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


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’.

From Bowie to Kanye: Death of an Icon

First published in WriteYou

Until June 23, when the UK decided to leave the EU, 2016 looked like it would be known as the year the celebrities died, one after the other, often unexpectedly.

A number of rock icons, David Bowie in January and then Prince in a lift at his Paisley Studios, among them. The very day Bowie died Julie Burchill wrote a piece criticising the ‘virtue sobbing’ over his shock passing by hangers on in the music industry.

There was certainly an embarrassment of middle-aged broadcasters claiming to be Bowie fans in the days and weeks that followed. But there seemed to be something more going on. There was a more widespread mourning or something approximating it. Was this our Diana moment revisited? Was it Generation X’ers very publicly contemplating their mortality? Sting, with a new album to promote including a song responding to the deaths of his peers, reflected in a recent interview: ‘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’.

Paul Morley, in his new biography The Age of Bowie, explains how in the seventies pop music had a ‘seductive, influential force’. Today it ‘is essentially part of the establishment’. The times are certainly a-changin’ when Bob Dylan receives the Nobel Prize for Literature; and Bowie gets his own commemorative Prom. Though I suspect this is more a case of the guardians of high culture having lost any sense of what it is they are guarding and why; than having any real regard for the work of the icons of the counterculture. After all, Strictly got itself a Prom too!

By comparison the Rock and Roll Hall of Fame looks conservative. That its 2017 nominees should only now include the 80s electronica of Depeche Mode (in addition to the seminal Kraftwerk), suggests the world of rock music is as dinosaur-like as ever. But as Paul Schrodt observes for Business Insider after seeing a father with his toddler at a Depeche Mode gig, even ‘the band that helped redefine rock in the 80s and 90s has literally become dad music’.

According to Morley, ‘The music that began as an articulation of youth and a making up of the future is entering a definite twilight zone’. That’s not to say there aren’t exciting artists out there doing interesting, and sometimes daring and innovative things. It’s just that the same names keep coming up. If it’s not Jay Z or Beyonce, it’s Kanye West. In the latter’s case at least rightly so. Lou Reed, just a few months before he died, praised West’s then latest album, Yeezus. There’s Lady Gaga too. Andrew Unterberger, writing for Billboard, admits she is ‘no longer the ringleader that all look to for what comes next’ but still ‘the sense of possibility in pop’ that she inspired anew ‘is as vast as it’s ever been’.

I hope he’s right. Closer to home the signs aren’t encouraging. There’s nothing original or daring about Robbie Williams singing “‘Aint no refutin’ or disputin’ – I’m a modern Rasputin’” but not, you understand, referring to the man the West loves to hate Vladimir Putin. And there’s Lily Allen of course, videoing herself crying in the Calais Jungle, and being rewarded with a fittingly gushing piece in The Guardian describing her as a ‘pop rebel’. Now that really is virtue sobbing.

From Bowie to Brexit in the Bastille Spirit

First published in Huffington Post

How quickly things can change. That sense of possibility we had just a few days ago is already in danger of dissipating. The political class is closing ranks. The Tories’ anointing of Theresa May as their (and our) unelected leader, and an attempted slow motion coup in the Labour Party, have the same object in mind. Saving themselves and putting a lid on the popular sentiment that was, to their mutual horror, released by the Brexit vote.

Having said that, when the man who once sang about ‘ch-ch-ch-ch-changes’ unexpectedly died at the beginning of the year, that sense of possibility resided very much in the past. We were nostalgic for celebrity representatives of a generation that young Remainers have more recently been hurling abuse at as selfish EU-wreckers. As Mick Hume, journalist and editor-at-large of spiked-online, describedthis icon in his early 70s heyday: ‘Bowie emerged as the spirit of that rebellious age in a dayglow jumpsuit’. Jennie Bristow, author of the excellent Baby Boomers and Generational Conflict, thinks our response to the ‘Boomer deaths’ that seemed to dominate the first half of 2016 was not just a response to the tragic passing of individuals held in popular affection but also to an overwhelming sense that ‘the spirit of the Sixties seems to be retiring as well.’

So is today’s generation, more likely to blame the Boomers for their problems than be inspired by them, really up to the task of taking on the political class? The fact that the Pretty Things rather than ‘driving their mammas and papas insane’ joined the March for Europe demanding that the EU Referendum result be overturned doesn’t bode well. The setting up of a ‘Brexit Department’, albeit headed up by the estimable David Davies, may be designed to put like-minds at rest, but is turning a popular decision into a drawn-out technocratic process requiring its own department and minister really what we want? As campaigner Tom Slater put it there is a real danger that without sustained pressure from without the unwanted result will be happily ‘kicked into the long grass’. An outcome that would be in keeping with our newly crowned prime minister’s promise to insulate the political class from the electorate until 2020. Will all be Hunky Dory in the end as May puts into action her words that ‘Brexit is Brexit’? Or are the signs ominous and the triggering of Article 50 that will put the nation’s decision in irreversible motion a distant or even endangered prospect? Either way they won’t pursue the matter in the same democratic spirit that forced it so reluctantly upon them.

One thing is for sure though, British politics has changed for good and will never be quite the same again. The political elite have been exposed as just that – with no real connection to the people on whose behalf they have disingenuously claimed to speak. The result of the Referendum vs their desire to remain in the EU Club has made that clearer than ever. We’re not so apathetic. When finally presented with a genuine political choice of real consequence, we made our view known. But faced with the biggest popular mandate in the UK’s political history, we were dismissed as too old, bigoted, or emotional to know what we were doing. We just don’t understand the repercussions said Labour peer Oona King in a debate she had triggered on holding a second referendum. Speaking in the House of Lords it would be ‘only fair and democratic’ she said. The irony.

What looked like being a year in which we rather morbidly obsessed over what and who has passed could be the start of a new era – a taster of what’s to come. Instead of looking back at a roll call of dead celebrities, as grim onlookers; we have found ourselves playing a part in the throwing out of the old and moribund party politics, and with the prospect of ushering in something new to take its place. Who’d have thought that even a few weeks ago? And the barbaric attack in Nice on people celebrating Bastille Day is a reminder that there is nothing intrinsically inward-looking about fighting for freedom and democracy. It is a universal aspiration that needs to be shouted ever more loudly across the continent.

The collapse of the political class in the face of their popular rejection is a historic moment. It’s not quite 1789. Not yet at least. But what started as a year filled with a sort of grief for what has gone now promises excitement over what is to come. There is reason to be optimistic about what the future might hold. The fear and pessimism that has characterised recent times, and that continues to grip and paralyse our political culture, can and should be relegated to the past.