The NHS is not what it used to be.

In the early days, an ambulance driver was asked to report for work with a jacket and tie. They were given a hat to wear and the keys to the ambulance. It was the days of scoop and run. If they looked like lasting at the job it was suggested they should take a course in first aid. In their own time, if they were interested.

Now, paramedics arrive at the scene with more skills and equipment than were found in the early Casualty departments.

We know that the growing number of elderly people is a pressure on the NHS. As is the growing number of people with chronic (long term) conditions. We are getting better at keeping ourselves alive for much longer.

We also know that the bulk of our health care is given by GPs and community nurses. They provide 90% of our contact time with the NHS but using only 10% of the budget. Many hospitals are underused and expensive to run. Planned day surgery is now very efficient, but many older hospitals continue to exist with huge estates, heating bills, and wards which are little different to nursing homes – but free.

But any politician worth their salt knows that they must be very careful if they say that hospital X needs to change, and to never say it needs to close. Even government ministers will defend every hospital in their constituency, even against their own collective policy. Why would you give up any part of the hospital, especially if any savings go back to the Department of Health, never to be seen again.

So, devolving budgets on NHS spending to local areas in England is the latest attempt to square this circle. The promise is, if you go through the political pain of changing hospitals, you will be allowed to keep the money saved to spend on other parts of the NHS, especially in community health and social care.

In Greater Manchester we can already see this emerging, for example with the proposal to change Wythenshawe Hospital to only do planned surgery and no more emergency care, which is concentrated at Manchester Royal Infirmary. If you believe that emergency care starts with the paramedics, and that travelling a few extra miles for expert care doesn’t matter because your care has already started, and that the money saved from an underused hospital will stay in the local NHS, then maybe you will support this decision, or at least not vote against the politician on the TV next time.

But if your children were born at that hospital, if your grandparents died there, if your sister survived her appendicitis there, then you might feel differently, even if you agree with the logic of spending more money on people and less on old boilers and heating systems.

If politics is the art of the possible, then devolved NHS budgets is an experiment in whether it is possibly to reconfigure health care with the support of local communities.

And a big factor will be the Department of Health itself. If devolution is just about “managed decline” in the provinces while the department happily gives new money to other places, usually the so-called elite hospitals in London, then the political setback will be for generations to come.

The big question in devolution, it seems, is not so much whether you trust the local politicians, but rather do you trust the national ministers and departments to not be devious?

And looking at the Northern Powerhouse idea and Network Rail’s “pausing” for maybe five years of major improvements across the north of England, the omens appear to be getting worse rather than better.

You could say that there is not exactly an abundant supply of good faith from government to local areas at the moment, and this risks undermining the idea of devolution if it just another way of making cuts. Transparent budgets and decision making at the national level is the missing key.

A number of left-wing commentators have written recently on the forthcoming UK referendum on continuing membership of the EU. The gist of these topical pieces is that the British left-wing should campaign for the exit of the UK, and not leave the running to UKIP. They acknowledge that the EU was pro-labour in the 1980s but since then it has become very pro-capital. The developments in Greece are seen as the starkest moment yet when these pro-capital powers are put to use, against the people.
OK, declaration due, my work often involves EU funding for public and third sector projects in the UK. But that apart, the UK always provided at least 50% of the funding and in some years the UK funds were far more generous and wide-reaching than the EU funds, though not any more because of austerity policies.
The EU is a massive compromise: between East and West Europe; North and South Europe; labour and business interests; left-wing and right-wing national governments. Some national leaders can work with compromise, but usually the more extreme leaders take an absolute position – my way or no way.
For the left, I think the fundamental issue is whether the EU is seen as an instrument of internationalism or one of globalisation?
For me, the flame is still lit – but flickering – for internationalism. The appalling treatment of Greece by the EU as well as the International Monetary Fund and the European Central Bank must be a lesson we learn from. The euro does not belong to any one country, despite Germany being the home of the ECB as a sop to local sentiment. Of course, there were horrors of hyperinflation in the 1920s and 1930s, but there were also massive subsidies such as the Marshall Plan from the USA in the 1950s.
But more than all these financial and economic arguments is the human one – the EU is foremost a peace-keeping project or it is pointless. Every straight banana and curly cucumber is absolutely worth it to save us from fighting ourselves.
And across Europe we pick our fights more easily than we like to think, whether it is in the Middle East or closer to home.
I guess where this leaves me is that the left-wing commentators have not yet found a compelling strategy to tackle globalisation, apart from retreating from anything international in case ‘business’ takes it over. And in the UK the New Labour project fundamentally said it could work with business for social justice, even though inequalities rose throughout its time in power.
To start to tackle globalisation, we need to look at reintroducing capital controls and exchange rates to protect weaker economies, and here the target needs to be the euro rule book not the EU.

Some days it is hard to be an optimist. The axing of official zero-carbon homes ambitions is one of those days.

I am reminded of the following self-deprecating quote, written in 1968 by the respected Fabian politician Leonard Woolf:

“I see clearly that I have achieved practically nothing. The world today and the history of the human anthill during the last fifty-seven years would be exactly the same as it is if I had played ping pong instead of sitting on committees and writing books”.

And blogs, we might add today.

But still we must push on, onward and upward!

http://www.theguardian.com/politics/2015/jul/10/productivity-plan-death-knell-zero-carbon-homes