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A week has passed since the election and our political parties have had time to reflect on their victory or demise. With such a huge majority in parliament, we can be certain, whether we agree with it or not, that Brexit will be done in one form or another. The prime minister at the first meeting of his cabinet, and as if on cue ready for my blog, in front of the cameras repeated the pre-election promise of 40 extra hospitals and 50,000 extra nurses.
Putting aside my cynicism and concern about how we, as a country, are going to grow enough money trees without our foreign agricultural workers after Brexit, I welcome this much needed investment. I should add here that in the true sense of fairness, pre-election, other parties were likewise offering wonderful trips to fairyland, with riches beyond our wildest dreams. Trying to out trump each other, they managed to even out trump Trump in their hyperbole.
However, rather appropriately as it turns out, whilst sitting in the waiting room at a general hospital on election day, I read a couple of disturbing articles in the i newspaper. Pointing to the fact that makeshift shelters are becoming increasingly common in British cities one article quoted statistics from Homeless Link showing that rough sleeping had increased by 165% since 2010 (Spratt, 2019). Alongside, another article stated that A&E admissions of homeless patients had tripled in the last eight years with 36,000 homeless people attending in the last year (Crew 2019). Whilst I am always cautious regarding statistics, the juxtaposition makes for some interesting observations.
The first being that the promised investment in the NHS is simply a sticking plaster that attempts to deal with the symptoms of an increasingly unequal society.
The second being that the investment will never be enough because groups in society are becoming increasingly marginalised and impoverished and will therefore become an increasing burden on the NHS.
Logic, let alone the medical profession and others, leads me to conclude that if a person does not have enough to eat and does not have enough warmth then they are likely to become ill both physically and probably mentally. So, alongside the homeless, we can add a huge swathe of the population that are on the poverty line or below it that need the services of the NHS. Add to this those that do not have job security, zero-hour contracts being just one example, have massive financial burdens, students another example, and it is little wonder that we have an increasing need for mental health services and another drain on NHS resources. And then of course there are the ‘bed blockers’, a horrible term as it suggests that somehow, it’s their fault, these are of course the elderly, in need of care but with nowhere to go because the social care system is in crises (As much of the right-wing pre-Brexit rhetoric has espoused, “It’ll be better when all the foreigners that work in the system leave after Brexit”). It seems to me that if the government are to deal with the crises in the NHS, they would be better to start with investment in tackling the causes, rather than the symptoms*.
Let me turn back to the pre-election promises, the newspaper articles, and another post-election promise by Boris Johnson.
My recollection of the pre-election promises was around Brexit, the NHS, and law and order. We heard one side saying they were for the people no matter who you were and the other promising one nation politics. I don’t recall any of them specifically saying they recognised a crisis in this country that needed dealing with urgently, i.e. the homeless and the causes of homelessness or the demise of the social care system. Some may argue it was implicit in the rhetoric, but I seem to have missed it.
In her article, Spratt (2019:29) quotes a Conservative candidate as saying that ‘nuisance council tenants should be forced to live in tents in a middle of a field’. Boris Johnson’s one nation politics doesn’t sound very promising, with friends like that, who needs enemies?**
* I have even thought of a slogan: “tough on poverty, tough on the causes of poverty”. Or maybe not, because we all know how that worked out under New Labour in respect of crime.
** The cynical side of me thinks this was simply a ploy to reduce the number of eligible voters that wouldn’t be voting Conservative but, I guess that depends on whether they were Brexiteers or not.
Crew, J. (2019) Homeless A&E admissions triple. i Newspaper, 12 Dec 2019, issue 2824, pg. 29.
Spratt, V. (2019) ‘You Just didn’t see tents in London or in urban areas on this scale. It’s shocking’: Makeshift shelters are becoming increasingly common in British cities. i Newspaper, 12 Dec 2019, issue 2824, pg. 29.
Dr Stephen O’Brien is the Dean for the Faculty of Health and Society at the University of Northampton
The other week I had the opportunity to visit one of our local prisons with academic colleagues from our Criminology team within the Faculty of Health and Society at the University of Northampton. The prison in question is a category C closed facility and it was my very first visit to such an institution. The context for my visit was to follow up and review the work completed by students, prisoners and staff in the joint delivery of an academic module which forms part of our undergraduate Criminology course. The module entitled “Beyond Justice” explores key philosophical, social and political issues associated with the concept of justice and the journeys that individuals travel within the criminal justice system in the UK. This innovative approach to collaborative education involving the delivery of the module to students of the university and prisoners was long in its gestation. The module itself had been delivered over several weeks in the Autumn term of 2017. What was very apparent from the start of this planned visit was how successful the venture had been; ground-breaking in many respects with clear impact for all involved. Indeed, it has been way more successful than anyone could have imagined when the staff embarked on the planning process. The project is an excellent example of the University’s Changemaker agenda with its emphasis upon mobilising University assets to address real life social challenges.
My particular visit was more than a simple review and celebration of good Changemaker work well done. It was to advance the working relationship with the Prison in the signing of a memorandum of understanding which outlined further work that would be developed on the back of this successful project. This will include; future classes for university/prison students, academic advancement of prison staff, the use of prison staff expertise in the university, research and consultancy. My visit was therefore a fruitful one. In the run up to the visit I had to endure all the usual jokes one would expect. Would they let me in? More importantly would they let me out? Clearly there was an absolute need to be on my best behaviour, keep my nose clean and certainly mind my Ps and Qs especially if I was to be “released”. Despite this ribbing I approached the visit with anticipation and an open mind. To be honest I was unsure what to expect. My only previous conceptual experience of this aspect of the criminal justice system was many years ago when I was working as a mental health nurse in a traditional NHS psychiatric hospital. This was in the early 1980s with its throwback to a period of mental health care based on primarily protecting the public from the mad in society. Whilst there had been some shifts in thinking there was still a strong element of the “custodial” in the treatment and care regimen adopted. Public safety was paramount and many patients had been in the hospital for tens of years with an ensuing sense of incarceration and institutionalisation. These concepts are well described in the seminal work of Barton (1976) who described the consequences of long term incarceration as a form of neurosis; a psychiatric disorder in which a person confined for a long period in a hospital, mental hospital, or prison assumes a dependent role, passively accepts the paternalist approach of those in charge, and develops symptoms and signs associated with restricted horizons, such as increasing passivity and lack of motivation. To be fair mental health services had been transitioning slowly since the 1960s with a move from the custodial to the therapeutic. The associated strategy of rehabilitation and the decant of patients from what was an old asylum to a more community based services were well underway. In many respects the speed of this change was proving problematic with community support struggling to catch up and cope with the numbers moving out of the institutions.
My only other personal experience was when I spent a night in the cells of my local police station following an “incident” in the town centre. This was a case of being in the wrong place at the wrong time. (I know everyone says that, but in this case it is a genuine explanation). However, this did give me a sense of what being locked up felt like albeit for a few hours one night. When being shown one of the single occupancy cells at the prison those feelings came flooding back. However, the thought of being there for several months or years would have considerably more impact. The accommodation was in fact worse than I had imagined. I reflected on this afterwards in light of what can sometimes be the prevailing narrative that prison is in some way a cushy number. The roof over your head, access to a TV and a warm bed along with three square meals a day is often dressed up as a comfortable daily life. The reality of incarceration is far from this view. A few days later I watched Trevor MacDonald report from Indiana State Prison in the USA as part of ITV’s crime and punishment season. In comparison to that you could argue the UK version is comfortable but I have no doubt either experience would be, for me, an extreme challenge.
There were further echoes of my mental health experiences as I was shown the rehabilitation facilities with opportunities for prisoners to experience real world work as part of their transition back into society. I was impressed with the community engagement and the foresight of some big high street companies to get involved in retraining and education. This aspect of the visit was much better than I imagined and there is evidence that this is working. It is a strict rehabilitation regime where any poor behaviour or departure from the planned activity results in failure and loss of the opportunity. This did make me reflect on our own project and its contribution to prisoner rehabilitation. In education, success and failure are norms and the process engenders much more tolerance of what we see as mistakes along the way. The great thing about this project is the achievement of all in terms of both the learning process and outcome. Those outcomes will be celebrated later this month when we return to the prison for a special celebration event. That will be the moment not only to celebrate success but to look to the future and the further work the University and the Prison can do together. On that occasion as on this I do expect to be released early for good behaviour.
Barton, R., (1976) Institutional Neurosis: 3rd edition, Butterworth-Heinemann, London.
A personal tale about the NHS – I am one of the lucky ones
This blog recounts the experience of the care of my parents in the last two years, which has been exemplary and, in the context of the recent reports about the crises in the NHS, reminds me how lucky I was to experience this. It also reveals how well the NHS can perform when it is not under stress, is properly resourced and valued, even when dealing with health problems associated with old age and during the extra strains which occur during winter.
My father passed away at the end of August last year, after 2 years under the care of an NHS facility specialising in caring for dementia patients. The illness had not just affected his memory, but had also led to aggressive behaviour which required him being sectioned under the Mental Health Act. This was obviously a stressful time for us all, but also a time when we understood this was the only option. He soon settled into a new routine, in a home where he felt safe, cared for and where his needs could be met. It was also vital that this was located near his home in North Yorkshire, so that my mother could visit three times a week, and maintain the bond of their marriage, providing both of them with the companionship they so valued. Visiting could be difficult if he had a bad day, but most of the time he appreciated the company and was clearly happy to be in a place where he just did not have to worry about anything.
What struck me most about the place was the demeanour of the staff – they were helpful, kind, accommodating, caring – all the things you would want from those in the health and social care professions. This facility brought these sectors together in a partnership to meet the many physical health needs of dementia patients, while remembering their role as carers. It was not just about administering the medication needed to keep patients calm, it was also about interacting with them, taking them for walks, days out and bringing in a variety of forms of entertainment. Patients celebrated Halloween, Christmas, Easter and engaged in activities which took them back to places and people they could remember, often through music of various genres. Dad always liked jazz, and occasionally classical, with a real fondness for Ella Fitzgerald. These times were so important, for 2 years, even though things had changed, the Dad we knew was back during some of our visits, and we could just appreciate this time until he passed away.
I feel sadness now at his loss, but also because I know not everyone with dementia who needs this sort of care will get it. In the lottery of health and social care, we won, and the prize was the sort of care I think everyone should have access to. What angers me about this is that it is NHS Trusts across the country, simply cannot provide this. They have to make decisions about the care of citizens based on budget spreadsheets and staff availability, rather than what is understood to be the best practice, clinically sound and will create the best outcomes for patients and relatives. The recent BBC report on the ‘10 charts that show why the NHS is in trouble’ (see http://www.bbc.co.uk/news/health-42572110) clearly illustrate why not everyone receives the care my Dad received. For example, it emphasises that we have an ageing population, meaning the NHS is dealing with increased numbers of patients with chronic conditions such as diabetes, heart disease and dementia. These are conditions which are described as ‘more about care than cure’ where patients need support, where healthcare requires as much of a focus on social care as it does on medical interventions. This has financial implications, as care for ‘average’ patients over 65 years old costs the NHS 2.5 times more, compared to the ‘average’ 30 year old, and this only increases with age.
Spending on the NHS has decreased from 6% of the government budget during 1997 to 2009, to 1% as part of the austerity agenda of the Conservative/Liberal Democrat coalition, with a slight increase back up to 2.5% under the current government. This also represents a lower proportion spent on healthcare compared to other EU countries such as Germany, Sweden and France – who are all above the EU average. They do this by through increased taxes, and this seems to be the crux of the matter. Would the citizens of the UK tolerate a rise in taxes to have better provisions in health and social care, for themselves and their family? According to a poll by Ipsos MORI, 40% would back a rise in income tax, with 53% supporting an increase in National Insurance payments. However, it was also revealed that the majority of participants valued the NHS and did not wish to change to an insurance based system.
So, a choice must be made. Personally, with what I experienced with my Dad and more recently, when my Mum had heart surgery to replace a valve, from which she is recovering very nicely, I cannot imagine not having the NHS. Perhaps we do not recognise its value until we need it, but given the strains it is under now, and that one way to alleviate this is to increase funding, then governments should surely consider tax rises to provide this. The NHS provides health and social care we will need one day, if not for us, then for loved ones, and it seems to be a model of healthcare most people in this country would prefer. With an ageing population, the current investment being below the average of 4% provided to the NHS since its inception in 1948, is having an impact. It is an impact which Jeremy Hunt and Theresa May seem to bat away as isolated problems, not trends, and as problems they are dealing with. I do not think we should be discussing our health service as being able to cope with crises and unexpected demands. We should be discussing in terms of being able to provide equality of care, even in the face of the unexpected, using a service which reflects the values of the welfare state, to ensure wellbeing, safety and healthcare from cradle to grave, for all citizens.
Senior Lecturer in Criminology