NHS horror stories, my life as a Twitter fogey, and cricket’s robot generation

Peter Wilby's "First Thoughts" column.

Horror stories about the National Health Service come thick and fast, conveniently for a government that wants to hand it over to private capital. One week, it is chaos in A&E; the next, substandard care at 14 hospital trusts and old folk being ushered to an early grave by the Liverpool Care Pathway (LCP). We should treat these stories with scepticism even when they are apparently validated by official inquiries.

With all the talk of “excess deaths”, you would think that our hospitals had become killers. Yet, as the NHS medical director for England, Bruce Keogh, observes in his report on the 14 “failing” trusts, overall mortality in hospitals has fallen by about 30 per cent over the past decade.

Inquiries, however, rarely conclude that the problems they were set up to address don’t exist and they would be dismissed as whitewashes if they did. Given the emotion and fears surrounding serious illness and particularly death, it’s easy to find allegations of medical neglect. Julia Neuberger’s report on the LCP is replete with phrases such as “some people”, “many people” and “all too often”. There are no references to randomised sample surveys. The inquiry invited submissions from the public (it received 483), talked to 113 people at meetings and looked at hospital complaints. Such evidence should not be ignored but it is naturally biased towards those who suffered bad experiences.

No institution is perfect and anything involving medicine, which is as much an art as a science, will be more imperfect than most. What we don’t know is whether a health service run by private providers would be better.

I offer this snippet: in 2010, the US health department’s inspector general reported that 13.5 per cent of Medicare hospital patients suffered “harm” from “adverse events”, nearly half of them because of care failures. British newspapers love to highlight cases of “wrong-site surgeries”, in which ovaries are taken out instead of the appendix, for example. The United States has 40 of those a week; the UK has about 60 a year. The NHS has failings but they seem relatively few and, by international standards, very cheap.

Guilt by association

What’s in a name? The Neuberger report acknowledges that “many relatives” of patients on the LCP felt their loved ones had had “good deaths”. Yet it recommends dropping the term. “Pathway”, it argues, suggests patients being speeded directly to their coffins. I wonder if “Liverpool” isn’t the greater problem. Thanks partly to the Sun and Boris Johnson, the city has acquired negative associations in the past 25 years. Mention Liverpool and people think of poverty, unemployment, riots, too much drink and a declining football team.

Seen but not heard

The BBC’s director general, Tony Hall, says that he intends to stop actors muttering in the corporation’s dramas. If so, he will be performing a service to theatregoers as well as TV viewers. Actors, it seems, are no longer being taught to articulate their lines clearly and “throw” their voices, largely because the big money is now in TV, where authenticity is thought more important than audibility. Being deaf, I nearly always buy front-row seats at the theatre, but in the West End recently, we sat in the grand circle and my wife, whose hearing is perfect, complained that she couldn’t hear, either. Theatregoers should start a campaign and, at an agreed signal, stand in unison and shout: “Speak up!”

Social outcast

We hear much about how social media companies hold extensive databases on us that could be exploited by governments and corporations. We also hear about their inadequate controls over insulting comments. But I have not noticed discussion of their arbitrary power over users. I returned from holiday to find my Twitter account “suspended”, without warning or explanation. After a polite, emailed inquiry, I was told to look at the rules. I replied I couldn’t see how I had broken them. Two weeks later, someone at Twitter emailed me, saying, “It’s been awhile since we’ve heard from you,” and that “hopefully” the matter had been resolved. It certainly hadn’t, I replied. The account was restored a few days later, still without explanation or apology.

Being an old fogey, I use Twitter spasmodically and was not greatly inconvenienced by its loss. To some users, however, it has become an essential working tool. In a telling example of how technology can restrict rather than widen choice, many feel they must use it because their professional peers do so. We should know more about the Californian geeks who run social media and what redress they offer to those arbitrarily blackballed.

Analyse this

How could Ashton Agar, a 19-year-old cricketer playing his first Test and batting at No 11, make 98, the highest score of Australia’s first innings against England at Trent Bridge? The answer is that, since Agar had played only 16 unremarkable first-class innings, the England coaches, lacking videos of him, could offer bowlers no plans for getting him out. International sides now analyse opponents exhaustively. They produce pie charts, spreadsheets, graphs and other statistical paraphernalia, searching for a batsman’s weakness as assiduously as physicists searched for the Higgs boson. Even the best modern bowlers are robots, programmed by back-room boffins. Without the usual input, they malfunction.

What redress does Twitter offer to the arbitrarily blackballed? Photograph: Getty Images

Peter Wilby was editor of the Independent on Sunday from 1995 to 1996 and of the New Statesman from 1998 to 2005. He writes the weekly First Thoughts column for the NS.

This article first appeared in the 22 July 2013 issue of the New Statesman, How to make a saint

Getty
Show Hide image

Staying in the EU would make it easier to tackle concerns about immigration, not less

Brexit is not only unlikely to deliver the control people want, it may actually undermine people’s faith in the system even further.

As Theresa May prepares to set out her latest plan for Brexit in Florence on Friday, those on all sides of the debate will wait to see if there are answers to fundamental questions about Britain’s future outside of the EU. Principle among those is how the UK immigration system will work. How can we respond to Leave voters’ concerns, while at the same time ensuring our economy isn’t badly damaged?

We must challenge the basic premise of the Vote Leave campaign: that dealing with public’s concern about immigration means we have to leave the EU and Single Market.

In fact the opposite is true. Our study into the options available to the UK shows that we are more likely to be able to restore faith in the system by staying within Europe and reforming free movement, than by leaving.

First, there are ways to exercise greater control over EU migration without needing to change the rules. It is not true that the current system of free movement is "unconditional", as recently claimed in a leaked Home Office paper. In fact, there is already considerable scope under existing EU rules to limit free movement.

EU rules state that in order to be given a right to reside, EU migrants must be able to demonstrate proof that they are either working, actively seeking work, or self-sufficient, otherwise they can be proactively removed after three months.

But unlike other continental systems, the UK has chosen not to operate a worker registration system for EU nationals and thus has no way of tracking where they are or what they’re doing. This could be changed tomorrow, if the government were so minded.

Other reforms being discussed at the highest levels within Europe would help deal with the sense that those coming to the UK drive down wages and conditions. The UK could make common cause with President Macron in France, who is pushing for reform of the so-called "Posted Workers Directive", so that companies seeking to bring in workers from abroad have to pay those workers at the same rate as local staff. It could also follow the advice of the TUC and implement domestic reforms of our labour market to prevent exploitation and undercutting.

Instead, the UK government has chosen to oppose reform of the Posted Workers Directive and made it clear that it has no interest in labour market reform.

Second, achieving more substantive change to free movement rules is not as implausible as often portrayed. Specifically, allowing member states to enact safeguards to slow the pace of change in local communities is not unrealistic. While the principle of free movement is a cornerstone of the European project, how it is applied in practice has evolved. And given that other countries, such as France, have expressed concern and called for reform, it is likely to evolve further.

The reforms to free movement negotiated by David Cameron in 2016 illustrate that the EU Commission can be realistic. Cameron’s agreement (which focused primarily on benefits) also provides an important legal and political precedent, with the Commission having agreed to introduce "safeguards" to respond to "situations of inflow of workers from other Member States of an exceptional magnitude over an extended period of time".

Similar precedents can be found within a number of other EU agreements, including the Acts of Accession of new Member States, the European Economic Area (EEA) Agreement and the Treaty on the Functioning of the European Union (TFEU). The UK should seek a strengthened version of Cameron’s "emergency brake", which could be activated in the event of "exceptional inflows" from within the EU. We are not the first to argue this.

Of course some will say that it is unrealistic to expect the UK to be able to get more than Cameron achieved in 2016. But put yourself if in the shoes of the EU. If you believe in a project and want it to succeed, moral imperative is balanced with realism and it hardly needs pointing out that the political context has radically shifted since Cameron’s negotiation.

In contrast, a "hard Brexit" will not deliver the "control of our borders" that Brexiteers have promised. As our report makes clear, the hospitality, food, manufacturing and social care sectors heavily depend on EU workers. Given current employment rates, this means huge labour shortages.

These shortages cannot be wished away with vague assertions about "rejoining the world" by the ultra free-market Brexiteers. This is about looking after our elderly and putting food on our tables. If the UK leaves in April 2019, it is likely that the government will continue to want most categories of EU migration to continue. And whatever controls are introduced post-Brexit are unlikely to be enforced at the border (doing so would cause havoc, given our continued commitment to visa-free travel).  Instead we would be likely to see an upsurge in illegal migration from within the EU, with people arriving at the border as "visitors" but then staying on to seek work. This is likely to worsen problems around integration, whereby migrants come and go in large numbers, without putting down roots.

We can do this a different way. The important issues that most drive public concern about EU migration - lack of control, undercutting, pace of change - can be dealt with either within current rules or by seeking reform within the EU.

The harsh truth is that Brexit is not only unlikely to deliver the control people want, it may actually undermine people’s faith in the system even further.

Some will say that the entire line of argument contained here is dangerous, since it risks playing into an anti-immigrant narrative, rather than emphasising migration’s benefits. This is an argument for the ivory tower, not the real world.

There is a world of difference between pandering to prejudice and acknowledging that whilst EU migration has brought economic benefits to the UK, it has also created pressures, for example, relating to population churn within local communities.

The best way to secure public consent for free movement, in particular, and immigration in general, is to be clear about where those pressures manifest and find ways of dealing with them, consistent with keeping the UK within the EU.

This is neither an attempt at triangulation nor impractical idealism. It’s about making sure we understand the consequences of one of the biggest decisions this country has ever taken, and considering a different course.

Harvey Redgrave is a senior policy fellow at the Tony Blair Institute for Global Change and director of strategy at Crest Advisory.