FABIAN REVIEW QUARTERLY MAGAZINE: This edition of the Fabian Review centres on the global climate emergency, with contributions from climate experts and an interview with energy secretary Miatta Fahnbulleh MP, alongside pieces on Labour’s vision of freedom, the UK’s proscription regime, LGBTQ+ rights, education, AI in public services, higher education, and Britain’s relationship with Europe.

Cheap medicine

The NHS’s growing use of non-doctors risks creating a two-tier health service, argues Jatinder Hayre

After Aneurin Bevan created the National Health Service in 1948, the principle of universality became firmly embedded in the popular consciousness: illness would no longer divide the British people according to wealth, and the quality of care received in sickness would not depend upon the depth of one’s pockets. Bevan articulated another principle which receives rather less attention today: that the state might finance medicine, but it should not command medical judgement. Doctors needed sufficient professional independence to practise according to the needs of their patients rather than the administrative or financial convenience of the state. Both principles are now being tested – and in some cases, rewritten.

Across the NHS, work historically undertaken by doctors has increasingly been transferred to physician associates (PAs), advanced clinical practitioners (ACPs) and an expanding constellation of other roles. I use “Noctor” as an umbrella term for the phenomenon whereby non-doctors cease to complement doctors and begin to serve as a substitute for them.

The language surrounding this transformation is revealingly anaesthetic: “skill mix”, “workforce transformation”, “new models of care”. These phrases make a profound political choice sound like an administrative rearrangement. Beneath them sits a simple idea: medicine can be dismantled into tasks, those tasks redistributed amongst more rapidly trained practitioners, and the whole reconstructed without meaningful loss.

Green Room

Miatta Fahnbulleh is right about everything. Will it matter? She talks to Iggy Wood about her plan for a green transition that benefits all

In the not-so-distant past, consensus around the need to tackle climate change at least superficially encompassed the entirety of British society. It was the historic party of capital – the Conservatives – who enshrined net zero in law, eliminated coal from Britain’s energy mix, and committed to ending the sale of petrol and diesel cars. Some of the most important progress was made under Boris Johnson, who, while not on the right of the party per se, was a Brexit-supporting populist.

Grid system

Unglamorous electricity grid reforms could be the key to winning on the doorstep

Even Andy Burnham was surprised to get a standing ovation for taking VAT off electricity bills. His plans to address the plight of the industrialist seeking a grid connection did not meet with the same enthusiasm during his first Labour conference speech as prime minister. Yet faster grid access matters far more for bringing down Britain’s high energy costs.

On 29^th September, the government announced GB Grid, a new entity under the government’s publicly-owned energy company, GB Energy. Seeded with £4bn of reallocated funding, GB Grid will be able to finance and build grid infrastructure and plans to compete with incumbent providers. Alongside GB Grid, the government announced it would expand self-build connections and accelerate competitive tendering for transmission projects, effectively increasing competitive pressure on networks. This is a refreshing approach to bringing down energy costs, combining a bold public ownership experiment with unglamorous but necessary competition reforms.