Monday, 31 December 2012

Not a good start to 2013 from Mr Ian Duncan-Smith

I do really wonder who is advising Ian Duncan Smith. He is using some very spurious statistics. He is looking like a man possessed. He is on a mission and has decided not to listen to those he no doubt regards as 'on the wrong side'.  Like all missionaries he won't rest until we are all converted or damned. Some say: Stop! You are making a big mistake! But he knows what is best. He is rescuing us all from damnation. He says he has 'brought back fairness to welfare.'

Mr Duncan Smith makes the extraordinary claim that tax credits increased by 58% ahead of the 2005 general election. Working Tax Credit introduced in April 2003 was the first national in-work financial support introduced in the UK designed to help people in work. It was designed as an incentive to 'make work pay'. It wasn't seeking to drive people back to work by cutting benefits for those unemployed or disabled. On the contrary, it was keeping people in work by increasing income. So what of Mr Duncan Smith's claim?

Between their introduction in 2003 and the 2005 general election working tax credits were increased in line with inflation. I doubt any government would win an election with an inflation rate of 58%! So Mr Duncan Smith is talking nonsense. So what could he mean by claiming that they increased by such rate? Perhaps he is referring to take up.

Tax credits at £23.7bn are the biggest slice  (27%) of the welfare cake, followed by Housing benefit (16%) and child tax credit (12.8%).  Incidentally, unemployment benefit is just 1.2% of the welfare budget; so much for 'shirkers' dragging us all down! The true cost of working tax credit however is not the headline figure. To get a true cost we would have to subtract the increases expected in other areas of the welfare budget if it was to be scrapped. Welfare budgets tend to reflect financial needs; housing, food and groceries, heating etc. These costs don't go away because a government may chose to cut a particular part of the welfare budget. IDS talks of wasted spending and fraud. No doubt the system has its share of fraud, as does the tax system in general. But does WTC work?

One of its aims was to 'make work pay', to act as an incentive so that people were not trapped by losing benefits if they chose to work.  IDS says it doesn't work. It is difficult to estimate the extent to which it does. How many people chose to take low paid employment rather than remain on unemployment benefit. I suspect few people really choose to be unemployed. That is a convenient myth fostered by the government to divide us into virtuous workers and sinful 'scroungers' and 'skivers'. Ed Miliband put them straight at PMQs by reminding Mr Cameron that the biggest slice of benefits goes to those in work and not the unemployed.

The problem with any system that subsidises low pay is that it provides less incentive for employers to pay decent wages. Companies like Starbucks take advantage of the British taxpayer by paying below the minimum. As such they are a subsidised business but pay little or no tax. A staggering 5 million workers receive below the minimum wage. That is the problem. That is what we should be addressing. We should be addressing the issue of low pay at its source.

All workers should be paid at least a living wage; a wage that covers essentials of food, housing, heating and clothing. The way to drive welfare dependency down is to increase the well-being of people. Simply cutting benefits drives them deeper into poverty. In the end it is all counter-productive. For the sake of cutting one slice of the welfare cake, the government ends up increasing the slice resulting from poor housing and ill health. They perpetuate the vicious cycle of poverty. I have little hope that the missionary zealots in the government will recognise this. But it is my New Year message to Mr Duncan-Smith, Mr Cameron and Mr Osborne.

Sunday, 30 December 2012

My New Year prediction for hot debate, epicure and all that.

A New Year is a time for prediction; for considering what prospect the new year holds. My prediction is that there will be renewed efforts to change the law on abortion.

A few years ago I was being interviewed about the ethics of human embryonic stem cells on the Stephen Nolan Show on BBC Radio Northern Ireland. I was presenting the standard utilitarian case for the use of human embryonic stem cells; that the benefits might be considerable in potential treatments for damaged tissues such the spinal cord or the eye. The developments of new tissue from implanted stem cells might cure paralysis or make a blind person see. A listener phoned in to ask 'where is God in all this?' A question Stephen Nolan repeated to me. It raised the question of whether there are or should be any limits to the development of new treatments; of whether there should be any no-go areas for science and medicine. Should there be a boundary that is not crossed no matter how great the potential benefits? If there is no such boundary then what would be the ethical and moral yardstick?

Boundaries are useful for a variety of reasons. They give some assurance to others that they exist and that there are limits. They act as a brake. Some would say they are a brake on progress, others that they prevent us going too far down a 'slippery slope'. I often told my students that boundaries are there for you to get your ethical clothes snagged up in. At least you have to spend time thinking about how you will get yourself free from the snags. Boundaries have a habit of creating new dilemmas. What to do at the boundary. Boundaries beg the issue of whether there are or can be exceptions. Sticking to a boundary simply because it is there, without question, would be unethical, particularly if sticking to the boundary leads to preventable harm. Following rules isn't itself ethical. Boundaries are a bit like the trenches in WW2, you spend a lot of time trying to go over the top of them and often arguing about whether they are in the right place.

Boundaries are a social and political construct. We argue around and about them. Few are ever really satisfied with them. An example is the gestational age limit for abortions. It is a fine judgement that it should be 24 weeks rather than 20. Usually the argument is about 'viability'. A fetus at 24 weeks is now potentially 'viable'; it can be born and has a good chance of survival. A baby at 20 weeks would not be able to survive. But 'viability' changes. Two decades ago we would have said that a baby born at 24 weeks would be unlikely to survive. Whether this should shift the boundary depends on why the boundary is there. But it also depends on the nature of the decision about termination. Shifting the boundary would shift the focus to exceptions; and there would be many legitimate exceptions. It would make more difficult what is already a difficult decision. Shifting boundaries often creates more difficult ethical dilemmas than those the boundaries were created to solve. It might make society feel more 'moral' or 'self-righteous'  but it might not produce a good ethical outcome.

In relation to the boundary for late abortions, it would be well to remember that it is 12% of all abortions. But many of the arguments presented refer to the total of all abortions. There are too many we  are told, therefore there needs to be a restriction. Something needs to be done, so let's change the boundary. Yet the overwhelming majority of termination occur before 12 weeks; a long way from the boundary! Shifting the boundary would simply make it more difficult for those whose decision is already difficult. It won't address the problem of numbers of abortions; if indeed it is a problem.

So why do I predict there will be further ardent debate in 2013? The reason for my prediction is that a new update of the epicure study is due to be published in the new year by the prestigious medical journal, BMJ.  Epicure is a series of studies of survival and later health of those born at extremely low gestational ages - from 22 to 26 weeks.  The report will no doubt generate considerable debate.

Saturday, 29 December 2012

Human cloning; the good, the bad and the ugly

The prediction that human cloning will be available in 50 years raises issues, good, bad and downright ugly. Whether it is ethical will depend on whether the 'good'  is sufficient to  outweigh the potential 'bad' and 'ugly'. But good and bad in this context are not easy to define or measure. Even supposing there were good reasons for using human cloning, and that is a big if, it would need to be a pressing need to outweigh the potential for harm. Currently the risk of abnormalities is high.

It has been suggested that cloning might be used to replace a lost child with a copy. And it is here a myth takes hold: the idea that cloning produces an identical human being. This is the stuff of science fiction, not of biology.  Cloning will not produce an identical, like for like human being. A cloned human will not develop and become identical to the person from whom this being has been cloned. If we wanted to clone a person rather than an organism, it is highly unlikely we could succeed. A person has a unique history and a unique development; their hopes, fears, loves and hates are as likely to be as different as any other two people.

But even biologically they will be different.  They are likely, for example, to carry different risks of health and disease. Recent work on the developmental origins of health and disease indicate that much of the health risks we carry are environmentally determined during development in the womb and in early life. It is highly unlikely this could be replicated. A cloned human will be as unique as any other human. They are also likely to carry risks specific to being cloned.

But let us consider the idea of producing a replacement for a lost child. The psycho-social environment in which such a child develops would include the fulfilment or otherwise of the parents needs. The burden of needing to be like the 'lost child' will make it less likely to be successful.  Better to be wanted as the person you are or will become than to always feel the need to be like someone else. The motives of such parents and their ability to adjust would be crucial. Perhaps they should not want to replace a 'lost child' but simply to have a child with his or her own personality. Psycho-social counselling would be better than a risky biological fix.

Postscript

Much of human development occurs after birth. This is particularly true of brain development and function which are critically dependent on sensory input and social interaction.  Environmental influences are a major feature in determining the function of our brains and our characteristics. In this sense alone we will each have a different trajectory, and this is one of the reasons why 'identical' twins are not what their name suggests, identical.

Friday, 28 December 2012

Why the Daily Mail and government are wrong on disability benefits

The Daily Mail has given its support to the government's 'crackdown' on disability benefits. In an editorial it argued something must be awry if 'Britain spends more on disability than almost any other developed country'.

The use of the word 'crackdown' to describe the government's policy is of course deliberate. You 'crackdown' on cheats. The argument is that because Britain spends more on disability benefits, then the difference must be accounted for by benefit cheats; those who don't need or deserve them. The Daily Mail doesn't consider that perhaps Britain spends more because it has moved forward in its approach to disability.  We are not behind but ahead of the game. It is not the first time The Daily Mail has made this case. But is it true? The answer as usual depends on how you read the statistics. And it is a lot more complex than the Daily Mail would have us believe.

Making comparisons with other countries is not straightforward. Different countries have different approaches to welfare expenditure, with different mix of private and public or central government spending.  In the UK, central government spending may be higher as a per cent of GDP, but this does not mean that overall spending on welfare is greater. Looking at overall expenditure on welfare  we  get another picture. According to OECD figures, the UK is ranked significantly below many other European countries including France, Germany and Italy on the amount spent on welfare.

Given that the overall spending is not greater than other comparable countries, then the Daily Mail's argument is at best specious. You cannot assume that because central government spending on benefits is higher that this means there is no genuine need. The Daily Mail could argue for a different mix of spending, but it would need to develop what this should be. Simply calling for a 'crackdown' is loaded with prejudice and little detailed analysis.

There is a genuine issue about helping disabled people to work. In recent  reports the OECD concludes that more needs to be done. But the objective is not simply to cut the benefits budget, but to find a mix of policies that will assist those with disabilities into productive work. The assessment regime introduced by the UK government does little other than force disabled people off benefits. It is a cruel and blind regime. That so many rulings are overturned on appeal indicates that the process is flawed and takes little account of the circumstances of those involved.

Cutting benefits does nothing to enable people to work. The OECD considers two disability policy indicators, benefits and employment integration (enabling people to work). Acting on the one without the other is a recipe for injustice. Furthermore the ratio of benefits to integration is a better index of comparison between countries than simply how much is spent on benefits.  On this measure the UK had been scoring well with a reasonable mix of policies designed to help disabled people into work. Contrary to the claims made by the Daily Mail, the benefits ratio was not significantly greater than the US or Japan and by 2007 the UK scored highly on its integration index, representing a fundamental shift from the position in 1990. The OECD highlighted the progress made by the UK in just two decades. This was because the previous government had already adopted a strong employment policy approach.

The Daily Mail editorial takes little or no account of this in its prejudiced approach. It would rather select its statistics from the OECD to fit its own agenda. It would rather promote the scandalous approach of the government in stigmatising those on benefits.


Thursday, 27 December 2012

The petition to deport Piers Morgan is little short of a 'fatwa'

There is something distasteful about the way Piers Morgan is being treated both in the USA and in the UK over his vociferous position on gun control. Democracy is in a parlous state when it becomes predicated on the concept that you are only welcome to contribute if you agree. America is surely bigger than this. Wanting to deport someone because they are a threat to security or a danger to others, or that they have committed a crime, is one thing; seeking to deport them because they hold views within the mainstream is repugnant.

We might argue that it is foolish, or culturally and politically unwise, for Piers Morgan to engage in such a contentious issue as gun control in such a full-blooded way, particularly as such an issue is so divisive. But he has been doing nothing he has not been doing on other issues in his TV chat show. He is an opinionated man. I have no doubt he courts controversy. But I have no reason to doubt the sincerity of his views on gun control. There should be no 'no go' areas in political debate other than those that might incite hatred or prejudice. 

Piers Morgan divides opinion, here and in the USA. He is not my favourite personality.  I doubt that the petition to have him deported is representative of public opinion in the USA, although it is gathering momentum. It now has over 81,000 signatures at the time of writing. But such a petition has hallmarks of a 'fatwa' against an individual person. In a civilized society, individuals should not be hounded in this way. It is a hateful petition. 

Nor is it that America or Americans don't interfere with the politics of other countries. America makes its opinions known. Many of the leading politicians and pundits will often rail against policies adopted elsewhere in the world. They will sometimes bomb other countries; a rather more intense interference than Mr Morgan's words. It will often do so to 'protect' the free world. But in a 'free world' people are entitled to engage in debate. TV presenters are at the front line of that freedom, and that includes Piers Morgan, warts and all. 


Wednesday, 26 December 2012

Mr Einstein's brain

It wouldn't be Christmas without stories appearing about Einstein's brain. It is a recurring theme; the intellectual man's chit chat about the weather. A group of scientists are studying the pickled brain of Einstein to see if they can 'discover' what was exceptional about it; something that could have given him his extraordinary intellect. I cannot think of a more potentially fruitless scientific endeavour.

Even supposing they did find something odd about his brain, it is difficult to see how they could now associate this with his intelligence. They might find, for example, that a particular part of his brain was proportionately large or small, but to conclude that this somehow gave him extraordinary powers of understanding would remain pure speculation. None of this is particularly new. Indeed, an odd feature has already been found in Albert Einstein's brain.

Back in 1999 it was reported in The Lancet that a unique morphological feature had been found in Einstein's brain. The surface of our brains is folded into bumps and grooves; a bump is called a 'gyrus', a groove is a 'sulcus' or fissure. These hills and valleys of the brain can be clearly identified and given names, and it was in these hills and valleys that an unusual feature had been found in the lateral, or parietal surface of each hemisphere.

Two grooves that are normally distinct were joined together. In anatomical language, the posterior ascending branch of one groove called the Sylvian fissure, was found to be joined with another, the postcentral sulcus. Two valleys, as it were, were merged rather than separate as found in most human brains. The feature that  would normally separate them, the parietal operculum, was missing.  But for this all other aspects of the brain appeared within normal limits in weight and size. The parietal lobe was bigger and had this unusual feature.

Now it so happens that this part of the brain is known to be important in visuospacial cognition, or three dimensional calculation, mathematical thought and imagery of movement. But what is more intriguing is that these are attributes Einstein himself associated with his scientific thinking.

"The words or the language, as they are written or spoken, do not seem to play any role in my mechanism of thought. The psychical entities which seem to serve as elements in thought are certain signs and more or less clear images which can be "voluntarily" reproduced and combined."  

Einstein it seems worked in images rather than words.

The authors of the report rightly add a caveat that the study cannot conclude that this provides us with a 'neuroanatomical substrate for intelligence'.  Indeed, it is difficult to see how it could be demonstrated other than using modern techniques of MRI to visualise the function of the brain during known tasks. It may say little more than the fact that anatomy is associated with ability. Certain kinds of intellectual ability may be influenced by anatomical features in the brain. Intellect covers a host of facets.

Most of these would have little or no correlation with gross anatomy. My computer is physically similar to any other of its type, but it is programmed to do different things. Any differences in how these programmes work is determined by their logic.  But how fast it works and with what kinds of elements depends to a large extent on bits of its 'anatomy' such as the sound card or video card, or on its storage space and how this is organised.

I understand that there are some who speculate that Einstein's genius lay in communication from aliens. Some have asked whether he was an alien!  I'd rather think that there really wasn't that much extraordinary in Einstein's ability; a genius, yes, but certainly human. His thinking wasn't magic. It was unique in the sense that he was Albert Einstein. And you can make what you want of that.




Monday, 24 December 2012

Changing pension age is missing the point

I am reminded of a discussion I had recently about future welfare costs and why something had to be done now to 'prevent it spiralling out of control'. One lady in the group repeated something we hear regularly from politicians of all parties.

"We are all living longer!" She said. As if this itself was a problem.
We were in the middle of a discussion about pensions and raising the age of retirement.
"No we are not!" I replied.
"Yes we are, on average!" She persisted. Oh dear, I thought, here is that 'average person' again.
"Yes, but I don't live 'on average'" I responded. I've yet to recognise an 'average person' at, say, a bus stop or waiting for a train. I have no idea whether I have sat next to one, ever, in a plane.

There is something absurd about the general panic that seems to be settling in. The fear that the welfare budget is about to be overwhelmed by pensioners. The working population is getting smaller as those in retirement gets bigger with images of vast numbers of aged dependants crushing the rest. An ever growing burden; more care homes; more carers, hospitals with little old ladies on trollies in corridors in an NHS bulging at the seams. The incontinence of it all! Demented grandparents looking for shops that once lined the high street all unable to cope with the burdens of modern life. There is even a phrase invented for it 'old age dependency ratio'.

The problem is that there isn't a problem; or at least not the problem in the public imagination. We are not all about to become modern day Noahs and live for hundreds of years. Far from it. I suspect that with the growing ravages of increasing poverty it is more likely 'we', many of us in the future, will have shortened life expectancies rather than increased longevity. The 'average' of the population doesn't take account of differences in socio-economic standing. As the life expectancy of some might be increasing, for others there is little change or it might begin to fall. We have yet to see the long-term effects of obesity and obesity-related diseases. We have yet to witness the outcome from growing poverty.

On average (oops now I'm doing it!) a man retiring in 1981 had a life expectancy of  14 years; in 2011 that has increased to a little over 20. For women, those retiring in 1981 would have a life expectancy on average of 22 years. Now that has increased to 28. But it isn't projected to go on increasing at the same rate. And the more important question is health rather than simply longevity. A healthy population is less likely to increase the 'burden' on health and care services.

The problem of health is unlikely to be solved by simply increasing the state pension age. It can only be tackled by addressing those issues that relate to the health of the population. And it is still the case that the cycle of poverty and ill health matters more. Breaking that cycle is a better strategy than worrying about increased life on retirement. Furthermore, a healthy population is more likely than not to go on working, to be able to go on working, beyond the statutory retirement age; and healthy people are more likely than not to want to go on working.

Increasing the statutory pension age is mere tinkering. If we are really concerned about the future 'burden' then it is better to tackle health, housing and diet and fitness now. It is better to tackle poverty. This is why cut-throat austerity is so foolish and blind to its consequences.









Sunday, 23 December 2012

Do Not Resuscitate and patient care; who decides?

A family's legal action to force the government to review and adopt a clear policy requiring hospitals to consult patients and relatives before making "do not resuscitate" notices has been denied by a high court judge. Nevertheless, the case highlights inconsistency in approach to these orders between healthcare trusts and a lack of guidance in the training of doctors.

End of life decisions are never easy. Advances in medicine enable clinicians to resuscitate and keep patients alive in intensive care. But it can often bring two principles into conflict: the duty to preserve life and the duty to do no harm.  One might assume it is always better for a clinician to treat a patient; but to treat badly is not in the interest of the patient or of their close relatives. Sometimes it is better to withdraw treatment that seeks to combat illness and then to move to palliative care; to reduce pain, minimise suffering, and allow the patient to die peacefully and in dignity. When treatment becomes futile, then a clinician has a duty to acknowledge this and inform the patient and/or their relatives, and then to discuss what can be done.

What can be done depends on circumstances and the wishes of the patient. At any time, but particularly at this time, patients bring with them their 'expertise'; they bring their needs, their wishes, their relationships and obligations to their families. Each patient is in this regard unique.  And thus the patients are best placed to consider what they wish  with regard to what might be done. There is little in the training of a clinician that enables them to second guess the wishes of a patient. And this is why doctors should be wary of making assumptions about the best interest of their patient. 

This is why decisions about possible resuscitation should be made wherever possible with understanding and consent of the patient or their nearest relatives. Care should be taken about adding Do Not Resuscitate (DNR) to a patient's notes without proper consideration. This should only be done with clear understanding and consent. Where necessary this should be reviewed and updated. The patients condition and circumstances may change during treatment. The patient may also change their  mind about resuscitation in the light of these changed circumstances.  Thus, DNR should never be allowed to fester in the notes. But what this needs is a clear procedure. A clear protocol should be adopted to ensure DNR is reviewed and should never be assumed. 

This does not and cannot mean that the final decision on resuscitation will always rest with relatives. Where it would not only be futile but also harmful to resuscitate then that is a decision that can only be based on clinical judgement. But, whatever conflict DNR may bring for the clinician it is never as acute as that which it can present to the patient and their relatives.

Saturday, 22 December 2012

Bah humbug to you too Mr Shelbrooke MP!

'Tis the season of goodwill. Bah humbug! From a political perspective 2012 has been defined by a certain kind of nastiness. It all started so well. We were all 'in it together'; austerity that is. We would all share the pain. But in 2012 it is clear we are not 'all in it together'.  Far from it.  Some big companies don't pay tax at all, yet rely on state-subsidised wages. The rich it seems pay tax on a voluntary basis, because if you tax them then they don't pay it. This was Mr Cameron's Christmas lesson for Mr Miliband. The poor on the other hand are a different matter. One thing we know already about 2013 is that the rich are set to get richer and the poor are set to get poorer. And what will happen to Tiny Tim?

This is the season of goodwill. A season to be jolly. And also a season to reflect on our fortune and the misfortune of others. So up pops Tory MP Alec Shelbrooke with the idea that those on welfare benefits should be given cash cards instead of payments so that they would  only be allowed to buy 'essentials.' They would be prohibited from buying alcohol, cigarettes, from gambling and watching pay per view TV channels (presumably nasty pornographic sports like football).

I can only suspect Mr Shelbrooke thinks those on welfare let their kids go hungry whilst they live a life of drunken debauchery. It is a very Victorian view of the poor; that poverty was the hallmark of a wasted life or a life lived in sin. It is a view of political convenience. It means the poor can be blamed for their poverty.  

And this view of the poor has very much defined politics in 2012. The unemployed have been stigmatised as 'work shy', lazily hiding behind closed curtains whilst the virtuous get up for work.  Those on benefits have been defined as 'scroungers'. The disabled have been assessed as, well, not disabled; the sick as, well, not sick, and many have been driven to despair, and a few to suicide.  It has all been a very sorry Victorian tale. 

When Seebohm Rowntree, a member of the famous confectionery family, studied the conditions of the working class in York at the end of the nineteenth century he came to an extraordinarily simple conclusion. And it should be a lesson to us all. The poor were not poor because they were sinful. They were poor because they simply didn't receive enough in wages for the work they did. They weren't lazy or alcoholics. The didn't waste their lives.  They just were not paid enough to cover the essentials of food, clothing and a roof over their heads. That is poverty. That is why people are poor.  It would be well for Mr Cameron, Mr Osborne, Mr Clegg and the likes of Mr Shelbrooke to understand this. Because, sadly, it is just as true now as it was in Seebohm Rowntree's time. 

A staggering  5 million people in Britain are paid less than a living wage. A living wage is simply the same concept as that applied by Seebohm Rowntree; a wage required to afford the basics of life. It is a disgrace that for so many this is not so. The answer  to poverty is not to treat or denigrate  the poor as sinful spendthrifts but to ensure they are paid a living wage.

There are many for whom Christmas will not be as jolly as Mr Shelbrooke's. And as he tucks into his Christmas turkey with all its trimmings, I hope he well reflect on how fortunate he is. I hope he thinks of Tiny Tim. Bah humbug to you too Mr Shelbrooke MP!

Thursday, 20 December 2012

The WOWpetition; time for fairness for the sick and disabled

A new war against poverty has been launched in the form of a petition. The WOWpetition calls for the repeal of the Welfare Reform Act and its pernicious attack on those receiving disability benefits. If you believe in fairness I urge you to sign this petition. It is a reasonable petition.  It calls for a debate. It asks parliament to reconsider.  It asks for an assessment of the impact of the government's welfare reforms on the sick and disabled. The British Medical Association has expressed its concerns about the impact of work assessments and the role doctors are being asked to play if employed by ATOS, the company contracted to do the assessments. I have considered in a previous post the cruelty and unethical nature of the disability assessments.

This should not be a party political issue. The criteria and assessment are clearly not working. With over 40% of appeals against the decisions made by ATOS being successful, it is clear that the regime is not working. Hundreds of thousands of sick and disabled people have been wrongly assessed. It is a brutal regime and the criteria and decisions are not transparent. It is time parliament looked again at this brutal regime.

And 'brutal' is the right word. Earlier this year, an investigation published by the Commons Works and Pensions Select Committee found that some patients had their benefits stopped as a punishment for not being able to attend an assessment because they were too ill or there had been an administrative blunder. This is a disgrace.

Liberal Democrats expressed their concerns about ATOS and the assessments at their party conference yet they continue to give support through the coalition. It is time they stood up for the sick and disabled.

A century  ago a reformist Liberal government sowed the first seeds of the welfare state. Introducing his reforming budget in 1909, David Lloyd George talked of waging war against poverty.

"This is a war budget. It is for raising money to wage implacable warfare against poverty and squalidness. I cannot help hoping and believing that before this generation has passed away, we shall have advanced a great step towards that good time, when poverty, and the wretchedness and human degradation which always follows in its camp, will be as remote to the people of this country as the wolves which once infested the forests."

The reformist Liberal Government of 1906-11 ushered in a fundamental change in how the British government considered its responsibilities to the people. It took a responsibility for poverty, its causes, consequences and its prevention. It enacted legislation focussed on four vulnerable groups: the old, the young, the sick and the unemployed. They introduced old age pensions, allowed local authorities to provide free school meals for poor children. They set up juvenile courts and borstals rather then sending young people to prison. They introduced the first National Insurance Act in 1911 providing compulsory health insurance and labour exchanges to help the unemployed find work. The idea was to provide basic support rather than total provision. Indeed, a criticism was that the reforms didn't go far enough.   But it was a start. Whatever the intention, the seeds of the welfare state were sown. It prepared the ground for the building of the post war Welfare State by the Labour government of 1945 and the foundation of the National Health Service. It transformed the lives of all of us.

It is time we waged another war. A war for fairness.







Wednesday, 19 December 2012

Unemploymment down but what lies behind the numbers?

Making sense of the unemployment figures reminds me of the song about the Grand Old Duke of York: "And when they were up, they were up. And when they were down, they were down. And when they were only half way up, they were neither up nor down!"

David Cameron at PMQs today made a great deal of the statistics showing the number of people in work has increased.  Indeed, according the the Office for National Statistics (ONS),  the number of people in work increased slightly in the last quarter to 29.6 million. The increase in number of people employed compared to a year earlier is now an impressive 499,000. Unemployment is down 0.2% compared to a year ago, or 128,000.  Now it doesn't take a mathematical wizard to realise that unemployment will fall as a percentage of the workforce if you make the workforce 'bigger'. A key issue is whether the new jobs are real. More than  20% of the increased employment was accounted for by an increased number of young people on government work and training schemes. They are not 'real' jobs.

Between September 2011 and September 2012, the number of people employed in the public sector fell by 324,000 and the number of people employed in the private sector increased by 823,000. Some of this transfer from public to private is not due to new jobs but to a reclassification of the public sector. Excluding this reclassification the number employed in the public sector fell by 128,000; the number in the private sector increased by 627.000. Some of this is good news. It is odd then that this doesn't appear to be filtering down with a feel good factor for the government.

There are possibly two reasons for this lack of feel good. The first is one of scale. It remains the case that the levels of unemployment at 7.8% remain stubbornly  high by the standards of recent times. Before the banking crisis unemployment was less than 5.5%. The other problem is that it is unlikely that jobs being created in the private sector are located in just the right areas for those losing jobs in the public sector to move into.  So there is probably a discordance between those feeling the ravages of cuts and those finding work. There is evidence to suggest that at least 1/3 of the new jobs have been created in and around London as part of the Olympics bounce, whilst in many other regions, such as Yorkshire and the Midlands, unemployment has been rising and stays above 8, 9 or even 10%.  But the third reason for lack of feel good is falling incomes and rising prices of food, energy and transport.

Record numbers are working part-time because they cannot find full-time jobs with 8 million people working fewer than 25 hours a week. This means that as the real cost of living rises with increased prices of food and energy, family income is falling.  Real monthly incomes are on average £22 lower than a year ago.





We need social solutions for social objectives.

We need social solution to social problems. For too long society has been regarded as simply an aggregate of self-interested individuals. I would say the rot was established in the 1980s. The then British prime minister, Mrs Thatcher, famously said there was no such thing as society. We hold personal success more highly than we view social endeavour. Our attitudes to people has been dominated by consideration of financial success; we measure worth in money terms rather than the benefit others may give or receive from others; making a fast buck over social vocation. In truth we have found social excuses for the excesses of selfishness. Some even suggested that excessive selfish behaviour benefits all by some miraculous trickle-down to the poorest. Someone forgot to wave the wand because it didn't trickle down. The poor got poorer; the rich got richer.

The argument was that the rich getting richer was good because it provided jobs and opportunities for others. This has all come crashing down to earth. One thing the financial crisis has led to is a questioning or how some were able to make so much money without really doing very much. And now we know that some of these people pay little or no tax; they give little back to the society they exploit. Many of them are greedy takers.

Not long ago if I was to say all this, the response was that this was the politics of envy. This of course was another smokescreen for the rich to exploit others and often poorly paid workers. Quite frankly it stank but so many of us were involved in creating the stink we failed to smell it.

Companies failing to pay tax in the UK is not new.  It didn't suddenly appear since, say, 2010. Companies like Starbucks, paying its workers poverty wages and paying no corporation tax, didn't suddenly appear. They have been a part of the financial game in the UK for a long time. We just chose not to question it. We turned a blind eye to it. If it is a disgrace now when austerity is hurting, it was always so even in the good times. How could the parliamentary select committee have been so surprised by it; why did they not question it before?  It was a disgrace, just as it was always a disgrace that bankers paid themselves excessive bonuses. They were ripping us off.  It couldn't last because it was unsustainable. It was a mirage. It had no foundation; debt, bad debt was being created and sold on. The banks were acting like pimps. Selling the sin of ever more debt.  Public debt became private debt as more were encouraged to over-mortgage themselves to buy houses. Meanwhile the social stock of housing was sold off and we stopped building. Cars, televisions, computers, mobile phones, a consumer bonanza fuelled by debt. We were selling our future; or more correctly we were selling the future of our children.

These companies were ripping off Britain, libraries are now closing, services are being cut, benefits slashed, the unemployed treated a 'scroungers' and even the disabled attacked for being work shy. This is an appalling state of affairs. Our salvation won't come from get-rich-quick buccaneers. It will come from steady investment in growth. It will come from social solutions to the need for housing, health and welfare. But the government will blame almost everyone other than the wretched people who got us into this mess in the first place. We need to establish social objectives and we must consider how best these objectives can be achieved. The poor must not get poorer; it must be an objective that they fairly share in the wealth they are helping to create. We must create a fairer society. We must no longer assume that growth for growth's sake is sufficient.

Tuesday, 18 December 2012

Free bus pass value for money. Keep your hands off Mr Clegg.

Free bus passes for the elderly are under threat with funding reduced by more than a quarter. Some transport bosses have warned that the scheme will become unaffordable.

Nick Clegg wants to restrict eligibility, arguing it is unfair that wealthy pensioners should also get the  concession. But does Mr Clegg really understand the value of the bus pass scheme for the elderly? And what of the consequences of means testing? Would it really be fair that one pensioner who judiciously saved for retirement should be denied a bus pass, while another who did not do so receives it?

Not long ago I met a lady coming off the train laden with several bags which I offered to help carry. "I'm only going to the bus stop." She explained, which was handy because I was catching a bus too.

I had daily gone to the station by car but now I was using my free bus pass. There was an hourly service that passed through my village and stopped at Leighton Buzzard station.

 "Are you going far?" I asked.
"I'm visiting my daughter" She explained. "She lives in Nottingham."
"Nottingham?"
"Yes."
"But how are you getting to Nottingham from here?" Nottingham was a long distance.
"I'm  getting the bus to Milton Keynes."

She would get another bus, and then another. She had planned it out, and she had done it before.
It took a long time but she could travel free, and that made all the difference.

We were united by our bus passes. I was saving fuel and she was saving money. We were both keeping fit. Or at least she was.

Bus passes do more than simply giving free travel. They enable people to get out and about, to maintain friendships and links with the community. They can prevent loneliness and isolation. They can bring people together; keep people in touch.

A recent study by researchers at Imperial College, London, found that free bus passes encourage the over 60s to be more active. They examined data from the National Travel Survey from 2005 to 2008. The free bus pass was introduced in 2006. They found that free bus passes had encouraged holders to walk more, at least three or four times a week; good for health and ultimately the health budget. A small amount of regular exercise such as walking reduces the risk of disability in older people. 

Postscript

A principal argument against the universality of the bus pass is the apparent unfairness: why should millionaires get one free too, surely that is unfair. Well it might be if indeed many millionaires applied for one.  But this kind of argument seeks to make a general case by example of an extreme. When I ask what threshold of 'wealth' there should be I rarely get an answer that makes much sense, or that wouldn't create more unfairness at the margin.  I have yet to see any flesh on the bones of Mr Clegg's position.

We should make no mistake that the real agenda here is cuts. The cost to the exchequer of free bus passes is around £1bn, that of the winter fuel allowance is £3bn.  Once again it is easy for politicians to divide the community on the issue of 'fairness'; what they won't yet do is to say what their real policy would be.

Monday, 17 December 2012

Clegg misses the point about pensioner benefits

Nick Clegg has set his eyes on major reform. A defining moment for Liberal Democrat politics; removal of free bus passes and TV licenses from 'wealthy' pensioners. So now we know what the Liberal Democrats stand for. I expect it will include the automatic fuel allowance. Is this really what Liberal Democrats have been in politics for? And do they not understand why some benefits are universal?

It may appear unfair that rich and poor alike can receive the same benefits. But there is a good reason to give some benefits in this way. Targeting involves means testing and it involves setting thresholds. Thresholds can create a worst kind of unfairness; those just above, those just at the margin, losing the benefit. Two elderly neighbours one receiving and the other not, all for the sake of being a penny above the threshold; one neighbour now 'richer' the other now 'poorer'. But there is something more worrying about means testing. Many elderly people tend not to apply for benefits even when they qualify and deserve them.  Each year, a staggering £5.5 bn of benefits that pensioners are entitled to go unclaimed.

Four million pensioners are entitled to pension credit, yet a third of them are not claiming it. This means they may be missing out on hundreds or even thousands of pounds of benefit they are entitled to, and yet Mr Clegg chooses to focus on bus passes and TV licenses. What kind of priority is it? 

The Liberal Party had a proud history since they introduced state pensions in the UK at the beginning of the 20th Century.  Now Mr Clegg wants to define them by taking away bus passes and TV licenses.

Sunday, 16 December 2012

The Conservatives brand the unemployed as 'shirkers'

The Conservative Party has adopted an aggressive set of campaign advertisements targeted at 60 constituencies contrasting "hard working families" and "people who don't work".  This divisive advertising represents once again their attempt to label the unemployed as lazy 'benefit scroungers'. It also demonstrates how little they understand unemployment and poverty. The notion that there are 'hard working families' and 'people who don't work' assumes these groups exist as separate social groups. One result of recession is that hard working families are affected. Company failures, factory closures and lay-offs don't just impact on 'scroungers'.  This is why the results of austerity are so devastating. It is indiscriminate in its effect. It is also why austerity doesn't work. It drives families, hard working families into poverty. 

Unemployment is a key driver of poverty.  Two-thirds of  working age adults in families where one or more of the adults are unemployed are poor.  Unemployment, particularly long term unemployment, grinds away devastatingly on families creating poor housing, poor diet and ill-health. It leads to a cycle of debt and targets for loan sharks. It leads to homelessness, eviction, repossession. It destroys lives. It leads to a loss of dignity and well being. This is why it is unethical of the government to target those most affected by austerity, brand them as work-shy scroungers and attempt to turn those better off against them. Mr Cameron once said 'we are all in this together'. Now the unemployed and those receiving benefits have become the government's scapegoats for the failure of their economic policies. 

In the aftermath of the riots of August 2011, the Prime Minister said "this is a country of good people". Now it seems he is saying this is a country of 'good' and 'bad' people; the haves are 'good'; the have nots are 'bad'; 'strivers' and 'shirkers'. It is a disgraceful turnaround and he knows this is not true.  It is cynical politics at its worst. 




Saturday, 15 December 2012

Tax dodging companies exploit British workers.

Unions such as GMB are campaigning for a living wage of £8.55 an hour in London and £7.45 outside the capital. A staggering one in five workers in the UK  receives less than the living wage. That is nearly 5 million people.  Yes, 5 million 'strivers'.  This is slave labour. 

A living wage is simply a rate of pay that enables a basic standard of living.  Any civilised society should aspire to achieving it.  If the government believes in markets then let's stop subsidising companies who pay low wages. We should insist that all companies should pay a living wage; it should be the minimum entry point for any worker. Not only would this be fair, a decent wage for work done, but it would also cut public spending on welfare.  It would enable people to make a difference to their lives and the lives of their families; it would provide dignity and respect for the work they do.

It is a disgrace that tax dodging companies like Starbucks exploit not only their workforce but also the British taxpayer. It is no surprise that Starbucks refuses to recognise union representation for its workforce. Companies like Starbucks are the real scroungers the government should be targeting and attacking with their stigmatising rhetoric.

Can we afford a living wage in the public sector?

The leader of Britain's largest public sector workers union, Dave Prentis, has said the Labour manifesto should contain a commitment to pay all public sector workers at least the living wage. This would be a bold step for Labour and would determine much else in their strategy on pay. But if Labour made this commitment what would be the quid pro quo from the public sector unions?

For a living wage to be meaningful for the poorest workers the unions would have to agree not to seek to maintain  pay differentials, else pay would ratchet up. A key question would then be whether this was sustainable. It would involve a self-imposed pay restraint for workers up the pay order. Is Dave Prentis willing to persuade his members of such a restraint? Some might doubt it as he is already threatening future industrial action on pay. It is difficult to see how he can square this circle.

He might argue that increased pay for public sector workers would not be inflationary and would not therefore affect the living wage. This would be most unlikely. Public sector pay increases have major impact on costs of providing services; somehow these costs would have to be met by either increased government subsidy, further cuts in services or increased taxes or charges. There is, however, one seed of an argument that might just hold.


Whilst private sector labour costs have increased recently,  public sector labour costs have fallen. The ONS statistics show the growth in labour costs per hour in the private sector was 1.4 per cent in the third quarter of 2012, compared with -1.0 per cent in the public sector. This in part reflects an increase in hours worked per employee in the public sector, compared with a year earlier.

This increased productivity in the public sector may provide a little wriggle room for modest increases in pay that would enable a living wage in the sector without a ratchet effect. But Prentis would still need to prioritise the living wage for the lowest paid public sector workers. If he is willing  to do this, would his members be also in accord?

The problem of outsourcing low paid jobs

It is scandalous that a living wage is not paid in the public sector - it is equally scandalous that anyone should be expected to work for less than a living wage in any sector. We must move to fairness in pay and this means in both public and private sectors. This is particularly so because most low paid jobs are outsourced to the private sector. Thus the private sector has a higher proportion or workers at or around the minimum wage and in particular women.

There must therefore be a commitment that no contracts can be awarded unless at least the living wage is paid. There should also be commitments to training and promotion. In this way a living wage can also be part of a programme of developing better services through a more productive workforce.


Thursday, 13 December 2012

Politics and the immigration game

Home Secretary, Theresa may has said that mass immigration needs to be curbed to bring down house prices, improve wages and reduce the benefits bill. Is there more to this than playing politics with a sensitive issue in the light of UKIP's growing appeal? We do need a sensible debate about immigration and one that isn't contaminated with racism. But is this another attempt to find a scapegoat for austerity along with 'benefit scroungers'?

Immigration was a major issue in the last general election. It is not a problem that will disappear. In the general election of 2010 all three main political parties, the Labour Party, the Conservative Party and the Liberal Democrats pledged to control immigration, but they disagreed on how this could be achieved. It was given added fuel in the election when The Daily Mail said that 98% of jobs created in the United Kingdom since 1997 had been taken by migrant workers.

In the 1960s many of us were appalled by the speech of then leading member of the Conservative Party, Enoch Powell in which he warned of future problems resulting from large-scale immigration.

"We must be mad, literally mad, as a nation to be permitting the annual inflow of some 50,000 dependants, who are for the most part the material of the future growth of the immigrant-descended population. It is like watching a nation busily engaged in heaping up its own funeral pyre." 

Powell was immediately disowned by the then Conservative leader, Edward Heath, and shipped to the political wilderness. His speech was regarded as an incitement to racial hatred. But it was the language used rather than the substance of his speech that created the problem. Many have since suggested that Powell's speech was not racist in deed or tone. Whatever the truth of that, it certainly had a racial and discriminatory element. Referring to the then Conservative position on equality he said:

"As Mr Heath has put it we will have no "first-class citizens" and "second-class citizens." This does not mean that the immigrant and his descendent should be elevated into a privileged or special class or that the citizen should be denied his right to discriminate in the management of his own affairs between one fellow-citizen and another or that he should be subjected to imposition as to his reasons and motive for behaving in one lawful manner rather than another."

This certainly appeared to condone discrimination.

Concern about  potential immigration from former colonies had been expressed by the Conservative  when in power in the 50s and and early 60s.  Immigration from former colonies, composed largely of economic migrants had increased from 3,000 per year in 1953 to 46,800 in 1956 and 136,400 in 1961. The alarm bell was heard in the corridors of power. The Labour government was also concerned at the impact of large-scale immigration. James Callaghan, as Labour Home Secretary, introduced the Commonwealth Immigrants Act in 1968 placing controls on entry of British passport holders with 'no substantial connection' in Britain. Speaking later he was to say:

"Public opinion in this country was extremely agitated, and the consideration that was in my mind was how we could preserve a proper sense of order in this country and, at the same time, do justice to these people – I had to balance both considerations".

Labour were no doubt mindful of how immigration had played as an election issue. In the 1964 General election the Conservative Peter Griffiths won his seat with the racist slogan "If you want a nigger for a neighbor, vote Labour" .  Thus, the issue of immigration became an issue between the main political parties, but significantly the problems of  immigration had become linked to racism, and to this day it has been difficult to separate them. It is rare that the issues can be discussed separately. Also 1,000 dockers had gone on strike against Heath's sacking of Enoch Powell.

Nevertheless, the Labour government also introduced the Race Relations Act in 1968 outlawing discrimination. It extended the powers of the Race Relations Board and set up a supervisory body, The Race Relations Commission.

In 1971 I had had a direct involvement with the issues of immigration and discrimination. I became  involved in racial equality as an Alderman in the London Borough of Wandsworth where I served on the executive board of the local body for Race Relations, Wandsworth Council for Community Relations,  dealing with issues of discrimination in access housing, jobs, schools and justice. As such, I witnessed first hand the results of racial discrimination, in particular those associated with the arrival of 27,000 Asian refugees expelled from Uganda by Idi Amin.


In the '70s, there was much talk about 'integration' and 'assimilation'. These became the focus of policy. But now we talk about multiculturalism with a greater appreciation that the very concept of 'integration' can be discriminatory. If we talk about cultural assimilation, then whose culture is it? It is a 'when in Rome, do as the Romans do' approach. "They don't behave like us" is the first stage of discrimination, or regarding differences as an excuse for stigmatising and treating others as second class citizens.  Nevertheless, in the 1970s I think it was thought that the barriers that divided people of different ethnicities would somehow dissolve over time and with following generations. Children of immigrant parents would feel British, and their children even more so. To a large extent the evidence suggests this is so. There is no real conflict in supporting both the English cricket team and also that of the West Indies, Pakistan or India, unless of course they are playing each other!

In 1990, the leading Thatcherite politician, Norman Tebbitt, famously invented the 'cricket test', testing the loyalty of immigrant populations. Earlier this year the Deputy Prime Minister, Nick Clegg pointed out that it was unlikely his children would pass it because they backed the football team of the country of origin of their mother who is Spanish.

The problem with this view of integration or assimilation is that it is naive of the nature of identity. People have different 'cultural heritage'; you cannot wipe history clean. We cannot pretend that the only history that matters is 'British', or that different cultural and ethnic groups have played a significant part in that history.  To pretend otherwise is a kind of cultural imperialism where one group  decide what is to be culturally British and then encourage others to adopt it, or force them to do so if they will not. We'll all be the same, we will all show the same behaviour.  But what is it, this Britishness? Culture cannot be defined in this way; and certainly not by a simple test.

Since Enoch Powell's speech a rational debate on immigration has been difficult in the UK, particularly as concerns about the impact of immigration have been considered racist. But there are genuine concerns about immigration that are not racist; the consequences of overpopulation and its impact on housing, education, transportation, health and employment, and the impact on community cohesion and identity. Ignoring these problems is not a solution.

In his controversial speech at the Conference on security in Munich, British Prime Minister David Cameron said the issue of identity: "Instead of encouraging people to live apart, we need a clear sense of shared national identity that is open to all. " Multiculturalism, he said, had 'failed' because it encouraged different peoples to 'live separate lives'.

Britain has been multicultural for a long time; it is not a recent part of its history.  But now we have become an overcrowded island and the clash between cultures appears more urgent. The inability of Islam to adapt to a secular order may be part of the problem. But the problem will not disappear simply because Mr Cameron believes that "the experiment" in multiculturalism has failed. It is not and has not been 'an experiment'; it is a fact of life. Societies undergo continuous change driven by economic circumstances and technological development. Being 'British', whatever it might mean, evolves.  We are a multicultural society and that's the end of it. We must learn to live with it. Integration is not measured by the extent by which a people must abandon their religious or ethnic identity, on the contrary, it is measured by the means by which they can be accommodated. For that we need to promote tolerance of the ideas of others as long as they are reasonable and conform to the ideas of liberty and gender equality.

Addendum 

Since publishing this post, Ed Miliband has also staked out Labour's position. We have to take account of genuine concerns about immigration and the problems of 'segregation', by which he means two communities living side by side but with little interaction. This means 'rejecting the idea that people can live "side by side in their own communities, respecting each other but living separate lives lives, protected from hatreds but never building a common bond - never learning to appreciate one another." He argues that if we are to tackle this problem then we need to tackle the barriers to being 'One Nation', such as proficiency in English language.  His approach has merit because it doesn't seek to reject 'multiculturalism' and doesn't simply focus on 'immigration'.










Wednesday, 12 December 2012

You couldn't beat mum's damson jam


You couldn't beat mum’s damson jam; damson jam doesn't taste the same now, but that is what reminiscences do; they alter your taste. Sunday roast has never been the same since either. So many differences! We didn't have a television for most of my childhood. I used to watch Popeye at a friend’s house whose mum gave us bread and jam for tea.  We never had it so good! Or at least that is what Harold MacMillan told us; and in so many ways he was right. The Tories didn't taste the same either!

Not that it cut any ice with mum; she was staunchly anti-Tory; didn't think much of the Liberals either. Labour had set up the NHS and developed the welfare state.  The Tories, if you believed the propaganda, were ‘setting the people free’ from Labour’s state control.  Of course they were not; what was happening was that people felt better as war-time rationing came to an end. People had become frustrated at how long it was taking, and the Tories had been able to capitalise on it.

There were more goods to buy and a developing consumerism. Now we were consumers rather than simply citizens. Labour lost the election in 1952 although they increased and had the majority of votes. It heralded 13 years of ‘Tory rule’. The 1950s boom would of course end in a kind of ‘bust’; but nothing like the financial collapse we have had today. Boom and Bust, or ‘Stop-Go’, was the order of the times; the ‘go’ would usually last for about 4 years; the economy would ‘over-heat’, inflation would rise, costs would rise, exports would fall, imports would rise and a balance of payments ‘crisis’ would bring it all to an end. Too much money follow too few goods. And that was it in 1964 when Labour won the election and Harold Wilson became prime minister.

I had started work as a temporary clerical assistant in a branch of the Home Office. I can’t recall anyone at work who was pleased that Labour won; most were Tory.  Labour had barely a majority and the economy was in a mess. I recall a lady at work telling me it would all end in bankruptcy; Labour she told me had bankrupted the country when last in power under Atlee. It was as if the world war hadn't happened; Labour it seems was to blame -a bit like the collapse of the banks now; convenient to blame Labour for the mess. Propaganda is a powerful tool!

"Really?" I replied, "but Labour had created the NHS." That is why they left us bankrupt she responded.  That is how I had my tooth pulled, I thought to myself, and my eye test and my glasses, and my measles jabs etc, and my arm fixed when it was broken.  If that was bankruptcy, then bring it on, I thought, and smiled. She was a nice enough lady. That’s when I learned there were a lot of nice people who didn't see the world as I saw it.

The Tories had been forced to accept the welfare state; although it was clear from their manifest in 1964 that they would begin to dismantle it. Had they gained another term, rent controls would have been eroded further and private practice in the NHS would have been  developed.  They talked of ‘fair’ or ‘market’ rents for council housing determined by supply and demand rather than subsidised rents families could afford. In London in particular that had meant a lot.  So-called ‘market rents’  would mean  that many would no longer be able to afford the decent social housing.  Thankfully the Tories lost. But it was a warning; a marker laid down, and when the Tories won in 1970 it was one of the major pieces of legislation, The Housing Finance Act, that would compel Local Authorities to charge ‘market rents’. I remember it well because by 1971 I had become a member of Wandsworth Borough Council. 

But in 1964 the Tories adopted a social language, and for Butler and MacMillan society mattered.  Alec Douglas-Home the Prime Minister and Tory leader wrote in his forward to their manifesto:

“The Conservative purpose is clear from our record and from our programme. It is to raise the quality of our society and its influence for good in the world.”

To raise the ‘quality of society’! This wasn't some Big Society nonsense of David Cameron. I haven’t met a Tory would can tell me what 'big society means; and most will dismiss it as nonsense. At best it means you cut public services and benefits forcing the poor to depend on charitable hand outs and food banks and the good will of blue-rinsed charitable ladies; big ladies for the big society.

In 1964 we all ‘believed’ in society. We just argued over what it was for and how it should be. Labour and Tory (although to a less degree) believed that for many of our problems there were social solutions. Society was more than an aggregate of individuals; people behaved as members of families, of communities and of society. And economic policy mirrored this view. Even the Tories believe in economic planning of sorts. The Tories had set up a major planning committee, the National Economic Development Council, bringing together representatives of government, businesses and unions.  They attacked Labour’s proposals for a national plan and central planning,  yet they adopted many of the same planning approaches themselves. Neither party at that time would have thought the only economic policy was to control the supply of money through interest rates.  ‘We were all Keynesians’ as the Tory Rab Butler would say. And this was not surprising. MacMillan and Butler had been genuinely shocked by the ravages of unemployment in the 1930s and were determined not to see it again. 

Then like now you had those who dismissed the parties as ‘being all the same’.  It clearly wasn't the case.  So much was different in the manifestos.  One of those differences I have already referred to would raise its head again when Labour lost office in 1970 – housing and rents. It is still a fundamental difference today. 

Full rent control had been reintroduced during the war (The Rent and Mortgage Restriction Act 1939).  After the war the Labour government had introduced the Landlord and Tenant (rent control) Act in 1949 empowering rent tribunals to determine a reasonable rent. These controls had been dismantled by the Tories in the 1950s, ushering in the scandals of unscrupulous slum landlords forcing tenants out of their homes.  Labour had promised to restore controls and repeal the Tory legislation and Harold Wilson’s government rapidly moved to pass the Protection from Eviction Act in December 1964 and the Rent Act in 1965 providing security from eviction.  It was a major promise kept and was to transform the lives of many. 

The Tories remain wedded to the idea of markets determining rents. But it was they who created the absurdity of a system of rent allowances that allowed landlords to hike up rents above the market. It all started with the 1988 Housing Act deregulating the rented sector, removing the rights to tenant protection and assessment of 'fair rents'. It meant landlords could increase rents subsidised by housing benefits. It introduced  distasteful exploitation in the rented sector with rents inflated by the subsidy. The rented sector became a gravy train; and with the decline in social housing, increasing private sector rents  meant that the housing benefit bill would spiral out of control.   Now the Tories are forcing people to move by restricting the housing allowance. But it was a mess they created in the first place. It was they who 'sold the family silver' as MacMillan put it. Don't let anyone say there is no difference between the parties.  

Nothing tasted as good as mum’s damson jam.  (to be continued). 

The banks raked in the profits and sold our future.

Britain's biggest bank, HSBC has been fined a record $1.9 bn by US regulators for money laundering and sanctions busting. .Money laundering, libor fixing, skulduggery of the highest order; illegality; breaking the law; a law unto themselves. The banks let us all down badly.

Whilst some bankers were cheating and breaking the law; whilst the financial service industry was driving us to ruin, and whilst year on year huge bonuses were being taken,  year on year endowment policies were failing to meet targets,  leaving families in difficulty with their mortgages. I have an axe to grind because mine became one of them although fortunately I didn't depend on it. I started to receive the dreaded letters; first informing me that my endowment was 'on track' (great) but they would keep me informed (ah!); then to say it was 'at risk' (oh!); then to tell me it would not meet its target (inevitable!). Angrily I pulled the plug because I decided I could do better with the money than they could. I cut my losses. But I wondered what on earth the financial 'services' sector had been doing to allow it to happen.

What they had been doing was for ever inventing new 'products' to bamboozle their customers. So many different types of savings, investments, insurance, endowments. Trackers, fixed-rates, flexible this and that; all tweaked to encourage people into debt. And let's be clear they wanted us in debt. They were about selling debt; so much so that unbeknown to us they were selling our debt to each other. A veritable trade in sin. We were being prostituted through our debt. Passed around to be financially gang banged. We were all hung out to dry for the sake of bank profits. 'Service' didn't come into it; financial 'services'  couldn't possible account for what they were doing. There wasn't a service ethos. It was all unethical; all of it! Run by people who appear to have been out of control and who thought they were accountable to no one, least of all their customers. Scoundrels!

When I tackled  my 'friends' in the financial services sector  (yes I do have a few), and particularly those in investment banking, I asked how could they get it all so badly wrong. It wasn't us they replied it was the markets. Markets can go up and down. Indeed they can. How silly of me to assume they had any expertise in the matter. It was all my fault for being stupid enough to think they would take care with my hard earned savings.

But I was informed that it was more likely they would than wouldn't; go up that is. I was shown a wonderful graph comparing the rise of the stock market since the year dot and house prices. Yes it goes up and down, I was reminded, but 'on average', well you can see can't you. On average!   But also wasn't it very silly to base mortgage lending on the premise that it would go on rising and at an unsustainable rate? To offer a product that was unsound is a bit like selling a car knowing it had been clocked. Yes, but they weren't to know of course. And why did they lend so much against so little, often 5 times a persons earnings?

Weren't to know? Then how were we to know?  Millions were mis-sold endowments. Many were mis-sold Payment Protection Insurance. Millions are suffering now because of the egregious unethical behaviour  of the bankers who encourged fast buck sales. And not only are they suffering but they have the ignominy of being called scroungers. The poor are not only shouldering the greatest burden of austerity but they are also being blamed for the poor ethical standards of the bankers.

It was of course unsustainable.  Growth was founded on a false premise; that somehow we could all go on spending the future. Private debt ran out of control fuelled by greed and a have it now culture. The banks raked in the profits and sold our future.

Tuesday, 11 December 2012

Marriages don't fail because they come to an end.

I am not sure I understand the opposition to same-sex marriage. It is not as if marriage as an institution has been particularly successful in recent times. But this post is not about same-sex marriage. It is about marriage in general.

Something like 33% of marriages end in divorce within a 15 year period.  The number of divorces is highest among men and women aged  40 - 44.  Marriages last on average for a little over 11 years. we talk of marriages that end in divorce as having 'failed'. But is the success of marriage best judged by its endurance? Perhaps there is a better measure of success.


Divorce is not an easy process. Half of couples divorcing having children under 16. David Cameron is pledged to 'strengthen families' by making it tougher to get a divorce.  The Tories see the 'breakdown' of marriage as symptomatic of a 'broken society'. But making it more difficult to divorce may not be the best approach to dealing with the collateral damage of divorce; indeed it may make it worse.


We talk of marriages as having 'failed' if they end in divorce; but marriages don't fail simply because they come to an end. Even a successful marriage might end if one or both people in it change; and people do change. Or at least what they might want changes. The marriage may have been successful in fulfilling the social union between the couple concerned, it might have achieved success with children and seeing them through their early development. The demands of life change with time, with jobs, with promotion or unemployment, with moving house, with stress and these may bring unexpected responses or affects on those involved. Even having children may have an unexpected outcome.

There is no manual for dealing with this.  The expectation that marriage is a life-long commitment may not in most circumstances be sensible.  The social and economic conditions for marriage as a social institution have changed.  "Till death us do part" regardless of context isn't necessarily the best road to happiness.  Even a successful marriage may end in divorce with changing circumstance.


Monday, 10 December 2012

Presumed consent may not be ethical in setting up NHS DNA database

A key issue in establishing a national NHS  DNA database, expected to be proposed by the Prime Minister this week, is that of informed consent. It should be understood that such a database of patients' DNA is not immediately clinically relevant. The sample is not being taken for diagnostic or potential treatment of the patient; the proposed database is for genomic research. This research may identify links between specific gene mutations and risk of disease, but it is not intended that this will then be used directly in any proposed treatment of the patient. 

It has rightly become a central principle of medical research that there should be full and informed consent  from any person included in a trial or from whom personal information or samples are obtained. The proposed database, unless it is set up on this basis, would breach that fundamental principle. But one suggestion is that in this instance consent will be presumed unless the patient specifically states that they do not wish their DNA data to be stored as part of the database. This is what is referred to as an 'opt out' approach to consent.  It assumes consent unless otherwise stated. An opt out strategy for the data base would assume informed consent  unless the patient specifically says they do not wish their DNA to be included. 

Ethical research depends on the credibility of consent and how it is obtained.  In this case I am dubious about  the robustness or efficacy of an 'opt out' approach. 'Opt out' is used for consent in a few clinical contexts. It is used for example in HIV testing in pregnancy. Unless the woman specifically indicates that she dosn't want their sample to be tested for HIV, then it will be tested. There are specific justifications for this approach, not least a consideration of duties to the unborn child.  But it is unclear how this could work in a research context; or what the specific justification for it would be. Concern for the time it might take to obtain consent, cost of information literature and processing consent forms are the obvious ones. But I know of no research where such concerns have allowed appropriate informed consent to be discarded. Without diligence a presumption of consent  may be open to abuse or mistakes.  It needs to be clear how patients are to be informed of their right not to participate and in what context and how they would be able to opt out without pressure or prejudice. What information is given  about the possible role of the database and how this is given is also important.  If opt out is simply in the small print then this would be worrying. Failure to indicate 'no' is not the same as 'yes'. 

It is not clear why 'opt out' would be needed other than the administrative ones. If the database is of sufficient value then it should be set up on the basis of consent being given through an  'opt in' approach.   In a clinical context 'opt out' can work where it is clear what the consequences might be for the patient or others involved. This is not clear in the case of research, where outcome is uncertain. 

Developing clear ethical guidelines in medical research has taken decades to establish. The key principles were set out in the declaration of Helsinki in 1964. Central to these principles was that consent  cannot be presumed.  Prior to the development of ethical review in research and the development of these key principles  patients and other subjects could be recruited to trials without proper consent. Proactive consent was central to the Helsinki declaration:

"participation by competent individuals as subjects in medical research must be voluntary...no competent individual may be enrolled in a research study unless he or she freely agrees." 

We should be wary of breaching this fundamental principle. Informed consent is not simply that they say 'yes' to being included, or that their consent is presumed if they say nothing, but that they agree after being informed appropriately of potential outcomes and benefits and of any potential harms to those in the trial or whose samples are being stored or used. 

We may feel that a database offers little or no potential for harm. It is after all just a database. But this depends of a number of factors: how the information will be protected, how it will be used now and in the future, and what will happen to the information as the studies based on it develop. This last point is clearly an unknown.  Without  safeguards it would be relatively easy to decide the data could be used in ways not envisaged at the outset.  If this was done then it would be done without consent of those included in the database, because proactive consent had not been obtained.

Whether such a breach could occur may depend then on the arguments presented. I have no doubt that in the future, persuasive utilitarian arguments will be marshalled in favour of potential breaches if it is believed the benefits were sufficiently great or in the 'public interest'. It will be argued that the benefits would outweigh the potential harms and thus justify a breach of the normal principle.  Furthermore, it is possible that the clamour for disclosure will come on civil liberties grounds, with arguments that individuals have a right to know what information is held about them in relation to the outcome of any research.  This after all would appear reasonable if studies using the database found significant links with particular gene mutations. 

There are potentially great benefits to be gained from establishing a national NHS DNA database. But we need to be vigilant about breaches of the fundamental principle of informed consent. Such a database must have proactive and not presumed consent from patients whose data is stored.