Archive for October, 2010
The lesson of the New Labour years that ended in the biggest global economic crisis since the 1930s is a simple one. ‘Shareholder value’ capitalism is a beast that cannot be made to serve social democratic purposes. By social democratic purposes, I mean those that see harm done to one citizen as harm done to all, and accept the value of collective institutions as positive means to limit that harm and so promote the general good. Social democracy doesn’t assume all ‘good’ is done collectively, but it certainly doesn’t have a general individualistic assumption either. In particular, social democracy gives weight to the idea of ‘solidarity’, which is why great inequality is so corrosive of its aims, and why universal welfare benefits, even if symbolic, cannot be given up too lightly.
The assumption of late twentieth century social democracy was first that unionised labour plus a strong state, then the state alone, and finally perhaps accounting sleights of hand by a clever chancellor, could offset the economic power concentrated by banks and large corporations. Pretty clearly, by the end, this social democracy wasn’t worthy of the name. Read the rest of this entry »
Under the coalition’s planned NHS reforms GPs could find themselves with a serious headache. Patients armed with detailed outcome data and on-line hospital reviews may enter a GP’s surgery demanding referral to a named specialist at a hospital in another part of the country. The patient-choice imperative will make this a difficult request for that doctor to resist, but the financial and commissioning responsibilities handed over by the reforms may give him or her a worrying conflict of priorities.
A traditional role of the GP in the NHS was as a ‘gatekeeper’, who filtered out those of his or her patients most likely to benefit from specialist care, and referred them according to knowledge of the local hospitals and consultants. In this way, costs were kept down, capacity constraints observed and quality was managed through professional reputation. Now that paternalism is a dirty word, self-diagnosis takes a few mouse clicks and professionals are no longer trusted by default, this is no longer acceptable. Read the rest of this entry »