Simon Duffy

Thoughts, Bemusements & Arguments

Tag: NHS

Social Care Car Crash

This week I have been working in the USA, but it’s been hard to get people to understand how severe the cuts to social care (children and adults) have been in England. But here’s my best shot at a metaphor:

A family is crossing a busy road. The traffic lights is red, the family crosses, but a car ploughs into the whole family – children, parents and grandparents are scattered across the road, bleeding, broken and dying. The car stops and a drunken driver leans out of the car window and shouts, “Don’t worry I’ll go and get help.” But when the car arrives at the hospital it smashes straight into the side of the ambulance.

The Government – which keeps promising to help social care – is the primary source of the disastrous cuts to social care – but somehow we keep normalising their destructive behaviour.

Today (in terms of numbers served) adult social care has been cut by 50%.

Graph showing 50% reduction in adult social care since 2009

Severity of cuts in English adult social care

Cuts to children social care have also been vicious.

This is because central government has cut funding to local government by about 60% or more, and these cuts are deepening every year. Since 2010, we’ve been told:

  1. It’s okay we can take money out of the NHS (healthcare) to subsidise these cuts – but funding for the NHS has not been increased to make that possible (and its a crazy way to solve the problem anyway).
  2. Don’t worry we’ll eventually come up with a plan for funding social care differently – but the only plan we’ve seen was to make older people pay more money for it and this was quickly shelved when the public got to hear about it.

As an Englishman there are many deeply upsetting and shameful aspects to what is happening in my country:

None of this necessary or fair. Social care has always been a small, but important, part of government expenditure (about 1-2% of GDP). It is low cost and relatively efficient. It is a preventive service which, when it’s working well, reduces the money spent on healthcare or on forms of institutionalisation.

The UK Government’s policy has also been severely condemned by the United Nations as a breach of human rights, and yet it continues unabated today. Even worse, this policy is just one part of the Hostile Environment created for people and families with disabilities: cuts to income security and housing combined with the growth of mean-spirited systems of assessment, control and sanctions are driving up rates of suicide and depression.

There is still no sense of national scandal and no sense of accountability on the part of our rulers. Grass roots organisations like Disabled People Against the Cuts (DPAC) have tried to force this issue onto the agenda but there is still no effective national campaign that combines the many powerful groups and organisations involved directly or indirectly with social care.

It doesn’t need to be this way

If the leaders of opposition parties, trade unions, major charities and local government could open their eyes, listen to people and work together then this policy could easily be reversed and a new direction set.

I would ask everyone who works in the social care sector, but especially those who are likely to retire with a good pension one day, to think about this problem and ask yourself:

What do you want to be remembered for when you’ve gone?

You survived the car crash

Or

You helped turn this problem round

Can Socialism Reinvent Itself for the 21st Century?

I am a proud member of the Socialist Health Association. I feel strongly that decent healthcare is a basic human right and that nobody should be deprived of it because of poverty, nor should the wealthy be able to buy their way to longer or healthier lives. If this is socialism then I’m a big fan.

Recently, the Socialist Health Association decided to review its fundamental principles, and as a philosopher by training, I thought I’d try and help clarify what socialism, at the beginning of the 21st Century, really means. However this turns out to be a rather difficult task.

It is certainly clear that socialists are against greed, exploitation, inequality, capitalism (possibly) and injustice (certainly). But what are socialists for?

One clue might be found in the social- part of the word socialism. Socialists believe in society, and more specifically I think socialists believe that society should come before the individual, that individualism puts the cart before the horse. 1 Certainly, the Socialist Health Association’s first principle as it currently stands, reflect this:

“The claims of the individual should be subordinate to social codes that have collective well-being for their aim, irrespective of the extent to which this frustrates individual greed.”

Now, as a piece of English, this is somewhat dry, abstract and rather confusing.

First, there is the strange notion of “claims”. This is quite a peculiar word. What am I claiming and to whom? Why is anyone interested in my claims anyway?

Second, there is the notion of sub-ordination. In what sense are my claims meant to be subordinate? Must my desires, plans or projects be directed towards “collective well-being”? This seems totalitarian in its ambition.

Or, on the other hand, are my claims legitimate as long as they don’t directly contradict the “social code” which has (somehow) been identified as for the greater good? Perhaps I can claim the right to drink alcohol, but I must only do so to the extent allowed by the state. This is perhaps nanny-state socialism, a little more tolerant than the totalitarian version.

All of this seems to be far too strong and quite alien to my reasons for supporting the NHS and social justice. I don’t want to be slotted (tightly or loosely) into some social code for collective well-being. I want to live in a decent society where we treat each other as equals. I don’t want to tell people how to live; I just don’t want to be advantaged at the expense of others, or to see others so advantaged. I really like the fact that the NHS is organised to limit how someone can jump the queue to get a better or faster treatment than someone else with similar needs, but less money. It’s fair.

The third problem with this way of defining socialism is that we are often confused about which “collective” matters. We can be part of many collectives: the family, the tribe, the class, the nation or humanity as a whole. Sadly, it has not been too hard for the wicked to corrupt the ‘social’ inside socialism into one ideal group that should be valued above all others. There is more than a theoretical link between socialism and national socialism and the twentieth century has seen millions sacrificed on the competing altars of these deathly versions of socialism.

But it is possible to imagine a better kind of socialism and one clue can be found if we go back, beyond the word society, to its Latin root socius or friend.

Friendship has nothing to do with state power and control. C S Lewis was not alone in observing that, at its core, the relationship of friend-to-friend is not a relationship of dependence, assistance or charitable action. Friends get along, even love each other, but not ‘in order’ that they can help each other. Helping gets in the way of friendship, and this is why friends hate to be in debt to each other. An undue level of do-goodery and interference in the lives of others is also irritating and unhelpful. It is certainly not friendly.

The challenge for socialism, at a practical level, is to convert our commitment to justice and our proper sense of responsibility for each other into a way of living that is ethical and sustainable. People who live only for others are not much better than people who live wholly for themselves. Citizens understand that they have obligations to themselves and to other people.

In practice most socialists are not trying to create totalitarian states or nanny states and they are quite aware that all human being are equally important. Today, much of the moral imperative of socialism has been converted into support for the welfare state and for the social contract it seems to imply: I must be prepared to pay my taxes, and in return – and as an equal member of society – I become entitled to some rights, such as being able to get free healthcare.

Now this welfare-state-socialism seems relatively benign, however it still has some peculiarities. For instance, notice that in this example of day-to-day socialism, the agent of good is now no longer acting from any moral principle. The doctor is not treating you because she’s a good person; instead she is (very) well paid to treat you. It is not the doctor who helps you, it is the anonymous welfare state, it is the system. So, interestingly, in order to operationalise itself socialism, appears to have moved away from the notion of friendship or mutuality. If we are not careful, the whole thing starts to feel entirely mechanical or transactional. I do this in order to get that. But then what is the difference between this kind of welfare-state-socialism and the kind of left-leaning liberalism that sees the welfare state as form of national insurance: we all put something in (according to our means) and we all get something out (according to our needs).

What seems to be missing is any deeper sense of our responsibility to our community, or even a sense of our unique individual value. Society has been converted from human-sized communities into a vast state-run charity. This may be a charity from which we all benefit, but as Arendt says, “charity is not solidarity.” In the face of this monolithic system we each become one part donor and one part recipient, one part tax payer, one part service user. The uniqueness and value of ourself and of our community disappears from view.

Welfare-state socialism is much better than totalitarian or many-state totalitarianism and much better than heartless forms of liberalism and individuals. But does it not feel we’ve sacrificed too much? Is there not a better way of defining socialism for the 21st century?

The fact that the meaning of socialism can be corrupted is no reason to abandon it, nor to abandon the concerns that it was developed to address. The underlying reasons for socialism are as real today as they were yesterday. Economic forces and greed do not control themselves; even the minimal democratic control of the state which we ‘enjoy’ today is no guarantee of justice, particularly when power and influence seems so easy to purchase. It remains essential that we examine what is really to the benefit of society, and not to treat society as if it were merely equivalent to a mass of self-interest.

However, if socialism is going to thrive we must find a better version of socialism.

For me the best starting point is the idea of citizenship. To be a citizen is to be much more than taxpayer, much more than a voter and much more than a right-holder or recipient. Citizens make community; their actions, innovations and creativity are the source of social value. They may be prepared, in extremis, to die for their community – but actually, more often, they get to live for their community.

The model of citizenship I use has seven elements, and I think each could be explored to develop a reinvigorated and healthier sense of what socialism might mean:

  1. Purpose – Citizens have a sense of purpose which is encouraged and supported; today’s dreams are tomorrow’s solutions.
  2. Freedom – Citizens are free, free to do their own thing, free to work with others, free to do the unexpected.
  3. Money – Citizens have enough, they abhor poverty and they don’t like excessive inequality (Plato’s suggested 1:5 income ratio for poor to rich would be much better than today’s tasteless and destructive excess.)
  4. Home – Citizens have homes, roots, neighbours and a sense of belonging. They are part of the community and they construct that community.
  5. Help – Citizens help each other, need each other, and know there is no shame in getting some assistance. However, what citizens don’t tolerate is sacrificing their freedom in order to get that assistance.
  6. Life – Citizens live life to the full, they work (and they know paid work is only one kind of work) they rest and they play. Citizens seek balance and know that you can only get out of life what you put into it.
  7. Love – Citizens need love, cherish love and respect love. Family, friendship and loving partnerships are all aspects of life that citizens nurture and protect.

Defining 21st Century Socialism seems a worthwhile project. The key I think is to leave behind the paternalism of the welfare-state-socialism and to rediscover the spirit of citizenship and community which actually built the welfare state in the first place. This does not mean abandoning the welfare state; it means reinvigorating and redesigning the welfare state. We must build the welfare state again, but this time not bury its builders and architects beneath its edifice.

  1. This point has a long pedigree; Aristotle, for instance offers us an early version of socialism “…even if the good of the community coincides with that of the individual, it is clearly a greater and more perfect thing to achieve and preserve that of a community; for while it is desirable to secure what is good in the case of an individual, to do so in the case of a people or a state is something finer and more sublime.” ↩︎

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