Tag: Austerity

A scientologist homeopath in a K hole.

The Nursing Times reports on the falling number of nurses and midwives registered to work in the UK over the past few months.

Perhaps this does not matter to most of us as we worry about whether to buy our Christmas from John Lewis or J D Wetherspoon, or before concerning ourselves with the searing injustice and travesty that is some prancing git in a sparkly shirt being being shown the door before he has had the chance to enthral us with his pretty feet. Perhaps we believe that the real life Holby Cities truly are staffed with the beautiful, if very flawed, people who can perform miracles with just a twitch of a stethoscope, frowning and cries of ‘morphine stat’ before being covered in projectile vomit. Perhaps we think NHS staff smile through the mask of emetic substances dripping from their faces as they perform miracles every hour.

To take our minds off the future, when many of us will face our last days in some piss stained, overcrowded brightly neon lit corridor being looked after by an alcoholic doctor, and a Zimbabwean care assistant whose slim grasp of English is matched only by a desert dwelling Uzbek goat fucker with access to a torn, half copy of the Beano in which to learn verb conjugation, we stare at the TV screen promising us youthful skin, a drive on an empty mountain road and the chance to vote on some nonentity whose song we will not remember, will not buy and will merely momentarily dose us to kill the pain of ennui that is everyday life in consumer capitalism.

Nursing is being reduced to running around with a bucket, a mop and some hope, all aimed at stopping the bleeding. We all have orifices that need plugging from time to time lest we leave a trail like a pissed up slug on a mission to the next lettuce. However Florence Nightingale had higher hopes for the successors of her young ladies in training than being reduced to cleaning wounds with their own tears and the silk of parachutes from the nearby war museum. The measures of success on many shifts includes having the same number of live patients that you started with, avoiding a fight with a drunk (it is a bonus if the drunk is not the consultant) and being sprayed with non infectious urine. The great vision for the NHS includes the provision of care by families and a few care assistants. Registered Nursing, you know…the sort that includes people who might be able to spot if your babbling and loss of consciousness is not the result of being given the bill for care but is in fact the early stages of sepsis, is on its way out. Family care is fine, if your family is more Waltons than Addams. Do you really want your old mum, or your wife, poking her finger up your anus in order to clinically examine your tonsils? What your wife does in your spare time at home is your own business, but is she the right person to be prostate tickling in the intensive care unit when you are actually complaining of a headache?  Imagine Grandad, after a six pints of mild and bitter, pushing his way through the throng around your sick bed shouting; “stand back, I’ve got this” while brandishing a toilet brush and barely concealed menace?

This is what the ‘Austerity’ actually means. Hunt will blather about more training places…but we know ‘more’ is not the same as ‘enough’. Austerity, we should remember actually means the ‘dissembling of the protectionist state in order to facilitate the transfer of public services to private ownership’. Hunt know this…it is part of the plan. He once called the NHS a ‘great commercial opportunity’. Why should Hunt et al give a toss about hospitals and schools that they will never use? They are as disconnected from our social reality as a Scientologist homeopath in a K hole.

I’m sending Granddad over to Richmond House.

Family ShirkersPhoto by Benji Aird on Unsplash

Photo by Benji Aird on Unsplash

 

Family Shirkers

 

Front page of the Daily Mail October 2017:

 

Britain is a ‘selfish’ society where families shirk their duty by ‘outsourcing’ the care of their elderly relatives, a Government minister has warned. Phillip Lee, a GP, said families needed to face up to ‘uncomfortable’ truths about the demands of looking after elderly parents or grandparents, rather than expecting the state to care for them. He said society had become too ‘selfish’, with help delivered only by workers who were ‘paid to care’. He said the UK was becoming an ‘atomised’ country that failed its most vulnerable – and it could learn from how the Muslim and Hindu communities look after their elders”.

Why did an anti welfare state, pro austerity, patriarchal national newspaper print this in bold on the front page?

Why has a Government minister put this out? Why has Theresa May allowed this minister to say these things? Why is this the latest plank in the Tory strategy?

One reason is Boris of course. We need to be distracted from ‘clearing away bodies’.

Another is fear. They fear a Labour resurgence.

 

Another is that they need to continue to gather support for cutting public spending.

 

Another might be post Brexit concerns that care staff who are EU nationals will not be here in enough numbers.

 

An atomised society? The Doctor however points to the causes of the ills of society to its victims rather than its perpetrators.

 

‘A selfish society’. Who is he referring to? The nurses who work overtime for no pay? The firefighters, alongside many other workers, who have had a pay cut over the past 7 years ? Women who give up an income to look after children? The army of retired volunteers who work across a variety of charitable organisations ? The RCN calculated that unpaid overtime by nurses saves the NHS about £360 million per year. How selfish is that. The bastards.

 

Is he referring to the top 0.01%, many of whom have enjoyed a massive increase in wealth for merely owning stuff, inheritance, luck and engaging in speculation?

 

Those that enjoy the fruits of finance, rentier and crony capitalism?

 

No. He means ordinary people dealing with myriad social and economic pressures who no doubt also include the ‘just about managing’. Except, in his eyes they are not managing well enough by adding neglect to the list of sins they daily commit.

 

If there is selfishness in society it can be found in the unwillingness of many in the capitalist executive (CE) and their friends in the political power elite (PE) to value and pay for caring as labour vital to keeping everything else going. This activity is also known as ‘social reproduction’. Capitalism recognises only two domains: The Public and the Private, in which labour is a commodity to be bought and sold in a market. Strip away the social, political and technological complexity that sits upon ‘cash for labour’, and you are left with this base relationship.

 

Capitalism does not recognise the other two domains: the household or the commons. In the household, labour is expected to be given as a gift. There is no cash nexus in the household. The commons is merely a resource to be used. Care is a commodity in the public and private sectors, but as a product of labour it merely stands as a proxy for labour and therefore is a cost which reduces capital accumulation. Just as capital tries to reduce wage costs, it has to reduce care costs through wage control. If capital can shift care back into the household where it is a gift, then it magics away a cost. Patriarchy assists in the ideological work required to shift care out of the public sector and back into the household. Religion based patriarchy is a powerful tool in this process, in that you can get women willingly to sacrifice themselves to the family in the name of holiness and love. Under capitalism, thus is sacredness made profane.

 

The need to reduce cost requires an attack on graduate professional nursing alongside devaluing what nursing is. Graduate nurses are expensive to employ.  Ideally, and ideologically, what nurses do should be done for free or for minimum wage because it is ‘merely’ care that does not require a degree, and is something all women can do.

 

In order to control the public finances the CE and PE are dismantling structures which have supported people in times of disability, illness and unemployment. This is done because they fear capital accumulation will be jeopardised if the national debt is not paid off. This ‘systemic structural selfishness’ thus places the requirement for capital accumulation above the needs of those requiring care. As a result, care is provided in many cases on low wages, terrible conditions and quite often as a gift freely given, a fact exploited by employers in care homes and hospitals. Health and Social care is conceived of as a capital cost rather than as fundamental to individual and social well being.

 

Underpinning this is the ideology of the patriarchal traditional family, in which the (male) breadwinner supports the (female) carer who looks after children and elderly parent. Social conservatism aligns with the political economy of Austerity. In short, you can cut public spending by getting women back into the home to provide unwaged, unpensionable care work as a gift to themselves, to their family, to society and to the economy. If you can designate nursing and social care as low skilled women’s work, it is easier to push it out of the public sector and back into the household.

 

The good doctor is a patriarch living in an affluent bubble cut off from the social and economic realities of millions of people’s lives. He projects his own values onto everyone else without considering if people are able to take the opportunity cost of lost wages.

 

His reference to Muslims and Hindus is interesting. Put aside that this is a sweeping categorisation, how exactly do these families look after their elderly? The picture is changing as some Asian families respond to changing social and economic realities. I don’t know if it is simply about their ‘family’ values, although it is often reported that this is a key aspect of caring for parents at home. However, do those values operate within large families were there are many children to take responsibility among them, and where women stay at home or work part time? If this is the case, is this the lesson we should be learning – have more children, don’t move away, women to leave the labour force? What if women do not want to pay the ‘motherhood penalty’ (could be 10-14% for maternal leave and taking 5 years to catch up) or in the case of parental care, the ‘daughterhood penalty’?

 

 

I think the narrative behind this ‘shirker’s’ comment is the current long running story: “There is no magic money tree, Labour crashed the economy, we have to pay off the debt”. When you want to pull the plug on financial support for social care you have to come up with a more forceful moral argument other than ‘there is no money’. The Tories realise that more and more people do not believe them when they say there is no money. They have seen for example an instant ‘bung’ to the DUP. The Tories realise that more and more people know that the banks, not Labour, crashed the economy. They also know that more and more people know that a national economy debt is not the same as a Household debt.

 

So, arguing for continuing Austerity is electorally more and more looking like a busted flush.

 

The Tories are getting desperate, they need a new narrative, or more correctly, to reinvent the old one.

 

The answer is to repeat and fall back on the ‘moral underclass discourse’ which asks you to think about strivers v skivers, welfare cheats, benefit scroungers and now add to that list we have ‘family shirkers’.

 

It is part of Thatcher’s ‘No such thing as society’ narrative. The pooling of risk through general taxation and then state spending to spread the financial burden across the whole population is ideological anathema to many, but not all, Tories. They prefer that only individuals and families should provide social care, with a minimal (affordable) input from everyone else.

 

This is not just about money…it is a deeply held ideological belief and moral position about who should care for whom. Of course, how that is paid for cannot be disentangled from this moral position.

 

Watch out for more stories about how ‘selfish’ children are abandoning parents in ‘sink’ care homes to ram home this ‘moral neglect’ narrative.

 

This will be done without referring to issues around geographical and social mobility, precarity in employment practices, house prices and affordability, wage stagnation, the cost of education, the disappearance of pensions, restructured families, family size, gender roles, inequalities in health, social inequalities, parental leave issues, employment attitudes and gaps and the level of consumer debt.

 

Instead, as with benefit cheats, there will be a focus on dysfunctional family relationships, a ’cause’ rather than as also ‘symptom’ of much bigger issues.

Of course families will want to, and do, provide care. Dr Lee knows this. But he is tapping into deeper moral intuitions in order to facilitate the cutting of the social care bill.

 

Andrew Dilnot in the Lancet lays out a less sensationalist argument:

 

“First, there is a fairness argument. In universal health-care systems, such as the UK’s National Health Service, the financial burden of health care does not fall on those unlucky enough to need it. Money is raised through a progressive tax system, and used to provide health care free at the point of use. If it is right to act in this way in the case of, for example, someone with cancer, why is it right to expect someone with dementia or acute arthritis, who cannot look after themselves, to bear the financial burden of their own care?”

 

“Second, there is a market failure argument. In the case of health care, in the absence of universal state provision the alternative is private insurance, which is available in most countries, and is seen at large scale in, for example, the USA. But this alternative is not feasible in the case of social care. The uncertainties surrounding the possible cost of social care provision are so great that private insurers do not and will not make such cover available. Therefore, in the absence of state activity, individuals cannot pool their risk, so that although most of them will not face high and extended costs, they are all left facing that possible worst case scenario. This scenario is terrifying for individuals, and very inefficient. If the private sector cannot pool the risk, the case for the state taking that responsibility, at least in part by providing social insurance, is very strong”.

 

Well in response, the Doctor argues that individuals and families should bear the burden rather than shirking their responsibilities. The real target is not shirking families, it is of course the ‘cradle to grave’ welfare State.

 

 

 

Crises in health and social care. Who pays/who cares?

Crises in health and social care. Who pays/who cares?

 

Roy Lilley has recently blogged about the provision of social care for older people in the UK. The important point being made is that private providers, Saga in this case, are finding that they cannot make any money out of providing that service. If they cannot make any money then the business is worthless. The question then is who will take this on?

 

Marion Dakers, financial services editor for the Telegraph, reported (in January 2015) that Saga was selling its publically funded care home business. In 2011, Saga took-over Allied Healthcare. This is important because Allied claimed that 93% of local authorities contract with them.

 

The CEO of Saga, Lance Batchelor, said:

 

“…the margins were not enough to justify the investment needed to grow the business…

 

In May 2015, David Brindle reported:

 

“… the Saga group quietly slipped out preliminary annual results recording a loss of £220m on its ‘discontinued’ Allied Healthcare business, largely through writing down its balance-sheet value to nil.”

 

There was more:

 

“… this value has been determined by considering the current asset and liability position of the business; the future profit cash flows and the associated capital investment set out within the management’s five-year plan for the business; the risk attaching to the various cash flows and the costs of disposing of the business,”

 

Brindle also commented that:

 

“In so far as homecare featured in the (2015) general election campaign, it was in respect of the sector’s questionable labour practices: heavy reliance on zero-hours contracts and low, occasionally illegally low, pay. We heard little or nothing about the centrality of the sector to any hope of making our health and social care system sustainable”.

 

Saga said:

 

There are a range of ways of valuing the business and it is our expectation that an appropriate buyer will ultimately value the business higher than nil.”

 

So currently Saga’s homecare business is worth nothing, in a market worth £6 billion. They hope however that a future buyer will be able to value the business above zero. What confidence do we have that a private sector provider will want to enter this business without increased payments from the local authorities who buy the service, or without decreased costs coming from cutting provision, downward pressure on pay or selling off assets.

 

The wider context is that local authorities have faced budget cuts under the last government and therefore they have less money to pay for social care.  A possible way of meeting the shortfall between what the LA pays and the actual cost of provision could come from individuals or families, or private insurance schemes. Efficiency savings in providing care seem unlikely to reduce costs.  Will a private sector company want this business without government financial support? Brindle’s point remains: to what degree is the current system of health and social care financially sustainable?

 

Roy Lilly argues:

 

“Considering the margins and liabilities involved; loss of reputation and brand value if something goes wrong, bad publicity or a serious, sustained quality failure… this is a toxic business. No one in their right mind will touch it. The business is worth nothing”.

 

If this turns out to be the case, who is going to pay for the health and social care needed by an increasing number of older people in the community?

 

Margaret Thatcher once said:

 

there is no such thing as society, only individuals and families”

 

One way of reading this is to think that society will not and cannot provide care, because it does not exist, and so it is up to individuals and families to do so. This is rooted in Edmund Burke’s philosophical conservatism which is distrustful of a big state. It is also rooted in Hayekian free market economics that also sees little or no role for the state in many spheres of social life beyond providing a safety net. ‘Individual responsibility’ for health and social care is a lightning rod, it channels fears about big state socialism which is antithetical to conservative, and neoliberal thinking. The answer is of course for more private insurance schemes if individuals and families want to provide care. The main message being sent out by government since 2010 is that ‘the money has run out’. The implication is that now individuals and families will have to pay more for health and social care because the state cannot.

 

David Cameron, in a speech at the Lord Mayor of London’s Banquet on November 11th 2013, outlined the strategic objective: ‘austerity is here to stay’, he said:

 

“The biggest threat to the cost of living in this country is if our budget deficit and debts get out of control again…we have a plan…it means building a leaner, more efficient state. We have to do more with less”.

 

Efficiency savings will only get us so far. Part of the ‘more’ he refers to is ‘more social care for older people’ with ‘less’ meaning Local Authority spending cuts. Again, how will this be paid for?

 

A 2012 report by the Nuffield Trust and the Institute for Fiscal studies on ‘NHS and social care funding: the outlook for 2021/22’, suggested:

“…only a long term freeze in other public service budgets or large tax rises could enable a return to the 4.0% average annual growth to which the NHS has become accustomed”.

Health and social care are currently split in terms of funding, but care needs, be they social or health, are in reality are part of the same package. The NHS needs increases just to stand still. So we are facing further freezes in public service provision, this may include LA payments for older people in social care and care homes, as large tax rises were not promised by the Tory government in the 2015 election.

 

The recommendations of the Dilnot Commission on Funding care and Support called for major reforms that would, if accepted, increase costs to the taxpayer. So both Dilnot and Nuffield suggest tax increase might be needed. This is antithetical to Cameron’s ‘more with less’ and to the visceral loathing felt by many on the political right for taxes. Cameron and Osborne are not stupid men, they must have been briefed in detail on this issue.  One conclusion is that during elections and in public they talk ‘tax cuts’ but in private know they will have to raise taxes or face down those requiring health and social care?

 

Richard Humphries, at the King’s Fund, gave a stark warning to people in the UK regarding paying for social care:

“I think they can expect very little unless they are very poor or have very high needs, in which case they will get help both with arranging care and with paying for it. But for the majority of people they will be expected to pay for it themselves.”

 

The BBC has set up a ‘costs of care calculator’ – a first step perhaps in understanding in future liabilities for care costs.

And for balance – don’t expect the leadership of the Labour Party to be any more generous on this issue.

Food poverty in the UK

George Osborne will give his Autumn statement to the House of Commons this Thursday. He will be upbeat about ‘recovery’ and GDP growth. What he will ignore is the fact that the recovery is very patchy, based on rising house prices, a mini consumer spending spree in certain areas (e.g. London) and increasing consumer public debt within the context of a low wage, precarious job market. These are part of the UK’s social determinants of health. The ’causes of the causes’ of ill health.

Admissions for malnutrition, BMJ graph

Watch out for entreaties to those will little resources to learn to cook and spend their money more wisely – in other words, “if your child goes hungry, it is your fault”.  This is what I call the default ‘Daily Mail’ individualist analysis which only gets you so far.  Use your sociological imaginations to analyse what is going on – how do you link the personal trouble of going hungry and being admitted for malnutrition with the public issue of food poverty in the UK today? The graph published by the BMJ shows that in 2008 when the UK experienced the start of the financial collapse, bank bail outs and the beginning of austerity policies aimed at reducing welfare spending, there were a little over 3000 admissions for malnutrition. In 2012 that had risen to about 5,500 admissions.

If only one person was admitted due to malnutrition we should look to the character and situation of that person for a proper understanding and analysis of why. When admissions have increased to 5,500 we need to look to wider explanations that go beyond the individual. What structural transformations are occurring which provide a fuller understanding of people’s experiences?

Both the correct statement of the problem and the range of possible solutions require us to consider the economic and political institutions of society and not merely the personal situation and character of a scatter of individuals” (C Wright Mills 1959).

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