A technofix for a democratic problem: on e-voting

THREAD

As i believe all the cool kids are saying.

#Scotland is (sigh) considering introducing electronic voting. Speaking as someone who helped evaluate English #evoting pilots a decade ago, I think it remains a well-intentioned but terrible idea.https://t.co/meiS6RCGVT

— Tim Atkinson (@Magpiemoth) December 20, 2017

You can dance around the technical detail (and many have done so) but the first key challenge is informed voter confidence. The geek community in the US and UK e.g. @OpenRightsGroup have been pretty sceptical about real existing #evoting as opposed to some platonic ideal.

— Tim Atkinson (@Magpiemoth) December 20, 2017

Without the reasonably well informed giving it the benefit of the doubt, what chance does #evoting have with a public deeply sceptical of politicians and companies' integrity?

— Tim Atkinson (@Magpiemoth) December 20, 2017

More fundamentally, it's a techno-fix for a 'democracy problem'. Solving this isn't just about making voting easier (although that's still a good idea), it's about addressing the reasons why people don't vote and improving the number and quality of opportunities to participate.

— Tim Atkinson (@Magpiemoth) December 20, 2017

PS. Here is a link to summary findings from the Electoral Commission's evaluation of 2007 pilot schemes including e-voting. The EC doesn't have a remit to cover the big existential questions like the ones above, but the summary (not written by me, for the record) is still pretty insightful on the issues with the pilots, as well as what would need to happen if Scotland or anyone were determined to give e-voting a credible go.

Ooh, Eduard Bernstein!

I've never been a member of the Labour Party - membership of a political party is something I've struggled to reconcile with the various jobs I've held over the years. So I've no personal stake in the direction of the party or the ideological and tactical debates that encircle it. 

Once upon a time, though, I did write my Masters dissertation on a lengthy comparison of Labour and the German Social Democratic Party (SPD), especially the modernising tendencies of the leadership of both parties from the mid 1980's onwards. So I'll admit to a lively measure of curiosity about what's going on now.

I know, I know: it's lazy to compare thirty years ago with the present day - although Jeremy Corbyn doesn't help with this when he appears on stage with (half of) UB40. So I'm not going to play that movie today.

Instead, I want to wind back over 100 years to this chap, who basically invented reformist Marxist socialism, and is someone I think about when I think about the health of democracy from time to time.

Eduard Bernstein (1850-1932) was one of the founders of the modern German SPD and a died-in-the-wool Marxist. But he was also the guy who pointed out that: 

a) The semi-parliamentary democracy of the German Empire was working out pretty well for the SPD, electorally speaking.
b) It gave them a platform to push for universal suffrage and incremental improvements in the condition of the working classes within capitalism, meeting Bismarck's heirs and their own paternalistic social policy halfway.
c) This was on the whole a better thing for everyday people than waiting for capitalism to collapse from its own contradictions, a la Marx.

'Playing the game'

This is almost certainly a monstrous paraphrase of Bernstein's own sophisticated thinking on the subject. But it's also a pretty good illustration of the judgement that all the mainstream social democratic parties of Western Europe reached at some point or other: that it was in their interests and the interests of those they served to 'play the game' and line up behind parliamentary democracy and a mixed public/private economy (which they usually helped to create). 

Typically, the cerebral German SPD did a lot more thinking out loud about saying goodbye to revolution than other parties, with Rosa Luxemburg being the equivalent figure to Bernstein on the other side of the question. In contrast, with only a homeopathic dosage of Marx in its founding fathers, the Labour Party could crack on with a more pragmatic approach right out of the traps.

After some initial qualified success in Britain and Germany, this approach started to pay off in earnest from the 1930's onwards, with the establishment for example in some form or other of the modern welfare state in country after country. All the mainstream parties of the left became in stages explicitly reformist and downplayed if not repudiated their radical heritage.  

Donald Sassoon's 100 Years Of Socialism goes into a lot more detail about this and is highly recommended if you want to geek out about the history of the Left in earnest.

But what game to play in the twenty-first century? Continued in a follow-up post.

Health-geekery Autumn 2017: season of mists and mellow linkiness

A seasonal, occasionally updated round-up from the depths of my Outlook read folder and my liked Twitter posts.

As ever, being included here doesn't necessarily mean I agree with it, just that it was sufficiently noteworthy to be recorded here.

NHS

Guardian: 'Ministers must admit that the health service can't cope'

A stark winter warning from NHS Providers

Labour call for £500 winter bailout

And Labour Conference sets out its stall on health reform - or at least what it's a'gin.

New National Voices report: Person-centred care in 2017 (with evidence from service users)

'We’ve assessed the extent to which services are or are not person-centred. We found that despite 20 years of policy promises, care coordination is still not prioritised, there is a lack of care planning, and involving people in decisions about their care is still poor in the NHS'

Research by Dr Rod Jones - same day stay admissions drive growth, but length of stay is increasing

King's Fund crunch the numbers on hospital beds and report on public attitudes to NHS.

Analysis of STP plans in London by the King's Fund and Nuffield Trust.

Benali Hamdache blogs on National Voices about the need for Parkinson's specialist nurses.

Healthwatch report about patient discharge from hospitals.

Ted Baker (the new CQC Chief Inspector, not the gent's outfitters) raises the alarm about hospitals.

Social care

Latest Guardian article about social care in crisis but with a) useful opinion research cited and b) links to the work of Future Care Capital on a 'care covenant' for the future.

'Social care meltdown' - new survey of social workers by Community Care Magazine, supported by the Care and Support Alliance (plus blog by CSA Board member Robert Morritt on this at Conservative Home)

Interesting piece on using human rights law in social care work

And an article on personal budgets in the Guardian - whither the transformative potential?

Report from the Red Cross on the implementation of the 2015 Care Act: 'local authorities in England must do more in their areas to provide services that prevent, reduce or delay the need for care and support.'

Benefits

Disability Benefits Consortium report calls for an urgent review of Personal Independence Payment (PIP)

The problems with universal credit (Nicholas Timmins, Institute for Government)

Care homes

New research from Healthwatch 

Centre for the Modern Family research finds we underestimate the cost of residential care for the elderly significantly (link to FT article)

Brexit

Lancet article on possible impacts of Brexit on health and health services

Wales

Link to official WG statement of new Neurological Conditions Delivery Plan 2017-2020

Northern Ireland

Belfast Trust savings consultation threaten to delay access to multiple sclerosis treatments

Notes on a divided kingdom, part 1

This post starts with Marx, although he's really only a jumping off point for talking about the present day. It eventually gets to the point, so please do bear with me. :)

No more 'merely human solidarity'

I've been reading an old (1940) but thoughtful book - Edmund Wilson's To The Finland Station: a study in the writing and acting of history. It looks at 'the revolutionary view of society' as expressed by different nineteenth century thinkers, especially Marx and his socialist succcessors. 

Basically, it applies the techniques of literary criticism to political philosophy, which makes for diverting reading even if you don't agree with the conclusions.

 

What Wilson is very acute on is how Marx and Engels helped to move the radical 19th century Left away from the universal citizenship of 1789 into a far more polarised space based on class. Here is his gloss on the Communist Manifesto.

'All men are no longer brothers; there is no longer any merely human solidarity. The "truly human'" is that which is to be realised when we shall arrived at the society without classes. In the meantime, the elements of society which can alone bring about such a future [...] in proportion as they feel group solidarity among themselves, must cease to feel human solidarity with their antagonists. Their antagonists [...]  have [themselves] irreparably destroyed that solidarity.' (p162)  

In other words - we don't have to talk to our opponents, but when we do we don't have to play nice. We don't have to deal fairly and honestly with them either: any relationship with them is pragmatic at best, rather than founded in common ground or a good faith dialogue.

Oh, and they started it.

Not inherently a left-wing position

Now, what Marx and Engels advocated and what they actually did on a daily basis is a fair way apart. But let's assume for the sake of following this line of thought that they were entirely serious about this redefining of the civic community to exclude members of opposing classes and groups. And let's face it: finding examples of this from Marxist-Leninist parties isn't exactly the hardest task to set a historian.

To avoid the rabbit hole of discussing one hundred and fifty years of history though, let me hastily clarify: I've started with Marx (with an assist from Wilson) because of their candour and clarity of thought on this point, not because they're describing an inherently left-wing position. From broadly the same period, I could have brought up Bismarck's anti-socialist law or the behaviour of the opponents of universal suffrage to make a similar point about the right.

Anyone, it seems, can un-person anyone.

And on that sad reflection, let's switch our attention back to the UK of the present.

Does this feel like 'human solidarity' to you?

Consider discussion of Brexit and its aftermath. Think of the toxic atmosphere that surrounds any conversation on immigration or the internecine warfare that passes for discourse on Twitter. Consider the adoption by some of bad faith arguments and trolling as a political tactic, the sheer difficulty in having a broad-based conversation about class, race, gender or sexuality without these behaviours manifesting.

I'm not singling out actors here from any point on the political spectrum, as that would be counterproductive to what I'm trying to achieve. I'm simply outlining a perceived trend.

Rather my question, channeling Wilson, is this: does this look like universal 'human solidarity' to you?

I thought not.

What it does look like is a willingness to exclude people from the civic community. Or at the very least, to use the languages of exclusion and bad faith, even if only in self-defence.

Wrestling metaphor incoming 

We have to acknowledge it's not all like this. There are organisations advocating for dialogue and social cohesion such as the Jo Cox Foundation, politicians of all parties and administrators at all levels working together and getting on with the job of serving the people. These are some of the things that give me hope for the future.

Yet, if UK democracy were a wrestling ring - which in many ways it is, what with the posturing, silly costumes and heel turns - it still feels to me like we're now jumping the ropes and battering our adversary with the chair way too often.

And that cuts to the heart of the matter. In the long run, a stable democratic society with an effective government depend not only on the willingness of each group, each individual to participate and follow the rules, but also to support everyone else to do so as well. We've known this since at least 1776 - it's old news - even if it's been honoured in the breach on many occasions.

But whether by passion or strategic design, if the current level of rhetoric keeps ratcheting up, if exclusionary behaviour continues to rise, if internal or external exile starts to look like a safer option than participation, then my fear is that UK democracy (or at least its current iteration) will eventually find itself in a crisis it cannot withstand.

"Yeah? That’s just like, your opinion, man"

Two concluding comments and caveats.

First, I'm going to be compiling a postscript to this post with any research or evidence I can find on this subject, whether it supports my reflections or not. This is one of those rare occasions when I'd actually like to be proven wrong.

Second, there's a lot more that could be said (and has been said) about all of this, including the long history of marginalisation on the basis of race, class, gender or sexuality. I've also stopped short of suggesting any action at this point. This sort of small-scale artisanal blogging can only eat the beast one piece at a time, so hopefully you'll bear with me as I go.

And perhaps it goes without saying, given that this blog has a comments section, but all reflections and recommendations are most welcome.

Health-geekery May 2017

There's been so much going on since my last round-up that I'm just going to steadily accumulate links here as I find time to go through them in my inbox.

As usual, inclusion doesn't necessarily mean agreement, merely interest.

MND

New drug licensed in America for the treatment of MND (the MND Association's research blog) 

The news broke at the Association's regional conference for people with MND and their families last Saturday in Liverpool. This event also coverered campaigning and awareness-raising: you can watch my colleague Colin Morris give a sneak preview of Awareness Month in June followed (from about 16 minutes) me introducing an absolutely barnstorming speech by local campaigner Debbie Williams on the MND Charter.

NHS

NHS left reeling by cyberattack in the Guardian (and a warning from Silicon from December 2016)
Labour now support a moratorium on STP's
Recruitment crisis in nursing (Grauniad again)
National Voices editorialise on health stats from IPSOS global trends report
Naylor Review of NHS estates summarised by The Whitehouse Consultancy.

Elections

Nice bit of infographery for the local elections and the General Election in Wales from Deryn

The third sector and the General Election:

Disability Rights UK
National Voices
Disability Benefits Consortium
Macmillan
Action Duchenne
Terrence Higgins Trust
Health Foundation
Nuffield Trust

Disability rights

Equality and Human Rights Commission reviews disability inequality in Britain: a journey less equal.

Wales

Snapshot survey from the RCP finds that doctors across Wales were struggling to cope with NHS winter pressures
Public Health (Wales) Act passes into law - some provisions about accessible toilets particularly relevant from a work perspective but lots more in there.
Extra money available for social care.

Health and social care campaigning

Responses to a question I asked in various places about campaign heroes (unsung and otherwise). Thanks to everyone who suggested candidates. 

Transforming mental health in Lambeth (via Nesta)
Roy Lilley
Self Directed Support Scotland
Dr James Fleming and Green Dreams (link to more about social prescribing here via the College of Medicine)
Anya de Iongh (the Patient Patient)
The Campaign To End Loneliness
Peer-to-peer behaviour change campaigns like Club Soda and others.
Unison's Care Charter
Save Lewisham Hospital
Mencap annual health checks campaign

Health-geekery March 2017

YOU WANTED THE LINKS! AND YOU GOT THE LINKS!

YOU WANTED THE LINKS! AND YOU GOT THE LINKS!

Or maybe you didn't, but in any case (with apologies to the Utah Saints) here's the latest list of health and social care links I compile on an occasional basis. 

As ever, the inclusion of a link doesn't mean agreement, just that it's made me go hmm (with further apologies to C and C Music Factory).

MND

MND Association new audit tool for health and social care services based on the NICE guideline launches.

Neurology

New report from Neurological Alliance based on patient survey finds services to diagnose, treat and provide on-going care are failing patients across the spectrum of neurological disorders.

Budget 2017

National Voices response.

Care Quality Commission

The CQC want to hear about your experiences of poor health and social care - also some useful information about complaining to a service and whistleblowing here too (via National Voices).

Care firms

BBC investigation finds that lack of money is prompting firms to end their care contracts with councils.

And the case for regulating homecare, courtesy of the Guardian.

Continuing Healthcare

Threats to CHC in Leicestershire and the threat of reinstitutionalisation (via MND Association).

Wheelchairs

Report on delays in wheelchair provision - quotes from Muscular Dystrophy UK and Wheelchair Alliance.

Northern Ireland election and coalition-wrangling special

Worries for charity sector funding in Northern Ireland in the absence of a 2017/18 budget due to election limbo (NICVA).

A handy list of new MLA's (NICVA again).

Analysis of election by Stratagem consultants

Video about Northern Ireland's GP crisis.

Local government nerdery in Wales

Want to read the Welsh Government's consultation document on local government, including its positions on joint working with health, council mergers etc, Thought so.

Devo Manc 

Progress report from The Health Foundation.

King's Fund trifecta

Quarterly NHS monitoring report.
The role of housing in Sustainability and Transformation Plans.
Elective waiting times target may not be reached for first time this year.  

Beds and delayed transfers of care

Good summary report from the Nuffield Trust with charts
And... as a complement, bed data from the BMA for each part of the UK

New palliative care awareness-raising campaign

Know About Me (Dying Matters)

Brexit and health

Record numbers of EU nurses quit NHS (Grauniad)

Research

Good summary here of Project AMBRoSIA on the MND Association's Research blog - the Association's biggest ever research project to date.

Elderly

Did you know more than 1.2 million older people are chronically lonely? Lovely campaign from the Jo Cox Commission on Loneliness running till mid-April. 

Teh datas

Call for a Health Data Lab to improve outcomes (NPC, backed by various charities including the MND Association).

Health Inequalities

Did you know Coventry was a Marmot City? If you think it has something to do with small furry animals, read on and be corrected (RCN Community Health Nursing Journal).

And finally...a giant spreadsheet of increased payments for adult social care from the 2017 Budget 

Just the figures, but if anyone notices anything interesting please share.

Health-geekery February 2017

I can't always get the health and social care links I want, but sometimes if I try repeatedly, I can get the health and social care links that I need.

As ever, inclusion in the list doesn't signify agreement, merely that I've found something to be interesting.

NHS

Belatedly, here's a series of essays hosted by the Kings' Fund imagining What If scenarios for the future of the NHS.

Even further back into the past, here's a very handy briefing by the Neurological Alliance on issues affecting neurology services from April last year.

Returning to the present, things do seem to have gone (temporarily no doubt) quiet on sustainability and transformation plans in the English NHS. However, Health Campaigns Together have produced some activist resources in the meantime, which may be useful whether you agree with their take on STP's or not.

Social care

New research from Scope finds that fewer than one in five people with disabilities (18 per cent) get the right social care, which [editorial voice intruding] is frankly gobsmacking.

Most councils unconvinced that increasing social care precept to 3% will resolve care crisis (ITV)

Local services by local people

New report from Locality calls for locally-commissioned and delivered public services which would provide "substantially better outcomes and value than standardised, one-size-fits-all services."

Transport

Changes to staffing on Southern Trains risks affecting accessible transport for people with disabilities. (Guardian)

Northern Ireland

Scope NI interview with NICVA Chair Seamus McAleavey has some interesting comments on health and health reform in light on renewed political instability.

Wales

News from the Wales Rare Disease Implementation Group as Rare Disease Day approaches on 28 February.

And a link to Wales' Digital Health Strategy, just because.

It's that man again...

Theresa May doesn't rule health out of any trade deal agreed with the US (Independent)
Caroline Molloy of Our NHS fires back

Resources

Presentations and related resources from National Voices annual conference.

And finally

An American patient in London - comedian Rob Delaney talks about his contrasting experiences of UK and US healthcare.

Health-geekery January 2017

It may be a new year, but health certainly hasn't been out of the news, with patients facing record waits in A and E and the British Red Cross describing the situation in hospitals as a 'humanitarian crisis.'

Below the headlines, here's how the think tanks are looking into aspects of the same story.

The King's Fund have timely data on how demand for NHS services continues to rise (and see accompanying blog).

Fourth annual report from Nuffield Trust and the Health Foundation monitoring the quality of health care finds "ongoing pressures on the NHS risk making the health service more vulnerable to serious lapses in care in future, despite impressive achievements in maintaining and improving care quality in important areas."

Northern Ireland GP practices at breaking point

One in six GP practices in Northern Ireland wrote to the Health and Social Care Board in 2016 to raise concerns about workforce pressures ... and NI GP's are now threatening to leave the NHS and charge patients directly (both stories from GP website Pulse) as they do in the Republic.

Sustainability and Transformation Plans

What are leaders in health and local government really thinking about STP's? The Institute of Healthcare Management has asked them and written a report on it.

Carers

Carers UK research suggests that if you don't identify as a carer you might not look to access the support available.

Social care

Centre for Health and The Public Interest publishes report with the leading title of The failure of private adult social care in England: what is to be done?

2016 in books

My favourite reading from 2016. Thanks due in particular to family, friends, Mr B's Emporium in Bath with its book spa service and the Hugo Awards for passing many of these my way.

Links are to reviews on the blog. 

Ben Aaronovitch, Whispers Underground, Broken Homes, Foxglove Summer and this year's The Hanging Tree 
Viv Albertine, Clothes, Clothes, Clothes, Music, Music, Music, Boys, Boys, Boys
Charlie Jane Anders - All The Birds In The Sky
Alan Bennett, The Uncommon Reader
H G Bissinger, Friday Night Lights
Lois McMaster Bujold, Penric's Demon 
Becky Chambers, The Long Way To A Small Angry Planet 
Samuel R Delany, Dhalgren
Philip K Dick, Do Androids Dream Of Electric Sheep, The Man In The High Castle and Valis
William Goldman, The Princess Bride
Doris Kearns Goodwin, Team Of Rivals: The Political Genius Of Abraham Lincoln
Frances Hardinge, The Lie Tree
Barbara Harford, Greenham Common: Women At The Wire
Alice Hoffman, Practical Magic
Dave Hutchinson, Europe After Midnight
N K Jemisin, The Fifth Season
Ursula Le Guin, The Wind's Twelve Quarters
Cixin Liu, The Dark Forest
R K Narayan, The Bachelor Of Arts
Naomi Novik, Uprooted 
Nnedi, Okorafor, Binti
Sydney Padua, The Thrilling Adventures Of Babbage And Lovelace
Joanna Russ, Extraordinary People  
Philip Sandifer, Guided By The Beauty Of Their Weapons
Neil Stephenson, Seveneves 
Charles Stross, The Annihilation Score
Koushun Takami, Battle Royale
James Tiptree Jr, Her Smoke Rose Up Forever 
Catherynne M Valente, Deathless
Jo Walton, The Just City
Alyssa Wong, Hungry Daughters of Starving Mothers and The Fisher Queen