The left must abandon the idea of change from above

The rusted levers of the central state simply cannot cope with the complexity of the new world.

If there is one feature, above all, which manifests itself in our public and economic lives it is this: the shift from ‘them to us’.  It is the shift from a way of being for both organisations and individuals that is centralised and hierarchical to a world that is decentralised and horizontal. The implications are profound.

What we are witnessing is the breaking up of old tectonic plates born of the centralising forces of the early and mid decades of the last century. The on-going crisis at the BBC, the archetype of this organisational form, this week labelled "incapable and chaotic" over the Savile affair, is witness to the cumbersome and ineffectual nature of this type of antiquated structure. 

But all our big old institutions are in crisis; the media more generally, banking, the police and the political establishment are all finding themselves unable to cope, react or adjust to new pressures and demands. Under pressure, they react the only way they can – through different shades of managerial and technocratic responses that simply make matters worse by showing how out of touch and tune they are. Old systems that are closed, rigid, hard and hierarchical are finding it increasingly tough dealing with new systems that are open, malleable, soft and horizontal.

This process cannot be clear-cut. Paradigm shifts are always a slow and messy burn. And what is happening is more than the pendulum swing between right and left. There is no natural political winner from the ‘them to us’ switch. The new devolved and decentralised forms can be a privatised and individualised as much as they can be ‘publicised’ and socialised.  Much of this new ‘us’ world is built around technology, the morality of which is strictly neutral. It can end up with Amazon or Avaaz.

The switch gives progressives an opening but only if we can tear ourselves away from the essentially Leninist/Fordist model that says "socialism is what a Labour government does". This outsourcing of socialism to an elite is typical of the old world. The rusted levers of the central state simply cannot cope with the complexity of the dispersed systems of the new world. People want to do things for themselves and where they don’t, things will go wrong. You cannot outsource socialism or the socialisation of your children to the market or the state – you have to co-produce it by getting involved and investing part of yourself in it. It’s the only way things really work.

The idea of the democratisation of our common life, more than anything else, must be the motif that runs through the radical politics of the future. In economic development the emphasis should be on local democratic ownership and the same vision should be applied to comprehensive schooling and health. Other essentially public assets like railways and trains should be taken back into public ownership but not to resurrect the monoliths of the past – but to create new regional and local enterprises that are accountable to the people and institutions they serve.

"The old is dying and the new cannot be born," said Antonio Gramsci, the celebrated Italian Marxist. But the contours of the new can be seen all around us; from peer-to peer design, production and servicing. From on-line banks like Zopa where people lend to each other and cut out the old banks, to Wikipedia, our first port of call on any research project, from political campaigning vehicles like 38 Degrees in which over one million decide the issue and then make the campaign happen, to on the ground change through organisations like Locality.

Zygmunt Bauman, the still prolific octogenarian sociologist, describes this world as "liquid modern". The old edifices still exist but the security they offered has long gone.  It is a world in which we are both blessed and cursed with freedom without security, which, as we are finding, is a frustratingly hollow form of being free.  The thin ice on which we skate in our daily lives, the effort to keep up and the fear and anxiety of what lies around the corner, the insecurity that overshadows the liberation of the mobile and iPad, can only be traversed by skating faster.

The challenge to the exhaustion and pointlessness of so much of modern life is to find ways of being secure while still being free – not from the top down, not by relying on someone else to make us secure. No one can. Only we can. The fight and struggle of the future will be about how we knit together a social and economic fabric that enables us to be creative and innovative the best way we can – with others. It is a future that will be negotiated, with alliances formed and reformed around different issues and the thread that runs through it all won't be a single party but a belief in the capacity of people collectively to shape their world.

Demonstrators take part in a TUC march in protest against the government's austerity measures. Photograph: Getty Images.

Neal Lawson is chair of the pressure group Compass, which brings together progressives from all parties and none. His views on internal Labour matters are personal ones. 

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Testing migrant children’s teeth for their age is not only immoral – it doesn’t work

Ministers have flirted with this idea for over a decade. It’s bad policy, as well as poor ethics.

This week, the Home Office finally ruled out the use of x-rays to establish the age of childhood migrants.

It’s welcome news, but this story predates the dispersal of the Calais “Jungle” camp. 

For over ten years, ministers in Conservative and Labour governments have flirted with these tests. And it’s been up to us – the practitioners who’d be expected to administer them – to pick holes in a policy that’s a great way of securing headlines, but simply cannot deliver on the claims made by its cheerleaders.

It goes without saying dentists are health professionals, not border guards. But our objections run deeper than that. And it’s worth revisiting the arguments, just in case future governments start grasping for silver bullets.

It’s ineffective

We can talk about philosophy later, but let’s start with a pretty fundamental objection: dental x-rays are simply not a reliable way of establishing age.

No two mouths are alike. I’ll add my own to that list, as I still sport two of my baby teeth.

Children and young people mature at different rates, so the level of accuracy in these tests changes with time. And these x-rays can estimate age in younger children much more accurately than in adolescents. So as children mature at different rates, the potential margin of error gets ever larger with age.

For example, the third molars, commonly known as wisdom teeth – the last permanent teeth to develop – can form any time between the ages of 16 and 23, and a small proportion of individuals never develop third molars at all (I’ll have to pop my name to that list too).

A 2010 study of 300 young people aged between 11 and 25, whose age was determined based on dental x-rays, showed this method of testing consistently over- or under-estimated age, with a two-year average difference between dental and known age.

So if you are searching for a litmus test that will tell you whether a subject is 17 or 19 years old you won’t find it here.

It’s inappropriate

A few MPs and pundits have found it hard to acknowledge the codes health practitioners sign up to, which make this test a no go.

We must always act in the best interest of our patients when providing a medical procedure. And it is beyond question that the process of radiography is a medical procedure that should be carried out only for medical purposes, and where the patient stands to benefit.

Now many people might not consider this test an invasive procedure. However, x-rays do carry a small risk of possible long-term physical impact, and current best practice in this area dictates that exposure to radiation should be kept as low as reasonably possible over a lifetime. They should be carried out sparingly and where there is a well-defined potential clinical benefit, which must always outweigh the potential clinical harm.

As taking x-rays to determine the age of an individual carries no clinical benefit, it frankly isn’t appropriate to expose a patient to the potential clinical harm it can cause.

It’s unethical

Our lawmakers cannot simply dispense with fundamentals like consent to show they are “taking action”.

It is a legal principle that before practitioners carry out any medical procedure, the recipient – or someone who can consent on their behalf – must be given a full understanding of the nature of the procedure, its significance, impact and potential consequences before signing up to it.

For the children arriving from Calais, this would be a difficult task without English as a first language. Consent may also be required from a suitable adult. Yes, these children may be unaccompanied, but it does not mean the need for valid consent and protecting the child’s best interests can simply be ignored.

The letter of the law might be inconvenient, but it is a requirement that can only be compromised where the urgency and necessity of the circumstances demand rapid action in a patient’s best interests. And even in these circumstances the validity of treatment has sometimes ended up being challenged in the courts.

Given that taking x-rays in order to determine age is not medically justifiable in the first place, the urgency justification really doesn’t come into play. And that means dental colleagues – in the absence of valid consent – could find themselves performing an act that constitutes a criminal battery.


In the past, ministers have debated whether there is a credible “public interest” case that might override these little legal or philosophical objections. But these practical and ethical concerns can’t really be separated.

But why bother constructing a case for a test that frankly isn’t much cop? Dentists can only hope the latest message from the Home Office marks the beginning of a consensus, which draws a line under a decade of wishful thinking.

Judith Husband, Chair of the British Dental Association’s Education, Ethics and the Dental Team Working Group.