David Boyle's Blog, page 83
April 27, 2013
Why everyone needs the middle classes
I have now read through all the responses on Mumsnet to my blog about my book (Broke: Who Killed the Middle Classes?).
I did so with some trepidation because there were 92 of them, and also because - well, how shall we put it - Mumsnet has developed something of a reputation for flame-throwing. In fact, the worst response I got to my plea to save the middle classes was "aw, diddums". Others were very supportive.
Though I have found a second stream of comments on the same website about my Sunday Times article, which includes this rather wonderful condemnation:
"The article is a whinge from those picking lowish paid middle class careers and then not being happy with their choices and the low income that results."
Of course! That's why I'm so impoverished! We should have sold insurance.
Three issues have tended to come up:
1. That I mention London too much. This is probably true. But London is simply where the trends are most extreme. It is also the direction the rest of the country is rapidly going in.
2. That I am somehow accusing the poor of being 'uncivilised'. That is absolutely not the case. I am defending the opportunity to have some space in our lives for education, culture or leisure, or to lead a civilised life. Not just for the middle classes, but for everybody - and if the middle classes are losing this because they have to hold down three jobs (I know people in this situation) and are measured every second by their 'efficient' employers - then so will everyone else.
3. That I am somehow claiming that there must still be poor people, because otherwise there can't be middle classes. This is also nonsense. It may be etymologically true that a middle requires a bottom (if you see what I mean), but it is not economically true. There is no reason, except the way economics is currently organised, why everyone should not lead a more relaxed life.
What I am saying is that the middle classes are the front line against a tiny global elite. If they are deemed 'inefficient' or 'overpaid', and are corroded into a new proletariat - dependent on the whims of landlords and employers - then what chance is there for anybody else?
There is also the usual accusation that I am pandering to people who look down their noses at the hoi polloi (as one critic told me on Radio 3) and who want to send their children to private schools. In fact, only 7 per cent of UK pupils are being educated privately. That is not the middle classes, the vast majority of which are fully committed to public education - not necessarily because they want to be but because they can't afford anything else.
So it is worth saying exactly why I believe the middle classes need to survive:
Because they provide political and economic stability.Because their fierce determination to retain some independence, from landlords and bosses, is a vital underpinning for the liberties of everyone else.Because the alternative is a kind of 'efficient' tyranny where a tiny elite dominates a vast proletariat, without assets or power.And if you think that is impossible, have a look at these figures which show that a majority of UK children will soon be growing up below the breadline.
I did so with some trepidation because there were 92 of them, and also because - well, how shall we put it - Mumsnet has developed something of a reputation for flame-throwing. In fact, the worst response I got to my plea to save the middle classes was "aw, diddums". Others were very supportive.
Though I have found a second stream of comments on the same website about my Sunday Times article, which includes this rather wonderful condemnation:
"The article is a whinge from those picking lowish paid middle class careers and then not being happy with their choices and the low income that results."
Of course! That's why I'm so impoverished! We should have sold insurance.
Three issues have tended to come up:
1. That I mention London too much. This is probably true. But London is simply where the trends are most extreme. It is also the direction the rest of the country is rapidly going in.
2. That I am somehow accusing the poor of being 'uncivilised'. That is absolutely not the case. I am defending the opportunity to have some space in our lives for education, culture or leisure, or to lead a civilised life. Not just for the middle classes, but for everybody - and if the middle classes are losing this because they have to hold down three jobs (I know people in this situation) and are measured every second by their 'efficient' employers - then so will everyone else.
3. That I am somehow claiming that there must still be poor people, because otherwise there can't be middle classes. This is also nonsense. It may be etymologically true that a middle requires a bottom (if you see what I mean), but it is not economically true. There is no reason, except the way economics is currently organised, why everyone should not lead a more relaxed life.
What I am saying is that the middle classes are the front line against a tiny global elite. If they are deemed 'inefficient' or 'overpaid', and are corroded into a new proletariat - dependent on the whims of landlords and employers - then what chance is there for anybody else?
There is also the usual accusation that I am pandering to people who look down their noses at the hoi polloi (as one critic told me on Radio 3) and who want to send their children to private schools. In fact, only 7 per cent of UK pupils are being educated privately. That is not the middle classes, the vast majority of which are fully committed to public education - not necessarily because they want to be but because they can't afford anything else.
So it is worth saying exactly why I believe the middle classes need to survive:
Because they provide political and economic stability.Because their fierce determination to retain some independence, from landlords and bosses, is a vital underpinning for the liberties of everyone else.Because the alternative is a kind of 'efficient' tyranny where a tiny elite dominates a vast proletariat, without assets or power.And if you think that is impossible, have a look at these figures which show that a majority of UK children will soon be growing up below the breadline.
April 26, 2013
We can't afford a three-day-week NHS
Rather over two years ago, I encountered for the first time the out-of-hours GP service in Croydon. I rang NHS Direct about my youngest child, who was worryingly feverish. They eventually put me through to the duty doctor, who advised me to bring him in.
It was the early hours of Saturday morning, and I could not believe what I saw when I got to the our-of-hours service. A waiting room completely full of ill-looking people, some of them moaning. It had the atmosphere of a slave ship about it - the dull acceptance on people's faces, the look of exhaustion about the place, as if they had been waiting a very long time.
There was no sign of a doctor, and the people waiting were being processed very slowly by three nurses. While I was there, one woman collapsed in pain. The nurses looked sheepish, and I am not surprised. It was a third world service, for people who had been advised by NHS Direct to go in and had taken the trouble not to just turn up at A&E - which was actually downstairs.
Two doors next to each other, and I couldn't help feeling they would have been far better going to A&E.
Now I don't remember whether this was a service run by Croydoc (which eventually turned out to be run from someone's home in Norfolk) or by the social enterprise Patient Care 24, which were told in January they had lost their contract - covering three vast boroughs - as well. That isn't the point. The real point is that Jeremy Hunt was absolutely right yesterday to blame inadequate out-of-hours care for the 400,000 or more people who show up at A&E every week.
But there is another problem behind all this, which is the way that the NHS shuts down at weekends. Accident and emergency services are among the few which just carry on going, though there are now weekend walk-in services.
This doesn't mean that the NHS works at full stretch for five days a week either. In most hospitals, Fridays are dominated by preparing for the weekends, and Mondays are dominated by dealing with the weekend problems. In effect, they are working three days a week with a buffer either side. My local GP closes at weekends except for an hour on Saturday.
Again, it is hardly surprising that so many people do the rational thing and just show up at the service which remains in place, where there are doctors and equipment and somebody to triage them.
Of course it would be difficult moving to seven-day working right now, when resources are so tight, though it would certainly provide a more efficient service. But GPs are paid a very great deal to provide this effectively part-time service, thanks to the disastrous 2004 contracts - one of the Labour government's greatest mistakes - and this ought perhaps be the starting point for moving towards seven-day-a-week primary care.
It is too simple to blame GPs for the current situation. Some of them work extremely hard providing out of hours care. But the standard of that care, certainly where I live, is so much lower than it was and GPs really need to shoulder some of the burden for putting it right.
It was the early hours of Saturday morning, and I could not believe what I saw when I got to the our-of-hours service. A waiting room completely full of ill-looking people, some of them moaning. It had the atmosphere of a slave ship about it - the dull acceptance on people's faces, the look of exhaustion about the place, as if they had been waiting a very long time.
There was no sign of a doctor, and the people waiting were being processed very slowly by three nurses. While I was there, one woman collapsed in pain. The nurses looked sheepish, and I am not surprised. It was a third world service, for people who had been advised by NHS Direct to go in and had taken the trouble not to just turn up at A&E - which was actually downstairs.
Two doors next to each other, and I couldn't help feeling they would have been far better going to A&E.
Now I don't remember whether this was a service run by Croydoc (which eventually turned out to be run from someone's home in Norfolk) or by the social enterprise Patient Care 24, which were told in January they had lost their contract - covering three vast boroughs - as well. That isn't the point. The real point is that Jeremy Hunt was absolutely right yesterday to blame inadequate out-of-hours care for the 400,000 or more people who show up at A&E every week.
But there is another problem behind all this, which is the way that the NHS shuts down at weekends. Accident and emergency services are among the few which just carry on going, though there are now weekend walk-in services.
This doesn't mean that the NHS works at full stretch for five days a week either. In most hospitals, Fridays are dominated by preparing for the weekends, and Mondays are dominated by dealing with the weekend problems. In effect, they are working three days a week with a buffer either side. My local GP closes at weekends except for an hour on Saturday.
Again, it is hardly surprising that so many people do the rational thing and just show up at the service which remains in place, where there are doctors and equipment and somebody to triage them.
Of course it would be difficult moving to seven-day working right now, when resources are so tight, though it would certainly provide a more efficient service. But GPs are paid a very great deal to provide this effectively part-time service, thanks to the disastrous 2004 contracts - one of the Labour government's greatest mistakes - and this ought perhaps be the starting point for moving towards seven-day-a-week primary care.
It is too simple to blame GPs for the current situation. Some of them work extremely hard providing out of hours care. But the standard of that care, certainly where I live, is so much lower than it was and GPs really need to shoulder some of the burden for putting it right.
April 25, 2013
How the City ruined the middle classes
‘The riches which should have brought wealth have brought poverty.’That is what the Spanish economist González de Cellerigo wrote around 1600, and it is worryingly relevant to our own time. Cellerigo was a lawyer in the chancery who worked in Valladolid, the landlocked city where Christopher Columbus died. We don’t know much about him apart from that, except through his writings – mainly the Memorials he published that year, and especially the one with the least snappy title, About the policy restoration necessary and useful to the republic of Spain.
Cellerigo’s thinking was relevant to the middle classes then. But it is also relevant to our own, because he was one of a handful of economists over the previous four decades who grasped what happens when huge amounts of money flood into a nation, as unimaginable sums had flooded into Spain – gold and, above all silver, in treasure ships from the New World.
The Spanish monarchs had agonized about why money was losing its value, prosecuting, occasionally executing, people for causing inflation, and now they knew: too much money chasing too few goods causes the value of money to fall.
The staggering influx of wealth into Spain during the previous century had operated rather as the cascade of wealth into the City of London has operated in our own time. Instead of financing production, it was frittered away on interest payments for debt, buying luxury goods from abroad, raising prices and, in the case of sixteenth-century Spain, on the purchase of Eastern luxuries from the Portuguese empire.
By 1660, the amount of silver in Europe had tripled. Spanish money was worth a third of its value in 1505, and most of the massive injection of wealth which had been siphoned off by the Spanish kings had been wasted servicing debts incurred for their incessant European wars.
Bankers profited. The Spanish crown did not. Financial services grew ever more complex. Worse, Spain soon forgot how to make things on its own behalf, believing that the import of money itself was sufficient for its economy. As much as 80 per cent of the goods shipped from Spain to its new colonies had been imported from elsewhere in Europe.
The business of money for its own sake, the sophistication of financial services, tends to price other productive businesses out of existence, and that was the ruinous effect it had on the Spanish economy. Gold – and therefore money – became more important than the wealth it represented. Of course it drove out productive wealth: it seemed more important than that. Also, the more precious metal there was, the more bankers could extend their credit. The more interest-bearing debt there was in circulation, the more power went to bankers and the more prices rose.
This was the Spanish tragedy in a nutshell. A tiny elite emerged to manage this extraordinary influx of wealth into Spain, which paradoxically destroyed the nation’s productive capacity.
What González de Cellerigo realized, and his predecessors did not, was that this was no accident. The discovery of the wealth of the New World had destroyed the power of the Spanish empire, not through some kind of mistake, but by virtue of economic laws.
Cellerigo didn’t beat around the bush. He articulated what few had really understood before. Spain would have been better off without the Americas. The influx of gold had not been mishandled; it was a disaster in itself. And here is why:
"Our commonwealth has come to be an extreme contrast of rich and poor, and there is no means of adjusting them one to another. Our condition is one where there are rich who loll at ease or poor who beg, and we lack people of the middle sort, whom neither wealth nor poverty prevents from pursuing the rightful kind of business enjoined by natural law.”
Cellerigo’s diagnosis was that the huge influx of bullion had driven out the middle classes, leaving instead a desperate upper middle class of hidalgos who were snobbish about work (in fact were forbidden to do anything wealth-creating) and looked desperately to well-paid sinecures in the burgeoning bureaucracies, and a desperate lower middle class who had lapsed into poverty and dependence.
The Renaissance Spanish economy was constructed to encourage people to buy government bonds, or juros, rather than investing in business. As in our own time, the economy provided a far better return for people investing in money itself rather than productivity.
The fate of the Spanish at their zenith offers us a terrible glimpse of our own future, and still we have not developed the kind of understanding that Cellerigo did from his office in Valladolid, watching the extraordinary decline of Spain, not despite the influx of wealth but because of it.
Our politicians have not yet seen that the measures taken to make speculation the central purpose of the UK economy – the miscalculations of Big Bang and all that followed – are creating the same small elite and pushing the middle classes slowly into poverty and dependence.
That is what will happen, first for our own generation retiring with our miserable apologies for pensions, and then in the next generation – unable to buy homes and condemned to eking out an existence, in jobs we do not want, just to pay the rent. Unless we learn Cellerigo’s lessons ourselves, in our own time, the decline of Spain is likely to herald our future.
And that, plus a rather more detailed argument about the peculiar way our politics developed over the past three decades, is the key message of my new book Broke: Who Killed the Middle Classes? (published today).
Let me know what you think!
April 24, 2013
When I became the squeezed middle myself
Well, now I really know what it's like to be the squeezed middle. There I was last night on Night Waves on Radio 3, squeezed between Mark Littlewood of the Institute of Economic Affairs and the historian of the working class Selina Todd, being battered about the middle classes
But it was worth it because they were both very kind about the book (Broke: Who Killed the Middle Classes? is out tomorrow). They just didn't agree with me.
Mark thinks things will get better and better for the middle classes, if only it wasn't for taxes and planning regulations (I caricature his position slightly).
Selina took that classic middle class position - that really I shouldn't be writing about them at all, I should be writing about the plight of the poor (again, I caricature).
I have said the following throughout:
1. I'm not saying the middle classes are suffering more than anybody else - quite the reverse - but there is still something to write about. Other people have written about the working classes (Owen Jones for example). I'm writing about the middle classes.
2. This isn't just about the current downturn: the trends were there before, collapsing pensions, rampaging house prices, and the moral corrosion that followed Big Bang.
3. This is not an issue about independent schooling - only seven per cent of UK pupils are educated privately, but well over 60 per cent are still home owners.
But Selina caught me out in one area that I've been thinking about since. I say that there needs to be a healthy middle class. It provides political and economic stability. She said that implies that there has to be bottom; there have to be poor people if there are middle people. Etymologically, she is quite right - but I don't think she is right economically.
All I am saying is this. It matters that there should continue to be the possibility of space in people's lives, that they should not need to be dependent on the whims of landlords or bosses, or measured every time they go to the loo, call centre-style. I am not saying the poor should stay poor. I am saying that there needs to be the chance of a civilised life.
I am saying that the future looks like a great division between the proletarian, controlled, monitored masses, and the tiny elite. I am also saying that would be a disaster - but nothing I say implies that people should stay poor.
"All the world over I will back the masses against the classes," said Gladstone. I've never been absolutely sure what he meant, but I think he meant this.
But it was worth it because they were both very kind about the book (Broke: Who Killed the Middle Classes? is out tomorrow). They just didn't agree with me.
Mark thinks things will get better and better for the middle classes, if only it wasn't for taxes and planning regulations (I caricature his position slightly).
Selina took that classic middle class position - that really I shouldn't be writing about them at all, I should be writing about the plight of the poor (again, I caricature).
I have said the following throughout:
1. I'm not saying the middle classes are suffering more than anybody else - quite the reverse - but there is still something to write about. Other people have written about the working classes (Owen Jones for example). I'm writing about the middle classes.
2. This isn't just about the current downturn: the trends were there before, collapsing pensions, rampaging house prices, and the moral corrosion that followed Big Bang.
3. This is not an issue about independent schooling - only seven per cent of UK pupils are educated privately, but well over 60 per cent are still home owners.
But Selina caught me out in one area that I've been thinking about since. I say that there needs to be a healthy middle class. It provides political and economic stability. She said that implies that there has to be bottom; there have to be poor people if there are middle people. Etymologically, she is quite right - but I don't think she is right economically.
All I am saying is this. It matters that there should continue to be the possibility of space in people's lives, that they should not need to be dependent on the whims of landlords or bosses, or measured every time they go to the loo, call centre-style. I am not saying the poor should stay poor. I am saying that there needs to be the chance of a civilised life.
I am saying that the future looks like a great division between the proletarian, controlled, monitored masses, and the tiny elite. I am also saying that would be a disaster - but nothing I say implies that people should stay poor.
"All the world over I will back the masses against the classes," said Gladstone. I've never been absolutely sure what he meant, but I think he meant this.
April 23, 2013
Be very afraid of a judicial system with a point to make
Reading yesterday that Chris Huhne was back in court fighting an award of punitive costs of £110,000, on the grounds that he took a long time to plead guilty, I was suddenly overtaken by a wave of sympathy for him.
It is true that I am not unbiassed. I know Chris and admire him a great deal. As far as I know, there is no law against self-incrimination - quite the reverse - so I don't see why he should be punished twice in this way. But then, I am not a lawyer either.
The really extraordinary thing is that Chris Huhne and Vicky Pryce were given eight months in prison for a non-violent single offence, and - let's face it - a rather common offence too, committed before he was even elected.
I know there ought to be another standard for cabinet ministers who lie to the authorities, but this does explain a little why our prisons are being so pointlessly overcrowded - 83,000 in England and Wales according to the most recent statistics which came out on Friday (down on last year, but still 3,500 over maximum capacity).
This in itself is some explanation why crime remains such a problem: prisons are so ineffective that the rate of prisoners reoffending within a year after release has just risen to 26.8 per cent. Some prisons are such breeding grounds for crime that the rate is over 70 per cent.
Worst of all, perhaps, imagine having to listen to the hypocrisy and cant, piled high from the prosecution lawyers and others over the Huhne case. Ugh.
But then, they have a point to make. Chris Huhne was a thorn in the side of the establishment. Too many people pretend that partners were driving when they get flashed by robot speeding cameras. He must not just be jailed, he apparently has to be talked to death, humiliated - and then fined.
I agree, I am not an objective observer - but I am unsure whether anyone ought to be imprisoned when they are no danger to the public. There may be exceptions in the case of multiple offenders, but they will be very rare. But like the Myth of the Great White Defendant in Tom Wolfe's Bonfire of the Vanities, Huhne was so unusual, so privileged in comparison to the hopeless cases who queue through the criminal justice system, that he had to draw the full enthusiasm of the system down on him.
By so doing, he revealed just how ineffective it is.
Which brings me round to Rolf Harris. Now, I've no idea what he is accused of, or when. But, again, you have to beware the judicial system when it is trying to make a point - this time, a mea culpa response to their failure to restrain Jimmy Saville.
I don't know Rolf, though it is true I'm not objective here either - I could forgive him almost anything because of the role he played in my childhood. But I can't see how anyone can defend themselves effectively against an accusation about something that happened three decades or more ago.
You know there is a whiff of a witch hunt when you have to think twice about criticising a prosecution in case people think you have something to hide yourself.
All this provides some clue why low level and violent crime remains such a problem in so many places. Because the system is off trying to make points, investigating elderly TV presenters after the horse has bolted, and filling up the prisons so counter-productively. What they ought to be doing - as they have been so effectively in New York - is building very local partnerships with communities to fight crime street by street.
In the end, as I may have mentioned before, what is important is what works.
It is true that I am not unbiassed. I know Chris and admire him a great deal. As far as I know, there is no law against self-incrimination - quite the reverse - so I don't see why he should be punished twice in this way. But then, I am not a lawyer either.
The really extraordinary thing is that Chris Huhne and Vicky Pryce were given eight months in prison for a non-violent single offence, and - let's face it - a rather common offence too, committed before he was even elected.
I know there ought to be another standard for cabinet ministers who lie to the authorities, but this does explain a little why our prisons are being so pointlessly overcrowded - 83,000 in England and Wales according to the most recent statistics which came out on Friday (down on last year, but still 3,500 over maximum capacity).
This in itself is some explanation why crime remains such a problem: prisons are so ineffective that the rate of prisoners reoffending within a year after release has just risen to 26.8 per cent. Some prisons are such breeding grounds for crime that the rate is over 70 per cent.
Worst of all, perhaps, imagine having to listen to the hypocrisy and cant, piled high from the prosecution lawyers and others over the Huhne case. Ugh.
But then, they have a point to make. Chris Huhne was a thorn in the side of the establishment. Too many people pretend that partners were driving when they get flashed by robot speeding cameras. He must not just be jailed, he apparently has to be talked to death, humiliated - and then fined.
I agree, I am not an objective observer - but I am unsure whether anyone ought to be imprisoned when they are no danger to the public. There may be exceptions in the case of multiple offenders, but they will be very rare. But like the Myth of the Great White Defendant in Tom Wolfe's Bonfire of the Vanities, Huhne was so unusual, so privileged in comparison to the hopeless cases who queue through the criminal justice system, that he had to draw the full enthusiasm of the system down on him.
By so doing, he revealed just how ineffective it is.
Which brings me round to Rolf Harris. Now, I've no idea what he is accused of, or when. But, again, you have to beware the judicial system when it is trying to make a point - this time, a mea culpa response to their failure to restrain Jimmy Saville.
I don't know Rolf, though it is true I'm not objective here either - I could forgive him almost anything because of the role he played in my childhood. But I can't see how anyone can defend themselves effectively against an accusation about something that happened three decades or more ago.
You know there is a whiff of a witch hunt when you have to think twice about criticising a prosecution in case people think you have something to hide yourself.
All this provides some clue why low level and violent crime remains such a problem in so many places. Because the system is off trying to make points, investigating elderly TV presenters after the horse has bolted, and filling up the prisons so counter-productively. What they ought to be doing - as they have been so effectively in New York - is building very local partnerships with communities to fight crime street by street.
In the end, as I may have mentioned before, what is important is what works.
April 22, 2013
Violet, Winston and the meaning of Free Trade
The controversy in recent weeks about whether Violet Asquith flung herself off the cliff for love of Winston Churchill has been preying on my mind - in a mild way, of course. I suddenly remembered that, unread at the back of my bookshelf, I had a copy of a book called Winston Churchill As I Knew Him by the lady herself.I got it down, blew the dust off and started to read. There wasn't anything salacious in it about their relationship (it was published in 1965, and does actually mention the cliff - though not the fall). But it is also by far the best work of political history I have ever read, atmospheric, pacy, and beautifully written.
I'm still only half way through - I obviously don't have enough baths to get through all 520 pages that fast - but it is a really extraordinary evocation of the background and drama of the great period of the Campbell-Bannerman and Asquith reforming government, seen through her eyes but also through Churchill's. The author's purpose is partly, it seems, to remind people after Churchill's death that some of his greatest achievements had been as a Liberal minister.
But what has really set me thinking is her description of how Joseph Chamberlain's intervention on imperial preference - keeping out foreign imports using taxes - split the Conservative Party so thoroughly after 1903 that it led to the Liberal landslide of 1906.
This is Churchill hitting back immediately from Hoxton:
"It will need his most weighty arguments ... all his courage and all his oratory to persuade the English people to abandon the system of Free Trade and cheap food upon which they have thrived for so long and under which they have advanced from the depths of poverty and distress to the first position among the nations of the world."
Now, bear with me on this, if you can face it. I've been asking myself why Free Trade could so destroy the Conservatives and so unite the Liberals, when the same cry today might equally work the other way around - and I have wondered whether this might be a clue to why the Liberal Party is not quite the rampaging beast it once was (in the nicest possible way).
I believe the answer is this. Liberals and Liberal Democrats have allowed the Conservatives to re-define Free Trade along their own aristocratic lines.
Let's imagine for a moment clawing back the idea for Liberalism, realising that - far from enjoying Free Trade - we are actually now battered by semi-monopolies and are paying more money for our basic foodstuffs because of it. When Monsanto owns 96 per cent of the GM seeds planted in the USA, when Tesco dominates a third of all the grocery sales here, and where their dominance keeps out the kind of challenge from below that the great Liberal Karl Popper said was the basis of progress - that is not Free Trade in the old Liberal sense.
Free Trade has become the right of the powerful to dictate to the powerless. It is not what its Liberal creators intended - an extension of the anti-slavery campaign to allow people to escape this kind of tyranny by buying where they want. Free Trade has become a perversion of itself - a privilege to monopolists and speculators to do what they like. It is the precise opposite of the idea which once united the Liberals and gave them the power to reform.
The Conservatives are just as split on imperial preference as they were back in 1905, when a leading backbencher described himself as "nailing his colours to the fence" - assuming that imperial preference has become the European single market (that is what Oswald Mosley said, certainly). But the Liberals have abandoned the Free Trade battleground.
They have certainly abandoned the old Liberal idea that Free Trade was the basis for world peace. You don't hear that any more (though Margaret Thatcher said something along those lines). It certainly isn't peaceful if it becomes a licence for clashing corporate titans or laying waste developing countries with economic muscle.
We might have to call it something different these days - 'open trade' maybe. But it needs redefining, just as Liberalism needs to commit itself again to small business, small-scale entrepreneurship and major anti-trust. But it is now time for this, it seems to me, and belated thanks to Violet Bonham Carter (nee Asquith) for making me think about it.
April 21, 2013
On getting onto the front of the Sunday Times review section
I don't know what I think about paywalls for online news papers, but - despite what I might have said in the past about making the universe free-to-view - paywalls can be pretty damn irritating. Like today.Today, I want to link to the lengthy extract from my new book about the death of the middle classes on the front of the Review section of the Sunday Times but, although I can link to it, I know that people will have to pay a subscription or come up with some kind of password to read it.
The same goes for yesterday's book review in The Times, a thoughtful piece by Anne Ashworth. It's like buses: you wait all your life for this kind of coverage for a book you've written and then, suddenly, two of them come along and you can't link to them to spread the word.
Still I can't really complain. The Sunday Times has also borrowed the last section from the end of the book to make it sound a bit more upbeat, which is fine by me. The book itself, Broke: Who Killed the Middle Classes?, is published on Thursday. Not everyone will agree with me - especially if they don't actually read it - but I hope it will get some of these issues talked about. This is the key paragraph from the extract they used:
"Given that extraordinary shift in fortunes – that cascade of money through property and financial services known as Big Bang – why is it that the middle classes feel so threatened? Why have they been sidelined by a new and aggressive international class of mega-rich? Why have their homes and way of life and retirements become virtually unaffordable, with home ownership falling steadily, and now lower than in Romania and Bulgaria? Why are they in such a panic about their children’s education? Why has their professional judgement been shunned? And why have they allowed their hard-working duty to career, family and salary to be so futile – given that, however successful they become, there is a banker half their age whose bonus makes them look ridiculous? In short, why are we wondering again whether the distinctive lifestyles of the English middle classes can survive?"
It is, in fact, a kind of non-fiction whodunnit, taking us back through the Thatcher, Major, Blair and Brown years - a sort of contemporary history as we all lived it - to find out what went wrong. I hope it will spark a debate. Probably what I need is for someone to review it with a sledgehammer and cause a stir.
Who should I ask? Nigel Lawson? Peter Mandelson? Fred Goodwin? Bob Diamond?
April 20, 2013
Why iron control leads to hospital mistakes
When the management theorist Naresh Khatri went to live in the USA, having been brought up in India and Singapore, one thing particularly intrigued him about the American health system: why did everyone talk about how much it was changing when, as far as he could see, it wasn’t changing at all?
Khatri had been in the USA before as a student, and – to him at least, and despite all the rhetoric and cacophony of change – nothing actually seemed to be any different. Certainly there were changes of regime. There were the new health maintenance organisations and the rationalisation of diagnoses and symptoms. But the basic feel of surgeries and doctors was much as it always had been.
There were still hugely expensive law suits, and the same vast insurance bills, the same huge hospital corporations and the same mistakes. Nearly 100,000 patients died in the USA every year because of mistakes, more than car accidents and breast cancer (in England and Wales, the equivalent figure is contested, but is variously put at 800 or 34,000 a year).
Khatri had no inside experience of healthcare at that stage. He had worked at the Federal Bank of India for five years. But like any good academic researcher, he set out to find out why there was this mismatch between his perception and everyone else’s.
He began to organise seminars on healthcare among his fellow management academics at the University of Missouri. He tested his ideas against similar research in other countries, and the conclusion he came to was that hierarchical management style, the blame culture, and the obsession with top-down IT systems, had just carried on regardless. If the new systems, which caused so much argument, were really more efficient, you might expect that mistakes would be going down too. Actually they stayed much the same.
Health reformers were even using the burgeoning cost of hospital mistakes as a reason for standardising and controlling even more, but there was little evidence that they were right. More targets, more numbers, more control, less change.
Khatri began to suspect that the highly-controlled culture of compliance and blame was actually why the mistakes were happening in the first place. So he and his team designed an experiment to categorise 16 hospitals in Missouri by management style to see if it had any effect on hospital mistakes. They also put in a whole series of tests to see if they were thinking along the right lines, including surveys of over a thousand health providers across the USA.
The results were peculiar: the expected link between medical mistakes and a culture of blame wasn’t there in the sample. But what was clear was that there were fewer mistakes when the medical staff trusted and felt good about each other, and more drug-related errors in hospital cultures which were exerting the most detailed control.
“The current bias towards innovative technological solutions over those that require the transformation of current dysfunctional culture, management systems, and work processes in healthcare must be corrected if medical errors and quality of patient care are to be taken seriously,” he wrote. More about Khatri and his research in my book The Human Element.
This confirmed that control is less effective than letting staff use their human skills, but it doesn’t explain why this might be. But other research that was going on at the same time suggested a reason. Another study found that up to 80 per cent of hospital mistakes in American hospitals had less to do with technical problems than with the personal interactions inside the healthcare teams.
Working in a blame culture forces staff to protect themselves, even if it is just against reams of paperwork. They put more effort into shifting blame than genuinely discussing mistakes, or what are called in the jargon ‘adverse events’. In other words, it is their relationships with each other – and with their managers of course – that make the difference. This isn’t about face-to-face relationships with patients, it is about face-to-face working relationships.
“We tend to think that, without regulation, people will do stupid things,” says Khatri. “But actually, they don’t. And when you exercise that kind of control, then you are not using people’s ideas fully.”
I thought of Khatri's research when I read the government's response to the Mid-Staffs crisis, and in particular John Seddon's system thinking response yesterday. More control is not a solution. More targets means more effort going into meeting the targets and regulations and less on patient care. It is precisely the opposite of what needs to happen.
Increasing the penalties for people who massage the target figures is the logical next step for iron control, but as Seddon says, it is impossible. To make things work, frontline staff always massage the figures. They have to.
Whitehall has still not learned from the failure of control during the New Labour years. It is staggeringly expensive, largely because it shifts resources and imagination into meeting the regulations rather than doing the work effectively. In fact this gap in learning is, for me, the central misjudgement by the coalition - and I don't really understand it.
Why do people who are so determined to set the economy free - so that people's entrepreneurial skills can be used - not realise that the same applies to public services?
Khatri had been in the USA before as a student, and – to him at least, and despite all the rhetoric and cacophony of change – nothing actually seemed to be any different. Certainly there were changes of regime. There were the new health maintenance organisations and the rationalisation of diagnoses and symptoms. But the basic feel of surgeries and doctors was much as it always had been.
There were still hugely expensive law suits, and the same vast insurance bills, the same huge hospital corporations and the same mistakes. Nearly 100,000 patients died in the USA every year because of mistakes, more than car accidents and breast cancer (in England and Wales, the equivalent figure is contested, but is variously put at 800 or 34,000 a year).
Khatri had no inside experience of healthcare at that stage. He had worked at the Federal Bank of India for five years. But like any good academic researcher, he set out to find out why there was this mismatch between his perception and everyone else’s.
He began to organise seminars on healthcare among his fellow management academics at the University of Missouri. He tested his ideas against similar research in other countries, and the conclusion he came to was that hierarchical management style, the blame culture, and the obsession with top-down IT systems, had just carried on regardless. If the new systems, which caused so much argument, were really more efficient, you might expect that mistakes would be going down too. Actually they stayed much the same.
Health reformers were even using the burgeoning cost of hospital mistakes as a reason for standardising and controlling even more, but there was little evidence that they were right. More targets, more numbers, more control, less change.
Khatri began to suspect that the highly-controlled culture of compliance and blame was actually why the mistakes were happening in the first place. So he and his team designed an experiment to categorise 16 hospitals in Missouri by management style to see if it had any effect on hospital mistakes. They also put in a whole series of tests to see if they were thinking along the right lines, including surveys of over a thousand health providers across the USA.
The results were peculiar: the expected link between medical mistakes and a culture of blame wasn’t there in the sample. But what was clear was that there were fewer mistakes when the medical staff trusted and felt good about each other, and more drug-related errors in hospital cultures which were exerting the most detailed control.
“The current bias towards innovative technological solutions over those that require the transformation of current dysfunctional culture, management systems, and work processes in healthcare must be corrected if medical errors and quality of patient care are to be taken seriously,” he wrote. More about Khatri and his research in my book The Human Element.
This confirmed that control is less effective than letting staff use their human skills, but it doesn’t explain why this might be. But other research that was going on at the same time suggested a reason. Another study found that up to 80 per cent of hospital mistakes in American hospitals had less to do with technical problems than with the personal interactions inside the healthcare teams.
Working in a blame culture forces staff to protect themselves, even if it is just against reams of paperwork. They put more effort into shifting blame than genuinely discussing mistakes, or what are called in the jargon ‘adverse events’. In other words, it is their relationships with each other – and with their managers of course – that make the difference. This isn’t about face-to-face relationships with patients, it is about face-to-face working relationships.
“We tend to think that, without regulation, people will do stupid things,” says Khatri. “But actually, they don’t. And when you exercise that kind of control, then you are not using people’s ideas fully.”
I thought of Khatri's research when I read the government's response to the Mid-Staffs crisis, and in particular John Seddon's system thinking response yesterday. More control is not a solution. More targets means more effort going into meeting the targets and regulations and less on patient care. It is precisely the opposite of what needs to happen.
Increasing the penalties for people who massage the target figures is the logical next step for iron control, but as Seddon says, it is impossible. To make things work, frontline staff always massage the figures. They have to.
Whitehall has still not learned from the failure of control during the New Labour years. It is staggeringly expensive, largely because it shifts resources and imagination into meeting the regulations rather than doing the work effectively. In fact this gap in learning is, for me, the central misjudgement by the coalition - and I don't really understand it.
Why do people who are so determined to set the economy free - so that people's entrepreneurial skills can be used - not realise that the same applies to public services?
April 19, 2013
BSE, MMR and official trust
This may be my advancing age, but I sat through Tuesday's rather patronising phone in programme on measles and MMR with mounting irritation, and the news that the inoculation programme in Swansea is not going very well has confirmed me in my discomfort.I have thought hard before writing this particular blog. But I can't be the only person to feel uneasy about the way this story is being communicated.
Before I upset everybody, let me say that I did, after some thought, have both my children inoculated using the combined vaccine some years ago. I left it later than I was advised to because I didn't want to overload their immune system, but I did it before they went to nursery. I don't have any regrets either. There were no major side-effects. It was fine.
Looking back on that period, the whole argument seemed a lot more confused than it is currently being painted - and I speak as a non-scientist. Because I didn't really trust everything I was being told.
It was confused because autism and aspergers rates were rising spectacularly (61,000 per cent over ten years in Illinois), and I've written elsewhere why this was. As far as I know, it had nothing to do with MMR, but you can see why people felt it might have done.
It was confused also because the previous health scare had been about BSE. And in that case, the establishment had closed ranks to explain aggressively that there was NO risk in eating beef. They execrated the reputations of any lonely scientists who said otherwise and bugged their phones. They battered us with 'evidenced-based' policy, aware that - actually - nobody would be given funding to research BSE. They took to the TV cameras to feed their children beefburgers.
As we all know, BSE was all too real, though - as it turned out - rare in humans.
So when the same thing happens again, what are people supposed to think? The establishment execrates the reputation of Andrew Wakefield. They talk about the 'evidence', when they know that funding is impossible to study the links between MMR and autism - try applying and see what happens to your career. They put on phone-in programmes with experts who explain ad nauseam that there is no evidence for any link.
So what did people do a decade ago? People remembered the controversy about Gulf War veterans whose health had collapsed after a cocktail of vaccinations. Most people know somebody whose child has had quite serious side-effects from the MMR jab, even if it isn't autism (I certainly do). Do you believe a government when you know that, even if there was a risk, they would probably begin by denying it?
Expediency is Whitehall's middle name. Would they tell the full truth if there was a health problem linked to one of their pet projects - fracking, nuclear energy, GM food? I doubt it.
Andrew Wakefield has recently claimed that US courts have paid out compensation to parents whose children developed autism after having the MMR. I don't know if that is true or not. All I know is that the Independent was in turn execrated for publishing his article.
The real problem here is only partly to do with Wakefield's research and the controversy that followed. It is about the breakdown in people's trust in 'official' advice. Personally, I find the claim that there is NO risk from MMR very difficult to swallow.
I allowed my children to have the jab because it seemed to me that the risks from complications from measles were much greater (also I very much don't want to get mumps, for obvious reasons perhaps). But I got no help from the government weighing up these risks, just a rather cross phone call from a local health official who believed I was delaying too long.
All this explains why I winced though the BBC phone-in, and found it so unconvincing. It was too heavy-handed. It gave me more sympathy for the parents of Swansea who did not respond to official reassurances, because those assurances had been compromised years before.
That doesn't mean that I believe the Swansea measles outbreak is anything other than a disaster.
So is there a solution? People will only trust official advice if they sense they are being told the whole truth. If there is a balance of risks - and there clearly is - then that is what needs to be explained. People are not going to be brow-beaten by experts wheeled out to explain there is NO risk, because there is never NO risk.
I know it would be in the public interest if there was NO risk. I know that single jabs, if their import had not been banned, would confuse the public further. But expediency isn't the same as the truth.
What we need is an Office of Health Responsibility, dedicated to the truth beyond expediency and with their own research budget. Some people will panic faced with a complex message, but they will panic whatever happens. In the end, trusting people with the full inconvenient truth is the only way to regain a bit of trust.
April 18, 2013
Why Tesco is sinking
So when a friend of mine alerted me to their new local Tesco, which is doing all it can to hide the fact that it is a Tesco at all, I suddenly got interested. The news today that Tesco's performance was its worst ever, and that they are pulling out of the USA, rather confirms it - and if they are trying to keep the brand secret, Tesco executives themselves must be slightly aware of its toxic elements.
This appears to be the case with the Tesco chain of One Stop convenience stores. My friend asked why it didn't say 'Tesco' on the outside of their new One Stop in Solihull and was told by the sales assistant that it was now policy because they didn't want to put customers off.
It is worth asking for a second why this might be. Is it that people are reacting against the overwhelming technocratic feel of Tesco, the sense of the security guard eyeing you up as you struggle with the robots at check-out? Or is it that people have now grasped the truth - that chain stores tend to suck spending power out of local economies, and tend to make people poorer as a result?
Is it even that people sense the huge privileges that Tesco's size give it - the right not to pay bills for 90 days when smaller competitors have to pay in 30 (providing them with the interest-free loan equal to two months stock)?
I know it is also that Tesco prefers not to allow comparisons between its Tesco Express stores and its One Stop stores, which are in poorer areas and charge up to 14 per cent more than in some other places (as always, the poor pay more).
A bit of all of them perhaps. Somehow this is even more significant than the news that their American chain Fresh & Easy is up for sale. When a shopping chain feels it necessary to pretend they are somebody else, then the writing is on the wall.
The real issue is this. What kind of entrepreneurial activity is most likely to bring local recovery and local resilience? The answer is probably not a chain store that competes in every market - the very opposite of an anchor store. It is going to be the revival of a genuinely local entrepreneurial culture.
What holds this up? The failure of political debate to distinguish properly between being pro-big business and pro-small-business. What we really need is to be able to articulate a political approach that allows the small to fight back effectively against the big, and stop pretending that pro-big business policy is somehow automatically supportive of small business, when the reverse is the case.
When the biggest of the big starts pretending it is a different brand altogether, then maybe something is shifting. Or am I being hopelessly optimistic?
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