Healthcare Manager — 2024 Election Special

The election special edition of Healthcare Manager is out now.

Election coverage is difficult. There’s a lot of noise to cut through but very little light shed on the big issues. We’ve tried to look at this election from our readers’ perspective, as people trying to manage health and care services in the most difficult environment since World War II. We’ve set out what we see as the business the next government – red or blue – needs to get done in the NHS. We’ve looked at what the experts say about six big issues – waiting lists, workforce, social care, reform, buildings and technology – and what Labour and the Tories are offering. And we’ve examined four (there are many more) looming trouble spots that you won’t hear much about in the campaign.

We also have an interview with GP, comedian and health campaigner Dr Phil Hammond, some tips on how to restart your career after redundancy and some frank advice on what to do if you’re being discriminated against at work.

I hope you enjoy it. The digital edition is free for everyone to download and read. 

If you would like to know more about Healthcare Manager magazine or work with us on a story, please drop me a line.

Book review: The French Exception, by Adam Plowright

Published by Public Service Magazine, Autumn 2018. Photo: Jacques Paquier/flickr.com

If you want to be French president, you usually have to be good at waiting. It’s a job for which even political giants, like Mitterrand, de Gaulle and Chirac, spent decades preparing before landing the prize. For others, like Michel Rocard and Alain Juppé, the prize never quite materialised.

But Emmanuel Macron doesn’t do waiting, and the scale and pace of his ambition is exhausting. In this book – a slightly uneasy blend of biography and tour d’horizon of French society – British journalist Adam Plowright portrays Macron as a leader belonging to the more swashbuckling tradition represented by Nicholas Sarkozy and Napoleons I and III: flashy, sharply-dressed, silver-tongued outsiders in a hurry. 

The idea of the “providential man” (or woman, in the case of Joan of Arc) who will banish the nation’s woes through sheer force of personality, is deeply embedded in the French psyche, Plowright claims. Quoting the eminent French historian Jean Garrigues, he enthuses about “a form of charisma, an ability to create a sort of collective enthusiasm, which Bonaparte and de Gaulle clearly had”, while also warning about “a Christ-like dimension, a sort of mysticism.” 

Macron emerges as surprisingly “cynical” and “manipulative”, even “quasi-monarchical”, for a modern European liberal. There is little internal democracy, Plowright points out, within Macron’s hastily-assembled political party, La Republique En Marche!, which still functions primarily as a personal political vehicle. And he describes how Macron has irked some supporters, and impressed others, with his insistence on the trappings of power – most famously with his bad-tempered rebuke to one young voter who had the temerity to call him ‘Manu’. 

For all the novelty of Macron’s youth, his “unconventional” marriage to his former arts teacher, his status as an outsider to the political process, and his sheer freshness in comparison to France’s grey and stale political class (in which some of Mitterrand’s cohorts are still active), what emerges from Plowright’s well-drawn pen portrait is a fairly conventional centrist European politician – though with his emphasis on work and efficiency, one who sounds more a bit more German than French. 

But while he offers a few vox-pops from Macron supporters, mostly small business people enthused by the prospect of it being easier to sack people, Plowright never really gets under the skin of today’s France. It remains a mystery how this pro-European, pro-business graduate of France’s elite political school managed to transcend the “sour national mood” in France, and become the unifying national figure who personified the change the nation needed.

One answer, of course is that he didn’t. By peeling away votes from the moderate left and moderate right, and sewing up the centre through his deal with veteran liberal François Bayrou, Macron scraped into the second round of the presidential poll, where, head-to-head against the neo-fascist Marine Le Pen, he was home and dry. His political future depends on holding that coalition together and forging it into something more meaningful and long-lasting.

France didn’t much take to its “normal” president, François Hollande. Yet, with Macron we see something like a palimpsest of his predecessors: the messianic qualities of Napoleon and de Gaulle, some of the cunning of Mitterrand, the centrist pan-European politics of Giscard d’Estaing, the haughtiness and faux-grandeur of Jacques Chirac and the flashy ambition of Nicholas Sarkozy. If he can avoid Hollande’s ponderousness and Pompidou’s chain-smoking, Macron – and France – might just be onto something. 

  • The French Exception: Emmanuel Macron – the Extraordinary Rise and Risk (updated edition), by Adam Plowright. Icon Books, 300pp, £8.99

 

Book review: Citizen Clem by John Bew

Published in Public Service Magazine, Autumn 2017. Photo: National Library of Australia (CC)

For someone often cited as our greatest prime minister, something of a reverse cult of personality surrounds Clement Attlee. The aura of heroism attaches more readily to his government than to the man himself. Who knows much now, for example, about Attlee’s distinguished service in World War I, when he was, as John Bew gleefully tells us in this classy new biography, “shot in the buttocks as he carried the red flag over the top”?

That red flag was the flag of his regiment, the South Lancashires, not the socialist standard sung about at Labour conferences. Bew argues convincingly that Attlee’s deep sense of patriotism and loyalty is the key to understanding his enduring political achievements. As a “social patriot” his patriotism, “meant not fidelity to caste or cohort, but to the commonwealth”. Attlee himself said his proudest achievement was not the NHS, but taking Labour into the wartime coalition with his friend Winston Churchill.

Bew explains how Attlee “matured into socialism” – developing the sense of purpose and steely determination that turned this shy and diffident man into the great achiever of the British left. Attlee “went left by going east”: his politics were forged in the years he spent as an East End social worker, subsisting in a garret above the youth club – an experience that Bew says inured him to the “Fabian aloofness” that infected many of his comrades.

Attlee’s genuine modesty led almost everyone to underestimate him (but not Churchill who, while often rude about his rival on the stump, deeply respected Attlee and defended him fiercely in private), and historians have long puzzled over how he survived 20 tumultuous years as Labour leader. While admitting that luck catapulted Attlee into the leadership in 1935, Bew suggests he was simply better than anyone else: “One of his undoubted skills was the navigate around the larger egos surrounding him, without letting disputes over personality get in the way of the swift execution of government policy.”

Like most effective revolutionaries – Thatcher, Lenin, Napoleon – Attlee was well read but always more of a doer than a thinker. Rejecting Marxism early on, he doggedly disputed the idea that socialism demanded an abrupt and complete break with Britain’s history and traditions, accusing more doctrinaire and impatient colleagues, like Harold Laski and Nye Bevan, of “demanding a caesarean section rather than a natural birth” for socialism. Poverty and inequality were a “national problem” which required the attention of the state. Attlee may have been a gradualist, but he knew where he wanted to go.

Without ever setting down a doctrine, Attlee painstakingly accumulated a bag of ideas about how democratic socialism should work, which he assembled into a distinctly British programme for government in the post-war years. They included a firm commitment to social justice, a balance between radicalism and pragmatism, a deep sense of patriotism, an emphasis on personal probity and loyalty, and a willingness to work with other traditions within society: Attlee knew that conservatism and socialism were different, but not opposites.

For today’s Labour Party, looking to combine radical socialism with electoral credibility, Bew’s book is a great place to start. Bew is right to argue that Attlee’s was a quintessentially 20th century project – 1945 cannot be repeated – and Labour would do better to learn from Attlee’s ethos rather than just basking in the reflected glow of his government’s achievements. After all, Attlee’s socialism – democratic but patriotic, principled but pragmatic – is the only kind of socialism that ever really worked.

I’m no Bennite. But I’m increasingly tempted by Jeremy Corbyn

Published by the New Statesman, 17 August 2015. Photo: YouTube/CC.

It’s a roll of the dice – but increasingly one that seems worth making.

In politics, I like to think of myself as principled but realistic. I’m a social democrat, not a Marxist. My political heroes were mostly practical, moderate socialists – intellectual heavyweights for sure, but people who didn’t mind dirtying their hands in getting something done: Denis Healey, Tony Crosland, Shirley Williams, François Mitterrand. People who understood the grubbiness of the material world and were prepared to work with it. People who had few illusions about how working people think, or about where extremism can lead.

When I was at university, 25 years ago, I was mocked (in a comradely way) for being the most right-wing member of the Labour club (although, as I remember, I was the only one prepared to join the Anti-Poll Tax Federation, a proscribed organisation in the Labour party at the time). When I left, the committee gave me a copy of The Ragged-Trousered Philanthropists, inscribed with warnings not move further to the right or become any more “careerist” (no worries on that score).

Inevitably, more than one or two of the wellwishers in that book went on to be leading lights in Tony Blair’s New Labour project. The party moved round me. What I thought of as mainstream social democracy went from being on the right of the party, to the centre and then to the left.

Even “Red Ed” Miliband couldn’t put together a coherent social democratic programme – although that had as much to do with lack of confidence as lack of conviction. By about 2000, it was a mark of the hard left to be in possession of, to use Denis Healey’s preferred definition of democratic socialism, “an obstinate will to erode by inches the conditions that produce avoidable suffering”.

The definition is, I think, Kolakowski’s. But in his memoirs, Healey went on to expand on his own feeling for what socialism should be:

Socialism emphasises the community rather than the individual, consensus rather than confrontation, public welfare rather than private gain; it puts the quality of life before the quantity of goods. But its priorities are not absolute; it does not deny that the values which it normally puts second will sometimes need to come first, or that it’s opponents may also give some importance to socialist values.”  

Spot on. But that’s Denis Healey, one-time monetarist chancellor and bête-noire of the Labour left in the 1980s. Spout that kind of stuff within earshot of today’s shadow cabinet and they visibly flinch.

Every fibre of my being says I shouldn’t vote for Jeremy Corbyn, but the reasons just keep melting away like snow on a hotplate. I think austerity is nuts; Corbyn is the only anti-austerity candidate. I think the NHS has had enough marketisation and privatisation; he’s the only one to rule out any more of it. I’ve always supported renationalising the railways; Corbyn is only candidate to say he agrees (I suspect Burnham and Cooper agree too, but are afraid to say so – hardly a compelling reason to support them). I’m against the cuts in tax credits which, after years of both parties telling people they’d be looked after if they got a job, are cruel and unnecessary. Corbyn is the only candidate who voted against them in the Commons.

These are not extreme or “hard left” policies. They’re solid, social democratic positions. And I’m willing to bet that they’re shared by a majority, or at least a very large minority, of the British people.

And then, just when I thought I’d found my personal red line, Corbyn ruled out supporting Brexit in the EU referendum.

But, scream Corbyn’s enemies, he can’t possibly win the election! True, all conventional wisdom and experience says it’s very unlikely. (I actually remember 1983). But that argument only holds water if you think any of the other three can win. I don’t.

Liz Kendall is in many ways an admirable candidate, but I’ve already written about how her England-only strategy simply cannot work. Andy Burnham and Yvette Cooper have so far offered little that’s new or interesting. And don’t even get me started on the delicious irony of a shadow cabinet which has led Labour to two disastrous defeats in a row lecturing the rest of the movement about winning elections.

What passes for Corbyn’s electoral strategy involves winning over non-voters and supporters of the Greens and the SNP. We don’t know if that can work; no one’s really tried it before. Election gurus tell us that non-voters are very hard to mobilise and many people think Scotland has “gone” already. So it looks optimistic, to say the least. But, after an election in which Labour lost 40 seats to the SNP and the Tory vote hardly changed, to say all we need to do is move closer to the Tories is just witless.

The best argument against Corbyn is simply that he isn’t a serious candidate. He doesn’t really want to be leader, still less prime minister. It’s hard to imagine him going up against Cameron at PMQs. He’s too old (71 at the next election). The rest of the shadow cabinet may not work with him. There are some unpleasant people associated with his campaign talking about purging the party. Corbyn himself has taken foolish positions with respect to the IRA and Hamas in the past, which will be ruthlessly deployed against him in the future.

Much more importantly, Corbyn’s policies, attractive as many are to people on the left, don’t add up to a coherent programme for a socialist government. I’m disappointed with Corbyn on policy; I hoped he’d be more imaginative and serious once it became clear he had a chance of winning. Corbyn’s campaign still prefers to chant slogans about the failures of free-market capitalism rather than do the hard work of transforming it into something better for working people. There’s no attempt to develop a serious political strategy that can unite more of the anti-Tory majority around a progressive platform. And I’m still baffled by Jeremy’s reluctance to back electoral reform. (Corbyn is now promising to make his website a forum for serious policy debate. Marina Mazzacuto and Will Hutton’s thinking about an “enabling” or “entrepreneurial” state – refracted into a political programme by Peter Hain – might be a good place to start.)

But if Corbyn’s campaign looks like a protest movement, that’s because it is. It increasingly resembles a typically English, cobbled-together version of the movement against austerity and neo-liberalism we’ve seen in Scotland, Greece, Spain and other parts of Europe. Young people, in particular, are flocking to Corbyn and his campaign seems to be igniting interest and passion in politics in the same way as the Scottish indepedence referendum did last year. If Corbyn can forge that movement – which stretches from moderate social democrats like me to the far fringes of the Occupy movement — into a political fighting force, that might be better for the left than trying to scrape together a Labour majority from soft Tories and refugee Lib Dems. But that’s a big “if”.

Voting for Corbyn means gambling with the life of the party we love for an uncertain, amorphous return. In normal circumstances I’d never go near it. But these aren’t normal times; across Europe, the future of the democratic left itself is at stake. It might just be worth rolling the dice.

Craig Ryan is a Labour member, writer and blogger. You can read his work here. 

Wake up or smell the coffin

Labour isn’t the whole left and it can’t do everything on its own. We need a progressive alliance to beat the Tories and change these islands for good.

The UK, with or without Scotland, now faces permanent Conservative government. Once the Tories have redrawn the constituency boundaries in their favour, it will be virtually impossible for Labour to win a majority in England and Wales on its own, and Scotland is no longer willing to ride to its rescue. Exit poll guru John Curtice says Labour needs at least a 12% lead south of the border to form a majority government – greater even than Tony Blair achieved in 1997 – and that’s without the boundary changes.

Nevertheless, retired Blairites like Peter Mandelson, David Miliband and Alan Milburn insist the party must return to the New Labour strategy of the 1990s. If only it were that simple. The three Ms ought to understand their own project better: New Labour relied on both a two-party system and the existence of a substantial number of “soft” Tories willing to consider voting Labour. That way, Labour could safely move to the right knowing that it’s “core” support among working class people had nowhere else to go. 

To borrow Jim Callaghan’s phrase, I tell you in all candour that that option no longer exists.

First, there aren’t that many soft Tories. The Conservatives polled only 36% in 2015, compared to the 43% in 1992. There are your soft Tories, right there in that 7%. Secondly, move to the right and Labour’s core voters now have other choices. The SNP tsunami in Scotland, the UKIP surge in the north and east of England and the more modest progress of the Greens in the south, shows they’re increasingly willing to exercise them. Slim pickings on the right and leaking votes to the left – pursue the New Labour strategy and the fate of the next Labour leader will look more like Nick Clegg’s than Tony Blair’s.

How does Labour solve this conundrum of having the be both more left-wing and more right-wing at the same time?

I don’t know. Perhaps someone can work out a programme that will be both convincing to working class voters and credible to the Tory-leaning middle classes. Perhaps the Tories will tear themselves to pieces over Europe and people will flock back to Labour. Perhaps a spectacularly charismatic new Labour leader will generate such enthusiasm that all these dilemmas and past disappointments will be swept aside. Perhaps if all three of these things happen, Labour will be able to win next time. But I doubt it. And I bet you do too.

So let’s look at this another way. Labour can’t solve the conundrum, but maybe it doesn’t have to. The conundrum isn’t the problem. The problem is Labour.

The Tory MEP Daniel Hannan said something very important on the BBC last Friday. He said people have stopped seeing Labour as part of the British radical tradition and now see the party as “something narrow” and Labour politicians as “just in it for themselves”. He’s right. Since the election, Labour politicians have been talking about Britain as if it was a political party with a small country attached. Stop it! I’m sick and tired of hearing about how “only Labour can” save the NHS, solve the housing crisis, end poverty and deliver a better life for working people. As we’ve seen, all too often Labour can’t. And if I’m sick and tired of hearing it, you can bet your last penny working people are fed up with hearing it too. 

I love the Labour party (I’ve been a member for 30 years) and the labour movement (ditto), but they aren’t the the only progressive forces in the country. We face a daunting task in opposing the Tories’ ruthless programme, which seems to be nothing less than reimposing the plutocratic rule of the pre-democratic era. To stop them we will have to take on and beat the most powerful alliance of right-wing forces we’ve ever seen: global financial capitalism, a ferocious right-wing media controlled from abroad and a deeply-rooted Conservative party establishment, which extends into most areas of national life. Yes, the coalition of opposition we could range against them is formidable too. But only some of it is in the Labour party and the wider labour movement. Labour can’t do this on its own. And it shouldn’t try to.

Instead, we need some sort progressive alliance of all the anti-Tory forces in the country. We need to get a government elected that will introduce a fair voting system so we can – for the first time – elect a parliament that actually represents us. This is no time to be tribal, narrow-minded or cynically detached from electoral politics. The alliance needs to stretch from the Liberal Democrats through Labour, Plaid and the SNP, to the Greens. At a minimum, would it really be that hard to come to some arrangement that would allow Labour supporters to vote for Caroline Lucas with a clear conscience or save social democrats like Vince Cable from defeat by another Tory?

I know I might lose some of you here, but we also need to reach out to UKIP, or at least the millions of working people who voted for them. UKIP’s support for PR is self-interested, but that doesn’t make it any less justified. A single seat is an insult to the four million people who voted for them and the left shouldn’t be afraid of saying so. 

But a progressive alliance or popular front is about more than a pact between political parties. It has to include anyone who rejects the Tory vision of a society based entirely on market relationships, where working people are just hamsters on a wheel in a global race that ever ends, where nothing humans make or do has any value except the profit someone (usually someone else) can extract from it. There are enough things we can agree on – an end to ideological austerity, investment in housing, universal human rights, fairer wages, better rights at work, fair votes, to name but a few – for us to put aside our differences for a few years. 

And the same alliance should work together to make the Tories sweat for the next five years and beyond. Progressive politics in this country needs to be much more robust. Too often we’re content to fling statistics around to win the intellectual argument, and then to give in. A progressive alliance needs to link up all the groups around the country who will otherwise spend the next five or ten years campaigning in isolation. We need to win and be seen to be winning. People like winners. They vote for winners.

We can spend the next five years working our socks off in our different parties and campaigning silos, and the odds are we’ll be wasting our time. Or we can try to change our islands for good. The choice is ours, for once, not theirs. 

None of this will happen, of course. No Labour leadership candidate will dare whisper his or her nagging fear that Labour can’t win on its own. The collective ego of the labour movement can’t take that kind of honesty. Probably the best we can hope for is a minority Labour government with a pact for voting reform cobbled together after the voting’s done. But if we’re going to do deals, wouldn’t it be better to do them well before the election so everyone knows where they stand? And wouldn’t it be so much better, so much more powerful, if Labour were to grow up at last and take the lead in such a progressive alliance itself?

Photo by Michael D Beckwith on Unsplash