More inspections won’t solve the care crisis

The Conservative Party might want to forget the ‘dementia tax’ debacle that haunted its General Election campaign, and marked the beginning of the end of its parliamentary majority. But the social-care crisis is not going away. An ageing population, rising costs (as providers are forced to pay care workers the National Living Wage), and cuts to local authority funding (estimated at £824million in England in 2017/18), are putting 12 per cent of the UK’s care homes at serious risk of going bankrupt, according to the latest research.

The pressure is expected to increase, with an anticipated growing demand for places (with one study in the Lancet identifying the need for 70,000 more by 2025) and a longstanding shortfall in staff – predicted to worsen with the much-cited Brexit effect supposedly putting off foreign workers coming to an allegedly hostile UK.

Care homes have been closing at a rate of around 500 a year, and for those that remain – it is not unreasonably argued – care standards can only suffer.
HMRC is currently chasing care providers for millions of pounds worth of back-payments for workers who were paid below the minimum wage for ‘sleep-in’ shifts. This will make further closures even more likely, argue those in the sector.

But do these factors fully explain the crisis in our care homes? It is certainly the case that local authorities are running out of options to deal with the crisis – other than raise council tax and make better use of the Better Care Fund (aimed at integrating local health and social care) – as central funding dries up. The Department of Health has responded by saying it will toughen up the inspection regime. But is the problem really that the Care Quality Commission (CQC) is too lax in its monitoring of care homes and the quality of the care that takes place in them?

I don’t think so. While there is a place for ‘light touch’ visits to weed out the worst offenders, it is the public-sector audit culture itself that is making a solution to the social-care crisis so hard to find. Notwithstanding ever-increasing demands and historic under-resourcing, the focus on meeting targets and pleasing inspectors crowds out a culture in which a commitment to care, and the autonomy of cared-for older adults, might otherwise be allowed to flourish.

‘What’s it like to live in a care home?’, published this month by consumer rights body Healthwatch, gives a sense of how bad things have got. In over a third of the nearly 200 care homes its volunteers visited across England, conditions were poor – from peeling wallpaper and rotting pot plants to being so generally dirty that a ‘deep clean’ was insisted upon. Some residents reported having no internet access or not having the opportunity to get some exercise for weeks on end; and others complained that they ‘didn’t get enough time to connect with those caring for them’.

For all policymakers’ high-flown rhetoric about ensuring older people are given more independence, choice and control over their lives, too often care homes were found to be failing even to uphold residents’ dignity or just ‘get the basics right’. As national director, Imelda Redmond, put it: ‘Care homes are not institutions, they are people’s homes.’ The sooner the managerial ethos is abandoned, and those who live and work in these homes are able to take control of decisions about care, the better.

First published in sp!ked

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