view, because they are a prime embodiment and propagator of the new Britain-centric political discourse and vision of the ‘nation’ that I’ve been describing. Despite Mr Webb’s comparison of the English-NHS story with an item of ‘regional’ news, the Corporation didn’t feel it was necessary to point out that the Tories’ proposals affected England only because they saw it as not just a ‘national’ story but a British story: about one of the national-British parties’ policies at the UK election for the ‘British NHS’, which were therefore of interest and relevance to the ‘whole country’. OK, ‘they’ – or some members of the various editorial teams involved – may have been dimly aware that, in fact, the policies related to England alone. But this fact would have been regarded as almost tangential and not worthy of being mentioned. The reason for this is that, for the BBC and the political establishment, there are really no such things as ‘English stories’ or ‘English politics’, but only British stories that happen, in some instances, to affect England only because of devolution but which are ‘British’ nonetheless because the nation itself is called ‘Britain’ and there is no such thing, officially, as ‘England’. These are, in short, ‘British’ policies that apply to a territory sometime known as ‘England’, and not ‘English policies’.

So the hard truth that I feel I’m perceiving more clearly now is that, for the British political and media establishment, the nation is Britain, and England does not exist: for them, England is merely the historic name for a part of Britain and a (British) cultural identity to which some remain sentimentally attached. England, in sum, is not present: neither ‘real’ in any objective, meaningful sense; nor ‘in the present’ (because it’s part of (British) history); nor represented in national politics (nor needing to be); nor requiring a mention when presenting ‘national’ policies.

Hitherto, my response to what I’ve called in this blog the establishment’s ‘Britology’ (the fabrication of a new British Nation as a sort of fiction: a creation of official and politically sanctioned discourse, language and symbolism) has preceded from the assumption that the ‘real’ nation that the fiction was intended to obfuscate and suppress was England, and that the establishment knew, more or less, what it was doing: a deliberate, politically led suppression of English national identity and pride. I’ve assumed that people generally knew that it was a lie, that they could see through it, and that the embargo of silence imposed on the word ‘England’ was really a conspiracy of silence maintained by all those who stood to gain from it: the established media and political parties.

But now I’m beginning to think that the establishment genuinely believes its own myths: that it’s not so much a case of collusion in the denial of England but shared delusion that England doesn’t exist. I think this is what we’re up against: not just the full weight of British political power but the power of a sort of collective psychosis. That may be too extreme a word to use. But really, I think there’s no alternative other than to conclude that powerful psychological forces such as repression (relegating unpalatable truths to the unconscious mind) are at work here if you are to really understand the systematic way in which all references to England are occulted from official documents, party-political pronouncements and media reports that relate to England alone; and the way that, when challenged, representatives of the organisations in question simply don’t get it: they genuinely don’t appreciate the significance and relevance of the omission of references to England.

Let’s put it this way: those of us who do love and value England, and see ourselves as English, of course think of England as a real nation. Therefore, when we notice that news stories and policies relating to England are presented as if they related to (the whole of) Britain, we think a mistake is being made: a deliberate mistake, intended to mislead, by the parties; and, if we’re being charitable, we think this is an oversight or error of omission on the part of the media for not picking the parties up on it. But if you try to get inside the mindset and assumptions of the Britological establishment, then you realise that they think England isn’t real and doesn’t exist; so that, for them, there are only British policies and stories at ‘national’ level. So saying that some of them relate to ‘England’ isn’t just a slightly irrelevant nicety but actually a non-sequitur: how can policies affect a non-existent country? For them, all policies are ‘British’ and relate only to ‘Britain’.

Devolution, as understood from this position, works like this: ‘all policies of the UK government relate to “Britain”; it’s just that some parts of Britain make their own policies in certain areas’. So ‘Britain’ is the name and identity of the nation, whether you’re talking just of the part (which we like to call England) or the whole. From this point of view, it isn’t deceitful to present policies affecting England only as ‘British’, because there is only Britain.

So I think we’re up against a government and establishment that not only refuses to recognise the right of the English nation to determine its own form of government, but which both refuses and – more profoundly – is incapable of recognising the very existence of an English nation. The new unofficial official map of the United Kingdom, for them, is one of a single, united Nation (‘Britain / the UK’), three parts of which are partially self-governing regions with a distinct national character: Scotland, Wales and Northern Ireland. England simply isn’t in the picture.

English nationalists are therefore inevitably not just campaigning for an English parliament but for recognition of England as a nation. Optimistically, you might say that the latter will flow from the former: if we manage to secure an English parliament, this will automatically entail official recognition that England is a distinct nation. But I would tend to put it the other way: we have first to win recognition of England as a nation for an English parliament even to be a realistic option on the table. If the establishment can’t even engage with relatively trivial and obvious complaints about omission of references to England in England-only policies and news reports, how can they be expected to seriously entertain calls for an English parliament? How can you have a parliament for a nation that doesn’t exist?

Maybe things are shifting more than I’m suggesting. It’s just that the wave of recent pre-election policy statements, in which the failure by the parties and media to mention their England-only character has been so gross, has depressed me a bit and made me wonder whether the powers that be will ever change. But it’s possible that change is nonetheless proceeding among the population as a whole and that, despite its inability to engage with any sort of English question, the establishment is getting increasingly isolated in its views from the people, who do think of themselves as English and want a government that cares about England and its needs. Maybe this is indeed the unspoken truth about the outbreak of disaffection towards the political class that was sparked off by the parliamentary-expenses scandal last year: that it reflects not just the ‘British public’s’ demand for a more accountable politics but the outrage of the English people at a British establishment that is pursuing its own agenda and interests without regard to the priorities, values and identity of the English nation. Perhaps England was the unspoken Other of this story, yet again.

So what do we do about the silence towards England that the establishment politicians and media would like to use to consign England to the dustbin of history? Well, the one thing we don’t do, even if tempted to, is fall silent ourselves. We have to keep on speaking out against it and asserting the right of England to be named, and so to exist. Keep on chipping away at the establishment armour – it might prove to be made of fragile porcelain rather than hardened steel.

As for me, I will keep complaining about unjustified omissions of ‘England’ where it should be mentioned, although I might vary the tactics a bit: not just write off to the BBC but consider other avenues, and also just ask them straight out why they chose not to mention that the policies or story in question related only to England? We’ve got to keep on gnawing away at their conscience and inserting ‘England’ into their consciousness, from which they’d rather relegate it.

Remember, apartheid South Africa and the Soviet dominion in Eastern Europe both collapsed at lightening speed after previously seeming as immovable as rocks. And that’s because the rot had set in from within: both systems were predicated on lies and on the denial of people’s right to freedom, democracy and national self-determination. Similarly, if the people continue moving away from the British establishment edifice by identifying as English and demanding a true national-English democracy, then that edifice may prove to be built on foundations of sand, not rock.

I for one, then, will not let England be an unspoken Other.

5 January 2010

A good day for burying references to England

The Conservatives published their draft manifesto for the English NHS yesterday, which failed to mention the only country it concerns – England – once. Yes, not once.

You can suggest questions on the policies, to be put to David Cameron in a webcast on Friday of this week, here. You can also vote on the existing questions regarding the omission of ‘England’. Please do so, as this will help ensure that at least one of them gets put to the Conservative leader. Mine is as follows:

“Do the Conservatives plan to reverse devolution in the area of health care? If not, I was wondering why your manifesto proposes policies for the NHS (i.e. that of Britain / the UK) rather than just the NHS in England? Why not mention England?”

Meanwhile, BBC Radio 4’s news output scarcely did any better yesterday, failing to indicate to listeners that the Tories’ proposals related to England only – eliciting the following complaint email from yours truly:

“Why did the news broadcasts on Radio 4 yesterday fail to mention that the Conservatives’ ‘manifesto’ for the NHS relates to England only? Is the BBC unaware of the effects of devolution in this policy area? Just because the Conservative Party fails to refer to England once in a manifesto that only concerns England, this doesn’t mean the BBC has to parrot them in such an uncritical manner.

“The BBC website performed a little bit better, saying that ‘[David Cameron] pledged maternity reforms in England to “meet mothers’ needs”‘. But even that could suggest that this was just one England-specific pledge in a manifesto that in other respects relates to the whole of the UK, which it doesn’t.

“This example also illustrates a tendency – on the website, and in TV and radio scripts – to signal that policies relate to England only in an incidental, passing manner, some way into the article, rather than up front in a way that unambiguously flags up the fact that the policies in question affect England only. For example, the website article begins: ‘Conservative leader David Cameron has said the NHS will be his “number one priority”, as the main parties step up their pre-election campaigning’. A casual reader could think Cameron is making the NHS across Britain his number-one priority. But he isn’t, as a Tory government would have responsibility for the NHS only in England. So why not say, “Conservative leader David Cameron has said the NHS in England will be his ‘number one priority'”?

“This complaint relates to an ongoing series of complaints I have with the BBC over its failure to properly report on English policies and legislation as English, not as ‘British’ as the parties try to pretend they are. Does the BBC have a political parti pris on this?”

Let’s see what they come back with on this. They still haven’t sent a full reply to my criticism of their coverage of the government’s plans to build nine nuclear power stations in England, one in Wales and none in Scotland, back in November.

20 November 2009

One good thing to emerge from the Queen’s Speech

In the spirit of praising best practice when it arises, I feel it incumbent upon me to record that, for once, the BBC’s radio and online reporting of Wednesday’s Queen’s Speech was exemplary in pointing out when the proposed legislation related solely or mainly to England and not the whole of the UK. The news broadcasts I heard on Radio 4 pointed out explicitly that the key measures for schools, the NHS and social care applied to England alone: something quite unprecedented for the BBC. And the summary of the legislative programme on the BBC website indicated for each item which UK nations they related to. E.g. Children, Schools and Families Bill, “Whole bill applies to England. Other parts cover Wales and extends in part to Northern Ireland”; Personal Care at Home Bill, “Applies to England only”; and Health Bill, “guaranteeing cancer patients in England a consultation within two weeks, a free health check for all over-40s and that no-one will have to wait more than 18 months [I think that should read ‘weeks’] between a GP referral and hospital treatment”. Well done, BBC!

I can’t comment on the TV news or on other news media, as I didn’t see them. But I was further encouraged yesterday by Radio 4’s reporting on the farcical row that has broken out about the proposals for free personal care, with some Labour MPs complaining they have pre-empted the conclusions of a consultation that ended only this week (a blatant case of electioneering, then). The Radio 4 report, on ‘Today In Parliament’, was prefaced by the mention that the proposals related to England only.

If the BBC can make it clear in this way which parts of the UK the government’s legislative programme relate to, then there’s hope that, come the general election, it will similarly make an effort to point out which of the UK’s nations are affected, and which are not, by the policies the parties present and debate during the election campaign. In any case, I’m keeping a watching brief and will be bashing off further emails of complaint should the occasion arise. I nearly did so the other night, in fact, when I heard a BBC World Service discussion on the work of NICE (the National Institute for Clinical Excellence): the body that decides whether to approve drugs for the NHS in England and Wales based on a cost-benefit analysis. The World Service report failed to mention NICE’s geographical remit, implying that its work related to the whole of the UK; whereas we know that Scotland enjoys better per-capita funding than England for drug treatments and is not under NICE’s thumb. But it was kind of late; and I need to get out more!

I have, however, received a holding reply to my last complaint, about the misreporting of the government’s proposals for ten new nuclear power plants, all but one of which are to be located in England – and none in Scotland (wonder why). So watch this space.

28 August 2009

Patients Association report on mistreatment of vulnerable patients in the NHS: why hide its England-only character?

The Patients Association – a lobby group that looks after NHS patients’ concerns and rights in England and Wales – yesterday published a shocking report containing 16 case studies of the mistreatment and neglect of elderly and vulnerable patients in NHS hospitals.

It probably won’t surprise my readers to learn that all the case studies in question related to English hospitals. However, this fact appeared to elude the media yesterday. At one point, on BBC Radio 4’s Today programme, it was stated that the case studies were drawn from “across the UK”, wording that was reiterated on the BBC website. Later in the programme, in the news headlines, they did indicate that all 16 case studies involved the experiences of English patients only, while clarifying that people from throughout the UK had contacted the Patients Association with similar examples of neglect. Another article on the BBC website does make this explicit while failing to make clear that not only the examples of abuses but the whole objective and scope of the report are to highlight instances of malpractice in England, and to call on the Department of Health (England) and the Care Quality Commission (the quango that looks after the quality of health- and social care in England) to take action.

Sky News are no better. The report on their website equally makes no mention of the England-only content and purpose of the Patients Association report. The Sky News web page contains a video in which agony aunt Claire Rayner, the president of the Association, asserts that many of the problems derive from the government’s obsession with targets, which force NHS staff to regard patients as mere units and as boxes to tick off rather than real people needing time, care and attention. Of course, this government-driven target culture, and the innumerable targets themselves, affect the English NHS only. They do things differently in the devolved NHS’s.

(Incidentally, I drew the failure of the Sky News report to mention the England-only nature of the story to the attention of their person in charge of dealing with viewer concerns, with whom I’ve been having an email dialogue following on from an open letter to the BBC that I posted on English Parliament Online and drew to Sky News’ attention. I received an initial response from the Sky News executive in question, in which he maintained that Sky does always take care to indicate when a political story relates to England only. I’ve since drawn to his attention two instances relating to the English NHS – including the present one – where this has manifestly not been the case; but I have yet to hear back from him.)

One of the reasons why the lazy media got it wrong – again – is that the Patients Association report does not make it explicit at any point that its observations and recommendations relate to England only. But they do affect only England: as I said, all the case studies concern events that took place in England; and the report’s call to action is addressed only to the authorities that deal with the English NHS. This absence of explicit references to England is in fact a characteristic of all the Patient Association’s communications and campaigns. Indeed, looking at its website, you’d be hard put to work out that the Association’s active campaigning is limited to England and Wales, and then in the latter country only in instances relating to common English and Welsh law. However, reading between the lines, all of the Association’s campaigns dealing with issues of health-care delivery, and the way in which they’re described on the website (with references to ‘the government’ and the Department of Health (England)), emerge as England-specific: GP services, care of older people, health-care-associated infections, dentistry and mixed-sex wards. I then discovered that there is a separate Scotland Patients Association – not affiliated to the (England and Wales) Patient Association – that deals with the corresponding issues for the Scottish NHS.

Why does the Patients Association (England and Wales) appear to go out of its way to conceal the in fact mostly England-specific nature of its activities? This seems in part to be an issue of funding. The PA reported that, after its report was publicised in the media yesterday, it had been “inundated by hundreds of emails and calls from patients across the country contacting us to offer their support and relate their own experiences of poor care”. This will in effect have served as a massive membership drive, and the Patients Association welcomes members (and corresponding financial contributions) from across the UK. It was therefore important for the Association to emphasise that their report deals with issues of concern to people across the UK, which the rush of offers of support and information on further abuses yesterday confirmed. Also, to be fair, the PA does provide information on how to complain about, and seek legal redress for, poor NHS treatment in each of the UK’s nations. But in terms of campaigning for action and change, the Patients Association’s activities are largely limited to England. The Association is in effect soliciting financial support from Scottish and Northern Irish citizens that would probably be more effectively directed to their own patients’ associations, which can actually do something about issues in those countries.

A similar situation applies to corporate sponsorship. The Patients Association’s list of corporate sponsors contains some impressive names; e.g. AstraZeneca, Denplan, GlaxoSmithKline, Johnson & Johnson, 3M, Napp Pharmaceuticals, Pfizer and Virgin Healthcare. Compare these with the sponsors of the Scottish Association: Arnold Clark, Barrhead Travel, It’s so Easy! Travel Insurance, Lloyds Pharmacy, Mobility Scotland, ScotWest Credit Union, Ross Harper Solicitors and Vision Call – Eye Care Home Services. Hardly as prestigious nor, one suspects, as remunerative! The Patients Association is clearly passing itself off as the ‘British’ association in order to secure the backing of such global blue-chip enterprises. Does it fear that if it more accurately designated itself as the Patients Association for England and Wales, it would lose some of these sponsors and the revenue they bring, and would have to rely on more ‘parochial’ English names?

On one level, I am reluctant to criticise the Association for this, as it is clearly important that it maximises its income in order to act as an effective advocate for English and Welsh NHS patients. However, is this advocacy not itself severely impaired and limited by the Association’s almost total avoidance of references to England, or to England and Wales, in the campaign material it puts out? Referring to issues relating to health-care delivery in England without any reference to England itself, as if they were issues of relevance to the whole of the UK, insulates the Association’s critiques and prevents them from becoming a truly powerful cross-UK analysis involving comparisons between practices, patient satisfaction and funding in each of the UK’s health services. It is as if the Association does not want in any way to connect its criticisms of bad practice in England with the politics of devolution, and of health-care funding and provision in the rest of the UK. But isn’t it vitally important to compare the experience of patients in England with that in Scotland or Wales; and if they’re doing things better in those countries, what can we in England learn from them – and do we need to direct more funding into improving the situation in England, given that per-capita expenditure on health care in England lags that in the other UK nations?

But clearly, the Patients Association has decided to avoid getting enmeshed in such political controversies. It would rather carry on working away in its own little bubble: drawing its concerns to the Department of Health (England) and the (English) Care Quality Commission without embarrassing either of these bodies by pointing out to the public that they’re letting England down compared with the corresponding bodies in the other UK countries that are more focused on the needs of their countrymen and -women. After all, rock the boat too much, and you could put off the corporate sponsors; and go on about England too much, and you could put off the individual members from Scotland and Northern Ireland.

But is it possible for the Patients Association to help bring about real improvements to the care provided to English NHS patients if the Association itself doesn’t care enough about England to mention her by name?

17 August 2009

The debate on the National Health Service is a proxy for a debate on nation-specific ideologies and policies

I’ve been particularly struck in the past few days by the extent to which the debate on the two main parties’ commitment to the principles and funding of the NHS has been completely blind to its English dimension. I suppose this should not come as any surprise, as it’s totally normal for Labour and the Tories to discuss England-specific matters as if they related to the whole of the UK. But this time, the blanket ignoring of the fact that the debate is relevant to England alone has been total, not only on the part of the politicians involved but also the media and bloggers. What is it about the National Health Service that makes us blind to its national specificities?

I suppose part of it is that the NHS is one of those national British institutions we like to think of as being present and valued to an equal degree in all parts of the UK, like the BBC, the Royal Family (for some, at least) and Parliament itself. But like Parliament and, to some extent, even the BBC, the national character of the NHS has been fundamentally changed by devolution. There are now four NHS’s (one in each of the UK’s constituent countries), with four government departments looking after them, four separate organisational structures, and separate funding arrangements. As with all legislation and social policy for England, the NHS in England is looked after by the UK government and the UK Department of Health. So although the government and Westminster politicians discuss policy for the NHS in the British terms relating to the level at which policy is made for it (at the UK level), the NHS in question is the English one, not a British one as such, which does not exist any more after devolution.

Given the apparent total unwillingness of the parties and the media to engage with the fact that the NHS whose future is being discussed is the English one, it is necessary to ask what they have to gain in ignoring this fact. In essence, the parties are trying to avoid framing an ideological polarity in national terms: ‘English’ political philosophy and social policy = support for privatisation, market principles and a reduced-size public sector; ‘British’ ideology and policy = support for nationalisation, state control of essential services and a generously funded public sector.

The truth of the matter is that, in England, the New Labour government has carried out major reforms to the NHS that have introduced more elements of privatisation than the previous Conservative governments were ever able to get away with; e.g. Foundation Trusts; autonomous GP surgeries competing for funding based on ‘performance’; public-private partnerships to build and run hospitals; outsourcing essential and ‘inessential’ services to private contractors; the introduction of patient ‘choice’, causing treatment centres to compete against each other to deliver the most lucrative and ‘popular’ treatments; more ‘consumer-friendly’ polyclinics being forced through despite the objections of practitioners fearing it would result in the break-down of individual doctor-patient relationships; etc. etc.

Not to put too fine a point on it, the Tories’ actual policies as outlined in policy documents such as their Plan for NHS Improvement are pretty much more of the same: advocating a flexible blend of public-sector and private-provider approaches to deliver the desired health benefits supposedly more cost-effectively and efficiently. This document, by the way, is an absolute master class in the art of dodging the issue of which National Health Service, or rather which nation’s health service, is being discussed, as it studiously avoids referring to England in all but some statistical examples that strangely relate to England alone (strangely, that is, if you thought the policy document was referring to Britain when in fact it was dealing with the English NHS only).

So for all the hullabaloo over the past few days, it turns out that there are in practice no ideological differences between Labour and the Conservatives over the NHS (in England, that is); just minor differences in the methods to be adopted to deliver the same type of ‘reforms’ – by which is meant the introduction of market mechanisms that supposedly lead to greater efficiency, and improved patient choice and outcomes. But to listen to the politicians from both parties as they traded blows over this you could be mistaken for thinking that what they are really falling over backwards to agree about is their commitment to the principles of a generously funded, public sector-based ‘British’ NHS that lives up to its founding mission to provide health care free at the point of delivery.

Two aspects are key here: 1) a general ideological shift has occurred, prompted by the recession, whereby people’s faith that markets could go on delivering ever greater prosperity, and hence the mechanisms and means to continually improve the NHS, has been shaken; and they are worried that talk of increasing private-sector involvement in the health-care system is simply an excuse to make expenditure cuts. Labour are clearly playing on these concerns; and the Tories are having to emphasise the fact that they plan to increase expenditure on the NHS (in England) in real terms, and underplay the fact that they are still intending to introduce more private-sector mechanisms for allocating those resources and delivering care; 2) both parties have a strong vested interest in suppressing the fact that the marketisation of the NHS they have been carrying out and intend to extend even further is limited to England, whereas the separately administered and funded NHS’s in the other countries of the UK have continued on more traditional public-sector lines.

In other words, the parties’ concern to underplay their commitment to market principles in the NHS is of one piece with their need to suppress the England-specific character of those market reforms – by which I do not mean that those reforms are supported by the English people and reflect the English ‘character’ as such; but rather the mere fact that those reforms have been and would be driven through in England only. Why is this? Because both parties, for their separate reasons, want to be seen as parties for Britain, not England. Labour is appealing to its core support, particularly in Scotland and Wales where it has supported and provided funding (via the Barnett Formula) for traditional public-sector NHS’s. Ignoring the rather different market-orientated policies that have been specific to its management of the English NHS helps Labour to invoke the folk memory of the nationalised health service when it was indeed a uniform public-sector service for the whole of Britain.

The Tories, for their part, are desperate not to be seen as a party associated with the Thatcherite market economics and wholesale privatisations that always enjoyed far more popular support (though never that of a majority of English voters) in England than in Scotland or Wales. For the Tories, openly supporting private-sector initiatives to improve public health-care outcomes, even though (and in part because) such measures would be limited to England, would be electoral suicide in Scotland and Wales. The Conservatives would then be portrayed as the party for the wealthy south of England, intent on cutting public expenditure in England, leading to reduced budgets in Scotland and Wales via the workings of the Barnett Formula. And, in fact, this is true. As I stated in my previous post on this subject, although the Tories are actually pledging to increase expenditure on health in England, they’re planning overall cuts in spending, which will result in lower budgets for the Scottish, Welsh and Northern Irish administrations, and possibly the need to cut spending on their NHS’s. So in fact, the Tories may end up spending more on the English NHS resulting in less spending on the NHS’s in the other UK countries.

So, by referring to the English NHS as the British NHS, the Labour Party are trying to gloss over their record in government, which has involved a substantial degree of privatisation of the service in England that the party has not supported in Scotland or Wales. And the Tories are also trying to downplay their actual support for market reforms of the NHS in England, which risks conjuring up the ghost of Margaret Thatcher and the idea that the Conservatives are the party for the wealthy and privileged of England (particularly, the south), not a progressive party for the whole of Britain.

But the consequence is that neither of the parties can be honest about their plans for the English NHS as such. Can we really be sure that if, by some freak, Labour got re-elected, they would not deepen their marketisation of the NHS – in England, only? And can we be confident that when the Tories set about extending the role of the private sector in the NHS (in England only), this will not become an excuse for delivering ‘efficiency savings’ that can then be passed on to the less efficient NHS’s in the other UK nations via the superior state funding they are guaranteed by the Barnett Formula? We don’t know, because the parties won’t tell us. They merely talk in misty-eyed terms of the British institution that is the NHS and how they stand firmly by its principles – even if those principles are put into practice in very different ways in England from the rest of the UK.

On one level, that’s fine: why shouldn’t the different nations of Britain develop the NHS along divergent lines in accordance with popular and national priorities? Why not, indeed? Except, in England, our actual priorities are not taken into consideration at all: the parties appeal to our affections for a fully state-funded and -run ‘British’ NHS and then they deliver an NHS in England that suits their own ideological and economic agendas, and is not what most English people are expecting, I would think. If the politicians actually engaged in dialogue with the English people and debated with them what sort of NHS we think we can afford, and the mix of public- and private-sector approaches that might best deliver the desired result, they might be surprised at the response they got. I don’t actually know what that would be: it might be more traditional public-sector, or more innovative, commercial and hybrid public-private. Genuine public consultation across the nation could deliver surprising results.

But the point is we’re not consulted, because a politics of dialogue between the English people and their political representatives would actually create a national English political community: one which might in turn design an English NHS that was worthy of the name. Instead, under the guise of a supposedly uniform British NHS that no longer exists, the parties canvass our support and that of those living in the other UK nations in order to deliver their own unspoken agendas for England. Unspoken, that is, because if they can’t even say the name of the country whose NHS they are supposedly standing up for, then such a health service is not a National Health Service that is truly designed with the best health outcomes in mind for the English nation.

And then they have the gall to talk of patriotism.

15 August 2009

Email of complaint to the Today programme on coverage of the ‘British NHS’ debate

Filed under: BBC,English NHS,NHS,Today Programme — David @ 7.42 am
Tags: , ,

Just sent the Today programme this email:

Do you think that Today and the BBC in general could take a bit more care to differentiate between what relates to the NHS across Britain as a whole and what is specific to England? In none of the discussion anywhere in the BBC yesterday did anyone point out that the party spokespersons’ competence related only to the English NHS, and that many of the discussion points concerning NHS funding and organisation were relevant to England only.

Another example: the discussion on this morning’s programme comparing US and British attitudes to each other’s health-care systems. The ‘British’ expert was in fact an English health-care practitioner and most of his points related to England only; e.g. NICE, the two-week cancer pledge, the statistics on waiting lists, etc.

Please when talking about the English NHS, call it as such. For further discussion on this, see my blog post: https://britologywatch.wordpress.com/2009/08/15/the-conservatives-are-the-%e2%80%9cparty-of-the-nhs%e2%80%9d-but-which-one/.

The Conservatives are the “party of the NHS”: but which one?

It’s as if devolution never happened and we were back in the ‘good old days’ when there genuinely was only one National Health Service. Not one single item – not one – in all of the news coverage I saw or heard yesterday on the reaction to Tory MEP Daniel Hannan’s criticism of the NHS on US TV correctly referred to the organisation in question as the ‘English NHS’ (or, at least, the ‘NHS in England’), which is what they were actually talking about.

At least, David Cameron, Andrew Lansley (the Conservative Shadow Health Secretary (for England)) and Andy Burnham (the actual Health Secretary in England) can only have been referring to the NHS in England in their comments following Hannan’s contribution, as that’s the only NHS they either will have (if the Tories win the general election) or presently have responsibility for. But you couldn’t tell that from what they said.

David Cameron: “Just look at all the support which the NHS has received on Twitter over the last couple of days. It is a reminder – if one were needed – of how proud we in Britain are of the NHS. . . . That’s why we as a Party are so committed not just to the principles behind the NHS, but to doing all we can to improve the way it works in practice.”

Andrew Lansley: “Andrew pointed out that many of the NHS reforms promised by Labour, including practice-based commissioning, Foundation Trusts, patient choice and independent sector investment, have stalled under Gordon Brown. And he stressed, ‘All those who care about the NHS know that these are the kind of reforms that will enable us to achieve the combination of equity, efficiency and excellence which should be the hallmark of the NHS’.”

Andy Burnham: “I would almost feel . . . it is unpatriotic because he is talking in foreign media and not representing, in my view, the views of the vast majority of British people and actually, I think giving an unfair impression of the National Health Service himself, a British representative on foreign media”.

Let me note in passing what a complete and utter joke those last remarks of Andy Burnham’s are. Has Burnham suddenly transmuted into an English patriot, as it’s only the English NHS that he and the government of which he is a part has anything to do with? I don’t think so. Hannan’s not a ‘British representative’, i.e. a representative of the British government or parliament. But if he was, then doubtless Burnham feels his job would be to do what Burnham himself does: not so much misrepresenting the ‘British NHS’ abroad but misrepresenting the English NHS to the English public as the British NHS!

And as for that Twitter stream, don’t waste your time checking it out. It’s full of junk now, and I had to click down a couple of hundred entries before I got any reference to England that wasn’t either a porn link or a job ad, or indeed practically any reference to the political debate.

But actually, Twitter is quite a good metaphor for the debate: full of sentimental waffle but very little substance. It’s easy to prattle on about the NHS as a great British institution of which the people of Britain are rightly proud and keen to defend from unfair criticism from abroad. But the reality is that as a national-British institution, the NHS already no longer exists. It’s New Labour, not the Tories, that did away with it through devolution. And its the New Labour British government that did far more than the Tories ever did to privatise the NHS in England, with things like public-private partnerships to build and run new hospitals, the introduction of internal health-care markets, Foundation Trusts, and competition between GP surgeries and the new supposedly ‘consumer-friendly’ polyclinics, etc. Admittedly, while all of that was going on, the NHS’s of the other UK nations were – for good or ill – remaining more faithful to Labour’s traditional socialist principles, with fully public sector-based organisations amply subsidised by the English taxpayer.

Does it matter, though, whether you call it the ‘English NHS’ or the ‘British NHS’? Isn’t this just semantics? Well, I think the English believe in the principle of calling a spade a spade: if you are talking about something that relates to England only, you should at least have the honesty and courtesy to let people know that’s what you’re doing. Of course, on one level, it’s legitimate to refer to the ‘British NHS’ even when discussing policy for its English variant; i.e. when talking about the founding principles that are said to inform the NHS throughout Britain to this day: fully public-funded health care free at the point of delivery. But the point is those principles are not applied evenly, and equally, across the whole of the UK. There is no longer a single UK model for how public-sector health care should be funded and organised. And the model presently applied in England has moved further away from the NHS’s original principles than that in any of the other UK nations.

This does matter for the political debate going forward into the general election. Daniel Hannan has helpfully exposed a vulnerability of the Tories in England, because it’s clear that the Tories do support further reform of the English NHS along the lines set out by New Labour. Those Tory reforms mentioned above in the context of Andrew Lansley’s reaction to Hannan’s remarks (“practice-based commissioning, Foundation Trusts, patient choice and independent sector investment”) are precisely New Labour policies that the Tories claim the government has failed to deliver. If the Tories pursue them, they will indeed drive further marketisation of the NHS – but only in England. By appealing to the founding ‘British NHS’ principles, and by promising to increase NHS funding in real terms, the Tories are trying to make out that they back the traditional, fully nationalised model for health-care delivery in the UK. They may well support a generously public-funded health-care system; but in England, at least, the delivery model will involve a much greater role for private companies and market competition, which will inevitably lead to inequalities and increased variations in the availability of high-quality NHS treatment for different conditions in different parts of ‘the country’ – England, that is. But the more they talk up their allegiance to the traditions of the ‘British NHS’, the more they hope we won’t read the English small print.

Plus the Tories are also addressing the non-English electoral ‘market’, of course, and are hoping that the uninformed (misinformed) public there – again, through the emotive appeal to the NHS as a national-British institution – will be deluded into thinking that a Conservative government will have direct influence on health-care policy in their countries (which it won’t) and will stand guarantor for traditional NHS values there – which it may do, through acquiescence with the policy variations and funding inequalities that have flowed from asymmetric devolution and the Barnett Formula. But actually, a real-terms increase in public expenditure on health in England will not necessarily deliver corresponding and proportionately greater increases in NHS funding in the other countries of the UK. This is because public expenditure overall under the Tories is set to decrease, so that increases in the health budget will have to be paid for by cuts elsewhere. And a decrease in overall spending in England will result in even greater proportionate decreases in Scotland, Wales and Northern Ireland. In other words, increased investment in the NHS in England may actually result in the need to cut the NHS budget in the other nations. While some of us in England might derive malicious satisfaction from what would in effect be a levelling out of healthcare apartheid (and, after all, the Tories have promised, dishonestly, to improve equality of NHS care throughout the UK), this is a wilful deception of voters in Scotland, Wales and Northern Ireland: the Tories appear to be promising to increase NHS funding throughout the UK; but actually, they’re talking about England only; and increases in the English health-care budget may indirectly lead to decreases in the health-care budget in the other parts of the UK.

But Labour can’t talk, either. This system of unequal funding and differing delivery models throughout the UK is the one that they set up; and to claim that they support a uniform UK-wide NHS organised along traditional lines is a pure, downright lie. Well, they might emotionally support it, with misty-eyed reverence towards Nye Bevan and the post-war settlement; but in practice, the New Labour government has already broken up that British NHS beyond repair. The truth of the matter is New Labour has run out of policy ideas for the NHS in England but has supported a traditional-type NHS in the other UK countries. So all it can do is appeal to ‘patriotic’ and nostalgic support for a great British institution that is no more (in England, at least) in the hope that it can deceive enough of the English people for enough of the time to secure another election ‘victory’ that will enable it to continue to cross-subsidise a traditional NHS in Scotland, Wales and Northern Ireland through further privatisation of the system in England – as they have done since 1997.

Well, the English people won’t fall for that one again. But they might fall for the similar trap the Tories are laying. The English people need to have an informed debate on the type of health-care system they want in England; because that’s what the whole argument is really all about. Health care in Scotland, Wales and Northern Ireland is dealt with separately by the devolved administrations. So it’s only the English system that the Westminster politicians can do anything about. By claiming, as David Cameron did yesterday, that the Conservatives are the “party of the NHS”, the Tories are trying to reassure the English people that the NHS is safe in their hands. But that’s not the point. There will still be an NHS; but what sort of NHS will it be in England, as opposed to the doubtless very different NHS’s that are developing along divergent lines in the rest of the UK? The Tories need to be honest and up front about the small print of their plans for England, and not obfuscate the whole discussion by misleading references to a monolithic British NHS that is no more. But so do the politicians of all parties.

After all, Mr Cameron, Brown and Co., you can’t fool all of the English people all of the time, even if you think you can.

Next Page »

Create a free website or blog at WordPress.com.