The NHS- Not Safe in Their Hands.

October 8, 2011

Last month, with the antics of the honourable member for Mid Bedfordshire providing a useful distraction, the House of Commons passed a bill that outlined several radical changes to the structure of the NHS.  Most dramatically it removed the duty of the Health Secretary to directly facilitate the provision of healthcare, which had been the backbone of all previous NHS legislation (compare section 1 of the current bill, here, with that of the 2006 NHS act, here).  This simple measure, at a stroke, removes what makes the NHS the NHS: the provision of healthcare nationally through one organisation accountable to the democratically elected Government.

Making the administration of the NHS more independent of the government, which has under successive administrations, used the NHS as a political football, compromising the stability of the service, and increasing local accountability, where the issue of healthcare provision can be considered independently of other political concerns, is not in and of itself a stupid idea, but the devil’s in the detail.  It is clear that privatisation, rather than democratisation and independence, is the main motivation behind the changes, with no democratic mechanisms included and ripe opportunities for extended private sector involvement.

This opening clause, sets the scene for the rest of the bill which outlines what it’s author, health secretary Andrew Lansley, envisages to replace the current system: healthcare commissioned, from a variety of providers, by a series of consortia, ostensibly controlled by local GPs.  This detail is a little bit of PR genius.  The public in general like and trust GPs, who currently work well as independent providers within the NHS.  The reality of course, is that most GPs will not have the time, skills or inclination to take on a whole new range of administrative functions and many, if not most, will outsource the commissioning functions to outside bodies, and plenty of private companies are waiting in the wings to take up this role.  The services “bought in” by consortia, will not be limited to those provided by the NHS.  In fact legal advice, obtained by the campaigning organisation 38 Degrees, suggests that the new arrangement will be subject to EU competition law with multiple providers competing for contracts on the basis of commercial law.  Both commissioning and provision will thus be transferred, on a large scale, to the private sector.

Let’s be clear, this country will continue to have universal, free at the point of use healthcare, and it may be that most patients won’t really notice the difference, a slight degradation of services here, where providers are dictated by competition not by expertise, a loss of provision there, where private companies skim off profitable services leaving unprofitable ones like, mental health, and emergency care, with depleted funds.  Nevertheless, the bill represents a further encroachment of profiteering businesses into the NHS.  Health care policy, over the past 30 years, has been driven by the big lie that publicly provided healthcare services are intrinsically less efficient and less effective.  In fact the British NHS is one of the leanest systems in the world, doing more for less than anywhere else. This has lead to the internal market and various other “choice” and “competition” initiatives, each one adding a new layer of bureaucracy, diverting scarce funds away from patients and towards political vanity projects.  This latest bill provides allows Andrew Lansley’s associates in the healthcare industry to profit at the expense of patients and the taxpayer and that is the greatest tragedy.

All is not lost, however.  The bill may have passed through the Commons, but it still has to go through the House of Lords.  With that in mind, the TUC has created an initiative called “Adopt a Peer,” whereby you are assigned a member of the House of Lords to write to.  I was assigned Lord Collins, of Highbury, and wrote him the following letter:

Dear Lord Collins

I’m writing to you about the Health and Social Care Bill, which is currently being considered in the House of Lords. As you are probably already aware, it makes a number of substantial and possibly irreversible changes to the fabric of the NHS. In particular the bill makes changes in its very first section, removing the duty of the Secretary of State for Health to facilitate the provision of healthcare as codified in the 2006 NHS act and prior legislation. It also fragments commissioning roles amongst a number of bodies from where it will almost certainly end up in the private sector. This fundamentally compromises the principles of the NHS as well as being detrimental to service users, diverting scarce funds to profit making companies.

As a Labour Peer, I imagine that you will be opposing the bill. What measures can be taken by the Lords to oppose its passage? Neither of the Governing parties have a mandate to make changes this radical, with the Liberal Democrats having campaigned on a platform diametrically opposed and the Conservatives not having been upfront about these plans prior to the election, with their leader promising “no more top-down reorganisations of the NHS” and that the NHS was safe in their hands.


Hannah Dadd.

To which he replied, with impressive promptness the very next day:

Dear Hannah,

Many thanks for your email regarding the Government’s Health and Social Care Bill which has now commenced its journey through the Lords stages of parliamentary procedure. I apologies for the delay in responding but I was heavily involved in the Labour Party Conference which took place in Liverpool last week.

Labour has always been clear that the proposed changes to the NHS envisaged by David Cameron, Andrew Lansley, and the coalition government are unnecessary, reckless, wasteful and bureaucratic. On top of this, the Bill goes against the coalition’s own promise, of only last year, for there to be “no more top-down reorganisation of the NHS”. They have no mandate for the changes they are planning.

Despite the pause and the Future Forum’s report, the Bill still contains the essential elements of the Tories’ long-term plan to set the NHS up as a full-scale market based on the model of the privatised utilities. That’s why so many experts still oppose the Bill.

I can assure you that Labour members of the House of Lords are committed to doing whatever we can to protect the NHS from the proposals in this Bill. Firstly we will try to stop the Bill in its tracks by voting against it at its Second Reading. Sadly, because the Lib Dems and Conservatives will vote together to keep the Bill, we are unlikely to succeed.

Over the next weeks and months, I and my colleagues will endeavour to make changes to the Bill in order to limit its damage to the NHS and improve the Bill. But we can’t do it on our own. We can only do this by building our own coalition. That means persuading independent crossbenchers, Lib Dems and Tories to vote with us on those key amendments. For that we need 80 peers from other benches to vote with us.

That’s where we need your help. Please contact crossbenchers and Lib Dems in particular to ask for their support. Without them Labour peers cannot limit the damage that this Government will do to the NHS. Please visit for full details of these Peers including email addresses.

Best wishes,

Ray Collins
Lord Collins of Highbury

What more encouragement could be needed?  Sign up to “Adopt a Peer” and pay particular attention to Lib Dem and crossbench peers.  Also, those who are enclined, can come along to the protest, on Westminster Bridge, on Sunday.

The Lib Dems in government part 5: the secret tapes edition

January 15, 2011

Just before the general election I went to a hustings in my hometown, with my parents and some family friends. This was just after the first leaders debate and the outbreak of Cleggmania. Our constituency had been represented, for the previous thirteen years, by a very popular Liberal Democrat, who had turned the seat from a conservative stronghold, in the 90s, to the nearest thing the Liberal Democrats have to a safe seat. Labour had been squeezed down to 10% of the vote and all but given up on the seat, putting forward a candidate who was younger than me. In the event, the evening turned out to be a bit of a one horse race.

The Conservative candidate’s opening gambit was that whilst the incumbent was all well and good these Liberal Democrats would never have any real influence and only he could guarantee a “seat at the top table” from which to represent his constituent’s interests. This was delivered in such a pompous style that it was hard to hold back laughter. As one of the family friends said later, far from being at the top table he was “lobby fodder – at best”. He compounded his error by saying, in reply to a question about the representation of women, that we needed more women in government because “women know how to balance a household budget”.

 Neither the Labour nor UKIP candidates managed to hold their own under even the most gentle of questioning. The sitting MP just stood up and confidently laid out his record in office and after that any sense of competition was just blown out of the water.

The questions mainly stuck to local issues and by the end of the evening the audience had sunk into a stupour. On the final question I thought of something to ask. I put up my hand but someone else was chosen. His question was something parochial about primary schools that had been covered earlier in the evening. You could feel the sense of anticlimax in the room. Then the host, our local vicar, decided to put an end to that question and take a new one. This time I was picked. Phrasing my question carefully to maximize the chance of a straight answer, I asked our MP, in the event of a hung Parliament upon what basis would the Liberal Democrats choose a coalition partner and prioritising which policies.

There was a rumble of interest as the audience roused from their stupour. He replied (or didn’t reply) that it wasn’t vote Clegg get Cameron, or vote Clegg get Brown but that a vote for him would get Nick Clegg and Vince Cable (this was back when this still had some cache) and that if we wanted to know their priorities we should look at their manifesto. A couple of weeks later he was returned to office, the Liberal Democrats went into coalition with the Conservative and he himself was made a junior government minister.

Looking at events since, their manifesto doesn’t seem to have been such an accurate indicator of their action in coalition. It has become clear that, even as early as the coalition negotiations, Nick Clegg was arguing against his party’s own stated position on deficit reduction. Of course since then we have had the u-turn on tuition fees from most of the Liberal Democrat front bench and a good number of their backbenchers, as well. This was something that went beyond a manifesto commitment, each Liberal Democrat MP, individually, signed unequivocal pledges, promising not to raise fees, garnering lots of votes in the process. Now we learn that they may even back down on control orders, conceding their one remaining position of high ground on civil liberties. At least one Lib Dem MP has dishonestly tried to argue that there apparent argument that their apparent reversal is in fact not a reversal at all.

The more common argument has been that they didn’t win the election and so are in no position to implement their manifesto, and if the public wants to see Lib Dem policies, they should elect a Lib Dem majority. This is not only irrelevant in the case of tuition fees – the controversy was not over their manifesto, which people cannot expect to be implemented in full in coalition (although it would be nice to see some of it), it was about individual pledges by individual Lib Dem candidates to vote a certain way- but disingenuous. Nobody seriously expected the Lib Dems to win an overall majority and, as the exchange in my local Baptist church hall shows, people were most highly concerned with what would happen in the event of a coalition. Most importantly, whilst the Lib Dems did not win the election, neither did the Conservatives. They are now in the position of pushing through the most radically conservative fiscal policy seen in generations, to devastating effect to many if not most people in the country, with a 36.1% vote share on a 65.1% turnout. That’s just 23.5% of the available vote. They have only been able to do this because a party has completely reversed the positions on which it campaigned. There is a fundamental subversion of the democratic principle here.

This all brings us to the revelations in the Daily Telegraph. Several Liberal Democrats, including Vince Cable, the Business Secretary, and my very own Steve Webb MP, were recorded by Telegraph journalists posing as constituents, making indiscrete comments about their coalition partners. Notwithstanding Vince Cable’s apparent inability to maintain blood flow to his brain in the presence of certain female journalists, these revelations actually make me respect them more. The worst part of the Lib Dems’ incorporation into the government has been the constant cheerleading for the policies that have been fed to them; the pretence that nothing is wrong. The suggestion that there may be policies that “haven’t seen the light of day” because of Lib Dem intervention and that they may be picking their battles is encouraging. The only hope for coalition between such diametrically opposed parties is one of open negotiation, where the differences are clearly delineated, possibly with independent portfolios. This would be challenging for British politics, with its dominant tradition that the government must maintain a united front against the public, with whips and collective responsibility. It would certainly mean running the gamut of press obsessed with gossip and psychodrama. Instead the Liberal Democrats seem to be being gradually cannibalised by their senior partners in government.

In reality, this was always going to be an extremely damaging term of office for whichever government was formed in May, especially with the numbers as they were. Labour couldn’t have survived another term of office without suffering electoral wipeout. No party has ever governed for more than four terms, and Labour was facing a tough economy and falling popularity. The Lib Dems faced a choice of patching together a wafer thin overall majority with an unpopular party with an unpopular leader and a rag tag of minor parties with their own agendas, or tying itself to a party whose policies its supporters abhorred. The only question was who was going to take the poisoned chalice. With their poll ratings going through the floor, the Lib Dems are now in a dire position. Do they activate Vince Cable’s nuclear weapon soon and face an angry electorate, or soldier on, possibly sustaining even more damage? They may, even now, be past the point of no return.

Killed With Kindness?

January 7, 2011

Not too long ago, Frances Inglis reappeared in the headlines, with her failed appeal against her conviction for murder.

For those who don’t remember, she killed her 22 year old son, Thomas Inglis, by injecting him with heroin after he suffered a brain injury after falling out of the back of an ambulance. She had previously made a similar attempt on his life but failed, causing a deterioration of his condition. She was given a mandatory life sentence with a minimum tariff of eight years, reduced to 5 years on appeal after the judges heard that she had a long history of depression and had been diagnosed with post-traumatic stress disorder (the event that triggered it hasn’t been revealed) shortly before her son’s accident.

Now all of this sounds like a simple personal tragedy for Thomas Inglis and his family. What makes it interesting from a wider political perspective is the reaction of the media and public.

The almost unanimous view was that what Frances Inglis had done was justified, that she had saved her son from his horrific condition and that she had been victimised by a cruel and inflexible law. ”Don’t punish this Mother Courage” is the headline of an article by Fiona Philips, in the Mirror. “Courage,” along with “love” and ”brave,” appear consistently in the reporting of the case. Within the mainstream media commentary I can only find Dominic Lawson in the Independent and George Pitcher in The Telegraph providing a contrary view.

Very little attention was given to the facts of the case, as outlined in the appeal judgment. Almost immediately after Thomas Inglis’s accident, his mother became morbidly obsessed with the notion that he was suffering unbearably, even though he would almost certainly have been comatose at this point, and that it was her duty to put him out of his suffering.

His doctors were optimistic about the likelihood of him recovering enough to live independently, but his mother disregarded their opinion. She illegally acquired heroin and, just two months after his original injury, injected him with it leading to a cardiac arrest. He was revived by medical staff at the hospital but his brain was starved of oxygen resulting in a second, much more serious, brain injury, after which his prognosis was described by one specialist as “exceedingly poor”.

Oxygen deprivation would have affected his whole brain leaving little him with little remaining function or room for recovery. At this stage the possibility of his artificial feeding being removed was discussed between his family and doctors.

Nevertheless it’s worth drawing attention to the fact that the appeal judgment reveals that there were some reports that his condition may have improved before his death. A year later Frances Inglis managed to gain access to him in breech of her bail conditions, by pretending to be his aunt, and barricaded herself inside his room. She again injected him with an overdose of heroin and, when interrupted by a nurse, said that she had HIV, and threatened her with the syringe she had used to inject her son. This time doctors were unable to revive him, and she was charged and later convicted of his murder.

There were a number of aspects to this case that put it outside the standard debate on voluntary euthanasia.

Firstly, it was very much involuntary. Thomas Inglis never expressed a wish to die, or indeed had the capacity after his accident.

Secondly, he wasn’t dying and his prognosis was relatively good for regaining some level of independence. Besides which, his mother formed and acted on her intention to kill him long before the long term outcome of his injury could have been known.

Nevertheless, the case was immediately slotted, by both the press and the public, into the wider liberal case for euthanasia. This may have had something to do with the fact that a rash of assisted suicide cases, at the time, had brought the subject to the fore, particularly the case of Lynn Gilderdale, who had a severe form of ME and committed suicide with the help of her mother, and that of Ray Gosling who claimed (falsely, it would later turn out ) to have killed a former lover who was dying of AIDS. However, I think there is a deeper phenomenon at play, namely the way the concept of “mercy killing” has captured the public imagination. The popular perception of the Inglis case was carried along by the strength of this narrative, almost without regard for the facts, which were those of a mother with a history of mental health problems, who was unable to cope with the psychological pressure of her son’s injury.

So why has “mercy killing,” as a cause, found such a firm place in the public imagination?

Firstly, it is important to realise that euthanasia and assisted suicide are primarily advocated for by those who are currently able bodied. Liberalism’s respect for individual autonomy is often cited as the central reason for relaxing the law on euthanasia. However support for Frances Inglis doesn’t fit with this a core motivation. Thomas Inglis had no say in his death, but this didn’t stop commentators from queuing up to defend his mother.

Foremost among these were “Dignity In Dying” an organisation ostensibly set up to advocate for legal assisted suicide. I suspect that the stronger motive is fear: fear of pain, fear of incapacity and fear of dependency. Thomas Inglis undoubtedly had a long, difficult and uncertain road ahead of him. Recovery from brain injuries of any kind is a gruelling and often distressing process. It is likely that he would have been left with some degree of disability and he would certainly never have returned to the condition he was in before the accident. Nevertheless, he was 22 years old – the same age I am now – with his whole life ahead of him regardless of how different from that which he had had before. As a society we adhere to a very utilitarian view of the value of life, we imagine it as a balance sheet of very clearly demarcated pains and privileges and if it goes into the red, it ceases to be worthwhile. In a secure and well off society, where few people suffer significant privations, the threshold of suffering, at which this point is reached, is fairly low.

In addition to this our society places a high value on independence, so being in a condition where you would require assistance in everyday tasks would be viewed, by many, as demeaning. This was shown in the case of Daniel James who traveled to Switzerland, with the help of his parents to kill himself, after becoming quadriplegic in a rugby accident. His parents said he didn’t want a “second class life.” They were also widely praised for their “courage.”

Both Daniel James and Thomas Inglis, were, before their accidents, young men in peak physical condition, something that signifies a high status in our society. Wider society finds this difficult to reconcile with the much lower esteem they would have, subsequently, been held in because of their disabilities. There former status is then projected forward onto their subsequent one as their authentic state, trapped or concealed by what they became. That is why a certain nobility is imputed to Daniel James’ decision and Frances Inglis’s – the former because he was too dignified submit to disability, the latter because she sacrificed her freedom to spare her son this perceived degradation.

Another, less openly acknowledged, fear is of the loss of freedom brought about by caring for a disabled relative. Parents who kill disabled children, particularly those with learning difficulties often get significantly reduced sentences compared to other killers. For example, Jacob Wragg, who had a rare degenerative condition, was smothered by his father, who was given a two year suspended sentence for manslaughter, after claiming that the killing was a “mercy killing.” Other family members described Jacob as happy right up until the time of his death.

In a similar case in Canada, Tracy Latimer, who had Cerebral Palsy was killed by her gather. Robert Latimer was convicted of Murder and sentenced to life imprisonment, eventually serving 16 years before being released on parole, in December, however he received an outpouring of public support and is considered to have fundamentally changed the way euthanasia is viewed in Canada. Juries and the public empathise with the difficulties of parents caring for disabled children, often more than with the children, who are seen as “other” because of their disabilities.

As previously stated, the legalized euthanasia movement is primarily driven by able-bodied people. In contrast, the disability rights movement is ambivalent and often hostile towards the idea. Their primary concern is that the lives of people with disabilities are considered as valuable as those without and are granted the same protection under the law.

One of Frances Inglis’s surviving sons suggested that lethal injections be legalised for brain-injured people. It has also been suggested that those who kill family members in the honest belief that they are suffering should not be charged or convicted of murder, but perhaps some lesser offence or not at all. This suggestion was made without considering that it would removed protection from fatal violence from anyone with a disability and would enshrine in law the idea that some lives have less intrinsic value than others.

Collectively, the disability rights movement also rejects the balance sheet model of happiness, recognising that people’s desires can change with their circumstances and that people can tolerate more adversity than many people with relatively easy lives appreciate. Satisfaction isn’t related to absence of hardship in a simple linear way. They also reject the notion that suffering springs inevitably from disability, instead seeing social attitudes and neglect as the main obstacles rather than disability itself. From this perspective Daniel James’s choice to seek suicide did not occur in a vacuum but cannot be separated from the attitudes that saw his condition as a humiliation and “second class.” Pity itself can be intrusive and burdensome.

Providing for easy assisted suicide is also something of a cop-out for society as a whole, obviating the necessity and political will for providing people with disabilities, however extensive, with the resources needed to live as comfortable lives with as much self determination as possible. Particularly at a time when disability services and benefits are being cut, and people with disabilities are seemingly under attack, it’s easy to see why they would experience the promotion of an easy, socially sanctioned way out, as an existential threat.

Ultimately, these factors were what made the Inglis judgment such a departure from received wisdom and hence so radical. The appeal judgment states explicitly “however disabled Thomas might have been, a disabled life, even a life lived at the extremes of disability, is not one jot less precious than the life of an able-bodied person.” This is an admirable statement, even more so for being fairly unusual in the discourse surrounding disability and death in modern Britain. Frances Inglis became a liberal cause celebre, but her conviction paradoxically upheld many of the values inherent to liberalism, namely the autonomy and inalienable value of the individual, in this case Thomas Inglis even in his parlous state at the end of his life.

In the judgment it is written that the defence implied that “Thomas Inglis was ‘already dead in all but a small physical degree.” The judges respond: “the fact is that he was alive, a person in being,” and more concisely “the law doesn’t recognise [that] idea. May that continue to be the case.

A little bit of made-up swearing

December 24, 2010

Having been absent from this blog for some time, I had intended to take the opportunity provided by the Christmas holiday to knock out several posts.

However, my parents have decided that the present weather is not completely incompatible with a 300 mile road journey to see family, so it looks like my views on the Lib Dems’ indiscretions shall have to wait until after the weekend.

As an entree to that I’ll reveal that I have become a little bit obsessed with the YouGov daily polls.

Watching the Liberal Democrats support flatline in single figures and the plunging Government approval ratings force the pollster to redraw the axes of its graph has engendered a certain guilty pleasure.

It was while poking around the YouGov site that I discovered this extraordinary poll on swearing on the television.

1539 people were given a list of swear words and asked whether they should be allowed on the television at any time, only certain times, or never at all. This elicited some surprising results.

Hearteningly, racial epithets were ranked up there with the dreaded c-word as the most highly offensive. Oddly, “wanker” is apparently, considered more offensive than “shit” by the British public, with 23% saying that it should be banned outright compared with 9%.

To my surprise I discovered that the authors of the poll had slipped in a word I had never heard of: “pimhole.”

Apparently, some 25% of respondents had not heard of it either, as they said that they didn’t know whether it should be permitted or not, higher than any other word. 23%, however, thought it was so offensive that it should be banned completely, placing it safely in the major league of swear words.

Imagine my surprise when I googled it to discover that it originated in an old Fry and Laurie sketch:

Merry Christmas!

Naughty and NICE

November 19, 2010

In the week that saw the wrecking of the Conservative party headquarters by student demonstrators the Coalition Government continued, more quietly, in its ongoing project of vandalism against the machinery of the British state.

This time it’s the National Institute of Health and Clinical Excellence (NICE) facing the axe. There have been many cruel and callous acts by this government during the six and a bit months it has been in office and it’s difficult to know where to begin when writing about them because cruelty and callousness often defy rational analysis.

Sheer stupidity, on the other hand, is easier to get a handle of and this move is profoundly and irredeemably stupid.

NICE was one of Labour’s more successful creations. It was designed to provide uniformity of access to innovative treatments and to control costs within the NHS by assessing every new treatment by a single standard. Treatments judged to be cost-effective would be offered to all NHS patients, whereas treatments judged too expensive would be rejected.

This idea was so simple and so effective that it soon began to attract international attention attention, as this New York Times article shows, with many other countries talking of introducing similar policies. Dr. Donald Berwick, the Administrator of the Centers for Medicare & Medicaid Services (CMS), in the US, described NICE as an “extremely effective, … conscientious, valuable and- importantly- knowledge building- system.”

The importance of NICE was that it tackled one of the major problems facing all advanced healthcare systems. The fundamental aims of healthcare – the treatment of ill health and the extension of lifespan – are goals without any natural limit. The ultimate logical aim, of immortality and perfect health, are forever out of reach and a country could very well expend all its resources in the effort.

This is particularly true given an intellectual property based model of healthcare innovation that means that drug developers can pretty much charge whatever they want and the end of the era of rapid advances in medical technology meaning that vast amounts of money could be spent on incremental improvements in outcome. NICE proved very effective at containing drugs costs by providing a clear non-negotiable cap on what the NHS would pay for treatments. It also helped to shield British patients from over-hyped and ineffective treatments.

Naturally, the pharmaceutical industry didn’t take this challenge to its control over drugs pricing lying down, whipping patients into a frenzy over “life-saving” treatments that were being denied, and creating fake patient advocacy groups. The tabloids relentlessly pushed this narrative, carrying multiple, emotive articles highlighting patients stories, and blaming NICE relatively poor cancer outcomes in the UK; a claim that makes no sense – the months of survival benefit these drugs have shown in clinical trials does not translate into years of advantage on a population level.

This campaign has often led to NICE being steadily undermined, a process that began with the Labour government intervening to ensure the approval of Herceptin for breast cancer in 2006, and continues with the coalition, first creating a separate fund to pay for refused cancer treatments, effectively neutering NICE in price negotiations, before removing its powers to approve or refuse new drugs altogether.

Health Secretary, Andrew Lansley, wants to replace this function with what he calls “value based pricing”. This will mean companies negotiating directly with the Department of Health over prices, and drugs being approved or refused directly by local GP consortia.

This plan is riddled with potential problems.

The DoH will be subject to extensive lobbying by industry and political pressure not to be seen to be denying drugs to needy patients – the ball will be entirely in the drug companies’ court and they know it.

GPs have neither the time, objectivity nor clout to handle these negotiations. Dr Ben Goldacre has written that it would take GPs 600 hours a month to read all the studies relevant to primary care alone, and that drugs companies are adept at massaging the data to favour their products, for example by failing to publish negative data and using positive data in multiple studies in different journals. These are tricks that are difficult to spot by all but the most careful reader, and certainly to busy GPs, themselves subject to corporate marketing and “hospitality.”

This plan effectively removes the ability of the NHS to force the pharmaceutical companies to lower prices, the GPs don’t have the clout to stand up to big multinational corporations and the government certainly doesn’t have the political will. It’s safe to say that the champagne corks will be popping in the boardrooms of those companies and their lobbyists (lobbyists such as the one wheeled out to defend the changes in the Guardian editorial linked to at the top of this paragraph) at the news.

Further to the reforms of the funding of the new medical treatments, we hear the news that many of the regulatory functions of the Food Standards Agency (FSA) with ”food networks” including representatives of the food companies to discuss “voluntary not regulatory approaches.”

We can see very clearly where Lansley’s political sympathies lie. He cannot plead ignorance, certainly on the issue of healthcare. He has spoken about the issue many times with Private Eye’s “MD” columnist (aka Phil Hammond), who has christened him “la-la Lansley,” assuring him that he has fully understood the need for rationing in the NHS.

These moves completely contradict the Conservative portion of the Coalition’s stated raison d’etre of fiscal responsibility- in an era of tightening health budgets, diverting precious resources to a small and vocal group of patients, to little end, and to pay to patch up an increasingly unhealthy public. This cuts away the myths of Conservative principles, exposing their core values of deference to business, deference to wealth and pathological hatred of the state.

The Rules of War

November 10, 2010

Two significant stories have emerged over the past week relating to the western military presence in Afghanistan. The first is the publication of nearly 90, 000 American military files detailing incidents that occurred in Afghanistan, between 2002 and 2009, by Julian Assange’s Wikileaks. The second is the trial, for “war crimes,” of Guantanamo detainee Omar Khadr.

The release of the Afghanistan files was widely reported in the British Media, with particularly in depth coverage from The Guardian. The Khadr trial, on the other hand, has received little attention outside of North America. This is unfortunate, as the case provides a shocking insight into the behaviour of the US since 9/11.

Firstly, some background. Omar Khadr is a Canadian citizen, and the son of Ahmed Said Khadr, an Egyptian with close ties to Osama Bin Laden. The elder Khadr’s family describes him as a “charity worker”. This charity work may or may not have served as a front for financing Al Qaeda. In 2002, the Khadr family was living in Pakistan close to the Afghan border. At some point Omar, who was then only 15, was entrusted to a band of militants to act as translator.

On July 27 that year, American forces attempted to search the building that the group was staying in, resulting in a firefight. After the soldiers had retreated, air support was called in bombing the compound, leaving only Khadr, and one other, man alive. Medics arrived and US forces continued to through grenades at the compound. At this point Khadr emerged throwing a grenade killing US soldier, Christopher Speer. Khadr himself was severely wounded.

Since then he has been detained by the US, spending the past eight years at Guantanamo Bay, for much of that time, without access to the outside world or normal legal protections. He alleges (warning: disturbing images in link) that he was tortured. Last Sunday he was sentenced to a symbolic 40 years imprisonment by military tribunal having pled guilty to 5 charges including the murder of Speer and the attempted murder of other soldiers. In reality he will serve eight years, with one more year in Guantanamo and a further seven in Canada (this all presumes that his conviction is not struck out by the Canadian courts when he returns to the country).

Khadr’s conviction rests on the US’s designation of him as an “unlawful combatant”. This designation strips him of the protections of recognised combatants under the Geneva Convention and exemption from prosecution for murder for any killings during combat. This is a highly contrived designation, largely created for convenience by the Bush administrations and, as senior lawyer for Human Rights First, Daphne Eviatar, and Loyola Law School Professor, David Glazier point out, completely lacking in legal legitimacy.

Under international law if Khadr was a recognised combatant as described by Article 4 of the Geneva Convention, then he is protected from criminal prosecution under civilian homicide laws for any killings he carries out in combat. If he carried out those killings in breach of the laws of war, for example by posing as a civilian or by falsely surrendering, then he is subject to prosecution for war crimes. If he does not have this protection, then he is outside of military justice and is instead subject to the criminal law of whichever jurisdiction he was in at the time-in this case Afghanistan.

The Americans try to have it both ways by going one step further and saying that, not only does he not have privilege under Article 4, his fighting as a combatant despite not being recognised as one, represents a war crime under the Geneva convention – thus placing him under the jurisdiction of the military tribunal without the corresponding protections as a prisoner of war. It is this claim- that he is outside the protection of both ordinary criminal law and protocols on the treatment of prisoners of law- that has been used to justify effectively disappearing him for so many years, taking no account of his age and subjecting him to treatment that would not be countenanced under any advanced legal system.

It gets even worse, as the Military Commissions Acts that grant the tribunal its jurisdiction and create the status of unlawful combatants (and bear in mind, this status is the sole basis of Khadr’s prosecution, there are no grounds for charging him with his actions during the firefight other than because of his allegedly unprivileged status – the Americans knew they were facing potentially hostile forces, and indeed attacked first) date from 2006 and 2009, his prosecution is in breach of international laws preventing ex post facto (for crimes created after they were committed) prosecutions.

Add to that the trial was held in front of a military judge and jury, the conviction was based on a confession given under extremely coercive circumstances and the psychiatric reports were based on the work of a Danish scholar who believes that the Muslim gene pool has been irreparably damaged by inbreeding, the Koran encourages criminality, and Muslims should not be allowed migrate to Europe, this trial makes a mockery of the idea of due process.

This stands in stark contrast to the response to the incidents described in the Afghanistan war logs. The reports detail just some of the hundreds of civilian deaths caused by allied forces. These include one incident where six Afghanis were killed including a young girl. In addition, a boy and two teenage girls were injured. In another, a fourteen year old girl was killed at a checkpoint and a two year old seriously injured.

There is rarely any serious come back for the military personnel responsible, and there is a strong resistance to the idea of Soldiers being held accountable for actions taken whilst under the pressure of combat. To the extent that allied soldiers are prosecuted for their actions, they are tried in their own countries or by the courts of their own militaries with full legal protections. It is hard to imagine either politicians, the military or the public countenancing a situation where British or American soldiers faced the threat of prosecution in international jurisdictions, let alone that they could be captured and held by a foreign power for years without any recourse.

It is one of the characteristics of those groups with power that they wish to see others stripped of their ability to cause harm while shrinking from their accountability for their own misjudgments. As Slavoj Zizek writes in the Guardian, outsiders must have their autonomy restrained, to be “de-othered” in order to neutralise any potential threat they pose us. War may be engaged in but “our side” must be shielded from its horrors.

Sgt Speer’s widow and children were star witnesses in the Khadr trial. Now, he was undoubtedly a wonderful and much loved man, but the death on both sides is an unavoidable consequence of sending troops into action. Khadr is the useful scapegoat to divert culpability away from the architects of the conflict. David Glazier notes that the fundamental basis of Omar Khadr’s prosecution was that he was on the “wrong side,” when the Laws of War are predicated on the fundamental equality of combatants on each side, no matter how repugnant the leadership they fight under.

The Bush administration tried to enshrine its own Manichean perception of its own fundamental, unshakable, righteousness (or at least so it would have everyone believe) into universal law. Now the Obama Government cannot or will not remedy this for fear of reactionary domestic voices and any potential risk to US citizens from any detainee.

To quote Prof. Glazier:

The U.S. approach has the practical effect of converting this armed conflict into a human hunting season; the government asserts U.S. combatants had the right to shoot Khadr on sight (he was shot twice in the back based on his being a hostile rather than because he posed any particular threat at the time) yet criminally prosecute him for fighting back.

Much media coverage has focused on Khadr’s potential for rehabilitation versus his hostility towards the west. In both narratives his past actions are viewed as fundamentally pathological. Far more radical and threatening is the idea that events since demonstrate the possibility that he may not have been entirely irrational.

And the elder shall serve the younger…

September 30, 2010

As Cory wrote on Sunday, Ed Miliband has been declared leader of the Labour Party, winning the Party’s leadership contest by the slimmest possible of margins. It was the result that we had hoped for and predicted (although now is probably the time to confess that any impression of confidence in our predictions was entirely illusory, up until the declaration it really was to close to call). Watching the result announced at the Labour Party Conference, on Saturday, was, to even a vaguely interested party, a supreme test of nerves. The announcement was choreographed to produce the maximum suspense. The candidates were lead into the hall and seated, already aware of the result, although no one else was, all eyes on them trying to discern a hint as to the outcome. In fact, their faces completely belied the reality: David Miliband strode in, grinning and glancing at the people around him; Ed, on the other hand, looked like a man who wanted to go off and have a good cry. Immediately, Twitter exploded with tweets declaring the contest for the elder brother, even Andrew Sparrow in the Guardian, and the BBC’s Nick Robinson were fooled. There then proceeded an exercise in suspense that beat X-Factor, or Who Wants To Be A Millionaire? into the ground. The announcer went through the vote distribution of each section of the electoral college, for each round in turn, and for each of those rounds David came out in front until the very last round when Ed pulled ahead with 50.35% of the vote, compared to David’s 49.65%.

This is not going to be an article to discuss the policy implications of Ed Miliband, as leader, or his current performance, except to say that I broadly support Cory’s analysis of what he needs to do next, and that those who elected him were aware of his relative inexperience and we can expect him to grow into the performance side of the role. Don’t forget that David Cameron was in a very similar position at the start of his tenure as Conservative Party Leader. Instead I am going to look at the response to Ed Miliband’s election. The notion of two brothers fighting for the leadership has captured the public imagination and arguably this has worked in his favour over and above Ed Balls and Andy Burnham. His victory, as well, touches on some very visceral emotions: he followed his older brother, almost exactly, at every stage in his career before finally supplanting him, at what could have been the moment of his greatest triumph- it’s almost an archetype. David Miliband has now stepped down, his defeat apparently total. Both Paperback Rioter writers are older siblings and we can appreciate the emotional impact. Ed Miliband’s victory doesn’t just have an emotional significance, though. David was often viewed as the natural successor to Gordon Brown, not just because of his seniority, but because he seemed to have been anointed even before Brown stepped down in May. Ed’s victory marked, therefore, a defeat not only for primogeniture, but also for the media and political establishment that had placed its weight behind his brother. The fact that this contest has not gone their way could not be more apparent from the subsequent reaction. To the “left,” John Rentoul penned an extraordinarily petulant article in the independent backed by angry twitter responses from David Aaronovitch and friend of Paperback Rioter, Darrell Goodliffe, makes a very good case for replacing the electoral college with one person one vote, comprising of all MPs, members and affiliates. This is an excellent suggestion- provided that affiliate organizations were allowed to maintain an independent identity- but it must be emphasised that Ed Miliband’s majority would have been greater under such a system, as it would reduce the weight given to the parliamentary section that favoured his brother. It is also worth remembering that David had the advantage of greater name recognition and overwhelming media support with endorsements from multiple tabloid and broadsheet newspapers. These endorsements, pushed for the days and weeks prior to the ballot, would have far greater potential to influence Union members than an endorsement from the union hierarchies delivered with the ballot. All talk of a “stolen victory” is hot air.

The tactics used to undermine Ed Miliband’s leadership represent an unwelcome importation of American style politics. Baroness Warsi, an emerging Sarah Palin figure, was given multiple platforms to air her facile analysis of the result and to implore Miliband to flagellate himself for not being a Conservative and the personal attacks have already begun (it’s always with the birth certificates!). Conversely, the virulence of the media response is in some ways encouraging, suggesting genuine fear on the right, of his potential to win an election and the direction he could move the country in. The Labour Party and its new leader need to hold firm against these attacks and start to actively take charge of the agenda. Make no mistake, Ed Miliband, is no messiah, but his election is a very hopeful development for British politics.


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