Britology Watch: Deconstructing \’British Values\’

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?


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:

12 June 2008

Campaign For Plain England No. 8: The BBC is told to ‘say England’

I can confirm that I am not Professor Anthony King, the author of an independent report commissioned by the BBC Trust, which appeared yesterday. I feel I need to point this out, as so much of the report could have been lifted directly from the analyses in this blog – particularly, this Campaign For Plain England series – of the way news reporting frequently describes the England-only decisions and statements of government as if they related to the whole of the UK.

So much of my analysis is there:

  • the way in which the TV or radio audience is often not “made aware by clear labelling which facts relate to which nations of the UK”
  • the way in which this leads viewers or listeners to assume that “the story applied to the whole UK when it did not”
  • the “common practice for presenters and newsreaders to mention at the top of a story that the story related only to England but then never to mention that fact again, even in the course of a lengthy programme”
  • the fact that “it was extremely rare for an attempt to be made to compare and contrast an event or development in England with a comparable event or development in one of the devolved nations”
  • the fact that in the Radio Four Today programme’s coverage of GB’s [Gordon Brown’s] commitment to train British workers for British jobs (which in reality meant only English workers and training), “the words ‘England’ and ‘English’ were used only three times in the course of six items; the words ‘Britain’ and ‘British’ were used 46 times, and there were two unexplained references to the UK and ‘the country'”
  • and the fact that this lack of clarity was very much reflected in the government’s own communications, as exemplified by a press release that left it to a footnote at the end to make clear that “this press notice relates to England only”. Actually, in my experience, the wording is usually even more insulting: “This press notice relates to ‘England’ [in quotation marks] only”.

The focus of Professor King’s report is somewhat broader than my analyses. As he puts it, “the BBC Trust . . . asked us, in essence, a single question: in recent years, has the BBC’s UK-wide network news, current-affairs and factual programming kept pace with – and responded adequately and appropriately to – the United Kingdom’s changing political, social, economic and cultural architecture?” His answer to this question is an emphatic ‘no’. Specifically, he criticises not only the way England-only stories are misleadingly presented as UK or ‘British’ ones; but also the failure to report adequately, in national UK news, on politics and government in the devolved nations, which would properly inform people (particularly, English people) about the different ways the nations are governed, allowing them to make informed comparisons of the very divergent policies being pursued by each national government. The two failings are obviously interdependent: if England-specific news is presented as if it were UK-wide, then it would be rather inconsistent to make a big effort to point out how differently things are being done in the other UK countries.

Well, it’s nice to be able to say ‘I told you so’ once in a while! Where I take issue with Professor King is in two minor but significant areas. First, he refers to the fact that media present England-only stories as if they applied to the whole of the UK as exhibiting “a general bias in favour of stories about England or telling stories from an England perspective” and as “Anglocentric”. This is despite the fact that he also makes clear – as in one of the examples I refer to above – that ‘England’ is often hardly mentioned explicitly in such reports, and everything is described as relating to ‘Britain’ and ‘the country’. It scarcely seems fair to call this ‘Anglocentric’. It’s only Anglocentric insofar as England precisely is not differentiated from the UK (and hence English politics is not differentiated from Scottish, Welsh and Northern Irish politics). In other words, such stories articulate an assimilation of England to the UK / Britain, such that it amounts to a replacement of ‘England’ by ‘Britain’: when politicians and media reports really mean England, they say Britain.

This relates to my second point of divergence from Prof. King: his diagnosis of why this ignoring of the differences in the politics of the UK nations has occurred, even on the part of the BBC with its public-service remit. The Professor identifies this as reflecting the London- and Westminster-centric mindset of the national media, and their being “accustomed to a nation in which almost everything that really matters – politically, culturally, socially, financially – happens in or near London”. There is also a “symbiosis between BBC journalists and Westminster politicians. . . . They have a shared professional interest in convincing themselves – thereby perhaps unwittingly convincing
others – that nothing has changed, that God is still in his heaven and that power, real
power, is still located uniquely in the Palace of Westminster”.

It’s with this ‘perhaps unwittingly’ that I disagree. The failings in the BBC’s news reporting are so completely consistent with government practice that it is hard not to come to the conclusion that there is deliberate collusion between Westminster politicians and BBC journalists. The piece that is missing from Professor King’s analysis – in fairness, it wasn’t part of his brief – is a study of how government has practiced to deceive in exactly the same way: referring systematically to ‘Britain’ and ‘the country’ where England is really intended.

Professor King is pointing to a traditional mindset that did, and still does, exist: the identification between England and Britain, reflecting the fact that England was the centre of power of a unitary UK that no longer exists. But, overlaying this under New Labour in the post-devolution world, has been a more sinister and deliberate refusal to acknowledge that so much of the work of the UK government applies to England alone. And the reason why this has been done is that the establishment (and this includes the opposition parties, which carry on exactly the same deceit) doesn’t want the English public to be aware of the anomaly that England is the only UK country that doesn’t have a devolved national parliament to deal with its nation-specific affairs. Hence, playing on English people’s traditional identification of England with the UK, and bolstering the illusion by plentiful references to ‘Britain’ and ‘the country’ when the subject matter being discussed involves England only, is a deliberate tactic to prevent English people from grasping the realities of devolution and so demanding a piece of the action for themselves.

Professor King gets very close to this, to me, totally obvious inference; perhaps he realises this is what is going on but doesn’t say so, as his remit is to analyse only what the BBC has been doing, not to make assertions – however well backed up by abundant circumstantial evidence – as to the political motivations. The Professor talks about the benefits that would result from the BBC reporting much more clearly and accurately about the differences in governance between the UK nations. He writes: “we have been struck by the network’s apparent reluctance to explore or even take note of the UK’s emerging institutional variety, even when that variety is of UK-wide political significance and may ultimately impact upon the future of the UK itself”. Well, precisely: the BBC, in common with the UK government, doesn’t want this particular can of worms to be opened up.

Again: “the union’s variety, the state of the union and the future of the union should be threads running throughout the network’s output”. Of course, this is what should happen; and the fact that it hasn’t is precisely because the powers that be wanted to pretend that it was Westminster business as usual and that the ‘future of the union’ was unquestionable. And again: “Even when mention was made of the fact that a news item related only to England, it was extremely rare for an attempt to be made to compare and contrast an event or development in England with a comparable event or development in one of the devolved nations”. Well, exactly: the government doesn’t want people in England to make such comparisons because then they’ll realise there are alternatives to unpopular England-only policies being pursued by an unrepresentative UK government, which they could get if they had an English parliament elected under PR like those of Scotland and Wales.

All the same, Professor King’s report makes refreshing reading: it’s a breath of fresh air when an impartial person with the authority to call the BBC to account makes very similar observations to one’s own concerning the inadequacies of the media to ‘say England’ (and, indeed, ‘Scotland’, ‘Wales’ and ‘Northern Ireland’) when that’s what they mean.

The number’s up on the cosy collusion between the national media and the Westminster political class. Let’s hope the BBC puts its house in order even if the House of Commons won’t!

17 January 2008

The Campaign For Plain England (No. 1)

Taking my cue from the Campaign for Plain English – the organisation that campaigns for public bodies and businesses to produce information for the public and consumers in simple, easy-to-understand English – I’m today launching the Campaign for Plain England: an occasional series pointing up failures by government, politicians, public-sector organisations and the media to make it plain when they’re referring to England.

First in the series, today’s news story about the House of Commons Public Accounts Committee report calling for GPs in England to prescribe more generic drugs rather than their branded equivalants in order to prevent unnecessary expense. The report does appear to refer to the fact that it relates only to the NHS in England: ‘England’ is mentioned in total six times in the report’s 36 pages. However, on closer examination, readers have to infer that the report deals only with England; or else they must rely on contextual information such as their background knowledge that the House of Commons has competency in such matters only in relation to England, or by reference to the BBC News’ website‘s clarification that the report concerns itself with England (hat tip to the said website for saying ‘England’ in the first sentence of its report).

The report never makes it totally explicit that its recommendations relate to England only. The actual references to England come in the form of statistical information concerning the historical and current situation with regard to drug prescribing. The rest of its lengthy deliberations contain no reference to England. Nor is England mentioned on the title page.

Perhaps this lack of transparency about the report’s exclusive England focus was what foxed the BBC Radio 4 Today programme this morning, as they referred to the Public Accounts Committee’s report in their news bulletin, and then conducted a five-minute interview with a supporter and opponent of the Committee’s recommendations, without once mentioning they related to England only. So there was I left hanging, not sure whether in fact the report was relevant to the UK as a whole or just England, but assuming that it was England only, which indeed turns out to be the case – I presume.

4 out of 5 for the BBC news website (not 5, as only one mention of England, admittedly in the first sentence)

1 out of 5 for the Public Accounts Committee report (several mentions of England but never totally explicit that the whole report relates to England)

0 out of 5 for the Today programme – total editorial failure there!

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