Lou the transphobe? Please!

‘Walk on the Wild Side’ Lou Reed’s most famous song, hit the headlines recently courtesy of the University of Guelph Central Student Association in Canada.  Originally recorded for his bestselling classic album Transformer produced by David Bowie and Mick Ronson (formerly a Spider from Mars to Bowie’s Ziggy Stardust), it somehow slipped a line about ‘giving head’ past the censors in 1972. This time around, 45 years later, the would-be censors published an apology for the song and its ‘transphobic lyrics’ finding its way onto a playlist at one of its events.

Apparently ‘the person making the list did not know or understand the lyrics’. They weren’t the only one. The rush to seek offence – a regrettable feature of contemporary life, both on campus and in the field of identity politics – is such that all is swept before it, even a song written by somebody who was no stranger to transgressing the norms of his day. ‘Bi? The fucker’s quad!’ one roadie was reputed to have anwered when quizzed about Reed’s sexuality. While David Bowie with that album had brought him renewed fame, it was Reed and the Velvet Underground, and the mifits that populated Andy Warhol’s Factory, that were the original gender-benders.

Candy Says, from the Velvets’ third album and also written by Reed, is a sad and tender song about Warhol muse and trailblazing transsexual drag-queen Candy Darling, who died tragically at the age of 29.  Reed even dedicated his sometimes overlooked gem of an album Coney Island Baby to his drag-queen lover Rachel. He was transgressive to the end, with his critically panned project with Metallica, Lulu, based on a couple of obscure German plays, with sexually-shocking lyrics sung by a 60-something Reed from the perspective of a female stripper-cum-prostitute.

But lets go back to the song in question. According to Hal Willner, who produced Lulu and Reed’s other late albums: ‘This song was how the world first heard about these people. It’s a song about love.’ Not least Lou’s love for the New York misfits he knew and wrote about. A world away from the curiously conformist one inhabited by today’s students and activists. What’s good about this bizarre controversy is that Lou Reed is back in the news. Dying just a couple of years before Bowie, I’m not sure enough people really know what a genius he was. And so influential too. Bowie wouldn’t have been Bowie without him.

He’d no doubt have dispatched his critics with a monotone-delivered but deadly one-liner if he was still around. The least today’s generation can do is take Lou’s advice. Take a walk on the wild side.

Don’t use nurses as fodder in the NHS war

Increasing numbers of nurses are leaving the NHS, choosing to take jobs stacking shelves in supermarkets instead. That’s according to NHS Providers chief executive Chris Hopson, who is responsible for most NHS hospital, mental-health and ambulance trusts in England. He said on Monday that nurses’ pay is so poor – pay rises have been capped at one per cent in recent years – and their working conditions so stressful that many are simply giving up. Hopson’s intervention follows claims by the Royal College of Nursing that more and more nurses are relying on foodbanks to get by.

But the problem with the NHS isn’t as black and white as it seems. Whether or not nurses are so underpaid that they’re actually going hungry, or are so demoralised they’d rather work in a supermarket, it is true that there is a crisis in the NHS. Prime minister Theresa May’s response to Copson – pointing out that there are ‘more doctors, more nurses, more midwives’ in the NHS than ever before – did nothing to address the fact that there still aren’t enough, and that the Tories are starving them of funding. Of course nurses should be paid more – they do an incredibly important job. And despite May’s cheery outlook, the NHS needs more funding to meet the increased demand on services from an ageing population, exacerbated by service dysfunction and the cuts to social care.

Solving the NHS crisis won’t be as straightforward as simply raising taxes, but without a greater funding commitment it won’t be possible to implement the changes needed to put things right.

In response to Hopson, May said that ‘you can only put extra funding into the NHS with a strong economy’. It was, of course, a jab at Jeremy Corbyn. But the problem is that the Tories have not produced a strong economy. This is why they’ve pursued public-sector cuts as part of their obsession with slashing the deficit. They’ve been incapable of fostering real growth.

But rather than challenging the government’s cuts to the NHS on economic grounds – arguing for more growth as a means to more funding, and a much bigger overhaul of the care system – the Labour Party and health-sector lobbyists have opted for emotive electioneering. They have framed the discussion about the NHS as a war between angelic nurses and cruel austerity.

Such cynical tactics won’t work. Instead of trying to shame the government with spin about impoverished nurses, critics would do better to challenge the NHS love-in, and ask if this aged institution is fit for purpose. The crisis in the NHS isn’t just about funding and wages. It is about the way that the NHS is run. Given the targets it is burdened with, you would think its purpose is to populate spreadsheets with agreeable figures rather than make the sick well again. It is this culture that is responsible for driving down morale, and undermining the sense of public duty among staff.

Groups that represent health workers should be offering up solutions as to how the NHS should be run better, rather than leaving it to the NHS’s target-obsessed managers. Instead of holding them up as objects of pity, why not urge nurses to take inspiration from the junior doctors, and lay down their bedpans until they win a better deal from the Department of Health?

Published in spiked

Is there a ‘silent epidemic’ of loneliness today?

Is there a ‘silent epidemic’ of loneliness today? The Commission on Loneliness, initially set up by the murdered MP Jo Cox, was launched in January with claims that it affects at least 1 in 5 of us, and can lead to depression, stroke, heart disease, high blood pressure and the onset of dementia. Britain has even been described by researchers as the ‘loneliness capital of Europe’. According to Sue Bourne, who’s documentary Age of Loneliness was broadcast last year, experiences like ‘losing your job or constantly having to move for work makes you rootless’. For all our so-called ‘friends’ on social media more of us live alone than ever before.

The breakdown of marriages can mean the loss of wider social networks and of a sense of what the future might hold. New mothers cut off from the support of family can also feel alone, and stranded with only demanding children for company. The young are lonely according to recent research, with leaving home – especially for students – an upsetting time. While Bourne argues that volunteering initiatives have a role to play in ‘creating new support networks to replace the traditional ones we’ve now lost’, is there anything worse than having to endure the enforced civility of well-meaning befrienders when all you really want is to be left alone?

The ‘cure for loneliness’ is not so much about meeting other people as about ‘learning how to befriend yourself’ argues Olivia Laing, author of The Lonely City. That and recognising the ‘larger forces of stigma and exclusion’. She’s only half right. In recent months we’ve heard little else from the young Royals than their ‘awareness’ campaigning, with government, about their and our mental health, prompting an irritated Katie Hopkins to suggest they ‘put a sock in it’. The emotional correctness of being told not to bottle-up our problems, and instead wear our proverbial hearts on our sleeves like their late mother, is indicative of where official campaigns to make us talk about our problems can lead.

It seems to me that the new high profile for loneliness instead of being an opportunity to examine the psychological impact of social fragmentation and the breakdown of community that is such a feature of modern life, is instead being used as Laing describes it, to homogenise and gentrify the emotions, and to reduce ‘difficult feelings’ such as ‘depression, anxiety, loneliness, rage’ to a health problem.

Turning loneliness into a mental health problem ignores the positive side to being alone, which more of us are able to experience as a consequence of living longer, more affluent and mobile lives. The experience of leaving home, getting a job or going to university in a new town, used to be exciting prospects full of the promise of independence, money, academic study or wild parties; not, as is increasingly the case, with isolation, emotional and mental health problems, and an excess of introspection. Surely there is something to be said for the quiet and contemplation that comes with solitude; and enjoying one’s own company.

But still we shouldn’t ignore the fact that Individuals have increasingly turned in on themselves as a therapeutic ethos has taken hold. There is a fearfulness of engagement with others, of commitment to relationships; and an absence of a social framework within which to engage with others. The demise of the family, church, workplace, the pub and the working men’s clubs, as places where people can meet, find meaning, socialise and share of themselves is as much a consequence of this as it is its cause. These institutions of the past reflected the way people used to live their lives. It is perhaps only in the creation of new solidarities emerging organically from our attempts to re-engage with each other, that the problem of loneliness will be tackled?

First published in WriteYou

Living wage? This is bargain-basement socialism

In November last year, the UK government published a Green Paper on corporate governance. This is not the sexiest of topics, but it did set alight the passions of the Equality Trust (established by Richard Wilkinson and Kate Pickett, authors of The Spirit Level: Why More Equal Societies Almost Always Do Better). The trust has published a report claiming that CEOs earn around 386 times more than the national living wage.

So are the ‘fat cats’ getting fatter while the rest of us are just about managing? Wilkinson and Pickett certainly think so. Low pay (and its corollary, ‘excessive pay’) is very much of the moment in policymaking circles. We might call it the politics of incomes. From minimum wages and living wages to universal basic income and the recent u-turn on taxing the self-employed, we’ve never been more obsessed with what people do and don’t get paid. Indeed, this week, Labour leader Jeremy Corbyn tried to overcome his poor poll ratings by pledging a £10-an-hour minimum wage.

No longer does the minimum wage spark controversy about the impact it might have on jobs. The national living wage is now regarded as right and socially responsible. Advocates of a universal basic income (UBI) have been emboldened by the acceptance of these previous schemes. In Scotland, Glasgow and Fife are now considering implementing a UBI. The Netherlands, Canada, India and Finland are piloting it, too.

But not all proposed income schemes have been so popular. In January, in the course of a single day, Corbyn infamously backtracked from calling for a ‘maximum wage’ to making a vague demand for restrictions on high executive pay, implementing higher top-rate taxes, and enforcing caps on pay differentials in firms. He couldn’t even claim these ideas as his own. Before she became prime minister, Theresa May advocated the publication of firm’s pay differentials and other pay-fairness measures.

There are all sorts of problems with these income-based utopias. Critics argue that the government is already effectively subsidising poorly performing businesses through benefit payments to underpaid workers, and that the introduction of a UBI would do little to fix this problem. As a recent Guardian editorial said, if set too low, UBI could also act as a subsidy to low-paying employers. But if set too high, it would be a disincentive to work (and would encourage the notion – especially among young people – that poorly paid work is beneath them).

How do we know if any of these income schemes even work? Guy Standing, economist, author and co-founder of the Basic Income Earth Network, looked at basic-income pilots in the US and Canada going back to the 1970s. He says they led to improved school attendance among poorer families, and also had mental-health benefits while decreasing crime, behavioural disorders and substance misuse. So, UBI is as much about experimenting on people, in essence; as much about managing their lifestyles as about providing a decent standard of income for all.

On the surface, the discussion of incomes seems to be driven by an egalitarian sentiment. ‘We cannot have a CEO paying less tax than the cleaner’, says Corbyn. ‘[W]e don’t want [to] turn Britain into a bargain-basement economy on the shores of Europe where we continuously reduce corporation taxation [and] encourage a low-wage economy.’ But it is Corbyn’s bargain-basement egalitarianism, rather than corporate pay, that is the real problem. Despite the stagnation of wages and rising prices over the past decade or so, it seems that, according to Corbyn, the best we can hope for is putting a cap on what the richest earn. It’s hardly inspiring.

At less than five per cent, unemployment today is at its lowest since the 1970s. But wages are growing slowly – less than two per cent in the past year – and this rise is more than cancelled out by rising inflation. Consequently, living standards are stagnant, if not falling. Much of the new work created over the past decade has been through self-employment. Self-employment levels increased from 3.8million in 2008 to 4.6million in 2015. While this in part reflects a rise in insecure work, and a reluctance among employers to put people on contracts, it also suggests that some are choosing to use their initiative and strike out on their own.

Corbyn, and many on the left, fail to recognise this ambition. ‘This is not about limiting aspiration or penalising success’, Corbyn insisted on the day he announced (and then shelved) his maximum-income policy. But it really is. Instead of seeking to impose a ceiling on the pay of the wealthy few, he should be calling for higher pay for all, and much higher than the measly £10 an hour he’s now pledging. Corbyn’s plans reveal the dearth of aspiration in the income debate. The left has given up on dramatically improving living standards and instead just indulges its paternalistic, regulating impulse. Left-wingers today would rather hold back enterprise than unleash it.

These various income schemes are always put forward by academics. But why should they decide what working people get paid? This never used to be an academic question. It was a point of political contestation – occasionally even violent confrontation – between employers and workers. The defeat of the trade-union and labour movements in the 1980s put an end to that. Today, there is a tendency to look to the state or expert committees to decide what working people should earn. The minimum wage is worked out by the supposedly independent Low Pay Commission and set by government. Don’t workers get a look-in?

Today, being a lefty seems to mean defending the tax system and waxing lyrical about ‘fat cats’. It is surely time we challenged the assumptions of these supposed champions of people on low incomes. If we are to go beyond the basics and maximise our earnings, then we need to get to grips with the underlying cause of stalled living standards and insecure working lives. We need to be much bolder, and more ambitious, than those coming up with low-horizon schemes. Any new ideas to improve people’s standard of living should be encouraged, but if the British economy can’t generate enough well-paid work to go around, it really will just be another academic exercise.

First published in spiked

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