British Politics (Fixing the NHS and Welfare State): What Has Gone Wrong?
I am writing this thread as there is a crisis in the Welfare State and NHS currently. I am sure that this goes back a long way. The Labour government of Starmer (and Rachel Reeves) are trying to find solutions, with a radical overhaul. However, so many people are so extremely disappointed because the solutions seem to target vulnerable growth, especially the elderly, disabled and people with mental health problems. Actually, from budgets and proposed policy it is questionable who will benefit, if anyone.
So much is being spent, especially on ideas of returning the sick to work, even though unemployment is rising as job losses are proposed in the NHS and civil service. Also, it comes in the context of the plan to inspect people's bank.accounts, which can be seen as extremely intrusive and questionable infringement of privacy. In addition, in the benefits system there is a whole emphasis on punitive measures, such as sanctions and suspending benefits.
The latest area is a plan for the government to take control of the NHS? Where is this likely to lead. I know that one current plan is to have door to door visits in the community. But will this really address issues of access to healthcare. I am very sceptical. I have been in hospital recently with a chest infection and got excellent standard of care. I fear that so much which is working will get lost. As I see it the problem is that so much money has been spent on welfare and healthcare, especially since the pandemic. Obviously, this is a large problem but quick-fix solutions are likely to be superficial and not address factors leading to increased sickness.
In writing this thread, I am aware that it needs to be answered without social media links. Therefore, I am asking for your thoughts. In addition, I am interested in what has happened in British politics in terms of policies and the underlying factors in British politics. Also, all of this occurs in a global context, with an emphasis on buying weapons, as well as the addition of Trump tariffs. So, for people in the UK, and others throughout the globe, I am asking how does the politics of the UK fits into the larger picture of the world?.
So much is being spent, especially on ideas of returning the sick to work, even though unemployment is rising as job losses are proposed in the NHS and civil service. Also, it comes in the context of the plan to inspect people's bank.accounts, which can be seen as extremely intrusive and questionable infringement of privacy. In addition, in the benefits system there is a whole emphasis on punitive measures, such as sanctions and suspending benefits.
The latest area is a plan for the government to take control of the NHS? Where is this likely to lead. I know that one current plan is to have door to door visits in the community. But will this really address issues of access to healthcare. I am very sceptical. I have been in hospital recently with a chest infection and got excellent standard of care. I fear that so much which is working will get lost. As I see it the problem is that so much money has been spent on welfare and healthcare, especially since the pandemic. Obviously, this is a large problem but quick-fix solutions are likely to be superficial and not address factors leading to increased sickness.
In writing this thread, I am aware that it needs to be answered without social media links. Therefore, I am asking for your thoughts. In addition, I am interested in what has happened in British politics in terms of policies and the underlying factors in British politics. Also, all of this occurs in a global context, with an emphasis on buying weapons, as well as the addition of Trump tariffs. So, for people in the UK, and others throughout the globe, I am asking how does the politics of the UK fits into the larger picture of the world?.
Comments (39)
From across the pond over here in Kakistan¹ it looks like, iirc, a clusterfuck of knaves: the Royals, Margaret Thatcher, the Tories, Tony Blair's "New Labour" & fuckin' UKIP. Just a wild guess ... but hey I get the latest on the collapse of the UK from that singular, man-in-the-street jounalist Jonathan Pie².
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:smirk:
Just had a news article pop up "Young people should be encouraged more to stay away from the GP so that the sickest in society can be prioritised, Wes Streeting has said".
I know people say the rich would just run if you try to tax them, but with studies showing hundreds of thousands dying from poverty, surely it's going to have to be put to the test.
Quoting Jack Cummins
Yeah. NHS England is/was dissolved, and replaced with some undefined government body. That new government body also has less staff. There are further cuts to the NHS, meaning less staff to do more work.
It seems to me, so far anyway, that the government's plan doesn't change the day to day operations of the NHS in any structural fashion - it makes the government take on the old role of NHS England with less staff. So far it needs to use all the old administrative and logistical mechanisms which contributed to the bloat they want to cut.
How much of the reasons for change resistance in the NHS are due to lack of funding? Probably lots of it.
Quoting Jack Cummins
Our population - and especially our children - are substantially less healthy and well off than they were 30 years ago. Our life expectancies actually dropped recently, and child mortality increased. Our median government salary worker will never be able to afford a house, substantial asset holdings, on their own means.
This is largely down to years of ballooning asset prices, stagnant real wages, and more recently {last 5 or so years} massive increases in grocery prices. The CPIs say 2-5%, which is bull, supermarket staples have gone up 10-30%. Open market rent's about 50% increased in two years in some areas {in Scotland}, it's still at like 75% of a worker's income pre-tax and insurance contributions. People are stopping having kids because they can't afford them, and kids know the future's that bleak. 20% of them have long term mental health conditions. Our schools in poor areas have food and clothebanks on them, they are running out of material.
Job market wise, there's far more applicants than jobs. Entry level positions for nonspecialist, non-trade roles are at like 50-100 applications per callback. Entry to mid level specialist, but non-trade positions, which get publicly posted on the internet, can fill with applicants to interviewer capacity in less than 24h. There are people applying for hundreds of jobs a week, for years, that are qualified for - or even experienced in - roles and receive rejection after rejection. For a job that will barely make them rent. Some letting agencies screen out minimum wage workers now, despite it being paradigmatically the most common age and disproportionately the age of young workers.
This environment potentiates health and employment for no one. And I've not even talked about the long term impacts of covid. Something like 1 in 7 people in the 30-50 age bracket have been off long term sick due to complications from covid, it was mismanaged here, and our population is full of comorbidities that made it more likely. Our government's unemployment figures are fudged a bit, since if someone's been off work for more than two years {can't remember exactly how long} they get removed from the total population for the calculation - they're "economically inactive". To my understanding this got redefined to hide the full extent of the shit Britain's in.
The government believes it's fucking broke - it is - and can't spend anything - it can though. Any effective redistributive measures, and investing in the construction of social housing, and tight rental regulations especially on price in line with the Nordics would help. Our energy regulator can also get tae fuck, record profits for our providers for years, and the elderly being unable to put their heating on, and kids shivering in the night.
Edit: here's something stark for you. If you check the life expectancies in a city, between rich and poor areas... the discrepancy is now over a decade.
The problem is that ideas like the young should stay away from GPs are such sweeping generalisations. The young can become very sick, not just mentally but physically.
Also, the notion that only the sickest should be using GPs involve a culture of fixing very severe problems. If problems are identified early, far less extreme treatment measures may be needed. There is also the idea of health promotion, but this can sometimes lapse into mere prescriptive advice rather than looking at underlying needs and issues.
Getting to the route of inequalities and poor health is going to be a key factor. The idea of staff going door to door in deprived areas seems going but it may be a bit hit and miss. Some people will not be home and it misses the need to address those who are seeking help. There was the idea of walk-in clinics and part of the problem was that they were overused. This points to GP surgeries and the NHS being at breaking point, especially in densely populated areas.
One aspect which is vital is for the link between deprivation, poverty and poor health to be addressed fully. Those with lack of money are less able to care for themselves fully, especially if they are struggling to buy food which is healthy and other essentials. This comes down to the lowest rungs of Maslow's hierarchy of needs.
There is little joined up thinking after 13 years of Tory Government and very much a hands off approach to food industry and the giant companies feeding people utter rubbish.
No idea how to tackle any of it but initiatives need to be piloted and then rolled out.
A simple example would be youth clubs and crime. I am fairly sure ever £1 spent on youth clubs and facilities/sports etc would save many times the investment on reduction on court system/prisons and mental health issues
Subsidising healthy food and taxing rubbish would help with long term health.
However, people need to make choices and we as a society have to make the better choices similar but we also need to expect people to up their game and stop be unfit and obese.
The NHS has been in crisis for as long as I can remember.
Another difficulty is it is part of the "Nanny State" interfering with peoples lives. The nanny state has been rolled back a long way; there used to be school nurses, district nurses free school milk, free school dinners, mother and baby clinics, cottage hospitals (where one went to recuperate after treatment or operation, medium and long stay mental health hospitals, subsidised orange juice, dried milk, and more that I have forgotten. As nanny's health and safety 'red tape' and interfering healthy living projects like swimming pools sports fields, and so on were rolled back, sold off, or whatever, the costs fell on the NHS, that was there to pick up the pieces of broken lives that resulted.
Translating the bullshit we have been sold in plain English, the trade unions have lost their bargaining power, the population has been taught that it is not the rich that are responsible for their misery but gays and foreigners, and that a state that supports the poor and the sick is undesirable and cost them too much. Hence taxes have gone down, real wages have gone down, and government spending on social care has gone down. This is also partly because we no longer have an Empire covering a third of the world to exploit. Those wretched foreigners again wanting to run their own lives.
This cannot be repeated enough (esp. here in the effin' United States of Kakistan since 1980) ...
Quoting unenlightened
:100: :fire:
The blaming on gays and foreigners are part of the problem of unhelpful propaganda. More recently, in England the blame is on the unemployed and people who are disabled or unwell mentally. It is a targeting of those who are less powerful.
I am aware that many may view the 'nanny' element of welfare as an imposition, especially with the idea of taxes. Nevertheless, the English welfare state has been modelled by so many other nations. In Western society, the emphasis on individualism and loss of community, means that without such welfare many would just die on the streets.
This is starting to happen in England, especially as deaths of the homeless are not recorded any longer. Invisible underclasses are developing. Of course, many have become dependent on the welfare state, used and abused it and stretched it to breaking point. But, one critical factor is what happens now when so many jobs are vanishing as tasks once performed by humans are being done by machines. How are those without work, especially those whose work abilities are restricted by health conditions expected to survive?
I agree that initiatives need to be started and ones that are innovative as opposed to punitive. The problem may be that the needs of the people, as opposed to those in power, need to be addressed.
I agree that so much is historically traceable. The privatations of the Thatcher years were significant.
It is extremely important to note how life expectancy may be decreasing, especially in certain areas. I am wondering how far this problem which is occurring will develop, especially for certain vulnerable groups. Also, so much has changed after Covid and the cost of living crisis. More children are living in poverty increasingly. Quality of life for people in Britain, which used to be a wealthy nation, is diminishing rapidly, with some so much more affected than others. The gulf between the rich and poor is widening and this probably corresponds with poor health.
Nor is it clear that things are better anywhere else. Housing is increasingly unaffordable in the US, yet it is one of the most affordable rental and ownership markets in the world. It's "hell" in Canada and the UK, yet income to rental/mortgage rates are actually a good deal worse in most of the developing world.
Certainly, Japan and Korea, might shed some light on things. These are wealthy states that haven't experimented with the neo-liberal ideal of the free movement of labor across borders (migration on a fairly unparalleled scale, e.g. to the extent that German children born today will be minorities in Germany before they are middle age) to nearly the same degree. This, and differing cultures, has given them a different blend of problems (e.g. too much work instead of not enough; homes losing value as investments, or even being given away for free, which is a total loss for someone). Yet some of the other problems are very much the same, or even more acute (e.g. the gender-politics gap/war is probably the worst in ROK, scarcity vis-á-vis healthcare services, etc.).
At the highest level, we can say that the welfare state is going to have sustainability issues if the population isn't growing and/or income and wealth aren't growing rapidly. One solution has been replacement migration, but the demographics who tend to meaningfully boost net population tend to also be low income and low networth, and in many contexts most will never be able to afford the mortgage payments on new construction, putting upwards pressure on housing prices while not resolving the welfare state's fiscal problems in the way native growth would. And the political buy-in required for major redistribution projects (like constructing trillions in new housing) seems to be undermined by the major demographic shifts of replacement migration.
Whereas on the other hand, the dramatic increases in welfare outlays and surge in demand for healthcare that come from a much older population (something migration offsets to some degree) have not been matched by the big increases in income, productivity, and automation that would be required to allow for a healthy welfare state under a shrinking/aging population.
Which is all to say that these problems seem to be an unavoidable consequence of falling birthrates and higher average ages (itself a consequence of falling birthrates), although they might be managed more or less well.
I am not sure if it's a wash though. Unfortunately, I remain pretty pessimistic about the long term ramifications of all this in terms of political stability in the West, and I think history to date bears this out.
And unfortunately, welfare economics has no way of looking at this malaise except as "if people could consume more they would be happier." But it's in no way clear if this is really true. Being able to consume dramatically more mostly seems to make us want to be able to consume even more, and to jealousy guard our new consumption. It doesn't ever seem to lead to blissful satiety. So, the widespread malaise, the ballooning "deaths of despair" and "diseases of appetite" driving down life expectancy, the fact that people find all sorts of labor "unsatisfying " or even "humiliating," and related pathologies seem to me to require deeper psychological, philosophical, and spiritual therapies. Economic policy will do very little on its own, especially when divorced from cultural and educational change.
:up:
Quoting Count Timothy von Icarus
Indeed, Blair's neoliberal all stars, New Labour, were active contributors to the problem.
Indeed indeed. New labour was post union labour. Socialist governments increase income taxes because they are progressive redistributive taxes; Blair's government stealth privatised the NHS with the private finance initiative. Never trust a politician who smiles!
Yet the structural problem is that the system is intended and developed for a situation where the population is growing. If Western countries would have the demographic pyramid of many African countries, this wouldn't be a problem. The larger younger generations could by taxes and other payments take care of the current retiring and retired generations. Because it's natural that after the brief encounter with the system as we are born, it is more likely that we will be customers of the health care system at old age.
That our population doesn't grow and basically is getting smaller makes huge economic problems, but also a problem with health care services. What happens after the boomers are all dead, that's a different situation.
Another issue is that this health care and welfare spending is consumption, and it doesn't create something to the future like true investment or education. Perhaps we should look at it as a necessity for the whole democratic society to chug along, as without the welfare state and transition payments, you will get at worst violent political upheaval, even a revolution. But that is something that we don't think about. We make the hypothetical "what if" only with defense expenditure: having no military, any large country would put itself to peril as a hostile country could take charge of "security" itself.
Yet it's obvious what a welfare state does give: security and social cohesion. When you don't have anybody begging on the streets, when you don't have homeless people in the streets, you don't have that wealth inequality so apparent. You do have lower crime rates and less fear. That welfare state can also alienate people and create a class of people that are dependent of welfare is in my view a smaller problem than having homeless people around on the streets where you live. The issue is that it simply costs a lot, because the services cannot be done by robots.
There is no general consensus about what is right and wrong, acceptable and unacceptable, what we should do as a society and what we are responsible for as individuals.
currently, the world is a billionaires plaything. The structured society that was built over many decades is slowly being dismantled.
As the world (as we know it is 'being dismantled, there no universal consensus about morality and what is acceptable. This was drawn from postmodern analysis and culture relativism. However, that doesn't mean necessarily that ideas of human rights and economic ethics are insignificant and meaningless. What do you think about this?
I think the classic standards of service to society and responsibility by the better off in society is more desperately needed than ever. The Victorians had their faults but they built great buildings, public parks and in the 20th Century there was social housing/NHS etc.
Also, there is no structure of what is acceptable any more. The Self has become a selfish infant for many many people.
About a quarter of the working-age population is economically inactive or unemployed in Britain. I would propose that the welfare state is unsustainable without all that labor to exploit. Multiply that loss of revenue by the amount which the economically inactive receive from the coffers, and its only a matter of time.
As for the workers, their exploitation also becomes unsustainable. When the theft of their income is used mostly to the benefit of others, including those who have yet to pay into the system, it becomes less-and-less beneficial, and more-and-more unfair, to find employment or otherwise let oneself be exploited by the welfare state. This is perhaps a reason for the British brain drain, as younger talent seeks better working conditions and more tax incentives abroad.
Lastly, the steady increase in state power comes at the expense of social power. This transfer of power is the cause of a lack of community. One neednt care for his neighbors when the government will do it for him. One neednt be charitable if the government does his charity for him. And so on.
It is a big problem that so many people are relying on benefits, especially due to mental and physical problems.
I am in the category whereby I am unemployed, considered fit for work, with no restrictions. However, I got so ill physically with a chest infection that I ended up in hospital with a chest infection and on oxygen. I had to report being in hospital to the DWP and was meant to provide a 'fit note' within 7 days. I am out of hospital but not fully well, needing to get to a GP for paperwork, but too unwell to travel to GP presently, especially as I am not managing to get one locally. A lot of problems stem from almost everything being done online, with artificial intelligence involved.
Finding work is not easy either. I apply for jobs all the time and often get no responses or unhelpful ones. In particular, I get sent spam from organisations that I apply for, such as jobs in other cities far away or with job requirements I don't have. So many of the 'middle' range jobs are vanishing in the information era. There is the option of applying for lower positions but when I do I usually get rejected or hear nothing.
Also, with the whole idea of getting the long- term sick back to work, part of the problem is that in a competitive society, preference is given to the most able. Employers don't admit to discrimination but it happens. There is also a trend towards what are considered to be Equal Opportunities details, which used to be separated and anonymous, being included in the main section, which means that discrimination can begin at the application stage.
The whole emphasis on getting people back to work often rests on assumptions about laziness. It ignores the way in which physical and mental health problems affect performance. Attempts to get the unemployed and long-term sick back to work need to go beyond telling people that work is good for them. Working may often help but it also causes stress, just as being expected to survive without financial resources impacts upon health.
The fragmentation of community may be a contributing factor to problems, especially isolation as so much is done alone, on-line. Such isolation may foster self-centerdness because it involves living in an egoistic bubble. Lockdowns created isolation, which affected mental health on a long term basis and in the midst of lockdown there was such a transition to virtual life which may be creating many kinds of problems.
Agreed. The framework of society in which we live has been mangled. Not for the better IMHO.
The unemployed are an important part of the economy. They, you, function to keep wages low, and therefore benefits are structured to be uncomfortable, humiliating, and insecure so that there is a strong incentive to find work, but enough to keep you alive, so that there are always people ready to take work at low wages, thus preventing workers from demanding better pay and conditions. Your desperation is functional in the economy. And as the vampire illustrates, you also function as scapegoat for the miserable state of the economy in general; miserable that is for the 99%.
There is probably a degree of functional of the 'unemployed', but it might have gone to the extent of dysfunctionality. This is when it is alongside many people signed off as long-term sick. With the latter group, there is so much debate as to people abusing the system, to opt out, or being ill genuinely. Both of these call into question the nature of 'work'. It is both the source of money for survival and about service, especially meaningful service. The idea of work to serve others and to find meaning may have been cast aside as people are expected to function and compete with machines. The value of the human may have become lost.
As far as scapegoating is concerned, which may include the unenemployed, mentally ill and other groups, it is not very progressive. So many are critical of wokeism but the idea of scapegoating as an asset of mass psychology can be criticised strongly being about the darker side of human nature. Rationality could lead to a deeper understanding and move beyond scapegoating and its projective processes in social groups.
Sorry that I have taken a while getting back to you. I agree that population is an issue but I am a little confused by your stance. That is because in England, at least, the problem is such a large population rather than the problem of the population not growing. This is partly due to medicine having increased life expectancy and social care needs previously. That is one of the reasons why age for retirement has been increased for men and women, and will continue to be increased.
Nevertheless, while life expectancy has increased previously, health is variable and many are unlikely to be fit enough to sustain employment until the official retirement age.
There is so much medical technology and pharmaceuticals but it is costly. The NHS and welfare state are at breaking point because of mass population. Amidst this, it is that many are not receiving what they need amidst the cost and chaos. Individuals are becoming mere numbers, with some gaining what they need while some are being thrown into deprivation.
The underlying issue which I see is how so many aspects of the system are reliant on online apps etc. In particular, I need a 'fit note' for the DWP and it is unclear from my discussion with a receptionist if this can be done at the face to face appointment or has to be done separately using certain apps. It also requires Zoom and this doesn't work where I am living because of a poor signal where I live .
So, I am fearing both benefits being stopped and ending up in hospital again if cannot get necessary medical care. It is so stressful, affecting both my physical and mental health and seems to be about a system where almost everything has been put in the hands of Gov. UK websites, which were introduced so much during the time of lockdown.
In the UK? heh.
https://www.gla.ac.uk/news/archiveofnews/2022/october/headline_885099_en.html
The US went through the same thing. My old hospital, which had struggled for a while, finally went under after the pandemic. It was bought out by a bigger system. Then that whole system was bought by an even bigger one. The central office for the mega-entity I work for is several states away now. It was actually beneficial for me, because I had been through many waves of austerity (hiring freezes, no vacation) while my hospital was independent. That seems to have passed now.
It's not really a bad thing to restructure from time to time. The whole history of medicine since WW2 has been one of backing off unnecessary testing, replacing invasive interventions with non-invasive ones, and placing a super high priority on protecting patients from hospital acquired infections. All of that has been assisted by financial pressure (in our case from Medicare). What's happened is that during those decades of intensive testing, physicians learned a lot about various disease mechanisms. They discovered that once that knowledge went into successful strategies, all the testing wasn't really necessary anymore. I'm sure the UK has been on that same trail for a while, but it's an evolving thing. There may still be some changes in priorities that have needed to happen.
It studied between 2012 and 2019. So before COVID hit.
It's not just a correlation either, it was the poorest areas that were disproportionately affected, with rising death rates among vulnerable populations.
I am not opposed to change or restructuring in itself. However, what does seem to be happening is that the pace of changes does not allow for so much unpredictability and uncertainty in life. The NHS in England had been restructured and was making so many changes before the pandemic. After Covid hit, so much was hit by cost. That is the main reason why the NHS is in crisis. So much is intended to save money, especially job cuts. Also, without being negative it is hard to know what will happen with the plan for the government to have more direct control over decision making.
In addition, so much change, in the NHS and other organisations is focused around technology being introduced. The people involved in such organisations are being trained in technology and policy. What may be lacking is the value of human individuality in this. In particular, communication skills and listening may be lacking in such processes, especially as staff are so busy on machines and computers.
But they haven't said anything about requiring co-payment from patients. That's a good thing.
There has been no talk of co-payment but what is starting to happen is in the form of inequalities, whether intentional or not.
In particular, many GPs require everything to be done on-line and requiring certain apps. Not everyone can access such resources or use them, especially the most vulnerable groups, meaning that they are in danger of being marginalised, or even excluded.
Also, GP appointments can be grabbed by the most healthy and denied to those who are most unwell. That is the likely reason why so many people are presenting at A and E departments. This will need to be addressed for effective change, as opposed to random community visits, which may ignore many less visible people.
As I see it, so much is being rushed through by the government. Such haste may be extremely disastrous and costly, leading to potential collapse of the NHS.
I'm guessing they make exceptions for people who can't do digital. You could probably just call them and tell them.
Quoting Jack Cummins
I think they'll be ok. Probably just need a progressive property tax on the rich to pay for it. Small revolution maybe.
How much allowance is made for people who can't do digital is so variable in public organisations. For example, I have heard of people who have been cut off from the benefits system as a result of losing a phone.
You seem extremely optimistic about any political agenda. I do not wish to be completely negative but see so much as being questionable. I see the need for people to be heard and fear that democracy is decreasing.
I am aware that you are writing from the USA. The versions we hear of news in both countries is likely to be filtered differently. This may be especially true at the present time where tensions between world leaders are extremely fraught. The relationship between Trump and Starmer is critical in this, especially with negotiations about Ukraine/Russia and Trump's tariffs.
I see what happens next as being fairly complex and may depend on who is involved or left out in the dialogues. It is with this intention that I wrote the thread, although it is likely that discussion here is of minimal significance in the power structures of political discourse.
I think we need to begin with a reality check. What resources does each nation have and how many people need those resources? We live on a finite planet as though nothing were finite. If populations were suddenly cut in half, those who remained would be valuable. Property owners would slash their rents in competition for renters. The housing market could also be flooded with would-be homeowners, and the cost of housing would crash.
I am forever thinking of the gold rush and how overnight there were booming gold and silver towns. When the mines were depleted, all property value fell as people left town, the bank was closed and businesses moved away. All that is left is ghost towns. Could that be prevented? How does a nation without capital build an industrial base? In reality, how do economies work? Should Iceland become a dependent part of the Great USA? Without the mineral resources of Iceland, would it be important for the USA to rule over Iceland? How do economies work?
A lot of what is happening in Britain, and other parts of the world is about resources. There is some difference between the monetary figures of economics and how it translates into material resources. But, a large part of the problem is the way of life which Western civilisation has come to expect is unsustainable.
It is not simply about politicians trying to deprive people but about tough decisions in thinking about the future. The cost of the welfare state and NHS is tremendous but people are reliant upon it. So, what can be done is a conundrum. How to manage it fairly is difficult, especially in an age in which digital technology plays such a role. The basic needs of people for food, housing and essentials may get missed and it is likely that there is so much wastage of resources. There is a need for resources to be shared and it is likely that a need to go beyond capitalism and socialism needs to occur to address the nitty gritty economic realities which lie ahead.