Loosely educative - a review

I'm torn over whether university should be totally free or have some form of contribution - it's a toughie and I don't think there's an easy answer. If it's totally free, then it means people who don't access HE are paying for those of us who do; but the argument that counters this is that HE is an inherently good thing for the nation. However, there have been some interesting mess-ups about the recent fee hike, which, like a lot of the rest of the stuff this government has thrown at us, was rushed and doesn't seem terribly well thought through.

Today OFFA has released the fact that a third of universities are planning on charging £9k - and the average will be over £8k - a year - for university. This is in stark contrast to the comments coming out of Downing Street not that long ago, in particular from Dave's Deputy PM and Simon Hughes, who went on and on about it only being a 'few', and it seems that they all live up to the 'access' criteria they have to abide by. So much for this only being a minor problem. (On that point, the government has said that a fee increase will not put off poorer students from applying to university. Yet they have been going on about only a few universities charging the extra. Is the government suggesting that poorer students will still apply because there are still cheap options available - as what else would be the benefit of some universities remaining cheaper? It's all very confused.)

So what has this done to the government's finances? Well apparently the fee increases may make loans unaffordable! Whether that is true or not is hard to know - but as a medical student, this is of particular interest...

Undergraduate medical students currently pay year 1-4, then there is an NHS bursary for year 5 and 6 (or the last two years at any rate - the graduate bursary is less generous). This means that, excluding living costs (which are considerable, especially in the clinical years), a medical degree costs the student around £14,000 (which is probably about a tenth of the true cost). Once the fees raise, it will cost £36,000. However, this bursary has only won a reprieve for a year - after 2012 intake, it looks like it will be removed, because it is UNAFFORDABLE! So the government cannot even afford it's own fees! That means that a medical course will cost up to £54,000 - £40k more than at present.

You might argue that because doctors earn good money this isn't a problem. However, let's not forget that doctors are public servants - and are performing a vital function. The best doctors are in it because they want, at heart, to help and heal - not because they want to earn lots. We need the best, academically and personally, to be in the profession. Yet if we tell them they must pay a lot more than any other degree, what on earth does that say. Not only does it say that we don't value education - but also that we don't value medics. If you study medicine, in other words, you'll be paying for it for years. So much for wanting a better NHS for patients...

But, of course, medicine isn't the point when we look at fee increases, according to the proponents of the idea. The problem we 'romantics' about education have is that we think all education and degrees are like the ones that used to exist - the idea of a degree for a degree's sake. Well, maybe. Maybe some degrees aren't terribly useful. Maybe some of the degree subjects could be taught in different ways. Maybe some things do provide benefit solely to the individual. Maybe payment for those should work in a different way. Maybe the arbitrary level of 50% of the population going to university was pointless and hasn't acheived much (surely getting the best kids from any socio-economic background to university rather than just increasing numbers is a far more sensible definition of 'access'). But that doesn't mean that increasing the fees across the board is the answer - simply making the current system, a very much imperfect system, affordable, rather than fixing it, seems a bit pointless.

The associated 'access' argument about allowing some students in to universities with lower grades is also missing the point. Schemes like ones run at some of the top universities that take children with natural talent but poorer grades, and get them up to speed, are very sensible, and to be applauded. The question that isn't being asked, however, is the most important one - why the hell do these schemes need to exist? What on earth is wrong with our school system that allows that to happen? My advice to government ministers desperate to meddle in universities and reduce the private school intake - sort the damned school system out first. Give the kids a level playing field and give them a chance. And don't try the money argument on me.

'We can't afford it' is the new phrase of government - that's the main reasoning for the cuts. But we can afford Libya (which has prevented genocide and which is thus fully justified). We can afford to help bail out Ireland. We can afford helping the IMF bail out Greece. We can afford the Olympics. Some of these are essential and important, of course. But if we can afford to do them, we have the money to do so - or at least we are willing to borrow to do so. That rather removes the government's 'necessary fast and deep cuts' arguments doesn't it. How about our poorest and most needy being 'essential and important'? And how about the country's future - at the mercy of its education - being 'essential and important'?

What a mess.

Graduation 2011

The following is an Address I gave in Queens' College (Cambridge) Chapel at the Graduation Service, 30th June 2011:

It’s a very great honour and a privilege to address you today, especially on the eve of what will be the first step along the road of adulthood and responsibility for many of us. It’s very hard to look back over the past three years without a fair share of happiness, regret, yes, and amusement. All of us have changed a good deal from the somewhat naïve and childish selves that entered Queens’ not that long ago; we are not fully formed – of course – but Queens’ has, and will always, leave a mark on us – one, I believe, that has shaped us for the better.

We are deeply lucky here to have that sense of community that a college brings. Even if it does mean everybody knowing everyone else’s business, it also means that there are always people there to pick you up if you are down; always people there who are, in a funny kind of way, just like you; and there are always people there to crib off. Relationship is, or at least should be, at the very heart of what it means to be human. Love, compassion, kindness, understanding – none of these are terribly popular when it comes to the cut-throat world of business (or, as I have found out, applying for research placements) – but without them, the very fabric of our society begins to fall apart. We are deeply lucky to have been here – and the question we must ask, at the end of it all, is – being given this great privilege of learning, what should we do with it? What was it for?

It’s perhaps difficult for me to stand here as a Christian and attempt to think this through with you. The church has managed, over its long and chequered history, to be cast as an engine of division and hurt as much as a force for social good. The bible and church tradition has been used to prop up slavery, to justify the burning of human beings because of their differing theology, and in more recent times, some groups still use it to prevent women from serving at the altar, and tell gays they are inherently sinful for showing love.

Let me tell you a story. In 1920s Harvard, it was decided that the sin of homosexuality was causing a, and I quote, ‘stain’, on the reputation of the place. Student after student was expelled. A mother wrote to the Dean of Harvard: "You could have done much good," she wrote, "had you perhaps had a little less sense of justice and a little more of the spirit of Jesus in your heart." Perhaps in today’s times, we could learn a little from that mother.

So what is that spirit of Jesus – and why is it relevant to this great period of transition in our lives? Well, that spirit of Jesus is love, and it is that love, so much stronger than anything else in our broken and sad world, which holds the key to our really bringing the kingdom of heaven to earth. How many times have we passed people living in the street by Kings and rather than loving, simply judged them? How many times have we told ourselves – I’m not going to give them money, but I will give it to charity to help them – and then never bothered to do so. I, for one, looking back at the number of times I got it wrong, am ashamed.

Christ, of course, doesn’t mince his words. ‘The gate is narrow, and the road hard’ we are told. Too often we opt for the easy way out – the turning of a blind eye to an obvious injustice (take our recent alliances with China to support trade, whilst some human beings are being rounded up and executed for disagreeing with the authorities by the very same Chinese leadership; or our continued purchase of cheap clothes whilst human beings a quarter of our age are working in sweat shops in what can only be called slavery). But it’s not happening in our consciousness – so we don’t care. Talk of a global village is, of course, political claptrap. But it shouldn’t be – and it is for our generation, and for people who have benefitted from the amazing opportunities of Cambridge, to change that.

But will we? The world we live in, and are about to work in, is not designed for those who care – the easy road is very much in the ascendency. It is hard not to be totally swept up in the pointless acquisition of wealth or material goods that we are constantly sold by commercial after commercial, celebrity after celebrity. ‘Look at the birds of the air, they neither sow nor reap, yet your heavenly father feeds them. Are you not of more value than they? Is not life more than food, and the body more than clothing?’ And we are given a solution: ‘Ask and it will be given to you. Search and you will find’. If we spent a little more time asking and searching, rather than judging and taking, how much more fulfilled and rich our lives would become.

But no, we are told that modern life is only worthwhile if you have the greatest possible material happiness; happiness is that perfect house, or those perfect designer sunglasses, or that perfect and illicit sexual encounter. John Terry, and I believe I can say that without being lifted off by the police, is just the last in a long line of celebrities who promote the lifestyle of take, take, take, and who cares about the consequences. ‘Do to others as you would have them do to you’. Just how many of us follow that, truly? Who cares about the consequences? Well Christ quite clearly tells us – ‘I do’. ‘Not everyone who says to me ‘Lord, Lord’ will enter the kingdom of heaven, but only one who does the will of my Father’. In the words of David Brent, we can talk the talk, but if we don’t walk the walk, or at least attempt to, then there’s not really much point.

Christ tells us: ‘where your treasure is, there your heart will be also’. So, as we come to the end of our three or four years here at Queens’, I suppose what the real question should be is – where are we going to store up our treasure? What will we do with all the learning and opportunities we have been deeply privileged to share in? Will we continue to sacrifice it on the altar of consumerism – where moth and rust consume, and where thieves break in and steal – or will be try to look a bit higher, and try to become more like the lamp that gives light to all in the house? Jesus tells all those who try to follow him that we are to be the light of the world – but the more that we turn towards ourselves, and selfishness, greed and ignorance, and away from asking, searching, loving, then the more that light becomes hidden. Life, and love, are deeply intermingled, and the more the latter influences the former, the more fulfilled it will be. Because, at the end of it all, we will all die; and if we haven’t shown love to those we leave behind, then our legacy is as nothing.

We have the chance to make the difference, we have the chance to be radical, but will we grasp it, and go through the narrow gate, or will we fall by the wayside and take the easy road? God give us strength to follow him as pilgrims on the route to the cross, working for the good of all, and not just for ourselves.

I will finish with a Pilgrims’ Prayer by St Gildas:

In health may I and all of my companions


Safely arrive with no harm or injury –


May my boat be safe in the waves of the ocean,


My horses safe on the highways of the earth,


Our money safe as we carry it with us


To pay due heed to our poor necessities.


May our enemies fail to do harm to us,


However evil the counsels which inspire them.


In the eternal name of Christ our Master,


May my roads all lie plain before me,


Whether I climb the rugged heights of mountains,


Or descend the hollow depths of valleys,


Or trudge the lengthy roads on open country,


Or struggle through the thickets of dense forest.


May I walk always in straight ways and shining


To longed-for places . . .

I promised myself it was exam term - but someone got me into a PICKLE

I actually cannot believe what happened tonight.

Eric Pickles gets the name for being one of the rudest and most unpleasant members of the Cabinet. I hadn't seen this side of him and thought it worth giving him a chance. I went to tonight's union speech to listen (not to disrupt like the extremists outside, who were determined to prevent free speech).

What a disappoinment. He started off by giving a seemingly fair account of what the current government are doing - he beat down some questions about rich councils keeping more money by noting that they had less to start with - so far, so good. He had some people convinced. He filled up with righteous anger when someone asked him why he was attacking the poor - he was from a council estate, he would never attack the poor, and how dare anyone suggest he would. He had us convinced - here was a man who genuinely did believe that his philosophy would help the poorest. Wrong, of course, but not out there to 'get the poor' as the protesters were suggesting.

Then I made the disastrous move of asking him why he thought the current Tory party, despite Cameronism, were still thought of as 'hating the poor'. I had already noted in my question how sad I thought it was that the extremists were attempting to prevent grown-up politcal debate. What I wanted was just that - from the mouth of someone who was Chairman of the Conservative Party. Why is it that people think they hate the poorest - from someone who passionately wants to help the poor.

His response was one of the most depressing in my lifetime. I can safely say I have never come across such unprovoked and vicious rudeness in my life. His response (and bear with me, because it is fairly incomprehensible) - 'it's because of posh people like you joining the Labour Party'. And so on. I admit, I shouldn't have shouted 'oi' at a Minister of State. But I asked him - where is your serious political discussion? What on earth do you know about me? What is my background? Just because I speak in a particular way, why does that link me with one social grouping or another? And why does it matter? - and that is the crux of the matter. If the Torie truly believe in meritocracy - why does it matter?

I joined the Labour Party, like many others who have had 'priveleged lives' like me (and believe me it's not been that privileged - losing a father far too young, being the only one who is the 'poor boy' amongst a bunch of public schoolies - but I accept, the opportunities I've had have been amazing - and they're opportunites that every kid born in a developed country like ours should have BY RIGHT) because I give a toss about people who haven't had these opportunites, and because I think we should be offering better education, better life chances, and higher income to people who haven't had the chance of a pampered upbringing, or who have been dealt one of life's blows.

The major difference between my ideology and that of the Tories is this - I simply don't believe that everyone 'can' do everything by themselves, and make it up the social scale in the UK, because of the way that our structure still is. The Tories do. They believe in hands off government - that is their ideological reason for cutting areas which will hit the poorest hardest - because they believe that those dealt the biggest blow in society can simply sort it out themselves. It's not true, and it's been shown not to be true by study upon study. Tories like Pickles don't hate the poor - and I believe them; but they do totally misunderstand the social structures and the reasons that people start off, and remain, poor in the UK.

So tonight has depressed me. I can't bear extremists on the 'left' saying that all Tories hate the poor - because it's not true. They're just wrong about how to help the poorest (and there's certainly a question mark as to whether they care about the poor who won't move up by meritocracy). Success in life and in general are much about the opportunities afforded to children - and the poorer you are, the fewer the opportunities - and the fewer there will be if more cuts are made in services for the poor.

Tonight was also depressing because it highlighed just the level of political discussion that is present in the UK now. The other day, I mentioned that I was bored by the constant personal attacks made by people in politics on each other in order to make party political points - and was rebuked by a Tory, who said it always came from the left. Well, rubbish. Tonight, a pathetic attack came from Eric Pickles - a cheap, boring, and groundless attack, based on nothing other than prejudice.

Well, Tories, you've always been good at prejudice - I'm just suprised it's my accent you are attacking this time. Ten years ago it would be the fact that I was in love with another man. People with chips on their shoulder, of all different kinds, need to get them well away from the political arena. Just because I was lucky enough to be privileged (and not arrogant enough to think that I deserved it) doesn't mean I have no idea about the poorest, or that I don't care about them. Pickles - you were cheap tonight, and you let your govenment down. But worse than that, your ideology and political philosophy is letting down our society and the poorest in society, and I pray fervently for the day that you are banished from the benches of power, back to the easy benches of opposition. Or maybe people will realise how rude you are and relieve you of a seat - who knows. What I do know is that with a Cabinet like that, the Labour Party just needs to hold tight and wait.

Ed - the fightback has begun, and at the moment, it's own goals all the way from Cameron et al. It's time for the Labour Party to fight; to fight and to win. The Tories' cuts are ideological - and it's time they were beaten.

NUS distress

Before I start today’s ‘beginner’, ‘ignorant’, ‘right-wing’ etc piece, I would like to make a couple of observations about the way my last article was received. On one side, those who identify as ‘hard left’ said it was right-wing. But my argument, that people rather than political ideas are attacked, shone through. So many of the aggressive and unpleasant comments attacked me personally. Charlie only cares about his own class, middle class bastard, he just asks his parents for money, so on, so forth, so tired. ‘I always assumed he was a Tory’ rather summed it up – because there are two lessons here. Firstly, don’t make unsubstantiated allegations about someone’s person or personal circumstances, because it leads to the charge of ignorance, or worse, arrogance. To those who attacked me personally – get to know my person first. And secondly, if you disagree with someone, at least work out why you do, and have a coherent argument against what they are saying, rather than just spurting a tired ideology. A political argument is interesting and helps shape ideas; a political diatribe, viciously attacking the other side but not understanding or engaging, gains nothing, and is frankly a bit too establishment for young people to be getting involved in. And please, try to be consistent. ‘Doctors are working class’ says one, as they sell their labour; and yet I’m told I am putting my own class priorities first, as a bad thing. I got rather confused – but also rather depressed by the fact that these who attacked me identify as ‘left wing’ and should naturally feel more affinity to people sharing a somewhat common goal than those more to the right. But no, apparently not; and what a shame that truly is. Maybe being sure of yourself gets you far in politics, but if you don’t listen, you might as well give up. Perhaps not listening is part of the ‘hard left’s’ psyche, but it won’t win people over. Still, they probably don’t care.

But anyway. Today sees the start of one of the most derided but potentially most dangerous conferences in the union calendar: the National Union of Students. Aaron Porter, a moderate and deeply committed President, has been somewhat forced out, and there is a real choice for next year’s leader. Slightly right, slightly left, and ‘hard left’.  And the extremists might just win – which would be a disaster for the NUS, and which will lead to distrust from those making and enforcing the law, the public and the majority of ordinary hardworking students. Delegates need to remember that they are representative (note to extremists – representative is when you’re elected for something – like I was – thus I can call myself ‘representative’) of their parishes, and should be voting as such.

The NUS has long been seen as a spring board to power for those centre-lefties who want to make it to the Shadow Cabinet by the time they’re thirty (what an awful thought – how about getting a life and having a life?). And this, together with various pressure groups, has led to a lot of non-student motions being debated. Let’s take one, for example. Israel Palestine, a situation that is as difficult as it is appalling, and one which I wouldn’t believe myself able to comment on, having only a basic grasp of the history and politics of the area. However, there are very strong views on both sides, and it’s something that should be debated in a number of forums. I’m all for debate. But debate and discussion is a very different thing to passing motions and ‘speaking for the student movement’. So a motion condemning Israeli ‘apartheid’ in Palestine, or Palestinian ‘terrorism’ in Israel, goes one step too far. Because it deigns to speak on behalf of ‘students’, not just a couple of politically active and ideologically driven wannabe politicians or activists of the future. It’s not that what is said is necessarily wrong – it’s the forum which shouldn’t be used.

A students’ union must be for students’ issues. The standard argument is that ‘what affects the public as a whole affects students as well’, and this is true – but that doesn’t mean that it is relevant or appropriate for the NUS (or our own beloved CUSU) to pass motions on it. It is perfectly appropriate for a students’ union – a lobby group, if you will – to oppose increases to tuition fees, if that is representing its members. It is also appropriate for the same union to be campaigning to save maintenance bursaries, etc. Because, as a union representing its members in their capacity as STUDENTS, with very specific things that we, as a body, take into consideration uniquely, it should be an effective lobbying force (whether it is or not is debatable – and perhaps it isn’t so effective because of all the peripheral non-student-specific issues that are motioned).

For those of us (and there are a lot, although most get so bored and fed up with political posturing at NUS/CUSU that they don’t get involved) that disagree with non-student-specific things being motioned at student unions, what are we supposed to do? The procedural idea of ‘this shouldn’t be debated, move on’ is a good one, but often it doesn’t work.  Instead, we end up having to speak against things that we personally agree with, but which are simply not the domain of the students’ union. I have personally been labelled a fascist this year for moving things to a vote, or voting against things, which are traditional ‘left-wing home-territory’. But if people actually listened to the reasons we have, when we oppose motioning for non-student-specific issues, then perhaps we wouldn’t be so vilified.

I’m all for political discussion, and I’m all for students getting involved and engaged with difficult issues worldwide and in this country (although I think it’s important to remember that students are generally inexperienced and don’t pay income tax), but do NOT use our student-specific lobbying body to launch a general non-student-specific political campaign. Some of the stuff up for debate in the next couple of days will truly affect the student experience. Some of it will be ineffective. And some of it will have nothing, at all, to do with student-specific business, and it should NOT be debated. And if it is, then I will have to vote against, because sometimes accepting your own potential ignorance, and remembering what you are doing – that is, representing a body which has mandated you to do so – is more important than your own political convictions. I am not there as Charlie Bell, member of Labour. I am there as Charlie Bell, delegate of CUSU to the NUS.

I trust and hope that we gain an effective leader, who will hold together the disparate strands of the student body who belong to the NUS. If we don’t, those who elect an extremist will plunge their colleagues – those who elected them to vote on student-specific issues, and get a better deal for future students – into a mire of destruction – and into an NUS that many will no longer feel is their union, and which will not be the representative body it must seek to be.

The ignorance of arrogance

A rather boring and tired complaint in the press is that 'left and right are just too similar nowadays'. Whilst this is blatantly not true, there is perhaps an element of truth in what they are saying. What that is, is that appealing to the centre-ground has never been so important. And what is that centre-ground? Essentially, people who neither have a burning desire for immediate social justice, but are not particularly selfish; people who are somewhat ambivalent about the 'class system' (whatever that means); people who want to see what a government can do for them, whilst giving a toss, to a variety of extents, about what happens to other people.

This is an unashamedly Labour blog, by the way. I am a fair and square social democrat. My argument here is that classic Marxism simply won't work in order to improve the electoral chances of Labour. I smash back the criticism that this means parties are just in it to win - of course they need to win to get power and thus implement their policies - but there must be ideology behind it. Marxism, and all those who are determined to turn the Labour Party into this kind of party, doesn't work - because it is deeply arrogant. It is misplaced arrogance, as well, and alienates the huge number of people who support the Labour aims, but don't identify as 'working class' - and it is deeply patronising to those who do.

It's rather similar to the selfishness of those far to the right (the keep-the-poor-in-their-place mentality) - it's the obsession with class. Blair famously said this is a classless society - this is, sadly, seemingly rubbish. We do have some form of class, in that we have some form of social strata. It's not a nice thing to have, but we have to accept it's there, and try to find a way to break it down. But Marxists love, just love, to go on about it, and about how to 'change' it. Let's be very clear here, if you are not 'working class', then you cannot help with bringing about the 'revolution'. They are not arguing for social change, with improved social mobility, with higher lower wages (or indeed closing the wage gap). No, instead, they say that the 'working class' are the only ones who have the ability and, let us say, 'right' to bring change - that is by bringing down the government and instigating measures such as public ownership etc. This isn't a review of Marxism - just a review of why it doesn't make any sense for the party to adopt it.

The Labour Party needs to have this discussion, and they need to have it now - even if it has been had before - because opposition can lead to extremism, if left unchecked. If they go down the Marxist line, it will be a total disaster. On the CULC blog, the argument has been made that we need a Labour party for the working class labour movement. What Labour has come to represent is so much more than that. Atlee, speaking of Labour, summed it up, that Labour legislation was ‘designed not for one class but for all’ (which is not denegrating the poorest, but appealing to the richest). The working class labour movement is, of course, at the heart - the heart which is all about social justice. But that now includes so much more than the outdated and unacceptable idea that firstly, there is something called the 'working class' that will always be the same, and is immobile; and secondly, that people who were, by chance, born into a different background, cannot care about social justice, improving the lot of the poorest, etc. What utter tosh.

Let me say it - the scrapping of the old clause 4 was one of the best things done by New Labour. New Labour got a lot wrong - of course - but that particular (unpopular) move was a triumph. The Labour Party needs to stand for social justice, and mustn't lose its roots - in the trade union movement, supporting the employed (that is, people) against the sometimes uncontrollable excesses of capitalism. But it also needs to keep its wide-church feel. It needs to welcome (in fact, recruit) anyone who cares about social justice in all its forms - rights for the underrepresented, a fresh look at immigration, removal of oppression and discrimination, improved lowest wage, increased education, improved ecosocial mobility, and so on.

The Labour Party needs to be the party of the people - that is, all the people who can get over selfishness, and care about protection of the most vulnerable. It isn't, and shouldn't, become a party for 'class war', because that, in and of itself, is deeply arrogant, and deeply flawed. The fact that the government front bench is full of Etonians (where George Orwell, of course, attended) should not be what is attacked per se - rather, it should be their policies, which may (indeed must) have been influenced by their backgrounds (look at Atlee, Gaitskell, Foot and Blair). The whole idea behind social democracy and its Labour incarnation is that accident of birth shouldn't lead to oppression - and a sharp swing to 'the left' (and I'd argue that calling it left is spurious) is dangerous and pointless, directly contradicting this.

So, Labour, keep attempting to attract the centre, because otherwise the Labour Party will become irrelevant. You don't have to be 'working class' to care - and you shouldn't need to be, to be part of the Labour Party. Class war is damaging, dangerous, and spurious - and an obsession with it, based on political philosophy, rather than an inclusive ideological and pragmatic application of social democracy, cannot be accepted by the public at large (including those who support Labour ideals), nor allow Labour aims to be implemented.

Hands off our NHS...and why Ed might be right...

Was today the new beginning? For the first time in SO long, I cheered when I heard a Labour leader's speech. He put forward some decent ideas, argued very well against the government, and made ideological and sensible arguments against a policy. Merci Dieu. 'Red Ed' no longer... for this seemed like a man on a mission, and a man whose mission was to appeal to the country, not just the unions (cf CULC blog today) - a man taking Labour in the right direction.

And what was he arguing against? Possibly one of the most rushed, potentially damaging, and unnecessary changes to one of our public services in living memory (or indeed ever) - and one that this government promised wouldn't be on the cards before the last election. No major top-down shake up of the NHS - what a pile of rubbish. An NHS for the patients? Again, what a pile of old tut.

I had the honour of going to the BMA Medical Students Conference this last weekend, and joined my voice to hundreds, if not thousands, of health professionals and service users by speaking against and condemning the appalling changes envisaged by the government bill (which has now been 'stalled' to allow Andrew Lansley the time to explain it further).

Let me outline the big four problems:

1. GP consortia - yes, of course there should be input from medical professionals in the delivery of care, but that doesn't mean smashing the PCTs or making a bunch of managers redundant simply to make yourself look like an effective government. Of course, a load of the middle managers (the ones the government wants to get rid of) will simply end up working for the consortia rather than the PCTs, hence leading to the removal of high-level managers, the ones with the expertise. Do GPs really have the skills and time to manage health care resources? Do they really want to? Why is there no involvement AT ALL of those working in secondary and tertiary care - those actually employed by the NHS - but rather total monopoly given to those who have a very different contract structure? We should be using all clinicians to inform resource provision, and we should also be using patient groups and government. This is a huge fudge. And another problem - take for example the patient who has a series of severe headaches, and whose GP refuses to grant an MRI scan. That patient has every reason to turn to his doctor and ask her why - and ask her whether it's about saving money. And what could she say to that? I'm all for having input, but there has to be managerial input at least at some level. Chucking out all the managers (and there are indeed arguably far too many at the moment) is simply not the answer, is ideological, gets cheap points, and is dangerous. Patients, our patients, will suffer. Look instead at the managers in hospitals who are employed to order a consultant's materials - which that consultant could do by themselves (and who did a few years ago), and rationalise there, rather than making sweeping and idiotic changes to the provision of the whole of healthcare.

2. The lie about competition -  at the BMA, I heard the argument go like this: we are all medical students competing for jobs. Therefore, competition is good for patients, so stop moaning about competition between the NHS and private companies for provision of services. Simplistic? Just a little. What a load of rubbish. The difference is that competition between people for jobs, meaning the best and most qualified is likely to get the job, is good for patients. But once price becomes an issue, then quality will suffer. Fact. The government has announced that value for money will be considered by Monitor (the new watchdog) rather than simply cost, as a carrot to those appalled by the plans. Sorry? That wasn't the original intention? How can competition be anything other than dangerous if quality is not the first criterion? Put it like this: would you like a hip replacement with cheap material and labour that will last for 5 years but have quarter of the cost of one that will last for 15 years? It's value for money, it's just you'll need three in the time. If you believe that healthcare is one of the things that should be equally given to all (like education, for example), then competition is not a good thing. Why not spend the time looking at how to provide NHS treatment better, or rolling out limited competition for specific purposes? We are primarily a caring profession - caring for patients. Giving them worse options to save money simply isn't ethical. That's not to say that we can continue spending what we do (or increasing spending) on healthcare - indeed, it is thought that if we continue to increase spending like we have for the last 10 years, then we will be at 100% of GDP spent on healthcare in the not too distant future. So what we need is a rationalisation, a bottom-up decided, and then top-down implemented system, to determine what we should, can and will pay for, and how best to achieve that within the NHS.

3. Cherrypicking - arguments abound on this - suffice to say that private companies taking the cheap and profitable operations, leaving the costly and complicated ones to the NHS, will lead to the destruction of the fabric of the NHS, making it even less sustainable. Which isn't what the Tories want to do, of course...

4. The national NHS - postcode lotteries are despicable. Utterly so, and it is a failure of the last government not to have destroyed them. Devolution aside (and I'm not a huge fan of it), if we believe in a national service which provides free health care at the point of use, that is what we should provide. We don't. We provide localised health-care, so 'local people can have a voice on what their priorities are'. This is NOT a NATIONAL health service, and devolving power from national to local government in this area does two things. Firstly, it removes the blame from the Dept of Health - so when the inevitable goes wrong, they can sit back and say 'not us gov'nor'. And secondly, it further cements localism which is damaging to a national health service. In this area, like in education, we need nationwide priorities, and nationwide services that are available. If someone in Surrey can get IVF on the NHS (or any number of other treatment), then someone in West Yorkshire should be able to as well. It's not fair, it's not popular, and it's not something we should countenance any longer. Taking it to extreme - if loads of people have heart attacks in Hampshire, but few in Cambridgeshire, should you be prevented from life-saving treatment simply because you live in the latter? Of course not. So anything provided by the NHS should be exactly the same.

These reforms (if that's really what they are) are a disaster, and in the words of the BMA, we should be going for evolution, not revolution. Ed Miliband struck the nail on the head today, and I hope this is characteristic of what is to come from the Labour opposition. He suggested a cross-party think on the NHS - one badly needed and well overdue - and I just hope he is taken up on it. These reforms are a disaster, they are not popular with the public or the health service, and we need to stop them. Otherwise patients will suffer, and then why bother having an NHS at all?

Manacles, morons, money-making and morality

Internet here is about as good as Alex Salmond's policies, so if you're looking for BMA stuff check  my twitter (@charliebelllive), which will have up to the minute updates on conference. I am currently in a bar with Hamish Meldrum, Chairman of the BMA Council... so here is a blog on current affairs that I wrote on the plane...

One thing which can’t go unnoticed is the absolutely unbelievable change to the prison system in the UK. No longer are we guaranteed that the hand of justice will be fair, even and community-based – no, instead we are diving head first (well, North first, needless to say) into a world of privatised prisons.

It doesn’t sound too outrageous to start with: especially in this time of cost-cutting, moving some public services out to the private sector is the ‘austerity compassionate conservatism’ that we’re being asked to support, or at least understand. However, is this not just a step too far? Take HMP Doncaster, for example – close to home for me, and indeed for the Labour leader Ed Miliband. The idea propounded by Ken Clarke QC, is that this will be a results based prison! And how will this be measured – simply, he suggests: the fewer repeat offenders, the more cash.

Maybe I’m over-complicating things, but I thought there were a few very simple concepts that British justice ran on: innocent until proven guilty, and all equal under the law. Well the first isn’t being challenged here (although it might well be under potential new rules governing child sex offence cases), but the second seems to be.

There is just such an incredible level of stupidity involved in the new plans. Once again, much like in the fee issue, money talks, sense is put to bed, and the philosophical – ideological indeed – reasoning behind the changes is totally ignored. Clarke, a natural liberal, surely cannot be very happy with the changes – and Labour, used to being seen as too ‘soft on crime’, will be unwilling to make too much noise: but they should. Another Blair (or actually Brown) phrase comes to mind – tough on crime, tough on the causes of crime. The latter, in particular, is philosophical – and something the government doesn’t seem to be considering in their ‘targets’ for prisons (indeed, I thought this was the government with new politics, moving away from the target culture…).

Let’s take the money for a second. How much is this saving – according to Mr Clarke, £265 million, over the lifetime of the contracts. Is it worth it? The current government mantra that cuts need to be deep, fast and now is already being somewhat eroded by their spending serious amounts on Ireland’s bailout, Libya and the World Cup bid. I’m not suggesting these are not worthy causes (maybe more on that anon), but the fact is, if there really is NO money, and the cuts were absolutely necessary to keep us on an even keel in May 2010, how much more now needs to be cut after those ventures? Nothing? If so, then something is awry. But anyway, is the relatively small saving worth it?

I would say absolutely not. What this means is that there is likely to be a disparity in provision at different prisons – look at the arguments over NHS contract outsourcing: are we looking for quality, or price? Surely the latter is important – even if it’s dressed up as ‘value-for-money’ – and if the former suffers, then we’re in trouble. The government’s answer – challenge private prison companies on their re-offending statistics, as though that’s an accurate way to determine quality.

The whole issue is another mess for the coalition – or the government, as I was reminded it is yesterday. Unless we can tackle the causes of crime, which will arguably be exacerbated with some of the badly-targeted cuts taking place, harping on about results from private prison companies is extraordinary. It’s an odd country where taxpayers are willing for companies to make profit, and shareholders to make money from prisons. I’m not one for public ownership of all utilities – thank goodness clause 4 was removed – but I am fully in support of public ownership of the things which are the cornerstone of our democracy.

It’s like the student fees issue – the questions which need to be asked aren’t being asked. ‘Prison works’ said Michael Howard. Does it? Do we have too many people in prison? Are community orders effective? What is prison for – punishment, preventing public danger, reformation? If the latter, why the low levels of education in prison? Why is there such a high level of crime in our inner cities? Why are so many petty criminals so poorly educated – and once again, cutting education budgets is inherently stupid! Why is there a huge increase in the level of antisocial behaviour? Look at knife and gun crime. Let’s get the causes of crime and effective methods to prevent offending first, and worry about cash once there is actually a plan.