Thursday, 24 October 2013

NHS trusts buckling under extreme financial pressure

There is more evidence today that that NHS savings are putting patient care at risk. A review by the Care Quality Commission (CQC) suggests that quarter of hospital trusts in England are at raised risk of providing poor care.

The findings are based on monitoring by the Care Quality Commission (CQC) of a host of data, including death rates, serious errors and patient surveys. It found 44 out of 161 trusts fell into the two highest risk categories.

Responding to the CQC’s review of hospital trust data in England, Dr Mark Porter, Chair of BMA Council said: 

"Having this array of information in the public domain is an important step towards improving transparency across the NHS, informing and empowering patients and shining a light on hospitals which are not performing to the standard we expect.

"Hospitals are large, complex organisations so we need to avoid oversimplifying or reducing vast amounts of data to a simple band or rating.

"It goes without saying that where trusts are found to be operating below par we urgently need to identify where the problems lie and find a solution."

But what is the basis of the problem? The BMA point to the acute financial pressure resulting from savings cuts imposed on the NHS. 

"The fact is many trusts are buckling under extreme financial pressure. The NHS is having to make £20bn of savings, leading to increasing pressure on staff and resources and, most worryingly, affecting patient care and outcomes." Dr Porter says. 

"Many hospitals are stretched to breaking point. If we are to deliver the improvements patients and doctors want to see, the government needs to address the significant funding gap in the NHS. 

"All hospitals should be meeting the standard of high quality care which patients expect and front line NHS staff want to deliver. But the reality is that the NHS simply cannot continue to meet rising demand with reduced funding."

The government cannot simply wash its hands of the effects of the cuts and the effects of the unnecessary reorganisation it has imposed on the NHS. 

The coalition promised to ring-fence the NHS from austerity. It hasn't done so.

David Cameron promised voters there would be no top-down imposed reorganisation of the NHS. He reneged on that commitment. 

Reorganisation and cuts are putting lives at risk. 

Monday, 21 October 2013

Doctors warn government that lobbying proposals could limit public health campaigning.

There has been much concern expressed that the Lobbying Bill could limit the campaigning activity of charities. Now, doctors’ leaders have warned that the Government’s proposed legislation lacks clarity, is excessively bureaucratic and could severely limit organisations, such as the BMA, campaigning on public health issues, including smoking, during an election year.

The warning comes in a new BMA House of Lords’ briefing, released today (21/10/13) ahead of an important debate in the second chamber on the Transparency of Lobbying, Non-Party Campaigning and Trade Union Administration Bill on Tuesday 22 October 2013. 

The Lobbying Bill would severely limit the ability of charities to campaign in a year in which there is a general election. The proposals have received widespread criticism and most recently from the Joint Committee on Human Rights and Lords Constitution Committee amid concerns that the proposals will curtail public debate by preventing charities, pressure groups, think tanks and other organisations from presenting information in the run up to an election. 

Some of these concerns have been recognised by the government, but the Bill still lacks clarity.  

Key points from the BMA’s briefing include:

Potential adverse impact on freedom of expression: The combined effect of vastly reduced spending limits and continued uncertainty around what activities fall foul of the Bill, such as production or publication of material made available to the public, would have a ‘chilling effect on freedom of expression.’

Lack of clarity: Despite the Government’s changes, it is still not evident from the wording of the Bill whether or not apolitical organisations, like the BMA, will be unduly restricted in what they can do. Absolute certainty is needed on whether and when the cost of activities will count towards ‘controlled expenditure’.

Excessive bureaucracy: The Bill currently proposes a system that would result in new administrative and regulatory procedures that would prove an immense administrative burden.

Dr Mark Porter, Chair of BMA Council said:

“Despite some improvements to the Government’s proposals, the Lobbying Bill still threatens to dramatically curtail the ability of organisations like the BMA to speak out on vital issues during the year before an election. This would include preventing doctors’ leaders from raising key public health issues, such as those related to smoking.

“The Government should not ignore the potentially huge and damaging impact of the legislation as currently drafted on all non-party political organisations. It cannot risk limiting our ability to speak on issues of public interest.

“We urge the Government to pause, listen and think again, rather than rush ahead with this ill-thought through piece of legislation.”

The government legislation as it currently stands could have the perverse effect of allowing lobbying by major corporations whilst restraining the ability of charities and other non-political organisations from campaigning. 

Thursday, 17 October 2013

Labour joins the 'worker' versus 'shirker' poor bashing?

The political obsession with the 'squeezed middle' hurts the poorest. It is understandable. Whichever political party can appeal most to the middle income earners is likely to win the next election.

Sadly this is why some in the Labour party appear ready to abandon the poor. You don't win elections by being compassionate and understanding about poverty.

So, Labour's Rachel Reeves, Labour's shadow work and pensions secretary,  vows to be tougher than the Tories on benefits and force the long-term unemployed to take up 'work offers' or lose their benefits. Labour is now in the same unethically divisive  game played by the Tories, to portray the unemployed as work-shy  'scroungers' or 'benefit cheats'; it is the 'workers' versus the 'shirkers' divide.

It is an easy story to buy into. We all know (don't we?) people who are on the dole who don't look for work and live in a 'benefits culture'. There is work out there (isn't there?) if only they would get off their backsides and look for it.

Unemployment in the North East is twice that in the South East. Are we to believe that those in the North East are twice as lazy as those in the South East? That these North Easterners are work shy compared to their cousins in the South?

Now, there is a problem for the long-term unemployed. The longer the period of unemployment the harder it is to get back into the job market. Help is required. But also what is required is relevant skills, experience. what is also needed, and here is the rub, is jobs.

No doubt a bit of stick should go with any carrot, but let us not deceive ourselves. Labour's tough position is little more than political expediency. It addresses not the real problem of getting the long-term unemployed back to work. It address and at that same time panders to the misconceptions about the unemployed held by the 'squeezed middle'.

The Tories have been rocked by Labour's potential appeal to this 'squeezed middle'. The standard of living has become a major issue. It has now outstripped the economics of growth or no growth and 'double dip' recession. As the latter recedes the Tories would expect a bounce in the polls. That it hasn't yet materialised is put down to the decreased earnings of the 'squeezed middle'.

The YouGov London poll for the Evening Standard is grim reading for the Tories with intention  CON 32%, LAB 45%, LIBDEM 10%, UKIP 9%  a swing of 5.5% from Con to Lab since the general election. This is in spite of the fact that Boris Johnson polls well with 64% approval for his job as Mayor.

There isn't much any of the parties can do about earnings (is there?) so the next best thing is to blame the poor. We would all be better off if we didn't pay so much on welfare (wouldn't we?).

Wednesday, 16 October 2013

Massive regional variation in unemployment

The labour market statistics published today by the Office for National Statistics continue to show the massive regional variation that has become a familiar feature of this recession.

As the UK climbs out of recession the benefit in terms of jobs is largely experienced in the South East. The disparity between the South East and the rest of the country grows. Unemployment is almost twice as high in the North East.

The unemployment rate in Great Britain was highest in the North East (10.3%) and lowest in the Sout East of England (5.9%).

The Claimant Count rate in Great Britain was highest in the North East (6.5%) and lowest in the South East (2.4%).

Another familiar feature is the large numbers working part-time or with temporary employment. 

The increase in employment is welcome news and another indication that the UK is edging out of recession. But there is a caveat, and it is again the regional disparity. The increased employment is largely in the South East. And there is a regional  disparity in the unemployment rate. Unemployment in the North West increased. Unemployment in the North East and the Midlands remains high with little change. Economic activity in these regions has not picked up and growth is patchy.

The feel good factor isn't yet reaching most parts of the United Kingdom, as these figures represent a growing national divide in potential opportunities and  living standards.

BMJ journal editors will no longer consider research funded by the tobacco industry

Today there was a momentous decision from editors of some key medical journals. Editors of The BMJ, Heart, Thorax, and BMJ Open say they will no longer consider for publication any study that is partly or wholly funded by the tobacco industry.

Writing on bmj.com today, in a hard hitting editorial, they say the new policy is consistent with those of many other journals and demonstrates their commitment to ensuring that - as far as possible - their journals publish honest work that advances knowledge about health and disease.

Critics may argue that publishing such research does not constitute endorsing its findings, but the editors believe this view “ignores the growing body of evidence that biases and research misconduct are often impossible to detect, and that the source of funding can influence the outcomes of studies in invisible ways.”

They argue that, far from advancing knowledge, the tobacco industry “has used research to deliberately produce ignorance and to advance its ultimate goal of selling its deadly products while shoring up its damaged legitimacy.”

They point to extensive research drawing on the tobacco industry’s own internal documents, that shows for decades the industry sought to create both scientific and popular ignorance or “doubt” – at first around the fact that smoking caused lung cancer and later to the harmful effects of secondhand smoke on non-smokers and the true effects of using so called light or reduced tar cigarettes on smokers’ health.

And they acknowledge that journals “unwittingly played a role in producing and sustaining this ignorance.”

Some believe that new tobacco products could represent potential public health gains, and company sponsored research may be the first to identify those gains. But the editors say that, however promising any other products might be, tobacco companies are still in the business of marketing cigarettes.

“The tobacco industry has not changed in any fundamental way, and the cigarette - the single most deadly consumer product ever made - remains widely available and aggressively marketed,” they argue.

In any event, it is a major reversal of editorial position from these journals. They recall that, back in 2003, the editor of the BMJ defended publication of a study with tobacco industry funding saying “The BMJ is passionately antitobacco, but we are also passionately prodebate and proscience. A ban would be antiscience.” But they now believe it is “time to cease supporting the now discredited notion that tobacco industry funded research is just like any other research.”

A problem with this approach is where it will stop. Would they consider bans on publishing work funded by the cosmetic industry for similar reasons? And if not then how can they be certain they are not being unwittingly used as they now believe they have been by the Tobacco Industry?

And what about the food industry. There is currently a major campaign about eating meat from the meat industry. Would these editors consider a ban on publishing any work funded by the meat consortium? It is all a tricky business. 

Putting aside these concerns, they conclude enough is enough: “Refusing to publish research funded by the tobacco industry affirms our fundamental commitment not to allow our journals to be used in the service of an industry that continues to perpetuate the most deadly disease epidemic of our times.”

Monday, 14 October 2013

Care Bill leaves forgotten young generation on cliff edge

With more people living longer, much of the concern about the future of social care has been focused on a growing elderly population.  But more young people than ever before with a range of life-threatening or life-limiting conditions are living into adulthood, and the need for planned social care is vital for this transition.

Within my lifetime I have seen a fundamental shift in attitudes to and life expectation for those with life-limiting disabilities. None gives a better example than changed approaches to Down's syndrome where it is now understood that with support those affected can expect to have productive and independent lives into adulthood. 

But what most often provides the key to coping with adulthood is available support and advice.

The support charity Together for Short Lives is calling on Peers to amend to the Care Bill today (14 Oct) to ensure a generation of young people with life-limiting conditions do not have to face a "cliff edge" in their care and support.

Peers will debate amendments tabled by Lord Patel that, if agreed, would ensure a forgotten generation of young people with life-limiting conditions are able to live as full life as possible to adulthood.

As it stands, the new law fails to set out when local authorities should assess the future needs of young people before they turn 18 years old – meaning that for thousands of young people with life-limiting conditions, plans for this important life-step may not be made in time. Badly planned transitions are currently leaving many of these young people “standing on the edge of a cliff, about to fall into a black hole” – facing a reduction in the support they receive and the range of services they can access.

Lord Patel’s amendments, supported by the Together for Short Lives Transition Taskforce, would ensure that children who need services at the age of 14 (and are likely to continue to need services as an adult) have a well planned transition of care initiated by their local authority. They would guarantee that a young person over the age of 16 years old would have a five year rolling transition plan.

Lord Patel said, “Much of the focus on the Bill has been about reforming the way we pay for our care as our population gets old. However, at the other end of the spectrum there are a growing number of young people living longer with critical, incurable conditions who are being overlooked. More young people with a range of different conditions are living into adulthood than ever before thanks to medical advances. Current failures to plan for their transition to adult care mean that many young adults with life-limiting conditions die before they can realise their ambitions to live independently. The need to ensure timely and well planned transitions for these young people is now more pressing than ever before.” [4]

In his speech today Lord Patel will focus on the story of 20 year old Lucy Watts whose case clearly demonstrates why good transitions to adult care are essential. Lucy’s has Ehlers-Danlos Syndrome, a condition which means she has to be fed straight into her bloodstream via a tube. Lucy can only sit up for up to five hours every day – she uses a wheelchair, but has to spend the majority of her time in bed.
Lucy’s mum, who also juggles a full time job, carries out the majority of her care - and all of Lucy’s day-to-day medical care.

Lucy’s transition to adult services was excellent because there was timely and well-planned joint working between children's and adult services. Lucy’s transition gave her control over decisions about her care for the first time – an essential factor for Lucy as she is not in control of many areas of her life.

Lucy herself has said, “Transitioning from children's to adults in the medical and social world is a huge step. You are moved into a world where you must make decisions about your life and your care – if you are able. The people involved in my care were brought in before I started the transition, so I had time to get used to them, which gave me the confidence to be open and honest. This is your life, so speak up and make your life, and your end of life, the way you want, and need, it to be.”

David Strudley, chair of the Together for Short Lives Transition Taskforce said, “Turning 18 years old should be a time for celebration, especially for those young people who have not expected to reach adulthood. Instead for many families it is the cause of great anxiety, not knowing whether they will receive the vital support they rely on every day. Lucy’s story shows that a successful, well-planned transition to adult care is possible - Lord Patel’s amendments would make that a reality for all young people with life-limiting and life-threatening conditions.”

Let's hope Lord Patel's amendments are passed and accepted by the government.

Wednesday, 9 October 2013

Busting the myth that economic growth is always good

The International  Monitory Fund (IMF) have adjusted estimates for economic growth. Whilst growth worldwide is projected to fall, the IMF now predict UK growth to rise faster than its previous forecast.

The IMF says it expects the world’s economy to grow by 2.9 percent this year—below the 3.2 percent recorded last year. Growth is likely to be driven by advanced economies, while the performance of emerging markets will be weaker than expected.

Osborne has seized on these new projections as further evidence that the UK is on the right track, and as a justification of the governments austerity programme. But is 'growth' the best measure of social and economic well being? Isn't it time we learnt the lesson that the answer to that question is that it is not?

Economic growth is 'good' because it leads to increased jobs and wealth. But distorted growth can lead to greater economic inequality and increased social injustice.

There is an argument that if the wealthiest get richer then the poor benefit from some kind of trickle down effect. It was an argument deployed in Thatcher's time. Look after the rich and somehow the poor will benefit. It doesn't work. The poor simply get relatively poorer.

In a sense this is obvious. Consider housing. There is more to be had from building houses for the richer middle classes than providing decent housing at low cost for the poor. As the middle get richer, house prices rise and push homes out of reach of the poorest. This is why we need more social housing.

I should make it clear that I am not advocating an equality of poverty; that we should all be equally poor. But the wealth of the few based on the poverty of the many should not be justified. The headline figure for economic growth will be good for the coalition in the UK, but their austerity programme has been divisive and ethically questionable. The poorest and most vulnerable have been made to pay the most for the sins of the banking crisis.

Lessons not learned

There is little in the economic statistics to suggest the lessons of the banking crisis have been learned and acted on by the government. We seem once again to be on course for a boom and bust approach. Little has been done to readjust the economy. As before, growth will be predicated on increased demand fostered by increased personal debt.

Social Justice as an economic goal

We need a strategy for growth that puts social justice  as its prime objective. This is signally lacking in a government approach that seeks to drive the poorest from their homes with a 'bedroom tax'.  The austerity approach has been indiscriminate and hits the poorest and most vulnerable.

Growth in employment has been achieved largely with more people working part time for wages that are often below the minimum. This is what drives 'welfare dependency', not a feckless work shy culture as the government would have us believe.

Growth must also be sustainable environmentally.  The government's message on the environment is mixed at best with the apparent abandonment of 'green' targets for energy. And this leads me to the greatest warning about 'growth'.

Good growth has to be sustainable and environmentally sound. Yet forecasts suggest a looming energy crisis with the energy supply regulator Ofgem predicting energy shortages by the middle of the decade. This is not the stuff of sustainable growth.



As energy prices are set to rise, the government will have difficulty persuading consumers of the benefits of forecasts for growth.

Figures issued by Ofgem (see diagram) show the increasing gap between wholesale energy prices and the price to the consumer.  The energy companies are ripping off their customers. Since 2010 fuel bills have risen disproportionately to the wholesale costs. So much for the benefits of growth for hard pressed families!


Wednesday, 2 October 2013

Exercise as effective as drugs for treatment of many diseases?

Coronary heart disease now costs the NHS £1.6bn a year to treat and costs the UK economy around £10bn. Yet when was the last time your doctor told you to take more physical exercise? 

Your GP may weigh you, take your blood pressure and pulse. You might be on repeat prescriptions for drugs. But a new review of evidence published today on bmj.com suggests that physical activity is potentially as effective as many drug interventions for patients with existing coronary heart disease and stroke.

Are we overdependent on drugs?

The researchers argue that more trials comparing the effectiveness of exercise and drugs are urgently needed to help doctors and patients make the best treatment decisions. In the meantime, they say exercise “should be considered as a viable alternative to, or alongside, drug therapy.”

Physical activity has well documented health benefits. Our sedentary lifestyles may be killing us, yet statistics from the British Heart Foundation show that in the UK only 14% of adults exercise regularly, with roughly one third of adults in England meeting recommended levels of physical activity.  

In contrast, prescription drug rates continue to skyrocket sharply rising to an average of 17.7 prescriptions for every person in England in 2010, compared with 11.2 in 2000.  We are becoming a nation on medication when exercise might be the best 'treatment'.

But there is still very little evidence on how exercise compares with drugs in reducing the risk of death for common diseases.

In the current analysis researchers based at the London School of Economics, Harvard Pilgrim Health Care Institute at Harvard Medical School and Stanford University School of Medicine set out to compare the effectiveness of exercise versus drugs on mortality across four conditions (secondary prevention of coronary heart disease, rehabilitation of stroke, treatment of heart failure and prevention of diabetes).

Secondary prevention refers to treating patients with existing disease before it causes significant illness.

They analysed the results of 305 randomised controlled trials involving 339,274 individuals and found no statistically detectable differences between exercise and drug interventions for secondary prevention of heart disease and prevention of diabetes.

Among stroke patients, exercise was more effective than drug treatment, while for heart failure, diuretic drugs were more effective than exercise and all other types of drug treatment.

The need for more evidence

So is exercise as effective as drugs in treatment of diseases? It is probably too early to say with certainty. The authors point out that the amount of trial evidence on the mortality benefits of exercise is considerably smaller than that on drugs, and this may have had an impact on their results.

They argue that this “blind spot” in available scientific evidence “prevents prescribers and their patients from understanding the clinical circumstances where drugs might provide only modest improvement but exercise could yield more profound or sustainable gains in health.”

Physical activity potentially as effective as many drugs

Despite this uncertainty, they say that, based on the available data, physical activity is potentially as effective as many drug interventions – and call for more trials to address the disparity between exercise and drug-based treatment evidence.

“In cases where drug options provide only modest benefit, patients deserve to understand the relative impact that physical activity might have on their condition,” they conclude.

Changing lifestyle may be more effective at treating and preventing diseases. But experience demonstrates it is more difficult to achieve than it seems. We have known for decades that regular exercise is beneficial yet so few of us do it. We live increasingly sedentary lives. Increasing awareness of the importance of exercise is insufficient to bring about an effective change.

Read also:

Something isn't right in the world of pharmaceuticals. Alarm bells are ringing.
Hilary and Steven Rose lift the lid on modern biomedical science.

The price of a loaf of bread

It is of course the standard interviewer ambush, what is the price of a loaf of bread or a pint of milk? Few politicians can answer such a question unless well-prepared. On its own the answer or lack of it reveals little of substance.

Yet it matters in a time of austerity, when the poorest are being pressed the hardest and made to pay for the financial sins of others.

A hard pressed mother or father watching the pennies is very much aware of the price of a loaf of bread. I should say they know the price of loaves of bread and they know the price of having to choose the least nutritional option.

So when politicians demonstrate their inability to answer, it demonstrates their distance from the hard realities of life. They clearly do not understand the pain and suffering of the poorest.

If there is an economic recovery, it isn't yet being experienced by people in general who are still feeling financially squeezed. And this is the problem for the coalition. The feel good factor is hard to find. Millions can find only part-time employment, often at wages lower than the statutory minimum. Their rents are rising as is the cost of living in general.

Far from being sympathetic, government ministers brand the poor feckless and work-shy and in 'welfare dependency'. Not only are the poorest on low earnings, but their benefits have been cut. The poor know the price of a loaf of bread or a pint of milk!

It isn't so much whether a politician 'knows' the price of a loaf of bread that matters. It is whether they can demonstrate by their response an understanding of the difficulties faced by the poorest.

Members of this government signally fail to demonstrate such understanding. Boris Johnson brushed the question off as if it didn't really matter, or that it was some kind of funny business on a panel game show. Ian Duncan Smith blames the poor for their poverty.

The poor suffer from some kind of Victorian disease called 'welfare dependency' from which they need to be shaken. The unemployed need to be forced into slave labour in return for their benefits. The story is told of the unemployed failing to look for work. This is nonsense of course because many do find work, but for the majority it is either part-time or at best temporary.

The rich get richer and the poor get poorer, yet the government not only behave as if this doesn't matter, but that it is something about which we should rejoice. Let's not blame the rich for the mess we are in, rather we should admire them for making money. Yet, for the rich to make money is pretty easy stuff compared to the difficulty of raising a family on the minimum wage and still finding time to help others.

It is time we readjusted our values. It is time we knew the price of a loaf of bread.


Tuesday, 1 October 2013

Tories bring back Victorian Poor Law without the workhouse

The attitude and policies of this government to the poorest and the least fortunate takes us back to the days of the Poor Law. Putting the poor to work is possessed of an attitude that the poorest are feckless and work-shy and must be put to work for their own benefit.

It is not only a divisive approach, setting the more fortunate against the least fortunate, but it is profoundly unethical and counter-productive. It has its populist appeal. But it is profoundly wrong. It tars the majority of unemployed with the brush of the minority.

I hear it said commonly in radio phone in programmes 'there's plenty of work out there if only they were willing to look for it.' And that about sums up as much as they 'know'. They know if for sure; there is work out there. Of course there is, but where is it?

Unemployment is said to be falling. The headline figures demonstrate this. But it is not falling uniformly across the country. In some regions it has risen and not fallen. One problem for the unemployed is that it is impossible to move from regions of high unemployment to find work. Costs are simply too high for such a move. So families are stuck.

But the Tory government adopts the old 'get on your bike' mentality, which suggests that somehow those who were in work before the recession suddenly became work shy during it.

The government says it wants to make 'work pay'. What they really mean is that they want to give the unemployed less in the mistaken belief that this will drive them back to work.

Now it may be true that for some there is little incentive to take employment when earnings will be less than that received in benefits. But to suggest this is the main reason for unemployment is to blame the poorest for the recession and assume that somehow they are masters of their own fate.

The poorest and least fortunate are being made to pay for the mess that the banking sector got us into. But the reason is that the Tory attitude to the poor isn't driven by understanding of the recession, it is driven by ideology. If IDS had the chance he would bring  back the workhouse. Driving people into 'work for their benefits' simply makes the low pay problem worse.

For the wealthiest this is great. We are heading for an economy based on virtual slave wages. Millions of decent, hard working people take home insufficient to meet their basic needs. That is the definition of poverty. To solve this problem we need to create an economy that pays wages that at the least meet basic needs of housing and feeding a family.

Mr Duncan Smith talks of 'fairness' without understanding what it means. He assumes it means 'treating people the same'. But this leads to the kind of indiscriminate cuts in benefits this government has imposed, such as the bedroom tax that takes little account of real need.

Meanwhile Osborne says he will create a budget surplus. This becomes a goal for which there is little need. Running budget deficits is not in itself a problem. If you run a budget deficit because of increased spending on health and welfare, the economy benefits from a healthier and more productive  workforce. This is something that enlightened Victorians realised, which is why they set about investing in infrastructure, public works that improved the health of the nation.

It would be better for Osborne to adopt three goals: 1) to create a full-employment economy based on 2) a living wage and to 3) improve housing and health of the population. These are real goals; running a budget surplus for its own sake  is a foolish goal that can only be achieved through austerity. In any event, if you want to run a budget surplus then full employment and increased productivity, a healthy sustainable workforce, is more likely to be successful because it increases revenue.

Postscript

The way government ministers talk about the unemployed suggests that they haven't been looking for work, and that somehow they have slipped into a 'culture' of 'getting something for nothing'. This really isn't born out by the figures supplied by the Office for National Statistics (ONS). Of the nearly 2.5 million unemployed people,  less than 1 in 5 (18%) had been looking for work for over 2 years. This is the 'hard core' of the long-term unemployed.  The largest group (47%) have been unemployed for under 6 months. There is very little here to suggest the unemployed wish to remain on benefits, or that they are feckless and work shy.

A feature of this recession is that more people than ever before are only able to get part-time employment, or their jobs are temporary leading to further periods of unemployment. Again there is little to suggest that these people are feckless and work shy or adopting a culture of dependency! 

On the contrary where we have a culture of dependency is for businesses who depend on paying low wages to workers. It is business that is being subsidised by welfare payments. Businesses needs to adjust to paying a 'living wage' to their workforce. Currently we have a labour market that is distorted and fosters low pay.

Read also:

The unethical language of 'welfare dependency'
The Conservatives brand the unemployed as 'shirkers'