On page 67 of the Conservative Party manifesto (analysis here), Theresa May's "team" announces a significant shift in the way elderly care is going to be paid for. Their plans have generated a great deal of controversy which, combined with means testing for winter fuel payments and ending the triple lock on pensions, moves the Tories away from protecting pensioners from the squeeze they unnecessarily put on public finances to one where they're going to have to also pay. It has proven hugely controversial. Some Conservatives are very unhappy with it, and you can bet this view is shared by more than a few of their MPs. Setting aside the politics of the changes and why the Tories have decided to put this policy in their manifesto, what do the measures mean and why is Labour dubbing it the 'Dementia Tax'?
Presently, recipients of residential care have to part fund the service they receive if they have assets in excess of £23,250. If they are applying for a place in a home, they have to include the value of their house in the means test. As around two thirds of pensioners are home owners, this often means selling the house from under them to pay for their care package - though an option exists to defer costs. To demonstrate, assume a 75 year old pensioner requiring residential care has £25k in savings and their house is worth £89k. Leaving aside income and assuming that person then lives for a further six years (in line with current life expectancy), according to care costs calculators for Staffordshire (because that's where I live) you're talking upwards of £190k. Note this will vary from county-to-county and by local authority area. Therefore, our pensioner would presently be required "contribute" almost £91,000. The remaining £23k of their assets will remain theirs. If on the other hand our pensioner requires domiciliary (at home) care, the application in this case would take into account their savings only. This care is cheaper, costing between 70-75% of being in a home and their contribution would be just £1,750 (again, leaving aside income from their pension(s)).
What they giveth in one hand they taketh with the other. Under the proposals in their manifesto, our imaginary pensioner above wouldn't have to pay anywhere near as much as the Conservatives promise to raise the capital floor to £100,000. Their contribution would shrink to just £14,000. Sounds alright, doesn't it? But here's the catch. The Conservatives want to redefine the asset base so the house is counted for residential and domiciliary care. Another change is they will only come for the assets after the person in receipt of care has died. On the surface then, pensioners who are poorer or moderately okay like the example given would benefit. But older people whose combined assets are in excess of £100,000 are going to get clobbered. Or, rather, their families and children are. The problem for the Tories is this is their vote base, and there are millions of pensioners in this position. All of a sudden, estates of people in receipt of domiciliary care are going to receive steep bills after their loved one has died.
This sets up all kinds of problems and difficulties. For pensioners living as couples, how does this recoup costs from shared assets like a home? If their house is £250,000, would the estate be expected to pay £150,000 or £25,000? And in either case, would the surviving partner be expected to liquidate their shared asset to pay the bill? Likewise, for live-in carers who might be sons, daughters or whatever, can we safely assume that they will be expected to sell up their inheritance to pay the balance off? And what will they do about the scramble of elderly people transferring ownership of assets to relatives before they put in a care application and therefore avoid the charges? Unfortunately, none of this is clarified in their manifesto. Unlike Labour who provided costings for their pledges, the Tories chose not to.
The Conservatives say they're doing this to put adult social care on a firmer footing. Since 2010, the Coalition and then the Tory majority government have foisted tough cuts on most local authorities by chopping down the local government grant year-on-year. As budgets have got tighter, councils of all political complexions have had to redesign, strip down, and withdraw services. This has mean adult care could not but be hit too. Waking up to it belatedly last year, partly thanks to the winter beds crisis in the NHS, the government have allowed councils to increase council tax by an addition 2% to pay for adult social care only. But this cannot fill the gap, and so the Tories are moving to a model whereby the user pays after the fact.
The result would be to grow the number of people eligible to pay more for their care. Hence why it has been dubbed the dementia tax. None of us know what care needs we might require when we get old. None of us can really do anything about avoiding them either. We all get weaker, a good chunk of us will suffer health complications, an unlucky number are going to develop dementia. Whatever happens, the state will look after us and when we die, grieving relatives can look forward to demanding letters from the council asking them to hand over tens, and in some cases, hundreds of thousands of pounds. The dementia tax is a tax on old age and that's why, despite everything, it could cost the Tories the general election.
Chatting to Alex Nunns on the Twitter earlier, he suggested the Conservative (and Unionist) Manifesto was a Blairite document. And he's entirely right. Not because of the substance of the politics, but because what Theresa May and "her team" are trying to do with it.
Looking at the manifesto, if Labour's was the best manifesto I've seen then, arguably, the Tory document is probably their least worst. Don't get me wrong, there's a lot that is deeply discomfiting here. Yet at the same time it's a patrician (matrician?) work invoking the spirit of manor-house-knows-best Toryism of Harold Macmillan and Enoch Powell. All the one nation lines are in there about tackling insecurity, sorting out mental health, and even a pledge promising to eradicate homelessness by 2027. And no, it doesn't mean dragging them off to the workhouse. There's some interesting wonkish stuff about investment banks, working with 'old' industries, introducing the variously floated 'T'-levels to replace the plethora of vocationally-based qualifications, redistributing government bureaucracies to outside of London (hurrah!) and a few other things. It's all there for the regen geeks.
This togetherness, of repositioning Britain as a giant community in which everyone knows their place and everyone is treated fairly is the running theme of the manifesto. Check this out, for example:
If you are at a state school you are less likely to reach the top professions than if you are educated privately. If you are a white, working-class boy, you are less likely than anybody else in Britain to go to university. If you are black, you are treated more harshly by the criminal justice system than if you are white. If you are born poor, you will die on average nine years earlier than others. If you are a woman, you will earn less than a man. If you suffer from mental health problems, there is not enough help at hand. These are burning injustices that damage the unity of our country, and we will address them. (p.51)
Can you imagine such lines even appearing in the 2015 Tory manifesto? Incredible.
Or not. Theresa May thinks the Tories have the election in the bag. That's why the chapter on Brexit is short on detail but long on optimistic rhetoric. A few trade treaties and technical terms are thrown into the mix to convey the impression the government know what they're doing. Though their persistence with the "no deal is better than a bad deal" idiocy shows they really don't. It's also why costings are entirely absent from the manifesto. Labour always get a hard time about such things. If they so much as want to repaint a school bus up pops talking heads demanding to know where the money's coming from. Not so with the Tories. There might be a day of froth before it subsides. After all, Dave got away with it last time. The size of her predicted victory is why May feels comfortable going out of the way with her bastardised Milibandism. The petit bourgeois-types usually suspicious of big statism have nowhere else to go, and May sniffs a big opportunity to inflict major damage on Labour that could take years to recover from.
And it's also why she may have made a big misstep. As the Tories are in the business of constructing a cult of the personality around a woman completely lacking in personal qualities, the leadership fetish commands an expression of toughness. And here it is:
First, we will align the future basis for means-testing for domiciliary care with that for residential care, so that people are looked after in the place that is best for them. This will mean that the value of the family home will be taken into account along with other assets and income, whether care is provided at home, or in a residential or nursing care home.
Second, to ensure this is fair, we will introduce a single capital floor, set at £100,000, more than four times the current means test threshold. This will ensure that, no matter how large the cost of care turns out to be, people will always retain at least £100,000 of their savings and assets, including value in the family home.
Third, we will extend the current freedom to defer payments for residential
care to those receiving care at home, so no-one will have to sell their home in their lifetime to pay for care. (p.67)
In 2010, David Cameron attacked Gordon Brown's proposals about using a person's estate to posthumously pay for care costs as a "death tax". And here it is, again. Rather than releasing monies to deal with the growing adult social care crisis they are shifting the costs onto individuals and their families. Well, not all. In the name of obligationism, this would not effect the very poorest elderly, but it would hit millions of better off pensioners. Some are bound to pass ownership of their assets to the children in the manner of the rich dodging inheritance taxes to get round it, but most won't. To be sure there's going to be a lot of people in Daily Mail land deeply upset about this.
May thinks she can get away with it because this is the core vote and the Tories reason they have nowhere else to go. Are leave-voting pensioners going to vote for Jeremy Corbyn and his plans to nationalise window cleaning? This is why this manifesto is a Blairite manifesto. With the core vote in the bag, the party is free to reach out well beyond its base to gain the thumping majority May craves. Clobbering pensioners' estates with care costs and rowing back on the triple lock might be enough to persuade younger voters that the Tories aren't just about the oldies and that they're trying to address age-related injustices in social policy.
Here, the Tories may have miscalculated. Looking at the polls, politics appears to have undergone a realignment again with the total collapse of UKIP (remember, we did this). Yet the vote the Tories have drawn in from UKIP is highly volatile, which is why the purples were always a declining force, even when, paradoxically, they were on the rise. That vote, which is mostly old, are going to have to weigh up how much a vote for Theresa May is going to cost their families. It will certainly put some off and, even though a switch to Labour might not be on the cards, them staying at home, or voting for another party threatens the prospects of a Tory landslide. If you're going in for voter suppression, then going after the new supporters you've just won over should do it.
This Blairite manifesto is ultimately another episode in keeping the balance of Britain's class forces tilted toward capital. It's conservatism doing what conservatism does: adapting, shifting, changing, responding to new situations and protecting what's theirs. The adoption of a Blairite approach to politics is from a position of perceived strength, but one that is not as certain as that enjoyed by The Master 20 years ago. It is our job in Labour to seize this and drive home what could be the Tories' most serious mistake.
I've got a guilty secret. I subscribe to CapX's mailing list and occasionally, I like some of its output. For those of you who don't know (or don't care) what CapX is, it's a fancy ass blog that styles itself as the home of some of the best politics writers going. And Daniel Hannan. It also happens to be firmly on the right somewhere between Cameroonism and the batshittery of so-called libertarianism. In many ways, its stock-in-trade is contrarianism, albeit not as strident or as obviously stupid as your average Brendan O'Neill missive. Its niche is the provision of middle brow arguments bigging up Uber, applauding Tory economic policy (well, until this happened), and blindly, blithely cheering on the anarchy of market fundamentalism. Still, lefties used to the thought-free rantings that normally passes for right wing thinking should check it out if they want their conservatism a touch more substantial.
Anyway, scrolling through their plugs last week, I came across this by Allard Dembe, a Health Services academic at Ohio State University. And his piece, 'The hidden dangers of a four-day workweek' isn't exactly a title that leaves a lot to the imagination. As readers know, there is an emerging trend on the left (and, indeed, in politics as a whole) interested in what's happening at work. Chiefly, most worrying for policy makers - and a system utterly dependent on the disciplining of workers - are predictions that advancing automation is set to wipe out millions of jobs, make thousands of occupation types redundant, and that the new jobs set to fill the gap will neither be available in sufficient quantities or offer a like-for-like replacement (Andy's taken a recent look at this, I plan on replying in due course). Hence discussion has been doing the rounds about reducing the working week, or introducing a basic income to support people outside of work.
As the historical record shows, the workers' movement from its inception has fought to reduce the number of hours we spend selling our labour power in return for a wage or a salary. As the work/life boundary becomes blurred for large numbers of workers and work is extending itself beyond the formal work day, we need to take this more seriously and start asking serious questions about what the economy should be for, rather than limiting economic debate to pushing up GDP figures and job creation strategies. It's in this context that Dembe's arguments should be appraised.
Dembe has considerable experience studying workplaces, and possesses a long publication list that testifies to this. Unfortunately, sometimes expertise doesn't necessarily mean you ask the right questions. He begins by listing a number of companies that have experimented with four-day working and outlines advantages in terms of reduced overheads for business, less time spent commuting, and so on. And then goes on to rubbish it by listing the disadvantages. Chief among them are the consequences of compressing work time. For instance, assuming that five eight-hour days are crammed into four days, Dembe notes the risk of at-work accidents creep upwards. Furthermore, using 32 years worth of data, long work hours are related to a plethora of later life health problems. And that's before we start talking about mental health problems, parental responsibilities and the like. He concludes, "I don’t know about you, but the prospect of a four-day week scares me. I already have a hard enough time getting my regular weekly work done over five days."
There is an obvious point here. Can you tell what it is yet? Why yes, Dembe is assuming the number of hours worked in a week are inviolable. There is more than one way to shorten the working week. Assuming the "hegemonic" normal working week, you could just redistribute the hours across four days. Or, here's a radical suggestion, work commitments could be redesigned so the number of hours worked are less. Instead of a working week of four 10 hour days, how about four eight hour days? As we have seen over the course of the last 30 years, productivity gains have resulted in record profits while wages have lagged well behind, and living standards kept afloat mainly thanks to credit and cheap consumer durables. There is no reason, apart from politics, why work could not be reorganised to spread these gains to everyone through the reduction of the working week without loss of wages. For Dembe, CapX and friends this cannot be countenanced - a day less at work surely means fully automated luxury communism is next.
What Dembe's piece demonstrates is a total poverty of imagination. It's a case study in how capital's intellectual bodyguards cynically try and narrow the horizon of possibilities around a particular issue, in this instance labour's economic dependence on capital, foreclose alternatives by failing to even mention them, and then provide drab technical reasons why such-and-such a proposal is unworkable and/or undesirable.
When I used to write letters to ministers for a living, it struck me that Damian Green was relatively decent. Well, if you ignore the appalling voting record, the missives we got back from the civil servant who scribbled his letters in immigration suggested he was a reasonable bloke, albeit one hemmed in by the politics he chose to associate himself with. This was entirely of a different character to his predecessor at the Department for Work and Pensions. Iain Duncan Smith's letters cadenced his cruelty with evangelism and zealotry. Now Damian Green has taken over from the execrable IDS, in a rare Tory concession to decency he has announced the government will no longer subject the chronically ill to repeat work capability assessments. Good.
Readers not familiar with the Work Capability Assessment will recall the well-publicised misery its work fitness test has caused. Not only have seriously ill and disabled people been found work fit, because the "trained medical professional" assessors deemed them capable of some form of employment, it has exacerbated illness in a great many cases as the dread of the assessment and the anxiety of going through the appeal process for many hundreds of thousands of people have compounded their conditions. We know it's been a factor in several premature deaths and suicides. Whether you believe whether some kind of independent, non-medical test is appropriate to qualify an applicant for social security or not (and I don't), if you can be found work fit simply because you went to your interview in a suit then obviously something is horrendously wrong.
Nevertheless, the Tories do not deserve any credit for exempting the chronically ill from future evaluations. It is true that Labour, for its sins, introduced this horrendous test. But the Tories made it their own, aided (lest we forget) at all times by the Liberal Democrats. The main question they have to answer is why chronically ill people, who aren't going to get better (the clue is in the name) were subject to repeat testing in the first place. The government have overseen social security policy for six years. If common sense proved elusive, there was evidence aplenty pouring in from the rate of successful appeals, repeat submissions from disability campaigners and charities, and the petitioning of Tory MP constituency surgeries by worried people. For years they've turned a tin ear to the experiences of some of our most vulnerable, and that alone condemns them.
On The Sunday Politics this lunch time, the formerly media-shy IDS was asked about this. He put up some waffle about the nature of the test. Under the old Disability Living Allowance system, access to disability payments was on the basis of medical diagnosis and need. Employment Support Allowance, which is basically dole for ill and disabled people, came with all kinds of conditionalities around income, capacity to undertake work-related tasks, and availability for "training". IDS argued he wanted to change the system to recognise the long-term ill and incurably sick, but was thwarted by the incompatibility of the two sets of support. The genius of the WCA was to disregard any and all medical evidence presented by applicants and recipients, and focus on whether they could lift a cardboard box or sit still for more than five minutes. Therefore to do what Damian Green has said means overhauling the test quite radically, tilting it - rightly - toward medical evidence. If indeed IDS is speaking the truth, and we know that our self-serving friend has form for a fib or two, then he was actively being overruled by Dave. That makes for another nail in the ex-PM's wretched coffin.
There's a whiff of cynicism about this. Since May appeared in front of Downing Street to do her Ed Miliband impression, this has been a government on a go-slow. The media again focused on the unnecessary Labour leadership contest and so a summer of Tory to-ing and fro-ing over Brexit, with May having to intervene publicly to slap down the likes of Johnson and disgraced international trade minister Liam Fox, went virtually unnoticed as far as folks outside of Westminsterland are concerned. They can't hide their paralysis forever - governing things involves being seen to govern things, after all. Piloted by Green, this change generates positive headlines, helps radiate an aura of Tory sensiblism and fluffiness, and gives some substance to May's one nationist pose. Pure coincidence the announcement is timed perfectly for Conservative Party Conference. If the decision was heartfelt and genuine, it would have been enacted in July. Meanwhile, the WCA continues alongside the system of punitive welfare sanctions. Note no change here: misery is fine as long as it remains politically expedient.
Here's a guest post from @CatherineBuca talking about Hillary Clinton's health. Like Cat, I'm no Clinton supporter, though she's definitely the lesser evil to the disaster Donald Trump would visit on America and the world. Here, Cat punctures the bullshit-filled balloons bobbing about Clinton's well-publicised funny turn and pneumonia diagnosis by pointing out its utter banality.
You'd think nobody had ever had their blood pressure drop and faint before. It happens to otherwise perfectly healthy people when certain stress factors are introduced, and certainly can happen to people who are already under the weather for one reason or another.
Let's take him indoors. Several years ago he pushed himself very hard to finish his masters dissertation. He finished it. He felt fine, if a bit tired. He came to pick me up from work (which is a story in itself), and as he was stood there as I was getting ready to leave he keeled over. No indication it was going to happen in the lead up to it other than he started to feel 'wrong' and then just went.
A few years later we've both got the flu, but we can't rest because my aunt's just died and I'm next of kin and we've got to sort everything out. We make it through the funeral, and we're on the train two days later to go and bury the ashes and we're sat there, doing nothing, as the train's going along, and over he goes again, in his seat. Exhaustion and dehydration from the flu and from not being able to rest. (The people telling me "he's probably had a stroke, love" didn't help. He hadn't.)
Cue a couple of weeks ago, he's in perfectly good health, but gets woke up in the dead of night by the cat scratching him. It's not too bad a scratch, a bit of blood but he's not scared of blood. I get him into the bathroom to clean it up, and he's fine at first, but then he can feel it coming on. He has to sit down. He goes wobbly. Eventually over he goes, toppling off the toilet seat and ending up curled in a ball out cold on the floor. He comes round, has a drink of orange juice, feels much better, goes to bed, is fine, is back to swimming and doing all the other things he does within a day. It was the shock of being woken up so suddenly that made his blood pressure drop.
When I was 18 I went out to a bar with my cousin. I started feeling quite hot, not quite right, and I wanted to leave (I'd not been drinking). My cousin was an arsehole and didn't want to leave. So we stayed. I was getting really warm, and felt worse and worse. Eventually, over I went. As soon as everyone got me up, over I went again. They got me outside, and then I was fine. It's never happened since.
Here then we have someone whose schedule must be hellish, who looks like she's probably suffering from a cold (now we know is pneumonia, apparently), but who hasn't let up on their schedule, who had to stand still for an hour or more which, as soldiers who pass out during passing out will tell you isn't the most fun thing, who it seems was dehydrated and overheated which was either brought on by the pneumonia or exacerbated by it, and so felt faint. It's not an unusual thing.
Don't get me wrong, I don't like Clinton and her politics. But if I'm going to critique her it's going to be on the things that matter and not based on some dodgy conspiraloon shit.
Jeremy Corbyn this morning pledged to try and change Prime Minister's Questions. Would he go for the "honest politics, plainly spoken" approach of his leadership campaign, avoiding the name-calling and yah boo sucks, or will he rise to the bait put to him by Dave?
As we now know, he started as he's been carrying on for the last 32 years. He began with housing, and asked about what the government would do about the lack of affordable housing and soaring rents. Dave's reply, the first as part of his new strategy to offer substantive responses, waxed about more starter schemes, help to buy, and the need to support aspirations. Meet the new politics, the same as the old politics.
Jeremy followed up with a question about how cuts to housing benefits threaten the viability of housing associations, and will cause job losses and worse living conditions for tenants. Dave's reply was that something had to be done about spiraling housing benefits, and the best way of doing that would be sorting out housing associations. Again, a substantive answer short on substance.
The next question came on tax credits, and talked about a family who had written in to say that tax credits kept them away from the food bank. Dave's answer was to mutter about minimum wage changes and the raising of the tax threshold. The follow up cited IFS figures, noting that the rise in the minimum wage only compensates for up to 26% of losses through tax credits and other changes - how could this be considered fair? Dave didn't have an answer, but he did have soundbites. We've heard it before - country living within its means, moving from low wages, high tax, and high welfare to the opposite.
Lastly, Jeremy used his last two questions for mental health services. Asked about unobtainable beds and people having to be moved miles away from home, Dave replied on his extra NHS spending, and the need to improve GP services and change public attitudes.
Well, at least it was more substantive than PMQs have been for many a year. It didn't set the world alight, but as one of many who've tuned in regularly to see Dave harangue and insult in the manner of a crap Malcolm Tucker, and to watch Ed Miliband calmly stroll into trap after trap, it was refreshing to see him having to restrain himself and for the initiative to remain with the Opposition leader. Crowd sourcing questions robs Dave of the ability to ridicule the issues Jeremy chooses to go with, and increases the likelihood the PM will get found out on his lack of substance. On the other hand, if this remains the way Jeremy does things opportunities to trip Dave up are lost. Still, it allows Jeremy and Dave to set out their respective stalls, and perhaps - just perhaps - might contribute to a more rational political culture.
At North Staffs Trades Council this evening, we heard about one of the latest TUC initiatives - the Dying to Work campaign. It turns out - and I didn't know this - that workers diagnosed with a terminal illness are not protected under workplace legislation. Unlike pregnant women who cannot (or rather, should not) be sacked under the law for any diminished capability during the course of their pregnancy, terminally ill workers can. This can lead to a loss of any death-in-work benefits that might be accrued during the course of one's employment, as well as a sudden loss of income, added stress as the employer shows their "appreciation" by turfing them out of work, and can attack a person's sense of dignity. Surely it's up to them how they spend their remaining few months?
The TUC - rightly - are campaigning for the law to be changed. Workers should not be cast off at an employer's whim.
Below I've reproduced Dying to Work's standard letter for MPs. There's plenty of other things you can do from your computer screen too. If someone is unfortunate to receive a terminal diagnosis, they should not have to worry about the stress of losing income and other work-related death benefits that will go to assist their family members.
Dear
Re: Dying to Work campaign
I am writing to urge you to pledge your support to the Midlands TUC’s ‘Dying to Work’ campaign.
As you will know, the Equality Act provides protections against discriminatory treatment based on the concept of ‘Protected Characteristics.’ However, currently workers with a terminal illness are not classified as having a Protected Characteristic and therefore have very limited legal protection against employers dismissing them due to illness.
Unfortunately this means that employers are therefore free to dismiss terminally ill workers once they have made ‘reasonable adjustments’ to the employee’s job to assist with the illness. I am sure you will agree with me that the last thing a terminally ill worker needs is to have to fight for the right to continue working and not to face the indignity of being sacked.
Furthermore, the loss of death in service benefits to terminally ill workers sacked before death is a further distress at a time when security for a family for the future should be protected.
I therefore hope that you are able to support the ‘Dying to Work Campaign’ and to work with the campaign to help introduce new legislation that
- Seeks to get terminally ill workers covered by Protective Rights at Work in line with those covered by Pregnancy/Maternity Rights
- Seeks to protect death in service benefits
- Seeks to allow workers with terminal illness to die in dignity
To find out more about the campaign please do email Lee Barron at the Midlands TUC lbarron@tuc.org.uk
I look forward to your response
Yours sincerely
Suicide is commonly understood as a deeply personal act. It is usually linked with mental health problems, and is - rightly - regarded as a tragedy for its victim and all those their life touched. The bereaved are often left with so many unanswered questions: Why? How could I have helped? Could they have been stopped? As a recurring phenomenon, no two suicides are treated the same way. It is a highly individuated response to a unique set of circumstances experienced by the person who passed away. It's down to psychologists to explain and counsellors to prevent. Because it is so private and so individual, this is why Emile Durkheim wrote a book about it. His Suicide, published in 1897, sought to turn the tables on conventional wisdom. It was more than a personal, individual act. Suicide was a social phenomenon and, as such, was a useful topic of study for the then fledgling discipline of sociology. Hailed as a classic since its publication, Suicide has been a touchstone ever since. My cohort studied it when we did our A-Levels. My students had when they did theirs. And before me my teachers had. It's part of how we learn sociology in Britain.
Not any more it seems. It was announced last week that AQA, the exam board that covers the majority of A-Level students is dropping it from the syllabus and expunging it from AQA-compliant text books. This act of disciplinary vandalism, like most things, is done with the noblest of intentions. A spokesperson for the exam board went on the record as saying it has "a duty of care to all those students taking our course to make sure the content isn’t going to cause them undue distress”. Really. What then is so distressing about Durkheim's Suicide?
There are two aspects to Durkheim's study: an analysis of suicide statistics among Protestants and Catholics, and a delineation of various "types" of suicide based on his reading of the data. He found that men were more likely to take their own lives than women, single people over married people, childless people over parents, soldiers over civilians, a correlation between it and higher levels of formal education, and the most stand-out finding: Protestants more so than Catholics. From here, Durkheim moved to explanation.
As a theorist deeply interested in the maintenance and perpetuation of social order, this figured quite heavily. He suggested that suicide fell into four distinctive types. There was egoistic suicide, which was related to being adrift from one's community, of not being integrated into and feeling apart from it. A precipitating factor was excessive individuation that sharply differentiated them from the rest of the community, and without that anchoring suicide became more likely. People falling into this category tended to be those with little or no social bonds, such as single/childless men.
Durkheim's second category was altruistic suicide, or excessive "deindividuation". Think of Spock sacrificing himself in The Wrath of Khan to save the Enterprise, as "the needs of the many outweigh the needs of the few". In a society with high levels of integration and solidarity, suicide here is arrived at because it has a socially sanctified end and, in some way, protects that social coherence/the greater good (however that is defined). Taking one's life to protect one's/family's honour, or self-sacrifice in times of war typifies this kind of suicide.
Thirdly there is anomic suicide. In his earlier book on the division of labour, Durkheim argued that industrial societies rest on divisions of labour that are only going to get increasingly complex. As it diversified and specialised, so our lives becomes ever more interdependent on one another. Durkheim hypothesised that this could lead to new forms of consciousness, that an 'organic solidarity' may emerge in which each is conscious of everyone's place in the social system, and that we're engaged in a common human enterprise. While regulated by sets of values and expectations, real societies fall somewhat short. The division of labour does not work for everyone. Whole branches of industry can disappear along with jobs and the social fixity they bring. Where social conventions no longer match social realities, dislocation and anomie - a state of normlessness - may prevail, and for some people the new situation is too difficult to cope with.
Lastly, there is fatalistic suicide. If anomie is the outcome of meagre social bonds, fatalism is related to too many. Picture an institution or society that is overbearing, has too much regulation, that intrudes into various aspects of individual life; a social situation in which the power of the collective is as pervasive as it is stifling. With such crushing conformity, some, who for whatever reason cannot escape, may come to the conclusion that life is no longer worth living.
Suicide is a classic text that lends itself to A-Level sociology for a number of reasons. It is a tightly-confined study. It serves as a basic exercise in comparative statistics without getting caught up in complex mathematical procedures that can test their veracity, and so on. It's useful to show that social relations are probabilistic phenomena, not iron laws that grind out predetermined outcomes. It's a good introduction to Durkheimian concepts like anomie, and how scholars attempt to build theory from data. And, lastly, it's an early corrective to the facts statistics baldly state. For example, as Durkheim noted, is it truly the case that Protestant societies have higher rates of suicide than Catholics, or because of the stigma and shame traditionally attached to it by the latter do families and communities conspire to rewrite suicides as death by other causes? Suicide is a simple, straightforward study that, crucially, introduces students to sociological thinking.
Taking Suicide off the syllabus is incredibly shortsighted. It's not as if any A-Level tutor introduces the study as a jolly good larf, rather than a classic 19th century investigation of a vexatious issue. I can understand that AQA are adapting to the "triggering" culture, but then all other awkward and potentially upsetting topics should stay off the course. More students, for instance, are likely to have been touched by domestic violence, racism, and so on than suicide - should these be scrubbed out too? Suicide is upsetting, but ultimately AQA are in flight from their wider social responsibilities. The one thing worse than talking about suicide is not talking about it. Sociology's job, among many other things, is to demythologise social phenomena in a never-ending attempt to understand the patterns of behaviours of huge collectives of human beings. If some areas are ruled out and made taboo, that understanding ceases. It becomes strange and, despite AQA's laudable motives, ignorance can breed insensitivity, potentially leading to more discomfort for the students they aim to protect. It's time for a rethink - leave Durkheim's Suicide on the syllabus.
How do you deal with people who have committed horrific and violent acts and yet at the same time have not been held criminally responsible for them? This is the premise for the latest two-parter from Louis Theroux, who in recent years has graduated from his tabloid telly documentaries to more mature - and darker - subject matter. This series sees him peer into several Ohio State psychiatric hospitals to meet the inmates placed there by the courts after being found NGRI - not guilty by reason of insanity. In this first episode the accent is very much on rehabilitation. This facility is not a lock up and throw away the key-type institution. The ghoulish and the titillated would not find a Hannibal Lecter analogue here. But the question remains and, given the nature of the crimes committed, are rehabilitated patients ready for the outside world again? And is it willing and ready to accept them?
As is usual Theroux practice, he tells the story through a number of character studies. The first we meet is Jonathan, a man who had spent two years in this particular hospital. Having had a history of mental illness that began with depression, he developed the delusion that his dad had abused him at a young age and was therefore responsible for his unhappiness. And so one morning, while his back was turned, Jonathan stabbed his father to death.
In the seven years since, he has come to terms with actions. It took several months for him to realise that he had done something truly awful and now believes he wasn't abused as a child. Later on in the show, Jonathan goes to the assessment board who advance him up to movement level five. These levels correspond to how "well" the psychiatric staff deem a patient. The higher the level, the more responsibilities and freedoms they can have. In Jonathan's case, as he has been making good progress with his treatments and responding to them well, getting awarded the highest level will allow him to leave the hospital unsupervised. And he plans to use this to visit the local library, go to church on Sundays, and have dinner with his Mom. The only problem is, which he recognised, were the triggers that may spark off an outburst or threatening behaviour. In Jonathan's case, he knew that stress was the catalyst - the last time he had encountered it was when someone recognised him but for his part he was able to resolve the issue and was able to prevent his symptoms from exhibiting.
We also meet Cory as he's about to undergo a periodic reassessment. As someone who is also on movement level five, he has concerns about his eventual release and being able to make it on his own, especially as he's not looking forward to living alone. Probed gently about why he's inside, he had also suffered a catalogue of mental health problems. It came to a head when his girlfriend slashed her wrists and thought that this was part of some conspiracy against him. This brought on the delusion that if he was to die, somehow his death would help Obama get elected to the White House. When the police turned up he attacked the lead officer with an iron bar, and despite getting shot three times he was able to seriously injure him. Talking frankly in front of the camera with a psychiatrist, he admits to hearing voices seeing shooting stars. Sometimes he does what the voices tell him, but won't listen if they suggest bad things. Besides, he says he knows they're not real.
Judith's case was something of the stand out. She had been hospitalised for five years for stabbing a woman on the bus. Despite witnesses, she denies this took place. She also recognises that she's been diagnosed schizophrenic since the 70s but denies her mental illness. Judith believes that she is being held against her will because her release would mean some very powerful people will get embarrassed. While clearly exhibiting mental health problems during her screen time, I was reminded of Erving Goffman's famous book Asylums - no patient could progress through the system until they admit they are ill and submit voluntarily to the programme. In Judith's case, because she refuses to countenance her illness she's basically stuck and doomed to remain there indefinitely until she does.
Louis did introduce us to a tentative success. After five years, William had been approved for conditional release. He had been committed for reckless driving, after getting the notion Wright Patterson Airforce Base were watching him from space. He also simultaneously believed himself to be the Muslim messiah and was in psychic contact with Benjamin Netanyahu. At the same time he suffered with bi-polar disorder, and we see him obsessively checking his medicine before bidding the hospital farewell. As far as he was concerned, these were what stood between him and insanity.
We catch up with him later in the month since release, along with his mom Beverley. Here we are treated to a potted case history that seemed to begin when William was 15/16, shortly after he started experimenting with heavy doses of LSD. Beverley is adamant this is where his problems stem from because as she put it, "do you want me to ever admit that I gave birth to a nut?" How very supportive.
Unfortunately, dealing with the final patient, Eric, we're reminded why the rehabilitation procedures and regimen of medicines discharged patients have to abide by are so stringent. In 1989 Eric was out on weekend release and for whatever reason, he did not take his meds. Eric ended up killing two people. Right now, he's stuck on movement level three seemingly unable to progress higher, apparently because of a 'verbal incident' tat has basically set him back 12 months - it won't be until next year before the assessment board meet again to determine his case. Nevertheless, he hasn't given up hope.
As a serious exploration of mental illness, Louis Theroux certainly deserves some congratulation for turning in a piece of film-making that explores it sensitively in much the same way his previous pieces paedophiles and American jails had done. These are not cardboard cut outs. In most cases they are shown to be people trying to come to terms with what they've done and how going through the system is helping rehabilitate them. This seemed especially the case with Jonathan. Though probably an effect of getting used to the presence of cameras, as the show progressed even lay people could see how his behaviour improved. He appeared more thoughtful and reflective, and indeed went out his way to thank Louis for asking non-medical questions that caused him pause for thought. There is still a huge distance to travel before mental illness is accepted, as well as treated with the due seriousness it deserves. But as someone who is fortunate enough to have good mental health, there's a good chance Sunday night's show did its bit to helping the tendency toward acceptance along.
However, there is one gripe with By Reason of Insanity I have an issue with. And that's informed consent. You get the impression there had to be some serious negotiations between the BBC and Ohio's mental health services. After all, this was the first time in 60 years that cameras had been let into any of their facilities. Yet where do the patients themselves stand with this? While all those interviewed appeared capable of making responsible decisions up to a point, were they informed that attracting extra publicity to their cases could have consequences for them on the outside? Even if the documentary is due for broadcast only in Britain, we live with the internet and it wouldn't be too difficult for something intended for audiences over here could circulate over there. Especially when none of the hospitals featured would be particularly difficult for Ohio residents to track down. So what were the patients told and what did their doctors advise? While doing a good job on mental illness overall, it is these troubling questions that are left unanswered.
This story caught my eye as I was preparing to teach earlier today. The science behind three-person babies is exciting and interesting, and holds the promise of banishing mitochondrial disease to the medical history books. The science, which I don't properly understand as I spent GCSE science tippexing natty doodles on my biology folder, involves removing mitochondria from an egg and replacing it with that from another donor before it is fertilised. Any babies born from this technique effectively have genetic material from three people.
You can understand why the Church of England and the Catholic Church in England are in a tiz about it.
Children are born from a union of a woman and a man, bound together in holy matrimony. Sex is a necessary evil to make babies that can only take place after a church has sanctified a relationship in the eyes of God. Just as same-sex relationships are abominations in traditional/literal readings of the Bible, and sex outside of marriage is also something Very Bad Indeed. Stands to reason that babies made from three parents, of being born not of one woman but two, falls foul of the holy screed.
And yet what's interesting are the grounds the CofE and CCE are choosing to oppose the draft legislation due before Parliament tomorrow. The BBC quotes Rev Brendan McCarthy, the CofE's adviser on medical ethics saying ,"We need to be absolutely clear that the techniques that will be used will be safe, and we need to be absolutely sure that they will work." Then comes a line about having the necessary ethical debates. In what looks like a bit of coordinated messaging, Bishop John Sherrington of the Catholic Church is quoted as saying "No other country has allowed this procedure and the international scientific community is not convinced that the procedure is safe and effective ... There are also serious ethical objections to this procedure, which involves the destruction of human embryos as part of the process."
This is very smart positioning by both churches on this debate. By leading with the scientific uncertainties around the process they make the inevitable theological follow up a bit more palatable. True enough, there are unknowns associated with the procedure - even though the genetic contribution from the "third parent" is a minuscule 0.2% of the resulting embryo's genetic make up. That said on the balance of that figure and a review of evidence so far, the balances of probability of abnormalities resulting from this procedure have to be vanishingly small.
What the churches have done is to seize upon the presence of a third genetic donor and - misleadingly position them as if they're an equal party to the process when they're not. They're relying on the wider public, including MPs due to debate the bill, who are interested/exercised by the ethical questions around fertility and genetic medicine to not be as equally well-informed by the actual science underpinning it. In other words they're spinning a story, quite adroitly, that appears to take up the science but uses that as a draw bridge for the theology to march across. That's fine, the churches are part of public life and should freely voice their opinions on public issues. It's just a shame they feel the need to bear false witness to do so.
Those lovely folks over at Daily Express TV have hit on a relatively untapped vein of hate. Marry together your idea of the undeserving poor sponging off the hardworking tax payer with fat people and you have the perfect scapegoat: someone who cannot work because they are obese. Channel 5's Benefits: Too Fat to Work is an exercise in demonology dressed up as concern porn, and befitting the quality publications of the station's proprietor the facts of the matter - such as only 12,000 people out of a population of 60m plus are officially deemed "too fat to work" - cannot be allowed to get in the way of an hour long exhortation to mock, condemn, and hate so we can feel better about ourselves.
There is Rachel Lacy from York, a 20 stone woman who's been unemployed since the summer. She is not in receipt of disability-related payments, really wants to work but states that her job-hunting is hampered by her weight.
Amy Johnston is an 18 year old woman who weighs in at 32 stone. She receives £120/week in social security support - £71 in what I can only assume is non-work related support group Employment Support Allowance and a top up from Disability Living Allowance. She's looked after by her mum, who was out of work at the time of filming.
Then there are the stars of the show, Stephen Beer and Michelle Coomb (pictured). Steve is 31 stone and has a number of health complications arising from his weight, whereas Michelle is 23 stone and doubles up as his carer. Both are unemployed - she hadn't worked for 20 years whereas Steve stopped working in 2008 after getting incapacitated by a stroke.
Because this is tabloid television, it makes every effort to portray our guests as utterly undeserving. And it does that by making them out to be shammers.
In Amy's case, it's the big bottles of coke stowed away in the cupboards. For Rachel, to save public money in the long-term she's elected to have a gastric bypass so she can slim down, be more healthy and find a job more easily. Yet the narrator refers to the £6,000 operation as "paid for by the state" and as a "tax payer funded procedure". This is prefaced by a "some people commit to diet and exercise" to lose the weight, implying - of course - that Rachel is but a sponger who can't be arsed to help herself.
The true venom is reserved for Steve and Michelle. They got what they call in Big Brother fandom a "bad edit". As the camera pans their living room, we notice the gadgets. Laptop, check. Tablet, check. Telly and cable box, check. Sauntering down the community centre for a slimming club weigh-in, he lost one pound and she five pounds in the previous week. How to toast the achievement? WIth a takeaway, of course. A large doner kebab for Steve and a mound of spicy chicken for Michelle. The narrator caustically notes, "£11.50 spent - best to keep it quiet". Later on, Michelle heads to the shop to buy bolognese and Steve is shown struggling to chop mushrooms. He collapses exhausted on to the sofa, and shows no such difficulty eating the meal and his ice cream dessert.
The narrator helpfully cuts in at all times with gems like "the taxpayer forks out £8,000/year for Steve's carer" - a woman who comes and attends to him twice a day. He gets about town on a mobility scooter "paid out of his benefits", and the £3,000 wedding the programme works towards (and ends with his hospitalisation because of a blood clot on his lung) evolves from "the wedding" to "the benefits wedding" to the "big fat benefits wedding". How we larfed.
Steve is ideal scapegoat fodder. He receives "£2,000/month in handouts" (he doesn't), he's profligate (because he orders one takeaway and spends £16 on some shopping), and doesn't help himself by not taking his diet seriously (more of which below). His, and that of his fellow guests, have had an image crafted carefully to enrage the audience, to make them objects of hate. Channel 5 took their characters and sliced and diced them for entertainment.
Too Fat to Work is condemn-a-little-more-and-understand-a-little-less in its almost purest (and most puerile) form. The show (to call it a documentary demeans the genre) doesn't explore why Amy, Rachel, Steve and Michelle people are obese. With Amy, her mum suggests it's because she was too busy with work to feed her properly when she was younger. Pulling 13/14 hour shifts were not conducive to family life, so she was fed convenience foods. With Rachel, there's a hint that depression might be the root of her weight problems. When we first meet her she talks about her pet rats and how feeding them means she has no choice but to get up in the morning. That sound like someone not struggling with depression to you? And for Steve, there is a moment, an almost a cast off suggestion that his difficulty with controlling his appetite is associated with his stroke. A struggling overworked and underpaid mum trying to bring up her kid. A woman coping with depression. A man whose impulse control was damaged by a stroke. Are these people worthy of your condemnation?
Weight and obesity in the UK is, if you forgive the pun, a big problem. 66.6% of men and 57.2% of women aged 20 and over are either overweight and obese. The obesity figures for the under 16s are 26% of boys and 29% of girls, up from 17.5% and 21% respectively in 1980. When one person in your community is obese, it's probably because of some medical reason or individual quirk. If there are masses of people who are and their numbers are growing, you've got a social problem.
People always make choices, of course. Choice, however, is always conditioned by circumstance. The obesity rates are up for all kinds of reasons - sedentary lifestyles, less physically demanding jobs, relatively cheap fatty/salty foods, convenience culture and dual income households, the increasing prevalence of depression and mental health problems, body image pressures, all these are doing their bit to make weight a social problem. Yet rather than look at these issues and learning how they conspire together, we have shitty programmes like Too Fat to Work taking a public health issue and using it to attack the "generosity" of social security provision and the individual moralities of people living with obesity. It's pure bait and hate, dividing and ruling.
Meet your new hate figures. Same as the old hate figures.
Cancer is the best death, apparently. As a medical practitioner and former editor of the British Medical Journal, one supposes Dr Richard Smith knows what he's talking about. His argument is almost philosophical, making the case that a long descent into the grave allows for the wrapping up of one's personal affairs and prepares friends and family for life after you. Considered in isolation from the traumatic experiences this disease causes millions of people every year, I suppose there's a certain logic to it. Though I'm not too sure about "wasting" billions on curing cancer. The pharmaceutical industry and its doings are far from unproblematic, but the war against disease is a good war. It should be up to individuals when to call it a day after all.
Published simultaneously was a study claiming that the majority (two thirds) of adult cancers are the results of bad luck. You have wonky genes, or one of your stem cells might slip up somewhere. It is, however, worth noting that we're talking *types of cancer* here, not cancers in total.
As Owen points out, cancer - like a great deal of disease - has been individuated. The rise of lifestylism and the markets that feed it are constantly reinforcing the message that health is a matter of personal responsibility. If you don't want cancer, then eat well, do your exercise, and avoid smoking, boozing, and fatty foods. Treat your body like a holy shrine, not a drip tray catching the run off from a revolving hunk of doner meat. That's the hegemonic set of ideas washing about health policy, public health discourses and the common sense of lifestyle gurus. Contrasting the biologically random chance of cancer puts paid to some of the guilt tripping this industry, for that is what it is, thrives on. That, however, only goes so far. Cancer is social.
Take Stoke-on-Trent, for example. According to the 2012 Public Health Report for the city, it is the 16th most deprived local authority area in England (out of a possible 326). 60.3% of people live in areas among the top 25% most impoverished areas in the country. About half of that (31.3% of total Stokies) lived in the top ten per cent of most deprived communities. In 2008-10, the life expectancy for men in Stoke was 76.2 and women 80.2, whereas for England as a whole it was 78.8 and 82.6 respectively. Of the main causes of death in 2011, 72.9% was made up of respiratory disease, circulatory disease, and the biggest was ... cancer. It accounted for 31.7% of total mortality across the city. The equivalent figure for England is 28.1%. Among the under-75s, the average cancer mortality rate per 100,000 was 141.6. A historic low, but significantly greater than the same statistic for the country as a whole (112.5). There's considerable variation within the city too. In Meir Park ward the rate was 78.4 whereas Bentilee and Ubberley returned a figure 0f 191.8. The difference? Wealth. If you live in a wealthier area, you're a third more likely to survive a cancer diagnosis.
As befits the age, the story our culture tells about cancer is one of individuals battling against the disease, as per Stephen Sutton, or folks rallying around to to raise awareness. What it refuses to talk about the bigger picture, how diagnosis and survival is very much linked to one's material circumstances. The danger is talk of cancer being entirely random disappears the awful truth: that regardless of type it is mediated by social conditions. That makes the war on cancer more than just a medical matter. It's a political question too.
Health emergency in West Africa? Who gives a shit. Until the last month or so, that pretty much summed up the attitude in Western newsrooms and policy-making circles. After all, when is there not some kind of health crisis blighting the people of Sub-Saharan, central and southern Africa? HIV/AIDS is an ugly shadow cast over the fate of entire nations. According to the UN 1-in-20 live with the disease, with over 15% of 15-49 year olds infected in some countries. As awful a social disaster and human tragedy this is, it pales next to Malaria where, despite falling infection rates, it kills a child every minute. Meanwhile, diarrhoel infections carry off approximately 1.5m African kids every year. So yeah, there's been outbreaks and rumours of outbreaks before but as long as it never threatened our green and pleasant, few but concerned journalists and far-sighted public health experts were banging the Ebola drum.
There's politics too. Successive governments make big deals about protecting the overseas aid budget. While Dave's parading of development cash smacks more of "not all Western governments!" posturing, there is precious little the department has done to challenge lazy journalism and the festering little Englandism it stokes. This is a politics that says Britain has no place helping the poor in developing nations when states there are building infrastructure and investing in future proof industry. This silence has helped engender an utterly toxic politics around aid questions paralleling home grown scrounger discourse. In the early stages of the Ebola outbreak, intervening decisively across Liberia, Sierra Leone, and Guinea required the kind of mobilisation we're only now seeing. The difference then, of course, that a great deal of political capital would have been staked without an obviously tangible outcome. No one is thanked for curbing a small-scale outbreak, especially where African lives are concerned.
And now, it's almost too late. The experts say our posse of barely-functioning states, Western military and medical personnel, and transnational NGOs have 60 days to get the outbreak under control before the contagion runs amok. With many blighted communities going "off-grid" and refusing to cooperate with what limited authority there is, and the drip, drip of infections outwith the region - including a likely Ebola death in Macedonia - it all smacks of the TL,TL syndrome (too little, too late). Given the scale of the disaster unfolding and the historical debts France, Britain and the US owe Guinea, Sierra Leone and Liberia respectively, more resource and more volunteers should be poured into the region.
Meanwhile at home, there is very little governments can actually do to face down Ebola. The much-vaunted screening splashed across the evening's bulletins are more about reassurance than public health. Remember, the disease takes 21 days to incubate before entering its most infectious - and lethal - phase. There's no breathalyser, no tricorder, no bloody speak-your-tropical-disease machines. It's just going to be an infrared scanner and medics with multiple choice questions. As the government flag up these "robust" protective measures, it's also emphasising how "well-equipped" Britain is to deal with Ebola infections. We have the procedures, the beds, the infrastructure and the expertise to deal. If it turns up on these shores? Nay problem. We are not Liberia.
All that might be true. If the government says it, of course it is. But beware unintended consequences. Sensibly we are being warned to seek medical advice/attention as soon as we present symptoms. Unfortunately, initial symptoms are fever, headaches, joint and muscle pain, and a sore throat. Last week I had the dubious pleasure of contracting freshers' flu. Guess what symptoms I was exhibiting? It's not beyond the realm of possibility that a few more confirmed Ebola cases in the UK could spark a stampede at walk-in centres, doctors' surgeries, A&Es of people suffering nothing other than the seasonal sniffles and shakes. Better-to-be-safe-than-sorry could touch off an almighty winter beds crisis, complicated by a decreased lack of capacity to catch Ebola sufferers. What a shambles.
And there we have it. Western complacency and the toxic politics of overseas aids has, in Britain's case, raises the possibility of an entirely avoidable health care meltdown. It's the kind of situation the word 'omnishambles' was invented for, but one in which misery will be reaped. Not laughs.
Let's get one thing straight from the off. The idea of charging a £10/month NHS "membership fee" is bloody stupid. Not just because it violates the principle that health provision should be free at the point of need, but for a whole host of other practical reasons. But let's glide Lord Warner's suggestion into a lay-by for the moment and deal with the concern he aims to address: that the NHS budget is spiralling out of control and something has to be done to arrest it.
Well, no. The NHS is not "unsustainable". The UK consistently ranks as a mid-table spender on health. But costs are increasing, and when you're talking billions of pounds here, billions of pounds there overall spending can look very scary indeed. Which is precisely why those on the right, including Warner, frame it as they do. By making it appear unaffordable they're breaking the ideological ground for yet marketisation, yet more shakedowns of the taxpayer by private health interests.
What are driving costs upwards though? Here are three key drivers.
The first of these is the outcome of what health watchers like to call the "epidemiological transition". That is back in the day, in the NHS's infant years a great effort was made to eradicate the causes of infectious diseases. Slum clearances, sanitation works, better nutrition, immunisation programmes worked together in a sequence of virtuous feedback that improved health and mortality rates right across the board. It's only now with the ominous spectre of drug-resistant TB and other nasties that infectious disease is becoming a public health concern. For most of the NHS's life, costs have been driven by the preponderance of chronic health problems. Partly associated with improved life expectancy, the care demands of broken, worn, aged bodies put pressures on health services. Quite apart from the rising demand for carers, the older you are the more you will need to see a doctor, take drugs, and go in and out of hospital. Particularly with present pensioners, the majority of whom would have had manual occupations of one sort or another, the wear and tear of working life can sneak up on you as you age.
Perhaps in the costs of chronic illness in the future will come down as the jobs of post-industrial Britain tend to be less physically demanding. But on the other hand, mental health problems are on the increase. The NHS may be left coping less with damaged bodies and more with broken minds.
The second are NHS supply arrangements - the servicing of PFI debts, procurement, and - increasingly - the growing costs of new medicines and medical technologies. Though gene screening and therapy, stem cell research, nanotechnology and exotic cocktails of wonder drugs promise a great deal, pharmaceutical companies are having to sink greater and greater quantities of capital into research with gradually diminishing returns. To recoup costs and, of course, make a profit new drugs and new treatments are very expensive. The NHS, however, can act like a captive market for many of these products. In fact, it might make sense to regard our health system as a manifestation of socialism for the rich. Big pharma takes a risk investing in a particular line of research, but mitigating it somewhat is the knowledge there's a guaranteed buyer already lined up. This allows drugs companies a great degree of latitude when it comes to determining a price and, of course, as profit maximisers they're going to ask for the highest price possible. Naturally, as their costs go up so does their charges.
Lastly, there is the bitter fruit of successive waves of marketisation, of which the Tory and LibDem Health and Social Care Act 2012 is the latest manifestation. While health care is free at the point of need in the majority of cases, the NHS is no longer an institution. What it is now is a label, under which wriggles public and private health providers all competing for commissioning contracts to deliver services. It's a complex, abstract business - which is why the government were able to force it through with comparatively little fuss. Strangely, ironically you might say, markets have been introduced into the NHS to drive costs down and strengthen efficiencies. As we know, there are too many politicians who believe the profit motive equals cheaper, better service. In the NHS, as it is in the HE sector too, reams of managers and accountants have to be kept on the payroll to put in bids for services, monitor market signals and, ludicrously, charm, schmooze and lobby funding bodies (Clinical Commissioning Groups) for contracts. Far from eliminating red tape, the market is building new layers of public bureaucracies. It's eating up resources that could be better spent elsewhere.
If one was truly concerned about the NHS bill, might I suggest these be looked at first? But returning to the £10 plan it is, once again, a mark of stupid empiricism - proving the Tories don't have a monopoly on this degenerate, decadent form of political thinking. There are two problems that immediately leap out. The first thing is the charge will strengthen the consumerist tendency among a layer of patients, fuelling a sense of service entitlement that could push up the demand for more GP visits, more drugs, more hospital appointments, and so on. The second and more serious issue is that a system of costs doesn't come for free - how much of the fee would be top sliced by local authorities (Warner supposes it would be collected via council tax)? How much would end up in NHS budgets? How much bureaucracy would be added to the NHS administering the charges system? It's a ridiculous idea, and had it appeared tomorrow it would be dismissed as the foolish larks of an obscure member of the upper house.
Another good cause. Another charity stunt exploiting social media. If you're unfamiliar with #NoMakeUpSelfieForCancer, it's pretty self-explanatory. Post a "bare" selfie of your face to the social media platform of your choice and make a donation to Cancer Research UK. Theoretically, friends in your timeline/feed will see it, do the same, and so on. As viral campaigns go, it's been a success with the charity reporting a surge in donations. It's very clever and raised a bag of cash. Great stuff, right?
Not a few Twitter celebs have written about the problematic character of the initiative - that women being seen without make up is a special event, that women are somehow compromising their sense of self without cosmetics, that by forsaking product for a day they are upholding hegemonic constructions of femininity. And, of course, there is the assumption all women avail themselves of the latest tones out of New York.
All of this is perfectly true. But also wading into the fray is the narcissistic self. Long exemplified by grasping celebs who "do a lot of work for charidee" (but don't like to talk about it, except on talk shows, in press interviews, or during telethons), the look-at-me nature of social media has similarly taken hold of charity as something that says good things about one's self. Or, rather, those who refuse to participate in orgies of charitable activity must have some deeply unpleasant character flaws. Who wouldn't wear a poppy or grow a moustache for prostate cancer?
Good points, none of which I can disagree with. But let's twiddle with the microscope a bit, and reduce the magnification so the intertwining of social pressure and continual constitution of gender is seen in its lived context, as it's happening at this very moment. In the 15 or so minutes it's taken to write the above, hundreds of pictures of - mainly young - women have tipped into the aforementioned trending topic on Twitter. A cursory glance down my Facebook feed shows dozens of women placing pics, donating and encouraging friends to do so, and occasionally swapping moving stories about loved ones - nanas, mums, aunties, sisters, daughters, friends - lost to cancer.
#NoMakeUpSelfieForCancer can be critiqued for the way it reinforces standard gender tropes, but that's half the story. The flipside is the generation of affective relations between participants, of sharing pain but, most importantly, facilitating a basic, weak tie of solidarity between women in addition to raising money for cancer research.
I find sexism and the oppression of women disgusting. But radical critique has to be careful piling into public manifestations of gender normative behaviour mob-handed, lest it reads like sneery, elitist cynicism. It must be dialectical - the drawbacks are inseparable from the positives and needs to be alive to them. In this case, a popular social media movement has ended up forging new connections between women around common experiences. Isn't that, from a feminist point of view, a good thing? Yes, it is. The job then is not to put distance between criticism and the real movement of women but think of ways of making that message as relevant to them as today's charity stunt has.
