Wednesday, April 8, 2015

The Plot Against the NHS

The Plot Against the NHS

In this lecture, based on the book The Plot Against the NHS, co-author Colin Leys attempts to set the record straight on plans for a new healthcare market. He argues that the healthcare reforms proposed by the Coalition are not as radical as they seem, but are part of a plot to dismantle the NHS born under Blair.
This lecture, given at Goldsmiths College, is based on the book The Plot Against the NHS, by Colin Leys and Stewart Player, published on April 14th.

The common view of the changes proposed in the government’s Health and Social Care Bill is that they would be the most radical changes ever made to the NHS. In one way this is correct: the changes do mean replacing a comprehensive, universal system of care with a US-style healthcare market, consisting of providers, all governed by the bottom line. There will be a limited, ‘basic’ package of services for everybody, funded by the state; and better-quality treatments, on payment of a fee or co-payment, for those who can afford to pay.
But in another way the common view is wrong: the changes that were made under New Labour were more radical. A simple consideration makes this clear. If Mr Lansley had taken office last year facing an NHS as it still was in 2000 his project would be unthinkable. In 2000 there were no foundation trusts; no payment by results forhospital treatments; no private health companies already providing NHS acute care and GP services; no independent regulator of a healthcare market (Monitor). Without all these changes, and many others, what Lansley’s Bill now proposes would be unthinkable.
All of these changes were major. Yet most people were largely unaware of them, and certainly unaware of where they were leading – and that includes many MPs and even many clinicians. And not just because the NHS is complex, and organisational changes don’t make sexy headlines. It is above all because the changes were made covertly, using government powers that did not require primary legislation. The true purpose of a series of so-called reforms was deliberately concealed. It is because of this that what has happened deserves to be called a plot.
The story begins for me in July 2000. Alan Milburn was Secretary of State for Health and was in the middle of negotiating a so-called concordat with the Independent Healthcare Association. The concordat said that from now on the NHS would take advantage of private sector healthcare providers on a regular basis, not just exceptionally, as for example in the annual winter beds crisis. The Independent Healthcare Association’s chief negotiator was Dr Tim Evans. I interviewed Tim Evans at the time. He told me that his vision was that the NHS would be just ‘a kitemark attached to the institutions and activities of a system of purely private providers’.
In my innocence, I dismissed this as a far-right fantasy. What I didn’t realise was that his vision was shared, to a greater or lesser extent, by a small number of people at the heart of government, especially Blair’s senior health policy adviser, Simon Stevens, Milburn’s adviser Paul Corrigan, and a significant number of senior staff in the Department of Health including, critically, its young director of strategy and planning, Dr Penny Dash, and Milburn himself. They all thought that to make the NHS efficient it should be reformed into a kind of healthcare market. 
The NHS Plan, which was published in the same month, July 2000, was written by a team that included Stevens, Dash, Corrigan and Milburn. It mentioned the main elements of the shift to a market, but it disguised them as mere improvements in the existing system. 
Three major changes in the NHS were required. First, the taboo on private provision of NHS clinical services had to be overcome, and a bridgehead created for the private sector in the NHS.  Second, NHS organisations had to be converted into real businesses, not the make-believe businesses of the so-called internal market. Third, the ties between the NHS workforce and the NHS had to be weakened, so that enough NHS staff would be ready to transfer to private sector employment as private providers took over more and more NHS work. Milburn initiated all three of these changes.
Creating a bridgehead for the private sector
Creating significant openings for the private sector in acute or hospital care faced a basic problem: the NHS was highly efficient, while the existing UK private health sector was tiny, with very high costs, and wholly dependent on the part-time work of NHS consultants. There were no British companies that could perform any procedure as cheaply as an NHS hospital, let alone compete across the board with a full District General Hospital. To overcome this was the real aim of the Independent Sector Treatment Centre (ISTC) programme. ISTCs are small stand-alone clinics specialising in standard low-risk procedures, chiefly cataract removal and hip and knee replacements. The programme was set in hand in 2002 by a new Commercial Directorate in the Department of Health led by Ken Anderson, a Texan businessman. 
The real aim of the programme was to put pressure on the existing British private health companies – chiefly BMI, Nuffield Hospitals and BUPA’s hospitals – to restructure themselves into high-volume lower-cost businesses. This was done by giving very lucrative and risk-free contracts to a set of newcomers from overseas such as Netcare from South Africa and Capio from Sweden. The incumbent firms were, officially at least, disconcerted, and set about restructuring. The BMI hospital chain started separating its private patient work from its NHS work, aiming to make its NHS work cheap and fast, and was then sold to Netcare in 2006.  BUPA sold all its hospitals to a private equity company, Cinven, which set about the same task. At the same time, because the new private centres were spread all over England the idea of private provision of clinical services was normalised everywhere. The ISTCs were also allowed to use the NHS logo (or kitemark), so that many if not most patients still don’t know they are privately owned and profit-making.
The official aim of the ISTC programme was to add to the NHS’s capacity to do elective surgery, and so reduce waiting times, which in 2002 were still very long. Since then there has been a dramatic reduction in waiting times, but it owes nothing to the ISTCs. They have never done more than 2 per cent of NHS elective surgery, and that has only been achieved by allowing them to use a growing proportion of NHS consultants and other staff – in other words they didn’t bring additional capacity. A good case can be made for saying that their extremely generous financial terms took capacity away from the NHS.
But by 2007 the ISTC programme had morphed into a wider system of private providers. As the incumbent companies adapted, they joined the ISTCs in a so-called Extended Choice Network of – at the last count - 149 private hospitals and clinics that are eligible to treat NHS patients and can theoretically do so profitably at NHS prices – at least for the lower-risk, least complicated procedures.  
NHS work now accounts for about 25 per cent of the private sector’s total revenues (for some firms the proportion is much higher). But this still accounts for only about 2 per cent of total NHS spending on acute or hospital care. It might seem that Tim Evans’ dream of a healthcare system consisting only of private providers is still a distant fantasy. But that would be to underestimate the potential for transforming NHS trusts into businesses, which was the second change initiated by Alan Milburn – foundation trusts.
Corporatizing the NHS
The model for foundation trusts was the so-called health foundations – fundaciones sanitarias - set up by the People’s Party in Spain. These were publicly-built hospitals that were handed over to private companies to run for a fee. They had freedom from the health ministry and could set their own terms of service for their staff. They were said to be more efficient than the regular state-run hospitals, although subsequent studies don’t support this. 
But Milburn liked the idea and decided to implement a version of it in England, and even took over the name, ‘foundation’. There was a key difference: when NHS hospital trusts got foundation status they were not handed over to private management. But they were freed from Department of Health supervision and could operate in many respects like private companies, including setting their own terms of service for their staff.
But the central point about foundation trusts is that the contracts they make are legally enforceable, and if they run up unsustainable debts they won’t be bailed out by the Department of Health. This means that they become fully exposed to the risk of bankruptcy. The independent regulator, Monitor, can step in and impose new management on a foundation trust that is heading for bankruptcy, or let it close and get its work taken over by other providers. This means that the crux of all policy decisions in the hospital becomes financial. Foundation trusts don’t have to pay dividends to shareholders but in all other respects they have to behave like private companies. Milburn’s aim was that all NHS trusts should become foundation trusts by 2008.
But they couldn’t behave like companies unless their income was related to their performance. So Milburn also introduced payment by results. Each completed treatment was to be accounted and paid for individually. This involved putting a price on every procedure, a price that varies according to the different level of cost and risk posed by each category of patient. These prices were fixed. For the time being competition was to be on quality alone. But once a system of payment based on price per treatment was in place, price competition could then be quite easily introduced.
The target date of 2008 was too soon, but the job is now being completed by Mr Lansley. All NHS trusts are now required to become foundation trusts, or merge with a foundation trust, by 2014, and all community health staff have to be part of a foundation trust or a social enterprise by this coming April. By 2014 all NHS services – acute hospitals, mental health hospitals and clinics, ambulance services, community health services and, of course, GP practices – will be run as independent businesses competing for patient income in a healthcare market.
All this makes Tim Evans’ dream look a lot less distant. There will be great scope for the private sector to pick off weak NHS foundation trusts once the new market is fully operational. Two years ago the Department of Health was already expecting up to 90 trusts to disappear over the next 20 years.
Detaching the clinical workforce from the NHS
But for this to happen smoothly, a good part of the NHS clinical workforce also had to be made available to the private sector. Accordingly, the NHS Plan of 2000 called for new contracts of employment for NHS consultants and GPs, and new contracts were signed and came into force in 2003 and 2004.
On the face of it the new contracts gave consultants and GPs large increases in pay for very little if any additional work. But their real significance was different.
In the case of the consultants, a show was made of trying to make them accept much closer supervision by hospital managers, and cut back on their private work. But it soon came to seem that the real aim of doing this was to make them feel more disenchanted with working as salaried NHS employees and readier to go into business – to form doctors chambers, on the model of barristers, or other kinds of business, and sell their services to any employer, public or private, that offered them the best terms. A significant number began to plan to do so and some have begun to. And as the cuts begin to bite there will be unemployment among hospital doctors. As you will have read, consultants are among those scheduled to be laid off by St George’s hospital in Tooting, and elsewhere. Working for private providers will become normal again in a way it hasn’t been since 1948. 
In the case of GPs, the new contract gave most GPs a huge pay rise; it also allowed them to give up out of hours provision for a very modest cut in income. It is not clear how far the size of the pay rise was intended, but almost as soon as it was introduced GPs started to be vilified as overpaid and lazy; and they had also lost their monopoly of primary care. Private companies were invited not just to take over out of hours care, but also to set up a large number of new GP practices, employing GPs on salary. By mid-2010 227 GP practices were being run by for-profit companies and all GP practices are now increasingly based on fixed-term contracts, which have to be competed for again at the end of each contract. 
That left the third main component of the NHS workforce in England – 250,000 community health staff.  After the 2005 election Patricia Hewitt became Secretary of State for health. In 2006 she tried to get the community health workforce shifted out of Primary Care Trust employment, into self-employment or employment by commercial employers. The aim was clear; staff should only be employed by organisations capable of competing in a market. There was a huge backlash, and Hewitt retreated. But what Hewitt failed to do Andrew Lansley has now accomplished. All community care staff have to be out of PCTs by this April 2011. Most of them have been taken on by foundation trusts. 
The last major change initiated by the marketizers was the attempt from 2007 onwards to set up some 500 polyclinics, or GP-led health centres, throughout England. The official aim was to achieve more ‘integrated care’ – meaning, especially, dissolving the boundary between primary and secondary care. The idea was to shift non-urgent work out of hospitals into more numerous, smaller organisations, with at most day surgery facilities and few if any inpatient beds, but offering relatively sophisticated diagnostics and other treatment services. Care would be provided by specialists as well as GPs, especially for the growing population of older patients with long term chronic conditions, but most GP practices would be expected to relocate into the new centres.
There was and is a lot to be said for the polyclinic model. But the key idea underlying it in 2006 was to use it to solve the persisting difficulty of building up a private healthcare industry. The Department of Health Health estimated that about 60 per cent of hospital work – all outpatient clinics, much diagnostics, most minor surgery – could be unbundled from the rest of hospital activity and shifted to these new centres, which would be built and operated by the private sector. This aspect was not mentioned by ministers in public. The official view was that the shift was aimed at improving patient care. But in private meetings held with the private sector every six weeks throughout 2007 and 2008 it was made clear that the new centres were to be an opportunity for private investors.
The front man chosen for the public exercise was Sir Ara Darzi, who was often pictured in his operating theatre scrubs, lending the project an aura of high-tech professional dedication. No one of any consequence was impolite enough to ask what qualifications a specialist in minimally invasive surgery had for making health policy. In reality his three reports all followed closely a script prepared for the Department by a team under the leadership of the same Dr Penny Dash who had been director of strategy in the Department of Health at the time of the NHS Plan, and who was by now a partner in the London office of McKinsey and Company. 
Towards the end of 2007 all 152 PCTs in England were ordered to have a one GP-led centre up and running by April 2009. In practice, by the end of last year 140 had been opened. About a third are run by corporations, such as Virgin Assura, but many more are run by GP-owned businesses. 
But this way of expanding the role for the private sector in NHS-funded health care has not gone according to plan. One reason why it didn’t was the financial crisis, which meant that private investors couldn’t borrow the necessary funds. A more important one – especially for Lansley, given that his market project hinges on GP commissioning – was that GPs were reluctant to move into the new centres. By the end of last year several centres had closed and more were facing closure for lack of business. None of them was a centre of integrated care, with high tech diagnostics and facilities for day surgery, involving specialists as well as GPs, in the way Lord Darzi had envisaged.
Last month Mr Lansley quietly shelved the whole initiative.
The shift to an unmanaged market
In my opinion this decision is very significant. Under New Labour, the marketizers envisaged a managed market. The private sector would have a growing share of it – but in structures prescribed by the government. The next major advance for the private sector was to be into Darzi centres.
But the private sector didn’t rush to do it, and not only because of lack of credit. It was even more because it wasn’t clear how much money there would be in it. Too many aspects of it were unknown: such as, for example, how easy it would be to get hospital consultants to come and work in the centres in places outside London. And there were many unknown unknowns, as Donald Rumsfeld would say. They were also waiting for the election.
The point here, which I think Lansley understands, and few Labour ministers did, is that businessmen want to work out their own opportunities, where they can calculate the risks and the returns. Opportunities selected by the government are only interesting to them if the government assumes all the risk, as it did with the ISTCs – and that is too expensive for governments to repeat very often. And this is what is really new about Lansley’s Bill: it promises an unmanaged healthcare market, in which how health care is delivered will be decided by what businesses see as profitable, controlled only by minimum health quality standards (set by the Care Quality Commission) and Monitor, the regulator. 
How the market will be regulated is something the experts are still trying to work out, so I am not going to attempt it here. Huge discretion is being handed to the independent regulator, Monitor, to decide what is ‘appropriate’ or ‘necessary’, as those who have drafted the Bill put it.
But I think a few things are clear. Over half of all NHS-funded activity - everything that is not paid for on the basis of the fixed-price tariff – is already subject to price competition. We are already seeing it in the way contracts for GP practices and community health services are now being awarded (for example Camden PCT awarded GP practices to UnitedHealth purely on the basis of cost, and replaced the physio services of the Royal Free by those the Newcastle-based company Connect Physical Health). And the interim chief executive of Monitor, David Bennett, has made it clear that price competition will gradually replace the fixed tariff for other activities, including hospital treatments. 
Once this starts to happen corporate bidders will undercut NHS hospitals for various bundles of hospital work, using loss-leading pricing if necessary to get started as they already have in primary and community care. The NHS hospital services affected will close, and clinical staff will move to where the work then is, either as employees of the new corporate providers, or as members of doctors chambers or social enterprises under contract to them.
Many entire hospitals will close, especially in London and other big cities. When a hospital cannot be allowed to close Monitor will move in and franchise its management to corporate management teams. This has already happened to the Hinchingbrooke Hospital near Cambridge (Circle Health), and experts expect it to happen to 20-30  more in the next few years.
Prices will rise. On the one hand, the cross-subsidisation that is practised inside NHS hospitals will come to an end as the less costly activities are taken out of them, forcing them to charge more for what remains. On the other hand, Monitor will have to ensure that prices are set so that all providers make a profit. To keep the NHS budget down, what is covered by the NHS will decrease. More and more treatments will be ‘decommissioned’ and will become ‘extras’, which you can have if pay for them. This is already happening in one particular way, thanks to another New Labour measure – personal budgets, or lump sums given to patients with chronic illnesses to buy their own care with. If you want more care than the lump sum will cover you can pay for more, if you can afford it. Inequality in health care will be restored. 
And while prices rise, quality will fall, because quality is hard to measure, and costly to police (the Care Quality Commission is only really mandated to detect cases of gross neglect or abuse, and is grossly under resourced). In other words the NHS will consist of a limited set of treatments of basic quality – and a kitemark. 
How was it done? 
This very condensed account omits several major issues that are covered in the book Stewart Player and I have been working on. Among other things it omits the way the shift to a market has already been anticipated by the Department of Health, in dozens of initiatives and ‘pilots’. It omits the development of the private health industry, which is now on the verge of a dramatic expansion at the expense of the NHS budget. It omits fraud, which is so much part of the history of many of the companies involved, and which seems bound to become as endemic here as it is in the US and other healthcare markets.
But one question can't be entirely omitted from even this brief account: how could the NHS be abolished as a public service without a debate and without the public knowing? The answer is really the story of what has become of democracy in the neoliberal age, condensed into a single case.  Spin, of course, has played a big part – secrecy, misrepresentation, manipulation of statistics, lies and the suppression of criticism. But even more important has been a radical change in the nature of government: in effect, the state itself has been privatised.
First, in terms of personnel, the boundary between the Department of Health and the health industry has become so permeable as to be almost non-existent. By 2006 only one career higher civil servant was left in the Department’s senior management team. The rest came chiefly from backgrounds in NHS management or the private sector. In addition, senior positions in the department were filled with personnel recruited directly from the private sector, while former department personnel (including two Secretaries of State) moved out to firms in the private sector. The revolving door has revolved faster in the Department of Health than in any other part of government except perhaps the Department of Defence. Conflict of interest has become so routine as to be almost unremarked. The idea of a boundary between the public and private sectors, which civil servants and ministers police in the public interest, has gone out of fashion.
Second, policy-making has been outsourced. This is an oversimplification, but not much. A so-called health policy community developed, structured especially around two main think tanks, the Kings Fund and the Nuffield Trust. The current Chief Executive of the Kings Fund was formerly director of strategy at the Department of Health, and so was the current vice chair of the board. Their governing bodies also have strong private sector representation and their seminars and conferences are where the market plans have been developed and disseminated. And this has been done partly at public expense, as these and many other think tanks, some of them militantly neoliberal, are charities, and so tax-funded.
Third, and particularly important in the run-up to the 2010 election, is the health industry lobby. Tamasin Cave and David Miller at Spinwatch have made a remarkable short film on the health lobby, called ‘The Health Industry Lobbying Tour’ which you can watch online at Spinwatch.org. When you have seen it you understand a lot more about Andrew Lansley and where his ideas are coming from.
I’ll leave it there. But just in case you are not convinced of the design behind this, and don’t think it is fair to call it a plot, let me add just one more item. In January there was a discussion on Radio 4 between Matthew Taylor, who was once Blair’s chief of staff, and Eamonn Butler, the Director of the Adam Smith Institute, where Tim Evans also works – same Tim Evans who negotiated the concordat with Milburn and looked forward to the NHS becoming just a kitemark. They were asked if they thought the NHS was really going to become ‘a mere franchise’. Butler replied, quite casually, ‘It’s been 20 years in the planning. I think they’ll do it.’

To read the first chapter of The Plot Against the NHS, or to order the book at a pre-publication price, visit the Merlin Press website. The book will be launched at Housmans bookshop on April 20th.
About the author
Colin Leys is an emeritus professor of political studies at Queen’s University, Kingston, Canada, and an honorary research professor at Goldsmiths, University of London.

Sunday, March 29, 2015

SAIC-Art & Science Intersect!

Art and science intersect at the School of the Art Institute


The School of the Art Institute of Chicago is deepening its students' connections to science and mathematics.
Eugenia Cheng had just cut a bagel into a Mobius strip and was explaining why a liquid could not assume the same shape, when a student posed a question: "That bagel looks like water coming from a waterfall," said Nico Camargo. "What if you froze water?"
Cheng considered, delighted at the proposal.
"A frozen Mobius strip," she mused. "Why didn't I think of that?"
"Art school," Camargo shrugged, grinning.
Art school — but one that is increasingly exploring the intersection of art and science.




The class, the first incorporating an academic subject into an art symposium, combines studio art and physics. At the graduate level, SAIC students are working with University of Chicago graduate students in physics, astrophysics and anthropology on projects like creating a 3-D fabric representation of the dark matter in the universe.
The work reflects growing interest around the nation. The National Endowment for the Arts and the National Science Foundation held a summit in 2010 on how artists, scientists and technology experts can work together. The NEA has funded some 30 arts-science and arts-technology projects a year since 2011.



The Rhode Island School of Design, another of the nation's premier art schools, is heavily involved with efforts to enrich the STEM fields — science, technology, engineering and mathematics — by adding art, a concept called STEAM.
And at the Museum of Science and Industry, the Art of Science Learning project is developing ways to teach science by using art. The initiative, which is funded by the National Science Foundation, brought together scientists, artists, educators and students in 2014 to develop projects like a healthy eating video contest, which were launched in 2015.
In a way, it is a return to classical tradition. Through much of history, artists were scientists, a role epitomized by Leonardo da Vinci. Only within the last 200 years have the two diverged into separate academic disciplines.







At SAIC, the efforts have been championed by the school's president, Walter Massey, a physicist.
"There's a lot of science in art," he said, from the reflection of light on various surfaces to the technology of materials used in making art.
But he wanted to explore the concept more deeply. He began convening faculty meetings to examine the similarities in the ways artists and scientists see the world and express what they consider truth.
The school now has a scientist-in-residence program. The first one, preceding Cheng, was David Gondek, a computer scientist who helped developed IBM's supercomputer, Watson, which is known for beating two champions on the "Jeopardy!" quiz show. SAIC offers Conversations on Art and Science, a public lecture series that recently featured Cheng. Students and faculty worked on data visualization in a course taught in collaboration with Northwestern University's McCormick School of Engineering.
To Cheng, a concert pianist as well as a mathematician, there is a strong connection between math and art.
"I work with abstract ideas; a lot of artists work with abstract ideas as well," she said.
In the "Articulating Time and Space" class, student Zoe Nyman sat perched on a stool and pushed herself to understand the relationship of abstract concepts to physical objects — specifically, whether a Mobius strip's shape was defined by a container or could be assumed by the material inside a container.
"Why can't coffee be a Mobius strip?" she asked at one point. "I'm asking seriously."
Cheng and physicist Kathryn Schaffer, the faculty member who teaches the course with artist Paola Cabal, took the question seriously. The conversation deepened into a discussion of the nature and limitations of mathematical theory.
Nyman finds physics and its abstract ideas of space and time deeply relevant. Her art, she said, "has a lot to do with the space around me and moments that I am within and experiences I am living in."
Camargo is also intrigued. For his next project, he is reading up on dark energy versus dark matter.
"Science is an area of interest, like lily ponds would be for Monet," he said.
The instructors revel in the class too. Cabal, a site-specific installation artist who proposed the course, has found it so intriguing that she did the physics homework along with the students.
"It's been really exciting to see some of the work the students have done," she said. "They've really generated some experiences that contextualize and visualize the physics in a way that feels very personal."
Schaffer finds that art students are eager to engage with the philosophical questions that first drew her to physics.
"They're interested in knowing for knowing's sake," she said.
For Cheng, teaching at SAIC is an extension of her work in bringing mathematics to wider audiences. Her short math videos on YouTube have been viewed more than 800,000 times, and her new popular math book, "How to Bake π: An Edible Exploration of the Mathematics of Mathematics" will be published in May.
She doesn't expect SAIC students to master complex mathematics. But that frees her, she said, to introduce the kind of advanced ideas that she finds most exciting about her field.
"Although it's true that in the class we don't have the rigorous techniques to be able to really get to full grips with them, I always say you can appreciate listening to music even if you can't play it yourself," she said.
Charles Shields, a student in her math class, said he finds the ideas intriguing even if he can't always do the computations.
"My work is all about perception and depth," he said. "I want to see depth in dimensions that are beyond my understanding right now, to see something beyond our perceptions. Mathematics can do that."
For one of his projects, Shields made a stained glass work depicting rectangles of color spelling out "1+1=1."
Cheng initially did a double take, but loved it.
"There are mathematical systems where 1 plus 1 does not equal 2," she said. "There are some in which it's zero."
With graduate students, SAIC's involvement is with the University of Chicago's Arts, Science & Culture Initiative. The initiative funds research projects in which science students team up with those in the arts.







The collaboration has challenged and entranced them.
Visual depiction of Diemer's data was inherently thorny. Facio found himself asking, "If dark matter is invisible, then what are we doing? If it's not visual, what are we rendering?"
"Artists ask very different questions," Diemer said. "Isaac's first question (on looking at Diemer's 2-D rendering) was, 'What's the perspective here?' It was a totally different way to look at it, a visual way.
Said Facio: "It's challenging my studio practice; definitely challenging my technique; and it's really making me think beyond what I typically make. I'm creating something that has significance."
That is exactly how the program is intended to work," said Julie Marie Lemon, who launched ASCI in 2010 and is its program director and curator.
"They begin to teach each other, she said. "It makes better scientists; it makes better artists."







Tuesday, December 23, 2014

Die Meistersinger

Met’s stolid “Meistersinger” fails to reach the high notes

December 03, 2014 at 12:55 pm
Johannes Martin Kränzle as Beckmesser and James Morris as Hans Sachs in Wagner's "Die Meistersinger von Nürnberg" bat the Metropolitan Opera. Photo: Ken Howard
Johannes Martin Kränzle as Beckmesser and James Morris as Hans Sachs in Wagner’s “Die Meistersinger von Nürnberg” at the Metropolitan Opera. Photo: Ken Howard
In all the uproar over the alleged anti-semitism of John Adams’s The Death of Klinghoffer, one item on the Metropolitan Opera schedule curiously slipped through unnoticed. While plans for an HD simulcast of Adams’s opera were scuttled, the HD presentation of Richard Wagner’sDie Meistersinger von Nürnberg will proceed.
Like much of Wagner’s music, Meistersinger has a troubled history, due especially to its later association with Nazism and twentieth-century German nationalism more broadly. Wagner’s own anti-semitism is well documented, and it has even been suggested that the opera’s pedantic antagonistic, Sixtus Beckmesser, is himself an anti-semitic caricature.
But in spite of its author’s prejudices, Meistersinger remains a seminal work by one of opera’s great masters, and it returned to the Met’s stage on Tuesday night—mercifully, without protest. Unfortunately, Tuesday’s six-hour-and-ten-minute season premiere did not exactly fly by. One might have expected an illuminating performance under the baton of James Levine, and his direction was clear, communicative, and clean, aside from a couple of shaky crowd scenes.
Levine’s conducting, though, lacked energy, and not just because of his deliberate tempi. The Met orchestra, for all their suppleness and rich textures, did not play with much fire, nor with sparkle, aside from the comedic trickery between Sachs and Beckmesser in Act II and the ensuing riot. Even the swaggering Act One Prelude seemed comparatively dull.
James Morris’s portrayal of the cobbler and poet Hans Sachs was a serviceable victory lap. The veteran bass-baritone has lost some meat off his voice since his masterful performances of the role a decade ago, and the part’s topmost range was simply out of his reach on Tuesday. Still, his vocal shortcomings actually give his Sachs a sort of naturalistic gruffness, and now and then he was able to conjure up some of his bygone rolling thunder, as in his ruminative monologue near the top of the third act.
The heroic couple were solid, but never outstanding. Johan Botha mostly took a stand-and-deliver approach to the role of the amorous knight Walther, and what he delivered was, while vocally powerful and technically solid, lacking in nuance. His performances of the mastersong, rather than taking wing, seemed encumbered—his top was clear, but never thrilling. The same went for Annette Dasch, who brought volume and consistent tone to bear as Eva, but found few lyrical moments.
It was the house debut of Johannes Martin Kränzle as Beckmesser that carried much of this performance. Already the owner of an established career in Europe, Kränzle brought unusual poise to the role of the aged bachelor. His fluid, caramel tone made his own hackneyed rendition of the mastersong in the final scene a pleasure to hear, crummy lyrics and all.
Hans-Peter König remains a vocal marvel, booming out leathery tone as Eva’s father Veit Pogner, combining gentleness and nobility in his character. Paul Appleby’s brassy tenor and earnest demeanor made him a winning portrait of Sachs’s assistant David. Karen Cargill showed a firm, full-bodied voice as the handmaid Lena, and Martin Gantner impressed with radiant tone in his debut as Fritz Kothner. Donald Palumbo’s chorus sang at their very best, bringing musical force and dramatic presence to the long evening.
Otto Schenk’s hyper-realist production still gets the job done after more than twenty years. At its best, it brings the sixteenth-century setting to vivid life through the colorful pageantry of the final scene, and at its worst the audience can still admire the handsome and towering gothic arches of the otherwise workaday first act. Anyone who wants to catch it will have to hurry—the impending arrival of Stefan Herheim’s staging from the Salzburg Festival might make this the final run of the Schenk production.
Die Meistersinger von Nürnberg runs through December 23 at the Metropolitan Opera. Michael Volle will sing the role of Hans Sachs on December 9 and 13. A Live in HD broadcast will be presented on December 13. metoperafamily.org
- See more at: http://newyorkclassicalreview.com/2014/12/mets-stolid-meistersinger-fails-to-reach-the-high-notes/#sthash.rfUqH60I.dpuf

Thursday, October 23, 2014

Shakin' Stevens

Shakin’ Stevens

Posted by Dr No on 23 October 2014
16_going_on_17.jpgYesterday’s news was bob-a-job docs, £55 for each and every dementia diagnosis, with old hands who should know better – they have been handbagging item of service fees in various shapes and forms since the beginning of time – decrying the idea as bribery, likely to cloud professional judgement, possibly even unethical. Dr No will believe their wails when they start handing back the contents of their handbags. For his part, Dr No thinks the idea, though crude, is not without merit, even if the sum is paltry for what is rather more long-term work than a snap diagnosis, because it sends a signal in terms the ex-apothecaries have always understood – payment for an item of service. Dementia is under-diagnosed, and patients and carers who want to know and plan miss out on help that is or at least should be available. Indeed, upping the recorded prevalence might even push up dementia funding. So all in all, though a bit grubby, the idea gets Dr No’s approval.
Today’s news is Shakin’ Stevens, with his radical shake-up plans for the NHS. In fact, he had a part in yesterday’s news, but today he is centre stage, booming out his new vision for the NHS. If the recent NHS changes were so big they could be seen from space, then Shakin’ Stevens’ NHS shake-up plans are so big they can be seen from another galaxy. Given the top ten past eight slot on the Today programme, Stevens was interviewed – mercifully, as Jimbo was co-presenter, and we all know what happens when Jimbo starts asking a question to which he does not know the end – by Monty, sounding the way anti-bacterial knickers would sound if they could talk, albeit with worrying signs of early Jimbosis, complicated by acute twitteritis. Stevens, on the other hand, exuded smooth presence, sounding the way silk boxers would sound if they could talk. Prepared and abreast of his material, he climbed ev’ry mountain Monty threw at him as if they were foothills, von Trapp style.
How do you solve a problem like the NHS? Stevens was ready with his own list of my favourite things. He started at the very beginning, a very good place to start: more government money, less government tinkering; less inefficiency, more localism, and a bigger focus on prevention. He even had a sort of Do-Re-Mi for the En-Aitch-Ess, where the very first note just happened to be Neighbour as much as National. Although he didn’t use the words, a picture emerged of many GP practices becoming poly-clinics, even mini day hospitals, as the line between primary and secondary care becomes deliberately blurred. Hospitals might even travel the other way - hopefully not on the other bus - to provide GP services.
Is this the sound of music for the NHS? Steven’s plans for the NHS are a big shake up for the NHS, but this time executed at a micro rather than macro level. His clear call for real extra public funding for a national health service – efficiency savings alone will not fill the black hole - will rattle politicians’ cages, but at the same he has a history of travelling on the other bus, including time at the giant American private health firm UnitedHealth, not to mention bowling from the pavilion end when advising the then Labour government about health in the early noughties. His answers this morning on the Today programme on the question of greater private sector involvement in health service delivery made up in broadness what they lacked in depth.
Stevens did cite his long history of working for the NHS, and on more than one occasion repeated on air the mantra of a comprehensive service provided on the basis of need not ability to pay. This is a mantra up with which we have not heard from government for some time. The tones were of great affection for a national institution.
Like the young postman Rolf in The Sound of Music who woos Liesl, the eldest von Trapp child, in another pavilion from a different time, Stevens is young in his new post as NHS England’s Chief Pongo. Maybe not seventeen going on eighteen, but still young in post - and ardent. Later in the movie, we learn that the singing postman is now batting for the other side, though at the end he redeems himself by allowing the von Trapps to escape the Nazis. We can expect some dalliance by Stevens with the other side, and some fear much worse, given Stevens’ past form and connections. We all must hope that, as for Rolf, when the time comes and mountains have to be climbed, Stevens knows where his true heart lies.

3 comments: