Why the changes to the NHS should worry us all

The plans for yet another reorganisation of the NHS should worry people greatly especially those who live or care for people in the disadvantaged areas of North Staffordshire. The NHS resembles a pinball being catapulted around at the whim of whatever governing party is in power.

In the last 20 years prior to which we had 40 years of comparative stability we have seen several major changes. In North Staffs the purchaser/provider split came and went followed by GP Fundholders then Primary Care Groups. Then ten years Stoke had three Primary Care Trusts and then two and then one. Newcastle and the Moorlands have also seen changes in how health care services are run. We have seen District Health Authorities, Strategic Health Authorities whose abolition has now been announced today come and go.

The Patient Voice has also been changed from Community Health Councils to Patient Public Involvement to Links with the influence of the user of health care service being progressively weakened until we end up with the appalling case at Stafford Hospital. This obsession with structure and reorganisation, which both Labour and Tory suffer from, has come at a cost, both financial and human.

Another change poses even more worrying questions. The transfer of resources directly to GPs echoes the Fundholding experiment of the 90s which had a rupturing impact on health care widening even more health inequalities in the poorer areas. GPs in the more affluent areas tended to acquire more resources and facilities at the expenses of GPs in the deprived area.

These reforms were not mentioned during the recent General Election, but these changes open the door to privatisation and the effective death of a socialised health service. We should sleep even more uneasily in our beds tonight.

A view from the tills

Working at a till at a checkout gives you a unique perspective on British society. For one thing most people use supermarkets and over a 4-hour period it is likely that you will see approaching 200 people. Some will be well off and the people on limited incomes will arrive late with the hope of getting some late bargains. Over the course of a day you will see many people engaging in consumerism.

I was working at the supermarket the other day and had occasion to look up. There was a line of several people looking very grim. On my facebook page I likened it to an illustration by Daumier from the 1820s of a line of prisoners being taken away in an execution cart to hang at Tyburn.

They all looked hollowed eyed.

People are not happy and it is a theme I have touched on before. There is something wrong in the land.

Something is profoundly wrong with the way we live today. For many years we have made a virtue out of the pursuit of material self-interest and possessions: indeed, this very pursuit now constitutes whatever remains of our sense of collective worth. It is how we identify ourselves. We know what things cost but have no idea what they are worth. I shop therefore I am.

The materialistic and selfish quality of contemporary life is not central, I believe, to the human condition. Much of what appears “natural” today dates only from the last 30 years: the obsession with wealth and the need to own, the cult of privatisation and the private sector, the growing disparities of rich and poor. And above all, the rhetoric that accompanies these: uncritical admiration for unfettered markets, disdain for the public sector, the delusion of endless economic growth.

We cannot go on living like this. David Cameron also thinks like although I suspect that the prognosis and the solution will be radically different. The crash of 2008 was a warning that unregulated capitalism is its own worst enemy: sooner or later it falls prey to its own excesses and like Cronos ends by devouring its own children.

If it is to be taken seriously again, progressives must find their voice, but it cannot be again taken in by New Labour as wedded to the false orthodoxy as the Conservatives. There is much to rage about: growing inequalities of wealth and opportunity; inequity of class; exploitation at home and abroad; corruption and money and privilege narrowing the arteries of democracy. There are now more former public schoolboys in the cabinet at any time since the 1950s. But it will no longer suffice to identify the shortcomings of “the system” and then retreat indifferent to the outcome. The irresponsible rhetorical grandstanding of decades past did not serve the left well. It must learn to engage with itself and with others. It should be a historic opportunity.

We have entered an age of neurosis””economic insecurity, physical insecurity, climate insecurity, political insecurity. The fact that we are largely unaware of this is small comfort: few in 1914 predicted the catastrophe that followed. Insecurity breeds fear. And dread””fear of change, fear of strangers and an unfamiliar world””is corroding the trust and interdependence on which civil societies rest. It is a reality evident even is as trusting a place as North Staffordshire.

All change is disruptive. We have seen that the spectre of terrorism is enough to cast stable democracies into turmoil. Climate change will have even more dramatic consequences in the years to come. People will inevitably be thrown back upon the resources of the state. They will look to their political leaders and representatives to protect them: open societies will once again be urged to close in upon themselves, sacrificing freedom for “security” and a fear of the other. The choice will no longer be between the state and the market, but between two sorts of state. It is thus incumbent upon us to recast the role of government. If we do not, others will.

The new MP for the Moorlands in the local paper talks about ensuring that the pain of the cuts will be equally shared but to quote a line from Samuel Beckett it will not. It will be the poor, the vulnerable and the isolated who will suffer the most

Poverty is a preoccupation especially for the poor. But the tangible results of an accumulated impoverishment are all about us. Poor neighbourhoods, derelict land, failed schools, the unemployed, the low paid, and the abandoned: all suggest a collective failure of will. These shortcomings are so contagious that we no longer know how to talk about what is wrong much less set about repairing it. And in that there is something seriously wrong.

To comprehend the depths to which we have fallen; we must understand the scale of the changes that have overtaken us. From the late nineteenth century until the 1970s, the advanced societies of the West were all becoming less unequal. Thanks to progressive taxation, government subsidies for the poor, the provision of social services, and guarantees against acute misfortune, modern democracies were shedding extremes of wealth and poverty. The Roosevelt New Deal and banking reforms being an excellent example.

Since 1980 we have abandoned this tradition. To be sure, “we” varies with country. The greatest extremes of private privilege and public indifference- the private affluence and public squalor argument- has resurfaced in the US and the UK: epicentres of enthusiasm for deregulated market capitalism. Although countries as far apart as New Zealand and Brazil have expressed periodic interest in deregulation, none has matched Britain or the United States in their unwavering thirty-year commitment to the unravelling of decades of social legislation and economic oversight.

Si monumentum requiris, circumspice

The UK is now more unequal””in incomes, wealth, health, education, and life chances””than at any time since the beginning of the 20th century despite 13 years of New Labour. There are more poor children in the UK than in any other country of the European Union. Since 1973, inequality in take-home pay increased more in the UK than anywhere except the US. Most of the new jobs created in Britain in the years 1977″“2007 were at either the very high or the very low end of the pay scale of which Stoke provides a good example. And on the radio this morning the head of the Centre for Cities gave a gloomy prediction for places like Stoke and Hull which have been loosing private sector jobs even before the recession.

The consequences are clear. There has been a collapse in social mobility: in contrast to their parents and grandparents, children today in the UK have very little expectation of improving upon the condition into which they were born. The poor stay poor. Economic disadvantage for the overwhelming majority translates into ill health, missed educational opportunity and””increasingly””the familiar symptoms of depression: alcoholism, obesity, gambling, violence and minor criminality. The unemployed or underemployed lose such skills as they have acquired and become chronically surplus to the economy.

. Even trust, the faith we have in our fellow citizens, corresponds negatively with differences in income: between 1983 and 2001, mistrustfulness increased markedly in the US and the UK, countries in which the dogma of unregulated individual self-interest was most assiduously applied to public policy. In no other country was a comparable increase in mutual mistrust to be found.

Inequality is a poison. It rots societies from within. And it is rotting the UK. The impact of material differences takes a while to manifest itself: but in due course competition for status and goods increases; people feel a growing sense of superiority (or inferiority) based on their possessions; prejudice toward those on the lower rungs of the social ladder hardens- think of the ridicule directed at Chavs. (Some of this mockery was directed at me as a checkout operator the other day) and the pathologies of social disadvantage become ever more marked.

The legacy of unregulated wealth creation is very bitter indeed.

As recently as the 1970s, the idea that the point of life was to get rich and that governments existed to facilitate this would have been ridiculed: not only by capitalism’s traditional critics but also by many of its staunchest defenders. Relative indifference to wealth for its own sake was widespread in the post war decades. Having carried out some research into the 1950s I can vouch for that at least from the greater social capital that we seemed to have in that decade.

How should we begin to make amends for raising a generation obsessed with the pursuit of material wealth and indifferent to so much else? Perhaps we might start by reminding ourselves and our children that it was not always so. Thinking the way we have done for thirty years is not deep-rooted in the human condition. There was a time when we ordered our lives differently. It is up to people to recover this past.