A civilised society supports people in need, but our brutal system shatters lives

Aditya Chakrabortty in The Guardian



Simon’s death certificate tidies away his life in a few terse official phrases. Date of death: 12 November 2017. Causes: “a) Fatty liver” and “b) Alcohol misuse”. No bureaucratic curiosity about how a 51-year-old’s life came to be cut so short.

Which leaves his only brother, Dave, dealing with the grief and asking all the whys. Why did Simon die so young? Why did no one else try to help?

No obituaries will be written for Simon, no plaques mounted, no tributes passed by politicians. But if you want to understand how Britain fails so many people in so many places, it’s stories like his you need to study.

Some people’s lives are like arrows, flying straight to their destinations. Not Simon’s. The Rhymney Valley, in south Wales, is where he was born and died, but it wasn’t where he spent most of his adult years, and it was never where he meant to land up. Bright boys, he and Dave had one notion drummed into them: get an education, and get out. On TV, Dave remembers, “We’d see the yuppie revolution going on in London – the Porsches and the red braces. It may as well have been another country.” For them, Thatcher meant mines closing, factories shutting, men being laid off in their thousands, and families going under.


Yet there are so many people like Simon, all surplus to requirements of this shrunken economy


Both sons flew away. Simon was the high-flyer, leaving Wales to do a science degree, going to Cambridge for postgraduate study, and becoming a software engineer with a giant defence firm. He married and settled far away, in Bushey, on the outskirts of London. He had got on his bike; he had looked for work. Now he was earning three times what his younger brother was making, and raring to join the yuppies.

Just as he was starting to live the dream, the dream fell to bits. He got divorced. He got laid off. Then their mother’s breast cancer returned – this time for good. The prodigal son moved back, moved in, and became her carer. Dave doesn’t remember him complaining once during the years their mother spent deteriorating and then dying.

Such setbacks await all of us, but one test of any civilised society is how well it supports us through them. In Simon’s case, Britain botched this test – over and over again. By the time his mother died, he had spent seven years outside the job market. It was 2007, the start of the credit crunch, and the economy was slowing. Even in boomtown London such a gap on the CV would have raised recruiters’ eyebrows. Here in south Wales, where jobs were already scarce, it was the kiss of death. Besides, it simply did not have positions for Si, with his Cambridge postgrad and software engineering background.

Simon “spent 25 years building up to be somebody”, says Dave. A quarter-century observing the social mobility rules laid down by Margaret Thatcher and Tony Blair. He had aspired, he’d grafted, he’d kept his side of the bargain. But while social mobility trumpets opportunity for individuals, it ignores the communities where those people live. The result was that Simon’s ambitions had outgrown his home, and now he was trapped.

Dave showed me the small terrace house their mother passed on to Simon, where he spent the last years of his life. No one was about as we walked through the speck of a village – just two long rows of cars parked outside the train station. This is the new Welsh commuter class that economists such as Cardiff University’s Calvin Jones talk about, the people who travel from the valleys to staff the call centres, shops and other minimum-wage employers in Cardiff or Newport.

Governments in Westminster and Cardiff Bay have spent decades promising to rebuild the shattered economy of south Wales. Serious money has been spent on shopping malls, new motorways and sweeteners for big business. Each time, the firms come, take the cash and – at best – leave a few poverty-paying jobs. You see the same cycle in so many deindustrialised parts of Britain. And each time, the politicians learn no lessons, and try the same thing again.
A few minutes from Simon’s old home is the town of Bargoed, where the greatest excitement in recent years was the opening of a Morrisons. Much of the rest of the high street is just memories: a huge statue to commemorate dead miners, the chapel turned into a library, and shop after shop with its shutters pulled down for good.

A rural bus services in Fochriw village, Bargoed. South Wales is one of the poorest regions of the UK. Photograph: Martin Argles for the Guardian

Simon signed on at the jobcentre, which told him to apply for 35 jobs a week. He sent off to become a teaching assistant, a warehouse operative, all the minimum wage jobs going. Barely an application led to an interview. Sometimes, “angry and very down”, he’d miss his targets or appointments. He would get sanctioned, go broke, and have to call on Dave to tide him over.

After years of knockbacks, Simon declared he’d never be able to work again. It came almost as a relief. “It meant he didn’t have to think of himself as such a failure. Now he could be a victim.”

Simon had always been a pub man. But now he’d get up in the morning and start on a glass of watered-down scotch and a sci-fi DVD. By the end of a day, he’d have finished the DVDs, his fags and an entire bottle of Scotch. Why does Dave think no employer wanted him? His answer comes back in a small, tight voice. “No one wants a 50-year-old, unemployed, overweight, drinking guy on the books, do they?”

Yet there are so many of them, all surplus to the requirements of this shrunken economy. A GP in Bargoed estimates that up to one in 10 of her patients have some kind of drink or drug addiction. Up to one in three suffer depression or anxiety. In these parts, a newborn boy can expect to live just over 61 years in good health; in the richest parts of London, it’s 75 years.

Having been one of Blair’s strivers, Simon was now one of George Osborne’s skivers. He was moved on to disability benefits, before the Department for Work and Pensions assessors declared him fit for work. His money would periodically stop until his GP contested the verdict. This spring, he was moved on to universal credit, which meant six weeks with barely a penny. Again and again, it was Dave who had to bail him out. It was Dave who suggested jobs Simon could apply for, small businesses he might start. The younger brother was filling in for the state, while Si lived in ripped clothes and ate junk. “The government was abusing a vulnerable man.”

Alcoholic Simon would go to the local NHS drink service once every few weeks – and every few months, he’d end up in such a bad state he would be admitted to hospital. They’d “dry him out, then spit him out”, says Dave. According to the thinktank the Nuffield Trust, the Welsh health system is underfunded by £500m a year.

Simon died in his small house, waiting to go back into hospital to dry out. He grew up in a town with men who’d had to dig out children from the Aberfan mining disaster; he died the year Grenfell Tower burned down. When such obvious tragedies strike, the politicians and the press vow to tackle the social injustices that caused them. But Simon was just one man dying in plain sight of his neighbours, his family and state officials. Far easier to chalk up his death to a fatty liver and booze, rather than inequality and austerity and the false promises peddled by politicians from Thatcher to May. A dead man, a dying town: he spent his last days being told he’s fit for work in an economy that has next to no work.
What’s left is a younger brother beating himself up about what he should have done and angry at others for letting them both down.

Before we part, Dave asks: “Why wasn’t there someone who could step in and help? Is that naive of me? To think that a modern, 21st-century society could do that for people who need it?”

The names in this piece have been changed and details obscured in order to protect the identity of Simon’s family

This NHS crisis is not economic. It's political

Aditya Chakrabortty in The Guardian


As the health services endures its biggest squeeze, talk of it being unviable is wide of the mark. We cannot afford to do without it

 

Patients wait for spaces in A&E at Royal Stoke university hospital in Stoke-on-Trent. A&E waiting time targets have been watered down in recent years. Photograph: Alicia Canter for the Guardian


How many times have you read that the NHS is bust? No need for answers on a postcard: I can tell you.

Over 2015, the number of national newspaper headlines featuring “NHS” alongside the words bust, deficit, meltdown or financial crisis came to a grand total of 80. Call this the NHS panic index – a measure of public anxiety over the viability of our health service. Using a database of all national newspapers, our librarians added up the number of such headlines for each year. The index shows that panic over the sustainability of our healthcare isn’t just on the rise ­– it has begun to soar.


During the whole of 2009, just two pieces appeared warning of financial crisis in the NHS. By 2012 that had nudged up a bit, to 12. Then came liftoff: the bust headlines more than doubled to 30 in 2013, before nearly tripling to 82 in 2014. Newspapers such as this one now regularly carry warnings that our entire system of healthcare could go bankrupt – unless, that is, radical change ­are made. For David Prior, the then chair of the health watchdog the Care Quality Commission - and now health minister, that means giving more of the system to private companies.

This means that the press and political classes are now discussing a theoretical impossibility. Think about it for a moment, and you realise the NHS can’t go broke. It’s not an endowment with a set pot of cash, but a giant service with a yearly budget. Unlike a business, it doesn’t need to raise money from sales – as taxpayers and voters, we have the final say over how much funding it gets. This panic isn’t economic at all, but politically created.

The balance to be struck with the NHS, as with all public services, is between how much cash we sink into it and how much we expect in return. Give the NHS less money, get less healthcare. Give it more, and the opposite happens. As Rowena Crawford at the Institute for Fiscal Studies says: “Financial stability just requires that healthcare demand and expectations are constrained to match the available funding.”

And that right there is the rub. Because the NHS is enduring the sharpest and most prolonged spending squeeze in its history – even while the government pretends no such thing is happening and the public expect the same service. Our health service is where all the paradoxes of austerity come home to roost.

This may seem an odd thing to say. Isn’t the NHS one of the very few parts of the public realm to be sheltered from this decade’s cuts? Didn’t David Cameron promise before the last general election to “protect the NHS budget and continue to invest more”?

  David Cameron addresses the Tory conference in October 2014. Photograph: Facundo Arrizabalaga/EPA

The figures suggest otherwise. True, the NHS is seeing a rise in its funding. Between 2010 and 2014, health spending went up 0.8% each year, adjusting for inflation. A plus sign in front, granted, but a teeny-tiny one – since its creation in 1948, the health service has never had it so bad. Over this decade as a whole, that allocation will amount to 1.2% a year, which is way down on the average 3.7% that health spending grew each year between 1949 and 1979. And, coming after the 6.7% extra that Gordon Brown was shovelling in annually by the time of the banking crash, it feels like a recession.

So on the one hand, you have a healthcare system that can cause even the most secular of Brits to get religion, that can drive Telegraph-reading colonels to channel their inner Nye Bevan – hell, that even beats Justin Bieber to a Christmas No 1. And on the other you have a Tory prime minister who wants to cut public spending but knows that harming the NHS will be electoral poison.

Put the two together and what do you get? A dangerous muddle of overspending, frontline service cuts and political self-denial.

Cameron pretends the NHS isn’t on austerity rations and expects it to do the same work to pretty much the same targets. The various parts of the NHS try to do just that with a budget smaller than they need, with the result that they begin missing targets and making cuts even while breaking their budgets.

Take the A&E waiting times. Under Labour, the old rule was that 98% of patients must be seen within four hours. Soon after Cameron moved into Downing Street in 2010, the target was watered down to 95% of patients – even so it is now routinely missed. The number of patients stuck on trolleys in A&E, while staff try to find them beds is now at levels that “no civilised society should tolerate”, according to the Royal College of Emergency Medicine .

Even while falling short, arm after arm of the NHS is now in the red: 95% of hospital and other acute care providers in England plunged into deficit in the first half of the financial year starting in April, joining 80% of ambulance providers and 46% of those in mental health.

Demoralised staff can resign, go on an agency book, pick their shifts and earn more

You might treat all this as argument for NHS staff to be more productive. Except that, as John Appleby of the King’s Fund thinktank argues, they are. He calculates that, had NHS activity only gone up in line with government money, between 2010 and 2015 it would have treated 3.7 million fewer outpatients and 4.5 million fewer A&E patients than actually got seen.

This is productivity as doing more with less, which is almost always unsustainable. A real increase in productivity would come from doing things differently. There’s certainly scope to do that – by doing more phone consultations with GPs, perhaps, or upgrading technology. One joke among NHS professionals runs that, in all of China, there’s but one factory left still making fax machines, and that its only client is the NHS. But this sort of change is never going to come in an organisation now in a frenzy of cost-cutting.

One example of NHS austerity’s screwy logic is its sudden reliance on expensive agency staff. This, says Anita Charlesworth of the Health Foundation charity, is a direct result of staff pay freezes and overwork: “If you’re a permanent member of staff and you’ve had no pay rise and you’re demoralised and disengaged you can resign from the NHS, you can go on an agency book, you can pick your shifts, you can pick your wards and you earn more.”

The result is that agency staff costs are rising at over 25% a year.


Meanwhile, NHS England pretends it can cap hospital deficits for the year at £2.2bn – even though in the first six months alone that had already hit £1.6bn . Some of Britain’s biggest and most renowned hospitals are now actively planning on ending the year in the red. And Appleby points out that everything from patient time with doctors and nurses to repairs of your local hospital’s roof is being sacrificed in order to do the same work with less money.

“I can see another Jennifer’s ear coming,” Appleby says, referring to the five-year-old with glue ear who waited a year for a simple operation and ended up being used by Neil Kinnock to attack John Major on health spending. “Only this time it probably won’t be something as innocuous as glue ear. It might be a child who dies of cancer because their medical care has been so drastically cut.”

As societies get richer and older, they spend more on healthcare. Compared with nearly everyone else in western Europe, the UK spends much less of its national income on health. By the end of this decade, we will be even further behind. Meanwhile, pundits will continue to claim the entire system is unaffordably expensive, even while the public still want and need doctors and nurses, their medicines and operations.

This is the paradox of austerity: pretending that you can scrap and scrimp on the services and institutions that make you a civilised country, without making your country less civilised.