Tag Archives: politics

Compassion is the real loser in this election……

Our newly re-elected government will continue to ensure the nation turns inward on its self, with one group blaming another for all manner of ills …….

The re-election of a more mediocre government is hard to imagine. The Tories must be laughing all the way to their banker mates tonight as voters have fallen for their well worn mantra around  welfare reform again, when really the issue goes to the very heart of society. This election result tells us much about  what we believe in and who we value.

Our newly re-elected government will continue to ensure the nation turns inward on its self, with one group blaming another for all manner of ills, as it did with the failure of an under-regulated financial sector by transforming its failure into a ‘witch hunt’ against anyone in receipt of ‘welfare’.

The re-elected government will continue to develop policy based on stereotypes of those most marginalised to address the problems caused by those most powerful, and voters seemingly appear all to ready to believe government rhetoric of a world where everyone is either a’ skiver or a striver’.

Compassion is the real loser in this election.

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Will welfare reform result in a ‘two nation’ society?

As David Cameron makes a U-turn on cigarette packaging and George Osborne finally understands government does sometimes need to intervene in the free market will others follow?

Our ability as an individual to stand against the power of big business is limited to say the least, however, some on the Tory right still expect individuals to form a ‘government of self’ and develop individualised systems of social protection (via ‘big society’). Such personal independence is beyond the reach of many.

However, David Cameron and George Osborne appear to have finally grasped that for ‘big society’ to truly thrive an active state is a necessity.

Commentators are suggesting Osborne is playing social democratic catch up on pay-day loans as the Conservatives have realised Ed Miliband has struck a chord with voters by focusing on the way markets are rigged against consumers.

Yet the prevailing ideology of the right is so strong it still continues to push the contracting out of public provision of services and privatisation, whilst resisting calls for regulation.

Such a singular approach does a disservice to us all. Some on the right adhere to a narrow vision of the ‘good life’, where the promise to those families who work hard, and are deserving, is that they can send their children to the ‘best’ schools (either private or ‘free’) whilst accessing privatised pension and healthcare schemes. However, those same ministers forget to mention how your future can be wiped out by an under regulated free market (think RBS and LLoyds Bank!). Meanwhile the rest of society, the undeserving, can live in a world marked by financial insecurity, mediocre education, rationed healthcare and an impoverished old age.

Economists have already christened such a scenario as the ‘dual economy’; two societies who live side by side, but hardly knowing one another, unable to imagine what life is like for one another. Conservative Prime Minister, Benjamin Disraeli, wrote of such a scenario in 1845, referring to ‘the two nations’

‘Two nations; between whom there is no intercourse and no sympathy; who are ignorant of each other’s habits, thoughts, and feelings, as if they were dwellers in different zones, or inhabitants of different planets; who are formed by a different breeding, are fed by a different food, are ordered by different manners, and are not governed by the same laws: the rich and the poor’

An alternative approach could be to try to close the gap between the dual economies by supporting a sense of shared responsibility between individuals, society and government. In this relationship government would protect the citizens it has been elected to serve from the abuse of power by the free market.

Individuals feel vulnerable and powerless because they are vulnerable and powerless. Is the average user of pay-day loans able to challenge extortionate interest rates on their own? Am I able to challenge the power of the energy companies as another cold winter approaches? Can any of us challenge the power of the financial industry at an individual level?

Many on the Tory right will scream ‘consumer choice’ as if it’s the answer to every woe, however, will changing providers of whatever service it might be really make a difference. I fear not, and that is why I want a government of politicians that understands where many in this country feel they are today, powerless, abandoned and hopeless.

That is not a good foundation from which to build our collective future. Control of one’s own destiny requires more than the fallacy of individual consumer choice in a free market economy, it requires an active and supportive state focused on the distribution of wealth, and the redistribution of wealth through the tax and benefits system along with regulation of key industries, such as the financial and energy sectors.

Well done Mr cameron and Mr Osborne, you are at last beginning to move in the right direction.

HSBC shows the way of a privatised NHS…..ignore at our, and our childrens’, peril if we want a fair system of care in the future

What has HSBC to do with the NHS?  Quite a lot in my mind.  

My biggest worry is we will not learn any lessons from the financial meltdown of the past 3 years as government persists in its drive to privatise the public sector.  As the ‘Peter Principle’ reminds us……why does history keep repeating itself?   Because nobody ever listens.

With commentators suggesting barely 10% of total care home provision remains in state hands confidence in the ability of the free market and financial sector to provide quality care is important. However, for me it boils down to trust and respect, and the simple truth is I do not trust the private sector to deliver, and I do not believe the private sector respects me enough to ensure it will prioritise meeting my care needs, rather than making as large a profit as possible.

The recent review of care at Winterbourne View Hospital demonstrates this clearly when it suggests lack of funding was not an issue, Castlebeck Ltd had clearly put profit before care. Indeed the very foundations of Winterbourne View Hospital lay in its ability to make money for investors.

However, successive governments continue to believe free markets are able to respond to individual need more quickly and flexibly than over bureaucratic state funded systems, leading to better quality care as providers compete to attract consumers.

Faith in the free market is unshakeable in government, and in many areas of life it has proved of benefit, however, the re-branding of care as a commodity over the last 30 years has all but ignored some simple truths pointed out by the economist Adam Smith several hundred years ago;  the purpose of the free market is to generate wealth for those who own the means of production, or the ‘masters of mankind’ as Smith christened them, it is not a charitable endeavour but a single minded system driven by cash not compassion, who Smith suggested had a ‘vile maxim‘  of  “all for ourselves”.  The ‘masters of mankind’  in Smiths time were the merchants and manufacturers who supported policy that enabled them to make more profit, they were not concerned with how such policy and their actions might impact on others.  Today the ‘masters of mankind’ appear to be financial institutions; banks, insurance companies, private healthcare providers and  international management consultants, such as  McKinsey and Company who wrote many of the proposals contained within the Heath and Social Care Act , and stand to makes several millions from there implementation.

At a macro level those private institutions who have already taken over some areas of  care provision have been found lacking, which does not bode well for extending this strategy.  Take, for example, HSBC who were fined £10.5 million last year for mis-selling care bonds to older people.  The Financial Services Authority found unsuitable sales had been made to 87% of customers, with the average age of those who purchased bonds being 83 years of age, many of whom having already died before the scandal came to light.  Whilst £10.5 million might sound a lot its not for a company who was recently exposed as allowing the laundering of at least 7 billion dollars of drugs money through its bank and who set aside 700 million dollars to cover fines, although it was eventually fined £1.2 billion (not too harsh for the share holders as the company made approximately £12 billion in profits last year).

The selling of care related products by the private sector can leave individuals vulnerable in a variety of ways, look at the treatment of vulnerable adults in Winterbourne View and the recent review, owned by a Swiss private equity company, has the company been penalised in any meaningful way? Or look at the doubling of the number of private care homes going bankrupt leaving older people without secure housing or care provision.

Successive governments are keen to point to the failure of ‘state’ provision as an argument for the introduction of more private sector provision. True there are problems, however, rather than addressing these issues government seeks to displace them into the private sector, an under regulated private sector, where problems can conveniently disappear from view and politicians spout an empty rhetoric of disgust when an issue is exposed. For example failure within the NHS in Cornwall and Sutton and Merton in learning disability services led to private providers, such as Castlebeck Ltd, replacing NHS provision. However, issues highlighted in the subsequent inquiries in Cornwall and Sutton and Merton, around the training of staff, shift patterns,  management systems and a general culture of indifference toward those who are vulnerable, were not addressed in any lasting or meaningful manner, so poor levels of care have continued, just in a different (private) setting.

It would appear when abuse occurs because of  failure of ‘free market’ providers, government believes the private sector is  not only to big to fail, but more worryingly, to big to jail.  In essence some major private providers, whether of financial care products or personal care, seem to operate with impunity to wrong doing.  If they are not held accountable and government is not held accountable, who is?  Oh of course, the ‘care consumer’ who bought the product will have to take responsibility, after all it was their ‘choice’.

The truth is the ‘free market’ is anything but ‘free’.  A favourite of Mrs Thatcher, economist Friedrich Hayek compared the free market to a ‘game’ where there are winners and losers suggesting trying to regulate the market in the name of social justice was a waste of time, there are winners and losers and it is not governments place to even the odds because we are all free to make choices, and should live with the consequences of those choices and not try to displace them onto others, such as government or other taxpayers.  Which in many ways I support, however, the market is not free and is comparable to a casino where the ‘house’ always wins.

Lets reflect on the global economic crisis brought about by the current ‘masters of mankind’ and the displacement of said crisis  on the public sector, and consequently those who use the public sector, to see how a system premised on  the free market is neither free nor fair, and the biggest losers are those most vulnerable.

The current government appear to believe there is only one game in town when it comes to the future of our health and social care sector, in fact the whole of the public sector,they are wrong.  Call me old fashioned but for me an active State should be about taking a lead, collective action and solidarity, setting a high bench mark for all in society, not running away and hiding behind the financial sector and an outdated ideological mantra of ‘private sector good, public sector bad’ where ‘money is the anthem of success’ like some National Anthem (Lana Del Rey).

 

‘Big Society’ and the future of health and social care

David Cameron suggests the Jubilee party was a ‘perfect example of ‘Big Society’.  Whilst it’s okay for a knees up, is it a suitable foundation for improving the quality of care  older people receive in Britain?

Unfortunately, David Cameron’s comments on Big Society do little to help us understand what “it” actually is, and to be honest, I am not even sure he  knows what it is beyond the usual sound bytes of ‘kitchen sink economic theory’*.  However, could the concept of Big Society actually have something to contribute to the debate on the future care of older people?

What is ‘Big Society’?

Big Society has been vilified as a return to the politics of the New Right,  a Trojan horse for smaller government,  and feted as the anatomy of the new politics  on which to establish the legitimate nature, and limits, of the relationship  between the  state and individual in a 21st century system of health and social care.  Phillip Blond is a central figure in the development of the concept of Big Society.  Blond  argues both the political Left and political Right have presided over a collapse of coherent cultural values and a shared commitment to a ‘common good’,  suggesting a redistribution of power from the ‘top’ (state) to the bottom (individual) is required, aligned with a more compassionate form of capitalism, to re-establish the common good.  For the current government this rests on the empowerment of local communities founded on voluntary networks of trust and mutuality.  From this perspective the purpose of Big Society appears to be to extend responsibility for the care of older people to local communities, rather than extending the responsibility of the state.

Policy programmes already implemented by the current government to develop Big Society include the National Citizen Service, which organise voluntary opportunities for young people, and the creation of the Big Society Bank, which will act as a central source of investment income for third sector organisations.  The Localism Bills’ accompanying guidance states ‘Big Society is what happens whenever people work together for the common good.  It is about achieving our collective goals in ways that are more diverse, more local and more personal (HM Government, 2010: p.2).

However, whilst at one level Big Society can be viewed as a mechanism of transferring more responsibility onto individuals, allowing the state to reduce public sector spending (Alcock, 2012) Big Society is also about believing in, and building on, the inherent ‘good’ within humankind.

Jesse Norman suggests Big Society involves moving beyond the ‘two way opposition of state vs. individual’ in the provision of care to ‘the three way relationship of enabling state, active individual and linking institution’ (2010,p.7).  For Norman the former is flawed because it ignores the diversity of human beings and their ability to act morally without interference from the state.  By justifying the legitimacy of the state, it polarises the individual and ignores the positive power and potential of individuals to create and maintain a ‘good society’, which cares for one another for altruistic reasons, rather than because the state legislate that society provide care and support.  Norman suggests state interference is a negative response to care provision, quoting Alex de Tocqueville (1805-1859)

“The more [the state] stands in the place of associations, the more will individuals, losing the notion of combining together, require its assistance.  These are cause and effect that unceasingly create each other.”

The ‘associations’ that mediate between individuals and the state can be conceptualised as operating within civil society.  Civil society is the space of un-coerced human action, the place where people take action as moral beings,  via all organisations and associations above the level of the family and below the level of the state.  The place where your jubilee street party was planned presumably.

Importantly for advocates of Big Society the role of government in this ‘space’ and ‘place’ is minimal.

How does this support the current approach to caring for older people?

From this perspective caring for older people, and ensuring care is dignified, is viewed as something we all agree is a ‘good thing’ and freely engage in, rather than something government should regulate or legislate for.  In this context government relies on ‘phillic’ associations, taken from the Greek ‘philia’, meaning friendship ties, affection or regard that are the essence of the space between individual and state.  Government would rather rely on these to guide human behaviour in the care sector than introducing legislation or regulation.

Hence, the governments  support for the introduction of a voluntary dignity code  (The Telegraph., 2012).

Big Society, freedom and money

However, whilst government may think treating older people with dignity and respect is viewed as a ‘given’, assuming we are all willing to  care for, and protect,  older people,  this is not necessarily true, as evidenced by a number of reports on the poor levels of care provision  older people experience across the care sector.

At the heart of the current debate are two related themes.  Firstly, an attempt to understand how the relationship between the state, private sector and individual should be formulated to fulfil a mutual responsibility in supporting dignified care for older people, and secondly  the affordability of care provision.   Successive governments since Margaret Thatcher have relied on a consumerist approach to improving the quality of health and social care provision. The question is has turning vulnerable older people into consumers improved their care?  For some yes, but for many of the most vulnerable older people in society, those older old people with dementia and who are frail, I’m not so sure.  However, what it has done is hide the abuse and mistreatment of older people from collective view for the last 30 years, and led society to engage in debate that does not move beyond the financial.  Research suggests this has had a detrimental effect on the moral health of society and academics are now suggesting the use of market mechanisms can change people’s attitudes and values, having a  ‘corrosive effect’.    Michael Sandel makes a pertinent point suggesting

It calls into question the use of market mechanisms and market reasoning in many aspects of social life, ……to motivate performance in education, health care, the work place, voluntary associations, civic life and other settings in which intrinsic motivations or moral commitments matter‘ (What money can’t buy, 2012, p122).

It is impossible to ignore the effects of systematic inequalities in liberal societies that effectively exclude, or compromise the rights of a variety of social groups.  Nor can we ignore the corrosive effect successive governments use of a consumerist approach to health and social care might have had on those ‘phillic‘ associations so vital to a ‘Big Society’.   The ‘Osborne Supremacy’  assumes the existence of a single unified ‘big society’ when it actually consists of many ‘societies’ with competing interests where the interests of powerful elites are advanced in the name of defending common interests, whilst the interests of marginalised groups, such as older people,  leave them without support.

Big Society or Big Con?

The answer will depend on your political and ideological viewpoint on the legitimate role, and limits, of the state in the provision of health and social care.  Whilst it is true Big Society clearly already exists, evidenced by the number of people already providing care freely in society, what is in doubt is whether it can be extended any further without an active state (Sullivan, 2012).

* Kitchen sink economic theory -this is a term used in my household to describe David Cameron and George Osbornes approach to the financial crisis.  It refers to a vision I have of a post war couple discussing there finances whilst stood washing up at the kitchen sink.  Gladys turns to husband Frank and says “money is tight Frank, what will we do?”  Frank turns to Gladys and answers “never fear mother, we’ll just have to tighten our belts, don’t worry we’re in this together”.  Of course Frank and Gladys are very naive and do not realise their actions will make no difference because the problem is a global financial crisis and not related to Gladys splashing out on a new apron!