Lansley’s NHS reforms will undermine fairness

Another organisational shake-up does not surprise doctors, but this is a much bolder move towards pr

Andrew Lansley has launched a white paper that has been heralded as the biggest shake-up of the NHS in a generation.

The key proposals are:

  • Abolishing ten strategic health authorities by 2012 and scrapping the 152 primary care trusts by 2013. This would mean that up to 30,000 managers face being cut or redeployed.
  • Replacing these management structures with about 500 GP "consortiums" (not optional), meaning that family doctors will have control of £80bn of public money.
  • Allowing hospitals to leave public ownership to become "not-for-profit" companies.

The first thing to note is that the NHS has been in a state of almost continuous reform for nearly three decades. There has been some form of organisational change almost every year since the early 1990s. Many of these changes resemble each other; 2002's primary care trusts were difficult to distinguish from 1982's district health authorities. The same goes for NHS trusts and foundation hospitals.

The cumulative effect -- apart from the fact that most new structures don't have time to show positive effects before they are changed again -- is cynicism in the medical profession, as evident in this doctor's blog:

As the ministers and commentators observe the effects of their "bold vision" and "strategic planning", I am happy to tell them how much difference this will make to most Jobbing Doctors -- very little. You see, we have seen this all before.

Under the internal market established by Margaret Thatcher, and not-much-changed by Tony Blair, GPs surgeries already operate much like private businesses that commission services from hospitals. Equally, under private finance initiatives, private companies have been involved in building numerous new hospitals.

But what the new plans do amount to is a much bolder and more open step towards privatisation of the National Health Service. As with so many of the coalition's reforms, the move towards less bureaucracy is not matched by guarantees of accountability, which are needed to maintain a consistent standard countrywide.

Oddly enough, Melanie Phillips makes a good point about this:

It also surely runs the risk of fragmenting the service, since GPs will try to look after their own clinical patch rather than the general good. And this gets to the crux of the problem. A national service needs to offer unified provision throughout the country in order to be seen to be equitable.

Yesterday, Lansley spoke of the need for competition and choice, echoing Thatcher's market ideology, ignoring that last time this was implemented, we were left with a hugely unfair postcode lottery. Lest we forget, the much-reviled target culture did produce results, with waiting list figures, among others, drastically improved (LabourList has some numbers here).

The NHS was founded on the principle of fairness. Let's not undermine that by restructuring the system in such a way that it has no mechanisms to help that fairness flourish.

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Samira Shackle is a freelance journalist, who tweets @samirashackle. She was formerly a staff writer for the New Statesman.

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Harmful gender stereotypes in ads have real impact – so we're challenging them

The ASA must make sure future generations don't recoil at our commercials.

July’s been quite the month for gender in the news. From Jodie Whittaker’s casting in Doctor Who, to trains “so simple even women can drive them”, to how much the Beeb pays its female talent, gender issues have dominated. 

You might think it was an appropriate time for the Advertising Standards Authority (ASA) to launch our own contribution to the debate, Depictions, Perceptions and Harm: a report on gender stereotypes in advertising, the result of more than a year’s careful scrutiny of the evidence base.

Our report makes the case that, while most ads (and the businesses behind them) are getting it right when it comes to avoiding damaging gender stereotypes, the evidence suggests that some could do with reigning it in a little. Specifically, it argues that some ads can contribute to real world harms in the way they portray gender roles and characteristics.

We’re not talking here about ads that show a woman doing the cleaning or a man the DIY. It would be most odd if advertisers couldn’t depict a woman doing the family shop or a man mowing the lawn. Ads cannot be divorced from reality.

What we’re talking about is ads that go significantly further by, for example, suggesting through their content and context that it’s a mum’s sole duty to tidy up after her family, who’ve just trashed the house. Or that an activity or career is inappropriate for a girl because it’s the preserve of men. Or that boys are not “proper” boys if they’re not strong and stoical. Or that men are hopeless at simple parental or household tasks because they’re, well...men.

Advertising is only a small contributor to gender stereotyping, but a contributor it is. And there’s ever greater recognition of the harms that can result from gender stereotyping. Put simply, gender stereotypes can lead us to have a narrower sense of ourselves – how we can behave, who we can be, the opportunities we can take, the decisions we can make. And they can lead other people to have a narrower sense of us too. 

That can affect individuals, whatever their gender. It can affect the economy: we have a shortage of engineers in this country, in part, says the UK’s National Academy of Engineering, because many women don’t see it as a career for them. And it can affect our society as a whole.

Many businesses get this already. A few weeks ago, UN Women and Unilever announced the global launch of Unstereotype Alliance, with some of the world’s biggest companies, including Proctor & Gamble, Mars, Diageo, Facebook and Google signing up. Advertising agencies like JWT and UM have very recently published their own research, further shining the spotlight on gender stereotyping in advertising. 

At the ASA, we see our UK work as a complement to an increasingly global response to the issue. And we’re doing it with broad support from the UK advertising industry: the Committees of Advertising Practice (CAP) – the industry bodies which author the UK Advertising Codes that we administer – have been very closely involved in our work and will now flesh out the standards we need to help advertisers stay on the right side of the line.

Needless to say, our report has attracted a fair amount of comment. And commentators have made some interesting and important arguments. Take my “ads cannot be divorced from reality” point above. Clearly we – the UK advertising regulator - must take into account the way things are, but what should we do if, for example, an ad is reflecting a part of society as it is now, but that part is not fair and equal? 

The ad might simply be mirroring the way things are, but at a time when many people in our society, including through public policy and equality laws, are trying to mould it into something different. If we reign in the more extreme examples, are we being social engineers? Or are we simply taking a small step in redressing the imbalance in a society where the drip, drip, drip of gender stereotyping over many years has, itself, been social engineering. And social engineering which, ironically, has left us with too few engineers.

Read more: Why new rules on gender stereotyping in ads benefit men, too

The report gave news outlets a chance to run plenty of well-known ads from yesteryear. Fairy Liquid, Shake 'n' Vac and some real “even a woman can open it”-type horrors from decades ago. For some, that was an opportunity to make the point that ads really were sexist back then, but everything’s fine on the gender stereotyping front today. That argument shows a real lack of imagination. 

History has not stopped. If we’re looking back at ads of 50 years ago and marvelling at how we thought they were OK back then, despite knowing they were products of their time, won’t our children and grandchildren be doing exactly the same thing in 50 years’ time? What “norms” now will seem antiquated and unpleasant in the future? We think the evidence points to some portrayals of gender roles and characteristics being precisely such norms, excused by some today on the basis that that’s just the way it is.

Our report signals that change is coming. CAP will now work on the standards so we can pin down the rules and official guidance. We don’t want to catch advertisers out, so we and CAP will work hard to provide as much advice and training as we can, so they can get their ads right in the first place. And from next year, we at the ASA will make sure those standards are followed, taking care that our regulation is balanced and wholly respectful of the public’s desire to continue to see creative ads that are relevant, entertaining and informative. 

You won’t see a sea-change in the ads that appear, but we hope to smooth some of the rougher edges. This is a small but important step in making sure modern society is better represented in ads.

Guy Parker is CEO of the ASA