This is the end

May 13, 2013 3 comments

As ex-readers may have noticed, this is an ex-blog.

The end came quickly, as I thought it might, but kind of hoped it wouldn’t.

I’ve got lots to do, and not that much time.  Some of what I do will change people’s lives for the better, and some of it won’t.  But if there’s one thing Dr Rieux in La Peste* and Rossmann in Amerika taught me, you’ve got to bleeding try.  So the blogging’s got squeezed to the point of no return.

It’s not the end of me completely in written form; I’m planning to pop up in written form in other places, and I’ve not forgotten my commitment to part 2 of the Habermas post, or my follow up to Gove as fascist post, but both these starter essays, and others, have got me reading more voraciously, scribbling more incoherently and even thinking thoughts occasionally, more than I thought they would, and blog-based follow ups that no-one reads anyway now no longer seems to fit.

If you’re stuck for something to read, go re-read Stumbling and Mumbling.  Chris is basically right.

Bye then.

 

*  ”None the less, he knew the tale he had to tell could not be one of final victory.  It could only be the record of what had had to be done, and what assuredly would have to be done in the never-ending fight against terror and its relentless onslaughts.”

Categories: General Politics

Message from Molière

May 10, 2013 Leave a comment

I have addressed the Right’s self-righteousness on matters grammatical before, on the basis that trying to teach kids grammar out of context is really quite stupid and wrong.

But it occurs to me that a better critique of the latest outpourings of bilious silliness is best addressed, for want of a suitable rejoinder from a French lesbian poet, by an extract by the great seventeeth century comédien, Molière, who knew a thing or two about combatting the vanities of the ancien régime.  In Les Femmes Savantes he takes the piss gloriously out the affected ways of those for whom ‘correct’ grammar is the be all and end all.

So I bring you a bit of Act II, Scene 6, in which the two grammarians, Bélise and Philaminte, aka. Michael Gove and Toby Young, defend the decision to sack servant girl Martine for the offence of bad grammar.

Philaminte
Elle [Martine] a, d’une insolence à nulle autre  pareille,
Après trente leçons, insulté mon oreille
Par l’impropriété  d’un mot sauvage et bas,
Qu’en termes décisifs condamne Vaugelas*.

Chrysale [confused husband]
Est-ce là… ?

Philaminte
Quoi ? toujours, malgré nos remontrances,
Heurter le fondement de  toutes les sciences,
La grammaire, qui sait régenter jusqu’aux rois,
Et  les fait, la main haute, obéir à ses lois ?

Chrysale
Du plus grand des forfaits je la croyais coupable.

Philaminte
Quoi ? vous ne trouvez pas ce crime impardonnable ?

Chrysale
Si fait.

Philaminte
Je voudrais bien  que vous l’excusassiez !

Chrysale
Je n’ai garde.

Bélise
Il est vrai que ce sont des pitiés :
Toute construction est par elle détruite,
Et des lois du langage on l’a cent fois instruite.

Martine
Tout ce que vous prêchez est, je crois,  bel et bon ;
Mais je ne saurais, moi, parler votre jargon.

Philaminte
L’impudente ! appeler un jargon le langage
Fondé sur la raison et sur  le bel usage !

Martine
Quand on  se fait entendre, on parle toujours bien,
Et tous vos beaux dictons ne  servent pas de rien.

Philaminte
Hé  bien ! ne voilà pas encore de son style ?
Ne servent-pas de  rien !

Bélise
Ô cervelle  indocile !
Faut-il qu’avec les soins qu’on prend incessamment,
On  ne te puisse apprendre à parler congrûment ?
De pas mis avec  rien tu fais la récidive,
Et c’est, comme on t’a dit, trop d’une  négative.

Martine
Mon Dieu ! je  n’avons pas étugué comme vous,
Et je parlons tout droit comme on parle cheux  nous.

Philaminte
Ah ! peut-on y  tenir ?

Bélise
Quel solécisme  horrible !

Philaminte
En voilà  pour tuer une oreille sensible.

Bélise
Ton esprit, je l’avoue, est bien  matériel.
Je n’est qu’un singulier, avons est pluriel.
Veux-tu toute ta vie offenser la grammaire ?

Martine
Qui parle d’offenser grand’mère ni  grand-père ?

Philaminte
Ô  Ciel !

Bélise
Grammaire est  prise à contre-sens par toi,
Et je t’ai dit déjà d’où vient ce  mot.

Martine
Ma foi !
Qu’il  vienne de Chaillot, d’Auteuil, ou de Pontoise,
Cela ne me fait  rien.

Bélise
Quelle âme  villageoise !
La grammaire, du verbe et du nominatif,
Comme de  l’adjectif avec le substantif,
Nous enseigne les lois.

Martine
J’ai, Madame, à vous dire
Que je ne connais point ces gens-là.

Philaminte
Quel martyre !

Bélise
Ce sont les noms des mots, et l’on doit regarder
En quoi c’est qu’il les  faut faire ensemble accorder.

Martine
Qu’ils s’accordent entr’eux, ou se gourment, qu’importe ?

Philaminte, à sa sœur.
Eh, mon  Dieu ! Finissez un discours de la sorte.

* See here on the grammarian Vaugelas – this being an important theme of the play.

Categories: General Politics

Franz Kafka and the socialist response to UKIP

May 3, 2013 1 comment

Today it looks like UKIP is on the rise, and may have broken through.  Very bad news.  At times like this, Kafka is need.

Kafka as Freudian?

There are about as many interpretations of Kafka’s work as numbers of doors I’ve knocked on in the last few months.    Lots.

There are some I don’t buy – it’s all just a straight condemnation of early 20thcentury bureaucracy because he had to work hard in a dull office, for example.

And at least until recently, I wasn’t convinced by wholly psychoanalytic explanations, though it was fairly obvious that Kafka had a grasp of Freudian concepts of the ego/id.

The more I re-read (and have learned German) though, the more convincing I find the Kafka-as-Freudian interpretation.  Certainly, the text is littered with what we might now call Freudian slips, where the unconscious (or ‘id’) peeps through the surface of the page.

This is facilitated by his regular use of the literary device of ‘erlebte Rede’ (‘experienced speech’) or indirect free speech, which collapses first and third person narrative; and indeed there is some evidence that Kafka was studious in the way he edited his work  to create this effect.

The notion that central to Kafka’s work is the tension between the ego and the id (in modern society), and that alienation, despair and death comes from the suppression of the id at the expense of the ego, is straightforward enough to sustain.  Just look at the way Kafka’s characters die for that evidence.  K (The Trial) dies ‘as though the shame were meant to outlive him’ because he never accepts his guilt – he never accepts that he is guilty of the suppression of his unconscious desires, instead indulging ever more convoluted rationalisations in a doomed bid to seek to win out over what must remain irrational because it is of the subconscious.

Gregor (Metamorphosis), on the other hand, dies happy (and his family goes out into the light for the first time in months) because he becomes accepting of the animal he is.  When does Gregor being to move towards a happy death? When his sister plays the violin – music transcends – and when he starts to accept that he is an animal (his id) rather than struggle against it.

And why does the officer in the penal colony willingly choose death through what to the explorer seems like (pre-modern) savagery, and yet still not get  ‘redemption’ on his face as he dies?

And of course The Castle ends with death in defeat, but reconciliation with defeat by what-is-irrational.

Kafka as postmodernist?

But that is not all there is to Kafka, not by a country doctor’s mile.

While Kafka’s work is ‘timeless’  – a message about needing to be true to yourself – such a relatively straightfoward interpretation risks leaving out from it a load of the words he actually wrote, especially about women.

To deal with this we need to set his work back into its  historic context of a new modernity/bureacuracy which was, for Kafka, heightening that level of alienation,  through the rise of an early capitalist consumerist society.

Ultimately, Kafka does not just question how people’s minds work within a social context, but also how ‘real’ that social context is in the first place.

In this respect he presages much of postmodern philosophical thought, and is the reason he is relevant to the Left.  Indeed I would argue that he is more relevant in the early 21st century than when leading thinkers in the left – notably Theodor Adorno and Walter Benjamin –  sought to claim him as one of our own some fifty years ago.

A useful starting for that interpretative journey, from an interpretation of Kafka as writer that just ‘messes with your Freudian head’ to one of Kafka as someone who has profoundly important things to say to us a century later is Jacques Lacan’s Marxian re-interpretation of Freud, who (as I’ve suggested) may have been at least an indirect influence on Kafka.

Lacanian psychoanalysis is notoriously difficult to understand – indeed there are those who suggest that Lacan wrote impenetrably because he was, in the end, talking pure bollocks, whether or not in a knowingly ironic manner.

I don’t side with this argument, but I am happy to acknowledge that his primary texts are simply too hard for me and my small-size brain to handle, and I need to turn to intermediaries to get what he’s on about.

Fortunately, when there’s Slajov Zizek around to write a ‘How to Read’ book on Jacques Lacan, you’re in pretty safe hands.

So, what happens if you take a Lacanian approach to the text of The Trial, for example?

What happens is that, suddenly, the apparent irrationality of the Law starts to look like the inherent irrationality of the ‘desiring agency’ of Lacanian psychoanalysis.  That is to say, the law is all-that-is-desire, and in Lacanian terms the Marxian dialectic of structure and agency, the essential incompatibility of which creates the alienation of the individual, is collapsed into a permanence of alienation, because ‘the law’ controls both K’s desire and that which is desired.

This ties into later elaborations in Lacan, in which he expands upon the Marxist concept of surplus value to include what he terms ‘jouissance’ (or enjoyment). Similar to the notion of surplus value, Lacan holds that any social enjoyment we get through work, leisure, consumption, sex etc.  comes a at cost, and is mediated through some bureaucratic agency, and intensified through the subject’s own compulsion to enjoy. This enjoyment can never be fully realised because it is mediated through these agencies,  which ‘skim’ off ever greater surpluses, leaving only enough enjoyment to engender further (obsessive) compulsions, to further consume and enjoy.

And so it in The Trial. It’s as if the Law operates both as the site of obscene enjoyment (the magistrates’ books are full of porn, the couple have sex at the back of the examination room), and as the agency compelling K to enjoy while also forcing its prohibitions (the student working for the court carries off the washer woman whom K was trying to seduce).

The relationship between women and K, and between K and the Law, is central to the book.

The Law is a wholly unknowable entity, from which things emerge/disappear but no answers can be given.  K receives no answer from the Law as it has none to give him.

What, then, does desire (the Law?) want? It wants K to keep on desiring, which is why the Law in the book permits an unlimited postponement maintaining desire until death, and even beyond, as the shame of (unfulifilled) desire goes with K to the grave.  In short, Kafka expresses, in poetic form and fifty years ahead of his time a post-Marxist analysis of what it is to be alienated’.

(In passing, I think there’s a parallel here with Milan  Kundera’s ‘treatment’ of women in the Unbearable Lightness of Being, where  the skimming of the surplus value related to sexual enjoyment actually declines as the main protagonist Tomášstrives towards some form of revolutionary consciousness).

But this is not where it stops – if Kafka were simply a very early Freudian-Lacanian psychoanlayst, and an emergent post-Marxist, it would be impressive, and Kakfa’s work would still be captivating.   But it would hardly be something for the Left to hold on to now, as an important influence (and consoltation) for the hard times that we now face.

Kafka as post-liberal socialist

For me, the pinnacle of Kafka’s intellectual outpouring is NOT the Trial, though it may be the most perfect work in terms of how it entwines form and meaning (though I’d argue that Metamorphosis and The Castle are both up there).

For me, the pinnacle is the last (unfinished) novel, Amerika (alternative titles are available as he didn’t give it one).

Amerika is the oft overlooked third big novel, ‘the lighthearted one’ which doesn’t really fit with the other two.  What Amerika is, though, is a step forward in Kafka’s ‘postmodern’ vision, and one which takes us beyond Lacan to the harder edged, but ultimately more liberating social theory of Baudrillard (at least in his last work, The Intelligence of Evil: The Lucidity Pact).

Baudrillard is of course most famous (and mostly pilloried) for his concept of a late capitalist society which has become a totalising ‘virtual reality’ (‘The Gulf war did not take place’), a world in which consumer overload means there is no longer even any potential for the kind of ’alienation’ that the left has hitherto set out as an inevitablity of the surplus value-based system of capitalism. This is because the concept of alienation in itself proposes some form of residual reality, however unattainable, or in Marxist terms, however far from the consciousness of the proletariat..

It is possible to conceive of the Trial, and The Castle, as just such ‘realities’, from which only knowledge in death can release us (and I’m sure David Bowie had been reading Kafka rather than early Baudrillard when he penned Quicksand on Hunky Dory).

But Amerika provides the resolution to the philosophical impasse, just as The Lucidity Pact does so about a century later.

Essentially, the setting of Amerika IS a virtual reality.  It is no longer the near but never totalising (consciousness-excluding)  universes of The Trial or The Castle, where desire is unfulfilled and the end must be death and/or shame, depending on the level of guilt acceptance; instead it is a complete world,  where things seem as they are because what is written of them is based on photographic representations and travel guides  – the early 20th century equivalent of the television travel programme, in which you enjoy a virtual holiday without having to leave your armchair).

But, as with Baudrillard’s Lucidity Pact, there is a liberation even within the acknowledgment that there is no escape.

It is no coincidence that Rossmann, the central character, joins a theatre – the epitome of artificial representation – and that this seems to be the key to his ultimate happiness (albeit in an unfinished novel).

Moreover, it is no coincidence that, at the end of the novel, Rossmann chooses to take a technical position (notably returning to a childhood daydream) instead of an acting position in the theatre.  He is at once accommodating himself to the fact that the theatre is the best place for him, and taking satisfaction that he is able to see it at one (small) step’s remove.    Importantly for the process of reclaiming Kafka for the Left, it is through engagement and solidarity with his fellow workers (how different to K, who seeks to dominate) – workers who are a disparate bunch but who get on fine, despite different language backgrounds  – that Rossmann nears contentment.

The way Kafka set out this contentment brings us full circle to Kafka’s early short story Metamorphosis; the final (unfinished) passage has the train with the theatre on board moving out into the vastness of the nature of America, similar to, but on a vaster scale, than the walk in the springtime that Gregor’s family take after his death in Metamorphosis.. Here, it seems, is a poetic resolution of how to live (even in the literal sense) with the fact that all is unreal, unknowable and alienating.

Which is precisely what Baudrillard is up to in the Lucidity Pact:

At bottom…..we are faced with an alternative: either we suppose a real that is entirely permeable to history (to meaning, to the idea, to interpretation, to decision) and we ideologize or, by contrast, we suppose a real that is ultimately impenetrable and irreducible and in that case we poetize. (p. 63).

Baudrillard, then, seeks out – as an explicitly political project – an ‘otherness’ of thinking, as a means to create a strained but workable compromise-with-virtuality by which we might live.

Kafka, it seems to me, goes one stage further in his explicitly political ending to Amerika – it is is through communication and solidarity with other human beings that we actually manage to accommodate ourselves to this ‘otherness’. And here, strange though it may seem, I think both Kakfa and Baudrillard meet Jurgen Habermas and his chunky Theory of Communcative Action coming the other way.

Habermas gets there by a completely different route – rejecting from the off what he considered to be the innate conservatism of poststructuralist/modernist relativity in favour of an appeal to ‘ideal speech’ as the foundation for a new call to universal and interpersonal values.

But in the end, it seems to me, Baudrillard and Habermas are united in the view that, while the ‘soul searching’ of the past fifty years of postmodernist philosophical development may have been necessary and worthwhile, it has also been regressive in terms of commitment to action, and that it’s time to move on with a renewed commitment to a clarity of (political) communication – whether that be as a result of some filthy pact with devilish virtuality, or because  the values of the enlightenment has been rekindled.

And what, ultimately, is communication in the context of universal values?

It’s solidarity.

Ultimately, I’d argue that the only real difference between the political philosophy journeys of Baudrillard/Habermas and Kafka is that Kafka travelled the road in a few short tuberculous-ridden years in the early 20th century, and used a lot less words to get there.

And for that reason alone, Kafka is worth reclaiming by the Left for what he is – not the Czech ‘enigma’, or the troubled genius, but a genius political philosopher a hundred years ahead of his time.  As I’ve noted, there have been plenty of  attempts to claim Kafka as one of our own (Adorno, Arendt), and more recently Michael Lowy has sought to identify Kafka’s ‘libertarian socialist’  leanings.

Sinead Kennedy also had a pretty good stab at it, analysing from ‘the hard left’ how Kafka was given a pretty rough ride by Stalin and his not-very-good-at-philosophy-or-art mates, but how he makes a lot of sense to the Left.

I contend that Kafka makes more than a lot of sense.

I contend that he should be regarded as a leading intellectual light of the Left, a key weapon in the intellectual armoury of the Left as it seeks to combat the thirty-year philosophical hegemony of the New Right, and in its wake, the rise of a  nastier ‘post-liberalism’ swiftly shedding any remaining enlightenment principle, which in turn, at least in central Europe, is already giving way to something even darker.

 

Categories: Book Reviews, Socialism

Michael Gove’s gerundial confusion

April 5, 2013 5 comments

Today, the Times Educational Supplement reports on the spelling and grammar tests being forced upon primary school children against the advise of educationalists:

Experts consulted by the Department for Education described the tests, which will be taken by 500,000 Year 6 students this summer, as “really flawed” exams that ignore academic research on the best ways to teach grammar.

Debra Myhill, a professor of education at the University of Exeter, and Ruth Miskin, an expert on phonics and member of the national curriculum review team, were among experts who raised concerns about the spelling and grammar (Spag) tests when consulted by the government.

They are concerned that the tests do not ask students to use grammar in context, meaning they will not be able to apply rules more generally. “I did a very detailed analysis of the test and I had major reservations about it,” Professor Myhill told TES. “I think it’s a really flawed test.”

Today, coincidentally, my son was doing a practice paper for this test.  It’s been provided by educational publisher CGP*.  Here it is for sales online.

This is question 7, scanned as completed by my son:

cpsgrammartestp.7 001

The question asks children to say which words are nouns, and which are verbs.  He says ‘flying’ is a verb, which is correct (Clever boy. It’s a doing verb**, he tells me confidently, as in ‘Gove is really flying by the seat of his pants with these ill-considered tests’ (I paraphrase).

Except, he’s wrong. Foolish boy. ‘Flying’ is a gerundial noun, as in “Flying by the seat of one’s pants in educational matters is unbecoming to a Secretary of State for Education.  That’s what the Collins English Dictionary people say.

So is he right or wrong?  Technically, it is a verbal noun, so it’s a noun, but are they expecting him to know that, or do they want him to display his ’verbs are doing words’ understanding. I honestly don’t know what answer is expected of an 11 year old, even of one who’s already sent chapters of adventure novels of to publishers, and who was a published comic-book author at the age of 7.

All of which goes to support Professor Myhill’s view that these grammar tests, with words out of context, are indeed ”really flawed”.

But I’m not sure Michael Gove** will care much that my son may grow up to believe that gerundial nouns are part of some kind of leftwing plot to reduce educational standards.

* I’m not clear on what basis CGP have set these sample tests, and what advice they’ve had from the Department for Education, but I think it’s reasonable to assume that the distinction between noun and verb, taken out of context in this way, is likely to figure in the actual tests next month.

** Quick further  research suggest it might be called the present or gerund participle of the verb.

*** Talking of nouns as verbs, I now suddenly remember that ‘gove’ can be a verb too.

Categories: General Politics

TCF and leftwing sex fiction

March 26, 2013 Leave a comment

Luke Bozier’s emergence as a writer of quality sex fiction (h/t @carlraincoat) reminds me that TCF is really very good in this genre too, though we specialise more in sex-fiction-as-interface-between Habermasian-lifeworld-and-anti-hegemonic-narrative.

Of course, TCF is always well ahead of the curve, so this little snippet is from a couple of years back, before sex fiction became part of the zeitgeist.  Still, we can pump this stuff out at a great rate of knots, so if any publisher wants a couple of short novels by the end of next week, we don’t mind making an honest bob or two.

Anyway, enjoy (though be careful if you’re reading this at work)

It was then the realization hit Malcolm, as fiercely as that recent blow on the back of the head from an agent of the state, in which he now fully understood that violence was always and irredeemably inherent.

Yes, yes, he thought. Ethel was the one. Ethel was the one who really understood the dynamic relationship between the ideological superstructure and the essential economic base, and how surplus value was really at the heart both of the so-called postwar economic miracle (as Jessopian ‘spatio-temporal fix’ in the principal form of the welfare state) and now more so much more clearly in ‘raw power’ form in this latest crisis of capitalism.

‘Oooh, Ethel’, he swooned, as she folded him in her womanly arms, strengthened by years of proletariat toil, and held him against her beating heart of socialist endeavour.

‘Ethel, tell me again about the relationship between Rosa Luxembourg’s incisive vision of how the working classes can come together in revolutionary force, and the somewhat later but, you suggest, no less relevant, writing of Gramsci on intellectual and moral reform within a temporal nation-state context.

‘Take your overalls off, comrade’ whispered Ethel, huskily, Poulantzian in her growing desire for unity between socialists.  ‘I need to feel your Lukacs compendium’.

Malcolm moved closer, and as the sun dipped behind the horizon, far to the well metaphorical left, Ethel gasped: ‘Now that’s what I call entryism by the Hard Left, comrade’.

Categories: Book Reviews

The early institution building of a new NHS

March 25, 2013 2 comments

The NHS is dying, pretty well exactly as I said it would  some two years ago now:

Some scandals may emerge in time over ‘backhanders’ paid by the private hospitals to the private commissioners, and in some circumstances it will turn out that the people doing the commissioning are simply commissioning themselves in another name – the whole inefficiency of which the provider-purchaser split was supposed to stop – but it will all be a bit esoteric and complicated for people to understand, and there won’t be much of a fuss.

In fairly short order, we may get these new commissioners creating two tiers of provision from within GP surgeries, with one level of care for those not paying, and those who just happen to have signed the relevant insurance policy forms, which just happen to be in the GP surgery.

Insurance-based healthcare, and the exclusions that this brings, will come not through a government announcement,  but by the surgery backdoor……

The consortia [now called CCGs] will end up being led by two or three ‘movers and shakers’ in each area, whose job will be simply to negotiate a decent deal for their colleagues and let the private commissioners get on with the rest.   There will be no revolt in primary care, and in secondary care no-one will actually notice till it’s too late.

Two years on, it’s being more widely recognised that, as of 1st April, the NHS privatisation will being quietly but in earnest, as the section 75 regulations kick into gear, Clinical Commissioning Groups with often overwhelming direct financial interests in private providers put services out to the market, public provision withers on the vine or simply goes bust, and private insurance arrangements start to become the norm, initially for (the more profitable) elective healthcare, and then for the rest.   As Lucy Reynolds from the London School for Hygiene & Tropical Medicine rightly notes, what comes next in this wildly ‘imperfect’ market is market abuse and health cost inflation.  This inflation around the ‘cherry-picked’ services, Lucy might also have noted, will lead to the stripping of resources from the less profitable services – no health budget ring-fencing will protect that.

So what is to be done?  By 2015, if and when Labour regains power, the promise of a repeal of the Health & Social Care Act (and the accompanying Section 75 regulations) may be a welcome statement of principle, but it will not significantly change the way in which services have already been privatised, seemingly irrevocably.  In many cases, there simply won’t be the public services to transfer them back to, and the incoming government is likely to consider the full-scale implementation of NHS II a little too much of a fiscal challenge, even if the recreation of the cumbersome institutions of 1948 were desirable.*

What Labour can do, though  – and needs to start thinking through now – is to tackle the local institutional architecture, in a way which creates the platform both for the establishment of local democratic control of both the type and quality of provision.  If it gets this right, this might actually lead, in the medium term, to a better health service than we currently enjoy - as I’ve noted before, it does not become Labour to gloss over the very clear health and social care failings caused by the managerialist ideology that has held sway for the last thirty years.

More specifically in terms of local institutions, the Labour government-in-waiting should first consider retaining the Clinical Commissioning Groups. but diluting the power of GP practices within them by making theirs a minority voting position, through the introduction of members of Foundation Trust governing councils (increasingly focused on quality standards if the Francis Inquiry recommendations are carried through) along with elected councillor representation in keeping with Councils’ new public health function.  The immediate impact of this is likely to be presumption against private sector provision where other options still exist (they won’t in many places).

Second, the Labour government in waiting should commit to ensuring that these new-style CCGs adhere both to the letter and spirit of the Public Service (Social Value) Act 2012 under which all CCGs (and the NHS Commissioning Board), have a duty to consider:

(a) how what is proposed to be procured might improve the economic, social and environmental well-being of the relevant area, and

(b) how, in conducting the process of procurement, it might act with a view to securing that improvement.

(Oddly, this is Tory legislation, aimed primarily at breaking the perceived monopoly power of local authorities, but can be used to the same effect against private sector dominance in healthcare provision.  That will really piss off the Tories….)

These two relatively simply steps will set the direction of travel back against wholesale privatisation, although of course attempts to terminate contracts are likely to result in lengthy and quite likely unsuccessful legal battles, so early progress is likely to be quite slow.

Nevertheless, institutional change at local level by government, especially if accompanied by moves within the Labour party and the broader movement to re-energise Trade Councils, in a move away from the vapid Tory ‘consumer localism’ and towards a quality-oriented ’worker localism’**, could provide early impetus for the creation of a properly socialist health and social care system – a system fit for the 21st century (whether or not this is tax-based or progressive social insurance based doesn’t really matter as long as it provides for equitable provision) , with private operators increasingly steadily cleared out in favour not just of direct NHS Trust delivery, but also a new surge of worker co-operatives (although charities and social enterprises may also play a valid part).

* It is always worth remembering, in the context of the fetishisation of the 1948-style NHS, that until very late in the day a radically different – and I would argue preferable – NHS structure was being argued for. This was a much more decentralised and locally accountable system, rather than the monolith we grew to love despite it tendencies to managerialism (and I would argue that this is why service standards have declined in the NHS faster than in local authorities, say).  See Rudolf Klein’s seminal The Politics of the NHS for more (the later edition is called The New Politics of the NHS but the early chapters are the same).

** This is not to argue for the introduction/retention of localised terms and conditions.  Trade unions should of course be encouraged to negotiate at national level, and a properly brave/strategic Labour government would use the need to ‘renationalise’ the NHS, and to invest quality in the hands of its staff (as opposed to its bosses) as a rationale for the relatively painless (in terms of reactionary public opinion) repeal of restrictive trade union legislation.  Frankly, I’m not holding my breath on this one.

Categories: General Politics, Labour Party News, Law, Local Democracy

The dangerous Dr Goldacre: Cochranian hero or garbage peddler?

March 17, 2013 5 comments

A few months ago I launched a pre-emptive strike on Dr Ben Goldacre:

It strikes me that the impulse to control a problem rather than ‘uncontrol’ it away finds its most dangerous expression in the growing ‘evidenced-based policy’ campaign being headed up by all-round-good-guy-civil-liberties-defender Ben Goldacre, in association with the Cabinet Office’s Behavioural Insights team.  Between them, they have produced a convincing story about how society would be much better off if all social problem interventions were assessed through Randomised Control Trial methodology developed by the biomedical sciences.  This is all very well, but the promotion of such scientific rigour overlooks the need, in order to fit the method, to atomise problems and interventions in a way which embeds garbage can model social policy practice.  Ultimately, a problem and intervention focus diminishes the power of people to make their problems go away, and enhances the power of the state to make interchangeable those problems and the people who have them.   But that’s a longer blog.

I never did get round to that longer blog.  Fortunately, though, someone much cleverer than me has.  Here’s Will Davies, Assistant Professor at the Centre for Interdisciplinary Methodologies (and the brilliant Potlatch blog):

[T]he spread of medical epistemology into public policy is strangely anti-theoretical, thanks to a somewhat naively optimistic view of a single technique: the randomised controlled trial (RCT). RCTs operate according to induction. The facts are meant to speak for themselves; the data and the theory are kept neatly and self-consciously separate from each other. A medic, Ben Goldacre, has co-authored a paper on the policy applications of RCTs for the British government, which opens with the line ‘RCTs are the best way of determining whether a policy is working’…….

By adopting the inductivist epistemology associated with RCTs and Big Data, social policy-makers may learn a great deal more about the world, but may also become commensurately less sure of what it even means for a policy to work in the first place.

There is a risk that, as with RCTs in psycho-pharmaceuticals, diagnoses of social pathologies might start to spiral.  Whole new problematic demographic sub-groups will start to appear to the gaze of the data analyst; new correlations of behavioural problems will be spotted; the perceived sources of our social, psychological and neurological malaises will simply multiply, and we’ll long for an age when it was all just a problem of the wrong ‘incentives’. Tesco’s Club Card is rumoured to produce 18,000 sub-groups of customer; the equivalent for the state would be 18,000 sub-groups of pathological behaviour to be nudged back into line. Without the extreme simplifications of rationalist theories, society would appear too complex to be governed at all. The empiricist response to the government’s paper title, ‘What Works’, might end up being ‘very little’, unless government becomes frighteningly ‘smart’. Alternatively, if theory no longer provides the procedures of evaluation, there is a risk that private backroom politics will do so instead…..

Nothing simply works unambiguously in social policy, gold standard or no gold standard. No policy delivers benefits without any ‘side-effects…….A policy might ‘work’ in terms of reducing unemployment*, but lead to an increase in family break-down. The inductivists response would be – yes, and that’s precisely the type of pattern that our new evidence centres will detect! So why use the rhetoric of ‘what works’, when it is plain that nothing unambiguously works, at least without also offering the standard (the QALY for social policy, if you like) through which ethical dilemmas and trade-offs will be addressed?

Will’s article is – like my earlier, less well formulated one - a call for the retention of political judgment at the heart of public policy, and a warning of what we risk by simply handing over control to the positivists, as the government now seems intent on doing.  This is not to say that RCTs have no value, of course.  But their use needs to be, of itself, a political matter, in which the area of research and the outcomes being tested are a matter for public and political argument.

This piece, therefore, isn’t a personal attack on Ben Goldacre (the title is just a brazen attempt at linkbait readership).  It’s not an attack precisely because Ben recognises appears to recognise the issues raised above, in a way which Will doesn’t acknowledge.

In his most recent paper, on how RCTs might be become the norm in education policy-making, he stresses the need for professional involvement not just in the research, but in decision-making over exactly what research happens and why. The problem is that such a worthy aspiration can all too easily be hijacked by a governments (not just the current one) very keen on the idea of using research evidence to impose their own views of what success in education looks like, and less, but much less keen on the development of the kind of ambitious, democratically oriented research governance infrastructure that he advocates, and which he suggests will provide the ”opportunity…..to become and evidence-based profession, in just one generation”.**

So, for example, where Ben may take reassurance that “performance on specific academic or performance tests” have quite measurable outcomes, and means to improve such performance are therefore open to RCT methods, I see risks that RCTs might be used to embed such tests (and their associated curricula) at the cost of the wider educational enrichment of children.

Overall, I sincerely hope that Ben does turn out to be the leader, or a key opinion former in what would be a genuine Kuhnnian paradigm shift in governmental policymaking (or, as in the terms he uses in his new paper, that he becomes one of a new breed of Cochrane-style ”mischievous leaders, unafraid to question orthodoxies by producing good quality evidence”.  Nevertheless, I can’t help worrying that Ben’s undoubted talents both as scientist and salesman are being co-opted for a deeply political process of depoliticisation.

To allay my fears, and get me (for what I’m worth) on side with his campaign for research both well-done and well-chosen, I’d like to set Ben a challenge – a challenge emanating from this sentence in his new paper:

Nobody in government would tell a doctor about what to prescribe, but we expect all doctors to be able to make informed decisions about which treatment is best, using the nest currently available evidence.

Quite right.  There’d be uproar if a government minister started telling the medical what drugs were best, and s/he just wouldn’t dare.

But, as I set out at some length here, that’s precisely what the Prime Minister did to the nursing profession last January, when he casually announced that nurses would now be required to reorganise the way they work and institute ‘hourly rounding’, because he had heard that this was a good thing.

As I set out back then – using the available evidence - this was not just an utter outrage and insult to nurses, it also creates huge long-term risks of a downward spiral in care standards (as I set out more fully later, there may well be very different reasons for the apparent decline in hospital care standards, none of which have been picked up as possible causes by Cameron’s Nursing and Care Quality Forum (who now simply ignore my letters and emails), which was set up after he had made his intentional rounding decision and which has duly complied with his wishes without undertaking any further research.

But no-one but me noticed what was going on.  Not even Ben, who you’d have thought might be alive to something so close to the medical profession.  (I did tweet the importance of what was going on at him, in the light of my article, but he didn’t respond.)

So here, better late than never, is the challenge. If Ben really is a Kuhnian/Cochranian hero for our times, he’ll join me in a concerted call for a Randomised Control Trial around the use of intentional rounding in British hospitals, to establish whether it does actually improve care standards.  The methodology will be necessarily complex, as outcomes are not tha easy to measures, but there are probably still enough wards left who have not instituted the new process to make it feasible to undertake the trial on the basis of existing organisational patterns (and therefore cheaply).

If he doesn’t bother, then I’m afraid I’ll be a little more convinced that, far from being a new Cochrane, he is indeed just a good exemplar of an actor in Olsen’s Garbage Can Model (this takes us neatly back to where I started): “a decision-maker looking for work”, content to take commission from the land of Gove for what is, if he’s honest, a somewhat thin paper bashed out on a wet Tuesday afternoon, happy to persuade government that they should look in his garbage can  for a solution he came up with earlier.

Here’s hoping.

*Will Davies’ example is an apt one, since reducing unemployment through ‘nudge’ tactics, and an RCT to prove that such tactics do ‘work’, is the example the Behavioural Insights team in Cabinet Office are most keen to promote as evidence of their worth.  However, I think there’s a somewhat wider ‘side-effect’ to be considered, which exemplifies more clearly than Will’s postulate the way in which the unchecked growth of RCTs (and other positivist methods) might act to depoliticise social policy.  This side-effect is that reducing unemployment/getting people into work is embedded, via the research, as sine qua non of economic as well as social policy.  While this may seem reasoable at the moment – after all, full employment remains a mainstream aspiration – it may well be that it is no longer an appropriate policy aim.  As Chris has set out, it may be that, whatever macro-economuc policy decisions are taken, we are in for a long period of stagnation or low growth.  Says Chris:

[I]n a stagnating economy, aspirations are dangerous. When there’s no aggregate growth, one person can “get on” only at the expense of another. Aspiration thus becomes a (near) zero-sum game, which is a recipe for conflict and social tension.

In such circumstances, it’s arguable that getting everyone into work becomes a very bad social p0licy (and more recently Chris sets out a ‘supply-side socialism’ alternative of a citizen’s income).  But if, in the meantime, policy comes to be driven by research into the best way to attain a harmful and decisive outcome……..well, you know where I’m headed.

** It’s worth noting here that by far the biggest challenge such a step change is likely to face is the uncomfortable reality that success or failure in education is currently caused mostly by factors way beyond the scope of anyone involved in education, and not therefore amenable to teacher-based solutions.

Categories: General Politics
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