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Theresa May’s speech on Monday was full of jarring contradictions. It’s already been noted that much of what she said was taken almost verbatim from a Cameron speech made at around the same time in his premiership. But the most prominent bit of plagiarism was of course her reference to a ‘shared society’. In what is a direct echo of Cameron’s ‘big society’ idea, she called upon us all to do our bit to make our world that little bit better.
It’s a cheesy, unoriginal and politically misguided proposal, but it’s not a bad idea in principle. It wasn’t even a bad idea when Cameron first proposed it five or six years ago. People giving their time to get involved in local issues and helping out in the voluntary sector is always going to be a no-brainer, and few people would argue against it. But where most people would diverge from Cameron and May is the extent to which we should rely on the goodwill of others rather than the guaranteed support of our elected government.
To be honest I’m not really sure if even the Tories believe this crap any more. Like most politicians, they survive the realities of life behind a screen of weapons grade cognitive dissonance, twisting the worst excesses of incompetence into a tissue of triumph and relying on half-truths so obfuscated by spin that they wouldn’t know authenticity if it was forcibly introduced into their rectum engraved on a live hand grenade.
In one of my own local constituencies we have a Tory MP who has just launched a campaign to save the local hospital from being downgraded. Amid stories in the local press about serious pressures being placed on hospitals, she seems oblivious to the fact that the party she facilitates in Westminster is largely responsible for the decisions that led to this situation.
But then again another of her personal hobby horses is a group called ‘Singing for Syrians’, a charity that tries to help Syrian refugees by singing songs (I kid you not). Her involvement is of course very laudable, until you check her voting record and discover that she supported the bombing campaign in that same country and opposed the Dubs amendment that would have allowed some of the children she was supposedly singing for a safe haven in the UK. That’s a disconnection between cause and effect that must be visible from space.
Is this just wilful ignorance to maintain a comforting belief in their own morality, or just plain old cynical politicking? It’s really hard to say. But it’s becoming increasingly difficult to give these people the benefit of the doubt.
In a similar vein, Jeremy Hunt’s call for “an honest discussion with the public about the purpose of A&E departments” has some merit. Doctors and hospital administrators have long been complaining that a significant proportion of people who present to A&E departments are there when they don’t need to be. Hunt would characterise this as people making inappropriate demands on a service that’s not intended for them. Putting the onus on us rather than his performance as health minister.
As Cameron and May have done, he’s trying to assert that many of the problems with public services could be resolved by the application of restraint and a heavy dose of civic responsibility. Again not much to argue with there, if you assume we’re living in a society where all vital needs are being met by a responsible administration. But as we all know, any claim in that regard from the Tory propaganda factory displays disingenuousness of Olympian proportions.
A&E is the bellwether of the NHS. As a walk-in service, it’s at the pointy end of any upsurge in demand. As temperatures plunge at this time of the year more and more people – mainly older people and those with long term conditions – need to seek medical care. The lack of proper social care provision in our communities amplifies demand as critical beds are occupied with chronically ill patients that should be in hospices or community hospitals, or better still; cared for properly at home where they’d all much rather be. In the good old days a local health visitor or district nurse would be on hand to facilitate that. But these days you need to complete a 32 page application form just to get 8 weeks of basic care. The deliberate undermining of these facilities pushes people to the most visible and available dispensary of primary care, and that is A&E.
Many patients who would traditionally have seen their GP are now faced with long waits for an appointment. We’ve arrived at the ludicrous incongruity of having to know weeks in advance that we’re going to be unwell. That’s a nonsense that’s glossed over amid reports of doctors abandoning general practice citing the impossibility of providing the care they feel is required. Little wonder then that emergency departments inevitably fill this gap. When you’re in pain or worried about distressing symptoms, the relatively short waiting times in your local A&E department seem preferable. 4 hours is a long time to wait to see a doctor, but it’s better than 4 weeks.
Theresa May chose to hang a large section of her speech on the provision of mental health care. Something politicians of all hues have tried to saddle up and ride into populist support, usually without knowing very much about it. But it isn’t something that can be solved on the whim of one disconnected PM simply to grab a convenient headline. Up until now mental health has been the Cinderella issue that could be quietly squashed. The fact that few people speak openly about psychiatric problems makes it an easy target for cuts and service reductions. But as with so many facets of healthcare they are all interconnected. You squeeze the system in one place and you’ll get pressures elsewhere.
Reports this week have identified a massive increase in the number of mental health patients presenting themselves in A&E. A report commissioned by the BBC from NHS Digital showed that between 2011-12 and 2015-16 the number of patients attending A&E units with psychiatric problems rose by nearly 50% to over 165,000. It’s no coincidence that in the same period we’ve seen reports of some of the worst catastrophes in NHS emergency care.
A few days ago the British Red Cross warned of a humanitarian crisis as all these factors conspire to produce an even more perfect storm than is usual at this time of year. Let’s just consider that for a moment. The Red Cross has put us on a similar footing with some war torn areas of the world. Yet this doesn’t make a dent on Jeremy Hunt’s self assured demeanour. He dismissed their claims, preferring to listen to ‘independent organisations’, ignoring the fact that the Red Cross is about as independent as they come. What he really means is he’d rather take heed of other reports that don’t put his lamentable management of our health service in such an appallingly bad light.
While Hunt argues with junior doctors about how many days there are in the week, they and other health workers battle with the problems of underfunding and overwhelming demand to try to keep our creaking health service from sinking under the tsunami. But even then they struggle to meet the arbitrary targets set by the DoH. Hunt’s response is not to ramp up funding and support for his dream of a 24/7 NHS, but rather to re-classify the patients seeking help in order to make his own figures add up. Theresa May has already confirmed that there will be no additional money for the NHS, so while she takes the ball back to the club house, Hunt sets about moving the goalposts.
In almost the same breath they have both lambasted health service managers for plundering extra funding that they claim was earmarked for mental health care provision. This may well be true, but when you’re faced with the kinds of choices NHS managers are, ring fences seem more like obstacles to keeping people alive. Given the choice between providing cancer care or counselling to someone who hears voices, I wonder which patient Jeremy Hunt or Theresa May would choose.
The reality is that this isn’t a choice anyone should be forced to make. Both conditions are potentially serious and both should be given sufficient resources. Mental health is also inextricably bound up with physical well-being.
The truth is that these claims of extra funding for all aspects of public services and the NHS are almost entirely specious. Whilst I don’t doubt there is wastage in the system, the bottom line is funding is not keeping pace with demand, and while governments refuse to face up to that reality the situation will continue to get worse year on year.
Of course Tory ideology will never recognise this. Their mantra is that public services should only be there to plug the gaps in a system of private provision. If you’re not able to afford personal health or social care, that’s just a facet of the free market. If taxes are kept low everyone should be able to provide for themselves and private companies will grow rich on the demand freed up by their underfunding of national provision. It’s a win/win situation as long as you’re still in the game. And it’s there that we see the darker truth in the rhetoric surrounding ‘big’ or ‘sharing’ societies. The underlying agenda is to let those who can’t afford to provide for themselves rely on the goodwill of others in their own community, because our government simply doesn’t want to be bothered with them.
It’s something we’re already seeing with libraries being run by volunteers, along with community centres and social care facilities. Even vital infrastructure provisions like the Air Ambulance service rely on donations and charitable support. A model I’m sure the Tories would love to see extended to the rest of the health service as soon as possible, unless there’s a few quid in it for a private provider.
It’s a situation that history has witnessed before in the days of the dark satanic mills where healthcare and safety provision were subject to the whim of the factory owner and philanthropy was a hobby practiced by the gentrified rich looking to assure their place in heaven. A time when workhouses provided shelter for the down at heel and local parish committees decided who was deserving of money from the poor box.
It’s clear that, as the boom years of the world economy start to recede into the distance, we are slipping back into community models where social justice is no longer an expectation or a right, but more something that you might get if you’re lucky enough to fall within the auspices of the local great and good.
You can re-brand it in any way you want, but what we ultimately need is not a shared society or even a big society, but a caring society, and that care has to be the responsibility of government.
While civic engagement and volunteer organisations will always have a part to play, they should not be the primary providers of essential services. Whether they really believe their own propaganda or not, any government that seeks to shift their responsibility for caring for its citizens has already forfeited its legitimate place in a civilised society.