David Cameron delivers a speech on NHS reform at University College Hospital on June 7, 2011. Photograph: Getty Images.
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The NHS is becoming an ever-bigger headache for the Tories

Labour stands to gain if the crisis in the health service becomes one of the major election themes. 

One of Labour's priorities for the summer is raising the salience of the NHS, the issue on which it enjoys its largest poll lead. "After living standards, we need it [the NHS] to be voters’ priority," a strategist told me. If one of the defining questions of the election is "which party do I trust to run the health service?" Labour's chances of victory will be improved.  

It is encouraging for the party, then, that both the Sun and the Times splash on the growing NHS crisis today. The former carries an investigation warning of record A&E waiting times and longer waits for GPs, while the latter reports that one in nine people trying to see a doctor cannot get an appointment, with GPs turning patients away more than 40 million times this year.

The Tories have long regarded the NHS as the dog that hasn't barked, boasting that the oft-predicted "winter crisis" never came. But the dog is certainly barking now. Worse, the party's "top-down reorganisation" of the health service (for which, it should not be forgotten, it had no mandate. Indeed, it had a mandate not to introduce one) means Labour can easily lay the blame at the Conservatives' door. 

Having once aspired to establish themselves as "the party of the NHS", the Tories are now narrowly focused on neutralising the issue. As I've previously reported, Lynton Crosby has told ministers not to mention it on the grounds that it helps Labour. 

In his speech at last year's Conservative conference, David Cameron said: "Some people said the NHS wasn't safe in our hands. Well - we knew otherwise. Who protected spending on the NHS? Not Labour - us. Who started the Cancer Drugs Fund? Not Labour - us. And by the way - who presided over Mid Staffs? Patients left for so long without water, they were drinking out of dirty vases...people's grandparents lying filthy and unwashed for days. Who allowed that to happen? Yes, it was Labour...and don't you dare lecture anyone on the NHS again." 

But don't expect to see a similar passage in this year's pre-election address. One of Crosby's most consistent pieces of advice to the Tories is "not to play on Labour's side of the pitch". This means talking about issues on which the party is strong, such as the deficit, immigration and welfare, and avoiding those on which it is weak.

Some Tories believe they can repel the opposition’s assault by deriding the state of the service in Labour-run Wales. But Ed Miliband has adopted a new riposte to this attack: Cameron wants to talk about Wales because he cannot defend his record in England. The disparity in performance between the two countries has narrowed as the health service has deteriorated under the coalition.

But Labour will be able to dwell on this issue for only so long before it is forced to confront a funding gap of £30bn by the end of the next parliament. Stephen Dorrell, the former health secretary, Sarah Wollaston, the new chair of the health select committee, and Frank Field, the former social security minister, all warn that the NHS will not survive in its present form without a real-terms increase in spending. Demographic pressures, the rising cost of technology and the growth in chronic conditions are such that merely ring-fencing the service from cuts will not do. 

One of the biggest questions facing Labour before the election, then, is whether, and how, to promise an increase in health spending. 

George Eaton is political editor of the New Statesman.

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How “cli-fi” novels humanise the science of climate change

The paradox is that the harder climate-fiction novels try, the less effective they are.

When the Paris UN Climate Change Conference begins at the end of November, the world’s leaders will review the climate framework agreed in Rio in 1992. For well over 20 years, the world has not just been thinking and talking about climate change, it has also been writing and reading about it, in blogs, newspapers, magazines – and in novels.

Climate change fiction is now a recognisable literary phenomenon replete with its own nickname: “cli-fi”. The term was coined in 2007 by Taiwan-based blogger Dan Bloom. Since then, its use has spread: it was even tweeted by Margaret Atwood in 2013:

It is not a genre in the accepted scholarly sense, since it lacks the plot formulas or stylistic conventions that tend to define genres (such as science fiction or the western). However, it does name a remarkable recent literary and publishing trend.

A 21st-century phenomenon?

Putting a number to this phenomenon depends, partly, on how one defines cli-fi. How much of a novel has to be devoted to climate change before it is considered cli-fi? Should we restrict the term to novels about man-made global warming? (If we don’t, we should remember that narratives about global climatic change are as old as The Epic of Gilgamesh and the Biblical story of the flood.) If we define cli-fi as fictional treatments of climate change caused by human activity in terms of setting, theme or plot – and accept there will be grey areas in the extent of this treatment – a conservative estimate would put the all-time number of cli-fi novels at 150 and growing. This is the figure put forward by Adam Trexler, who has worked with me to survey the development of cli-fi.

This definition also gives us a start date for cli-fi’s history. While planetary climatic change occurs in much 20th-century science fiction, it is only after growing scientific awareness of specifically man-made, carbon-induced climate change in the 1960s and 1970s that novels on this subject emerged. The first is Arthur Herzog’s Heat in 1976, followed by George Turner’s The Sun and the Summer (published in the US as Drowning Towers) in 1987.

At the turn of this century, Maggie Gee and TC Boyle were among the first mainstream authors to publish climate change novels. In this century, we can count Atwood, Michael Crichton, Barbara Kingsolver, Ian McEwan, Kim Stanley Robinson, Ilija Trojanow and Jeanette Winterson as major authors who have written about climate change. The past five years have given us notable examples of cli-fi by emerging authors, such as Steven Amsterdam, Edan Lepucki, Jane Rawson, Nathaniel Rich and Antti Tuomainen.

Creative challenges

Cli-fi is all the more noteworthy considering the creative challenge posed by climate change. First, there is the problem of scale – spatial and temporal. Climate change affects the entire planet and all its species – and concerns the end of this planet as we know it. Novels, by contrast, conventionally concern the actions of individual protagonists and/or, sometimes, small communities.

Added to this is the networked nature of climate change: in physical terms, the climate is a large, complex system whose effects are difficult to model. In socio-cultural terms, solutions require intergovernmental agreement – just what COP21 intends – and various top-down and bottom-up transformations. Finally, there exists the difficulty of translating scientific information, with all its predictive uncertainty, into something both accurate and interesting to the average reader.

Still, cli-fi writers have adopted a range of strategies to engage their readers. Many cli-fi novels could be classified as dystopian, post-apocalyptic or, indeed, both – depicting nightmarish societies triggered by sometimes catastrophic climate events. A future world is one effective way of narrating the planetary condition of climate change.

Some novelists are also careful to underpin their scenarios with rigorous climatic predictions and, in this way, translate science fact into a fictional setting. Kingsolver, who trained as an ecologist, is the best example of this – and Atwood and Robinson are also known for their attempts at making their speculations scientifically plausible. Also, cli-fi novels, particularly those set in the present day or very near future rather than in a dystopian future, tend to show the political or psychological dimensions of living with climate change. Readers can identify with protagonists. To some extent, the global community is represented in fictional everymen or everywomen. Or, often, it is through such characters that science is humanised and its role in combating climate change better understood.

Can cli-fi lead to change?

Could cli-fi affect how we think and act on climate change? The paradox is that the harder cli-fi tries, the less effective it is. Many writers want to inspire change, not insist on it: the line between literature and propaganda is one that most novelists respect. Literature invites us to inhabit other worlds and live other lives. Cli-fi at its best lets us travel to climate-changed worlds, to strive there alongside others and then to return armed with that experience.

In Paris, the UN will seek a global agreement on climate action for the first time in more than 20 years. There is plenty of climate change fiction out there to help provide the mental and psychological space to consider that action.

The Conversation

Adeline Johns-Putra, Reader in English Literature, University of Surrey

This article was originally published on The Conversation. Read the original article.