Maybe we should scrap the NHS and start again

When the Leave campaign backpedalled on claims it made during the EU referendum, particularly the claim that leaving the EU would free up £350million a week for the NHS, there was outrage. As accident and emergency (A&E) services struggled once more to cope with demand this winter, there was even more controversy: the Red Cross declared the state of Britain’s health service a ‘humanitarian crisis’.

The NHS is seemingly in constant crisis. Patients are left on trolleys to massage waiting times. Hospitals are dangerously overcrowded. Trusts are running up deficits approaching a billion pounds this year. Then there’s the crises in recruiting nurses and paramedics, the problem of burnt-out anaesthetists, overburdened GPs and striking junior doctors.

Why is the NHS crisis, much like the housing crisis, so apparently intractable? Part of the problem is that, for all the hot air, the debate rarely moves beyond funding. Funding is not unimportant. Crisis or no crisis, paying for a healthcare system is always going to be expensive. This is not primarily because the NHS is badly run (although that is true), or even because of the demands of an ageing population (though that also has a part to play). As national prosperity rises, and as new, life-saving treatments and technologies are made available, costs inevitably rise. It should go without saying that this is no bad thing. If we want to live longer, healthier lives, our healthcare cannot be bought on the cheap. However, we must recognise that there’s more going on here than funding problems.

Unfortunately, the health secretary, Jeremy Hunt, is avoiding the bigger issues. His battle against ‘health tourism’ is a case in point. Requiring GPs to inquire into the residency status of their patients (a move initially described by the British Medical Association as an attempt to turn GPs into ‘border guards’) is counter to the ethics of good health practice. It doesn’t even make financial sense. The amount that could be potentially recovered is trivial – no more than hundreds of millions, compared with the billions the health service needs to get back on its feet. Then there’s the adult social-care crisis, which is also the responsibility of the Department of Health. Local authorities have faced large cuts to their budgets in recent years, and are now struggling to provide even the most basic care to their older populations.

The chair of the Health Select Committee, Sarah Wollaston, recently called for an all-party group to review how tax and national insurance could be used to raise funds. She wants us to move closer to what our European neighbours pay for their health services as a proportion of GDP. But should we really just be throwing more money at an evidently failing system? If we can land a satellite on a comet, surely it’s not beyond the wit of man to do something about the relatively mundane problem of bed-blocking?

Clearly, money isn’t everything. The National Audit Office reported this month that the Better Care Fund, a pot of government money (£5.3 billion in 2015-16) aimed at solving problems like bed-blocking, has made little difference. A lack of policy direction from government, the pressures placed on the system and the squeeze on funding are proving too much of a distraction for local services. Attempts to join up provision have largely failed. While there has been some success in keeping older people out of hospital and residential care for longer, the Better Care Fund hasn’t stemmed the flow of patients into the system.

Emergency admissions into, and delayed discharge out of, hospitals have actually gone up. A combination of ‘misaligned financial incentives, workforce challenges and reticence over information sharing’ has got in the way of progress. Older people, who are medically fit to go home, are unable to do so and are instead stuck for hours, days and even weeks in desperately needed beds. This is not the fault of under-funding. There is no correlation between the two, according to health think-tank the King’s Fund. It points to historic under-investment in community-based care, leading to an overreliance on hospitals and a lack of support at home that could prevent or delay people needing acute care in the first place.

The political elite, having divested itself of any responsibility for delivering a decent health service, has instead busied itself with turning the NHS into a vehicle for its moralising and therapeutic tendencies. A recent study based on interviews with GPs, funded by Cancer Research UK, concludes that people (particularly young people) need to be frightened into changing their lifestyles. They should be engaged in schools and supermarkets and enticed into ‘cancer booths’. Then there are the high-profile mental-health campaigns (backed by the prime minister and the young royals), telling a large minority of us that we’re probably mentally ill. But is any of this ‘awareness-raising’ really going to save money, lives or the NHS? A much more likely outcome is that it will further clog up GP waiting rooms and put even more pressure on A&E services.

We need a more wide-ranging discussion about the NHS – one which moves beyond money. But in order to do that we need to jettison the officially cherished status of the NHS, which was so underlined by the significance attached to it by both sides during the EU referendum. Failing to do this will make it more difficult to have a rational debate about what should be done. Despite the establishment love-in for it, it should be clear by now that the NHS and the wider health and social-care system is hopelessly complex and dysfunctional. Tory peer Lord Saatchi called for a royal commission to avoid having a political debate about it, so ‘toxic’ is the mere suggestion that the NHS (which turns 70 next year) be given what he calls a ‘full body check-up’.

The Guardian’s ‘health network’, in a recent, somewhat presumptive Valentines-themed address to its readers, asked: ‘Why do you love the NHS?’ And, in case readers were in any doubt, they were reminded: ‘For all its problems – an overstretched workforce, increasing waiting times, bureaucracy, poor IT – the health service remains a national treasure.’ In an Ipsos MORI poll last month, 49 per cent of respondents described the NHS as a big issue, more than any other – with Brexit coming second at 41 per cent. Whether or not Brits are fond of the NHS, we’re certainly worried about the state of it.

Can the NHS be reformed? Or is major surgery required if it is to make a full recovery? We need to come up with much more radical reform than is currently being proposed. And if that doesn’t work, instead of accepting the somewhat back-to-front NHS version of TINA – in which we are told that there is no alternative to a welfare-state-era model of provision frankly unfit for the 21st century – we need to replace the NHS with something better.

According to Benedict Spence, writing in the Independent, ‘pretty much all of our European counterparts have a universal and in many cases much better healthcare system than the UK – and, horror of horrors, most European healthcare is what we would call “privatised”’. The UK is unusual among developing nations, he says, whose often social-insurance-based systems often perform better than ours (for example, in cancer survival rates). And yet, the defenders of the NHS remain ‘aggressively insular’.

Whether or not we think healthcare is better on the continent, and whether or not we think the NHS should be privatised, is one matter. I myself would favour a fully integrated state-led system of health and social-care provision, rather than fragmenting it further. But Spence is right about the prevailing defensiveness about even having a debate about how the NHS compares to the health services of other countries. This is ironic, when you consider that the most forthright, inward-looking defenders of the NHS against foreign ways have spent the past six months abusing ‘Little Englanders’ for their supposed anti-Europeanism.

We need to move beyond this sentimental attachment to the NHS. Only then can we have an open debate about building a public service that can meet our collective health and social-care needs – and about how much we are willing to invest in it. The critics are not wrong to demand more money, but if we are to avoid perpetually wasting it on a model of provision that is no longer fit for purpose, we must embrace change.

First published on spiked


Who’d be a football coach now?

First published in sp!ked

It is nearly a month since former professional footballer Andy Woodward told the Guardian he was sexually abused as a boy by Barry Bennell, a former talent spotter and youth coach who spent most of his career at Crewe Alexandra and Manchester City. Woodward’s disclosure was the cue for other alleged victims to come forward and make allegations of sexual abuse, complete with suggestions of cover-ups, against Bennell and others (including former employees of Southampton, Newcastle and Queens Park Rangers). Now, with the child abuse scandal rolling through club after club – at the last count, over 20 police forces were investigating allegations at 98 clubs, and hundreds of calls have been logged by the NSPCC – questions need to be answered. How widespread is abuse in football? And is the current focus likely to stop would-be coaches from entering youth football?

Yet some have already made up their minds. Peter Wanless, chief executive of the NSPCC, says the scandal ‘reveals the worrying extent of abuse that had been going on in the sport’. According to Reuters, it is already ‘one of the worst paedophile scandals Britain has ever known’.

Surely a bit if perspective would be wise here. Not least because the hysteria about abuse in football is not conducive to establishing the facts. As it stands, we don’t know whether sexual abuse in football is on the same scale as the systematic abuse of young girls supposedly in the care of their local authorities, and for which the men responsible were convicted. We don’t know if it’s on the same scale as the Savile scandal, and the array of follow-on allegations, some true, many false, made against assorted public figures. We don’t know, because no one seems that bothered about establishing the facts before drawing hyperbolic conclusions.

The amnesia here is striking. Have those currently calling this ‘one of the worst paedophile scandals Britain has ever known’ forgotten about the collapse of Operation Midland, the Metropolitan Police’s completely groundless inquiry into the alleged sexual abuse and murder of children at the hands of senior politicians, army figures and spooks? Are they simply ignoring the folly of the now seemingly discredited Independent Inquiry into Child Sexual Abuse, which, with its impossibly broad remit, has proven nigh-on impossible to conduct? Too often, child-abuse hysteria has led to grave mistakes being made, from false accusations to ineffective suspicion-spreading inquiries.

Whatever the child-protection lobby might say, the truth is that child sexual abuse is extraordinarily rare. Most of what is recorded as suspected abuse is actually neglect, and few cases of abuse are suspected to be of a sexual nature. The official figures from the Department for Education show that in 2015/16, 50,310 children were subject to a child-protection plan, which means social-care professionals agreed that these children were suffering or likely to suffer significant harm. Of these 50,310, 46 per cent were recorded as possibly subject to neglect and 35 per cent to emotional abuse. The figure for suspected sexual abuse is not even cited because it is so small – tentative estimates suggest just six per cent of all ‘child in need’ assessments involve suspected sexual abuse.

The very scale of the national game, with 3.35million children aged five to 15 playing football in England, means that the child-abuse panic in football has far-reaching consequences. Yes, of course, one child abused is one too many. But one child denied the opportunity to play football at the weekend because their parents are scared that the local coach might abuse them is also one child too many.

That is the problem with the evidence-lite claims now being made about football. It is a panic that will eat away at people’s trust in coaches and clubs – and will ultimately further undermine children’s trust in adults. Instead of recklessly joining in the hysteria, the authorities owe it to young footballers not to overreact to allegations of awful but thankfully rare abuse. A measured response will ensure that children are able to enjoy their childhoods unhindered by very adult obsessions and suspicions.

In the past, those institutions and clubs now being accused of standing by while the abuse was carried out might have attempted a cover-up. Now they tend to the opposite, and open themselves up, issuing mea culpas and launching investigations and inquiries. So Martin Glenn, chief executive of the Football Association, wasted no time in announcing an immediate internal review committed to ‘openness and honesty and everyone exposing what has happened’. Such moves are meant to reassure people, but they actually succeed in eroding the longstanding trust football clubs have built up with local communities. It is bad enough when the BBC or parliament embrace child-abuse hysteria; but football is part of families’ everyday (or at least weekend) lives, bringing together parents in a way that doesn’t happen all that often anymore.

Introducing kids to local football clubs means placing them in the care of strangers, adults who will hopefully not only develop children’s football skills, but perhaps develop their character, too. There are no procedures or checks that can ever guarantee children are absolutely safe. But the minuscule risk that they might be abused should not be allowed to poison the adult-child relationships on which youth football is based. By actively undermining parents’ trust in football clubs and the people who work or volunteer for them, those who claim to be concerned about children’s welfare are actually ensuring that children will be worse off in the long run.

The abuse-in-football panic, as with the other child-abuse scandals of recent times, won’t help prevent rare and distressing cases of actual child abuse. But it will lead to the growth of yet more suspicion in our already atomised and anxious society.


Did Cathy Come Home? Homelessness Revisited

First published in Huffington Post

I was speaking at a debate on homelessness a few weeks ago at the Battle of Ideas Festival (a wonderful event that I urge you all to go to next year by the way!). What was most striking for me was that there was little battle over the fact that it’s at least as bad as it’s ever been. Which is quite a thing when you consider the hook for the debate was the 50 year old groundbreaking docu-drama Cathy Come Home, that so shocked the nation that it gave rise to the campaigning charities Crisis and Shelter that are still with us today.

How could homelessness have got worse when we’ve otherwise become so much more affluent? What is causing today’s homelessness problem and what solutions are being put forward to solve it? In trying to answer that question I found as many difficulties with the proposed solutions as I did with the problem they were supposedly designed to solve.

Homelessness comes in many different forms: from rough sleeping, staying in hostels, shelters and temporary accommodation; to those officially recognised as ‘statutorily homeless’ by their local authority, as well as those ‘hidden’ in overcrowded housing, squatting, ‘sofa surfing’, sharing or sleeping on the night bus. In the space of five years the numbers deemed homeless have roughly doubled. Those living in temporary accommodation have risen by 40%. In 2015, 30% of those recorded as statutorily homeless were private tenants forced out of their home because they could no longer afford to pay the rent; and in the same year it is estimated that 2.3 million households contained ‘concealed’ single people.

The government plans to build 400,000 affordable homes by 2021 – half of them starter homes and 135,000 shared ownership. Most experts will tell you that we need to build at least 250,000 homes (‘affordable’ or not) every year. There has been wide support for the Homelessness Reduction Bill; not least from my co-panellist Daniel Dumoulin at St Mungo’s who was involved in its drafting, and from MPs on the Communities and Local Government Committee. Recently voted through to the next stage in parliament, it will impose greater duties on local authorities to advise the homeless, (somehow) prevent homelessness happening in the first place, and to provide relief or emergency accommodation where necessary. All without building more houses.

The problem is, of course, that you can’t legislate against homelessness or force local authorities to provide stock that they don’t have. So what should be done instead? We need to build at least sufficient housing to break even i.e. to replace aged stock, and then more again to reflect the growing population and the changing shape of households. This isn’t a ‘luxury’, as my co-panellist Rebecca Wilson of the Labour Campaign to End Homelessness claimed. It is a necessity if we are to prevent further rises in homelessness, and if house prices and rents are to fall and become genuinely affordable. Policy-makers and campaigners need to stop accommodating to diminished expectations, and start accommodating people with the housing they need and want. That’s not to say that a bricks and mortar approach to the homelessness problem is going to be enough – as is clear from the mix of personal, socio-economic and policy determinants at play. There needs to be more targeting of more resources in more coordinated ways if the specific, complex and entrenched, needs of some homeless people are to be properly addressed.

We also need to stop expecting the homeless to play the vulnerability card. That would mean, for instance, abolishing the indignity of people having to prove that they are in ‘priority need’ and instead making common cause with them to demand more. I agree with Ken Loach, the man responsible for Cathy Come Home, who said in a recent interview: ‘People are not docile victims … they fight back’. He’s right, or at least he would be if he didn’t level this accusation at the Tory right alone – as my co-panellist, John Moss, chairman of an almshouses charity and Tory councillor, might agree.

Across the political spectrum the homeless tend to be treated as passive recipients, whether of abuse or pity. While bad housing and welfare policy are creating more homelessness, it is often the critics of these policies that are creating homeless victims. The left infantilise young adults, thinking 18-21 year olds are too vulnerable to have their benefits taken away, as will happen next year. And they think little of tenants too, campaigning against government policy that says they and not their landlord should receive their housing benefit. Our right wing government is, in this instance at least, doing the right thing by expecting tenants to pay their own rent. Apparently Loach is thinking of rejoining the Labour Party with the supposedly left-wing Corbyn in charge. If he knew this he’d surely think again?

Pop Go The Idols

First published in Huffington Post

I was lucky enough to produce and chair From Bowie to Bieber: What makes a music icon? at Battle of Ideas held at the Barbican, London, last month. The discussion was prompted by what looked like being a year defined by multiple celebrity (particularly rock star) deaths – Bowie, Prince and Lemmy (of Motorhead) prominent among them; and with the recent addition of the great Leonard Cohen, though at a somewhat grander age. That we have Brexit and Trump to thank for 2016 turning out rather differently – forcing our collective political futures onto the agenda, rather than shoe-gazing over our pop-cultural past – is no bad thing.

So you might ask why would apparently intelligent people devote an hour and a half to discussing the relative merits of Jay Z and Beyonce vs. Bowie et al, when there are other much more important things going on in the world? Why were so many of us so apparently overcome by a sort-of-mourning for those iconic strangers in the first place? ‘All of us, when we lose our cultural icons, are affected in a profound way because there’s a child in us who thinks they’re immortal’, said Sting in a recent interview. But surely there is more to it than that? For Barb Jungr, singer, writer and performer, icons are an ‘alchemy of image, intention, place and form’. At their height we were ‘watching the same things at the same time’; today iconography has given way to branding.

Tom Slater, deputy editor at spiked-online echoed Jungr, arguing that today’s pop stars come to us via ‘myriad channels’. They struggle to achieve iconic status: to be both ‘great and weird on a huge scale’ he argued – a combination, to be fair, that even in the past was rarely achieved. (Bowie was unique precisely because he could be mightily weird one moment, whether in his made-up Glamishness or his avant-garde starkness; and be wearing a chunky sweater the next, doing the intro for The Snowman or singing Little Drummer Boy / Peace on Earth with Bing Crosby for a Christmas special.) Icons were also, said Slater, identified with a ‘youthful spirit of rebellion’, but young people are too ‘scared of the world’ these days to be truly rebellious.

Chris Sharp, contemporary music programmer at the Barbican Centre, who broke off from rehearsals to join us, was also positive about today’s artists. Indeed he was critical of the ‘ossified idols’ of the past, describing Prince’s output as variable; and reminding us Bowie fans of his less successful work, for instance with Tin Machine. A reminder that we can worship our idols a little too much. And that there is still exciting music being made by intriguing young artists. It’s scattered and harder to find but discovering something new has its own appeal.

Still, there’s something missing. Lady Gaga may have changed her image, and rappers may be pushing boundaries musically, but this sense of play and exploration doesn’t have a wider impact. I’m not so sure that icons belong to the past, or that a multi-media world necessarily makes them obsolete. But there’s nothing dangerous about pop music today, it doesn’t unsettle any deeply held beliefs or sensibilities (not counting easily outraged ban-happy student bodies). Maybe that’s not their fault. We live in politically bland times after all. Or at least we used to. Perhaps the political earthquakes of recent times will play a role in the making of future pop idols.

Into the mind of David Bowie

First published in sp!ked

As psychologist Oliver James has it in Upping Your Ziggy, the young David Bowie, then known as David Jones, was haunted by the family curse of madness, which afflicted three aunts and his ill-fated half-brother Terry. Yet despite an emotionally stunted upbringing and, James believes, a borderline personality disorder, Jones flourished as the favoured child. He was able to ‘express his emotional turmoil’, rather than succumbing to it, ‘by creating musical personas’. But Bowie could be delusional, particularly when snorting industrial quantities of cocaine as the Thin White Duke; or imagining himself the ‘leper messiah’ of his most famous creation, Ziggy Stardust. But he would regain control: ‘I took that image off. I put it in a wardrobe in an LA hotel and locked the door.’

For James, Bowie is a case study in support of his argument with psychiatry regarding ‘the bogus boundaries between madness and sanity’. The music is treated as little more than a ‘sort of therapy’. What matters most for James is the idea ‘we can change who we are through our minds’, although these minds are determined by the ‘irreversible limits’ of our brain chemistry and the ‘parameters of our destiny’ imposed by childhood.

Paul Morley, Bowie fan and cultural critic, takes us beyond the psychological origins of Bowie to explore the making of, to use the title of his book, The Age of Bowie. It was in 1969, the hippy, happy year of Woodstock, that Bowie recorded one of his most famed songs, ‘Space Oddity’. This was an incongruously child-like novelty piece that was also ‘menacing and desolate’, both an uneasy commentary on the moon landings and a reflection on the recent death of his father. ‘Space Oddity’ launched Bowie’s career even if, as Morley drily notes, he was floating in his tin can for a couple of years before reappearing. In 1972, with the arrival of Ziggy, the ‘ultimate dreamcatcher for a new generation’, Bowie really looks like he’s been beamed down into the Top of the Pops studio from outer space. Still, as Morley recalls, the playground progs dismissed Bowie as ‘light, superficial, trashy’ compared with the ‘authentic roar of Led Zep, Pink Floyd and Black Sabbath’.

There was certainly a pretence about Bowie, something he would embrace. The music papers were creating a ‘riveting, semi-fictional framework’ and Bowie, too, in interviews, was ‘inventing as he went along’. But ‘he kept himself open enough’ for us to project our fantasies and theories on to him. ‘He let others make him up’, says Morley. It was only really in the Seventies, when pop music was a ‘seductive, influential force’, that Bowie was able to align himself with pop culture, from Ziggy through Diamond Dogs and the ‘plastic soul’ of Young Americans, to the Thin White Duke and the experimental Berlin albums, and personify the daring unbounded spirit of the times. Nevertheless, Bowie was still constantly renewing himself, observes Morley – he was always debuting, right to the end. In his final years, Bowie’s withdrawal from public life only excited greater interest. He even staged his own death, inasmuch as he made a performance of it; his final album, Blackstar, was released just days before his death.

You don’t hear about anything beyond Ziggy from James. He admits to not knowing much about Bowie beyond the quotes he Googles and an old biography, which he relies far too heavily on. As fascinating as he is on mental illness, James doesn’t tell us anything new about Bowie himself. It feels too much like a guess, a rush job and, dare I say it, a way of cashing in on a celebrity death. It’s not that Bowie’s backstory doesn’t tell us anything about him. His family’s history of mental illness was mined by Bowie as source material for his songs – indeed, it is one of the major themes that runs through his work. But to reduce Bowie’s music to a coping strategy, or his rock’n’roll lifestyle to addiction, to portray the sheer inventiveness of his work as no more than an expression of hard-wired early experiences, is to flatten out and completely misunderstand the significance of one of the most extraordinary artists of the past century.

It was Bowie’s ability to self-mythologise, and to weave this mythology into his songs without ever giving anything away, that made him so compelling. We’ll never know for sure to what extent he was grappling with his demons or just playfully drawing on his troubled family background to keep everyone guessing. While at the time it was enormously important, today the arm draped over Mick Ronson’s shoulder during a Top of the Pops performance of ‘Starman’, is of only historical note. ‘Do you like girls or boys? / It’s confusing these days’, Bowie would later sing on his 1995 album Outside. In the age of gay marriage and LGBT traffic lights, it is hard to appreciate how ground-breaking that gesture, however calculated, was. And I suspect the supposedly Nazi-like raised arm to fans in London’s Victoria station in 1976 would have him accused of inciting racial hatred today.

In the end, it is Morley who does the better job of getting inside Bowie’s head. The Age of Bowie is as much an act of imagination and devotion as it is research, so steeped in Bowie is he. He captures better than any other biographer I’ve read the essence of the man and his times. Morley understands that Bowie was doing so much more than just coping with a troubled and troubling past; he was also inventing something new. And he was doing it over and over again until nobody knew where David Jones ended and David Bowie began. For all that, he was a one-off, something that James fails to realise in his recommendation that readers do what they can to ‘up’ their own Ziggy Stardust. Bowie has left a gaping hole in the firmament. For the foreseeable future we are faced with a grim line-up of dying stars, thinks Morley. ‘The music that began as an articulation of youth and a making up of the future is entering a definite twilight zone.’ Where Bowie trailblazed his way through a decade upsetting conventions and orthodoxies as he went, today, ‘pop and rock music is essentially part of the establishment’.