Monday, 28 December 2015

Overturn the tables of the money changers

This is the season to be jolly, and I wish all readers a prosperous and rewarding new year! I thank you all for taking the trouble to read Song of Life in 2015.

You will forgive me if I say that our celebration of a new year should be tempered with the knowledge that so many are suffering the consequences of austerity. Poor working people have been made to take the blame for the financial crash and the actions of irresponsible bankers. Their prospects in 2016 are not good.

The NHS is at breaking point. Social justice is being eroded. The social care system is crumbling.  2016 will be the year when local taxes will rise to pay for government cuts - more families will lose their homes.  There will be more NHS rationing as 'efficiency savings' create post-code lotteries in health care. The poorest local authorities will find the most difficulty meeting social care needs. It is likely that more residential home providers will go bust. Happy New Year!

Christmas and New Year are times for reflection.  For Christians Christmas is a time to celebrate the birth and life of Jesus, and a passage in his story I think is appropriate for our times - and that is Mathew 21:12 and 13:

"And Jesus entered the temple and drove out all those who were buying and selling in the temple, and overturned the tables of the money changers and the seats of those who were selling doves. And He said to them, It is written, My House shall be called a house of prayer; but you are making it a robber's den."

I don't know about being a 'house of prayer', but I do know that the City of London is the centre of global finance where the Gods of wealth and greed are worshipped. Love thy neighbour is changed to beggar thy neighbour.

I am not a soothsayer, but there is one prediction I can make with a fair degree of certainty. The 'robber barons' of global finance will still be plying their trade and taking their ill-gotten gains for many years to come.  Global finance is as little regulated now as it was before the crash. The same 'mistakes' are being made. Growth is being 'stimulated' through increasing household debt. We seem to have learnt little from the financial crash.

Imagine these robber barons in the Dragon's Den making their pitch. "We have come up with a package made of nothing, filled with nothing, based on nothing. We can trade so fast nobody bothers to see that it is nothing. And we can make billions and pay no corporation tax." What an ingenious product! "Everyone will become so dependent on it that nobody will dare say it is nothing, worth nothing, based on nothing. Their pensions will be dependent on it." Such is human ingenuity. 

Meanwhile, there is something absurdly self-defeating about a government seeking to promote 'home-ownership' whilst driving so many out of their homes.

It is as if the government believe its own distorted truth - that putting the economy right is all to do with tackling the deficit.  Sadly it is a narrative that reaped success for the Tories in the general election. But it is a false prospectus, and one Chancellor George Osborne is increasingly unlikely to fulfil.

Where have compassion and social responsibility gone?

Whilst the poor and disabled are being driven out of their homes by austerity,  we now find that five large banks paid no corporation tax last year.  That is a disgrace. Despite making billions in profits they paid zilch! The robber barons rule! They don't need to understand the difference between 'lawful' and 'ethical'. If they can find a way, any crack or crevice, they will worm their way into it to escape social responsibility.  They are literally taking us to the cleaners. 

We need a new politics with a new economic and social strategy.  An economy that doesn't simply 'grow' but has social objectives, and where economic success is judged not by increased wealth but by social wellbeing.

We need to put society back at the heart of our economy and not follow blindly an economic strategy predicated on greed and selfishness.  We need an economy with a clear set of social and environmental priorities.

Tony Blair was wrong when he said simply 'education, education, education'. It was a great soundbite, but really what we need is 'education, health and social wellbeing'.  It isn't such a good soundbite, but it is the foundation for a strong economy.

In the three decades following the Second World War, full employment was adopted as an objective. Government acted to clear the old Victorian slums and build new homes.  The State invested in health care and created the National Health Service.  The Welfare State was developed and with all this massively increased public spending, the national debt, which was at a historic high...fell. The debt was paid off!

Yes, it fell.  The economy had ups and downs, but it grew. Increased spending on eduction created a skilled workforce. Increased social spending increased wellbeing. A healthy workforce is a productive one.  This is not to say that all was perfect. It was not. Poor industrial relations and restrictive practices bedevilled production and reduced competitiveness.

Industry after Industry collapsed through the late 1970s and 80s, and the industrial decline continues. It laid waste to so many parts of Britain and these areas continue to suffer deprivation now. Our economy became distorted and reliant on London's position as the Capital of global finance. We import what we should be making.

Yet, the answer to the failure of rampant global finance cannot be found simply by going back to the 1970s.  This is the challenge Jeremy Corbyn's Labour Party faces.  It needs a new narrative - a new set of clothes.  Above all it needs a coherent economic and social strategy, and the truth is it doesn't yet have this.  Let us hope that in 2016 a new narrative gains credence.

We need to overturn the tables of the money changers. But we cannot do that with anger alone. It needs new policies that work with business to meet clear social and environmental objectives.  We need to develop our local economies, working with businesses to harness local potential and resources.  Such a strategy isn't anti-business. It is pro-business. Business harnessed to local needs and social objectives - creating coherent local economies - developing infrastructure, creating jobs. Local authorities, businesses, environmental groups, communities, all working together with clear plans to promote clean and socially responsible growth.

We can no longer go on exporting our carbon pollution through massive imports of manufactured goods, and then claiming we are meeting our carbon targets. When we take account of imports, we are amongst the largest polluters. Currently, meeting 'our' targets is a charade that puts the planet in jeopardy.  I have little faith in the 'agreement' at the Paris climate summit this year.  Only time will tell if we can grasp the nettle to genuinely reduce our carbon footprint. To do so we need an antidote to globalised capital.

So, here is to 2016. I don't have all the answers, but I hope you will continue to join me in 2016 in searching for some of them.  

Friday, 18 December 2015

The case for mandatory folic acid fortification?

The UK’s failure to fortify flour with folic acid has caused around 2000 avoidable cases of neural tube defects since 1998.  This is the conclusion of research published online today in the Archives of Disease in Childhood.

The researchers say that the UK should now follow the lead of the US and 77 other countries  in legislating for mandatory fortification of flour to curb the associated toll of fetal and infant death and disability.

Folic acid is a B vitamin which is vital for the formation of red blood cells.

The UK has rightly been cautious about making 'medicines' or dietary supplements mandatory.  In medical ethics we emphasise autonomy and the right to make decisions about one's health and treatment. Autonomy is a fundamental principle of modern medical ethics.  It sets a high ethical threshold, and a key concern must be that the benefits of mandating medicine should be sufficient to breach this fundamental principle.

To a large extent this is a utilitarian ethical calculus, the balance of benefits and potential harms, but there is another fundamental issue, and that is the extent to which the state should discharge a duty of care on behalf of those who cannot make decisions about their lives - in this case unborn children.

In relation to the ethics of mandatory fortifying of bread with folic acid the real question is whether it is necessary to discharge a duty to protect the unborn child.  If current strategies are failing, then we have a duty to consider other approaches.  These authors present convincing evidence that the current strategy isn't working.

We are dealing with appalling consequences. Neural tube defects, which are birth defects of the brain, spine, or spinal cord, include spina bifida, anencephaly, and encephalocele which can be profoundly disabling conditions.

In 1991 the UK Medical Research Council Vitamin Study showed that a supplement of folic acid taken before and during early pregnancy cut the risk of neural tube defects by around 72%.  That is a big difference.

The problem is that it is difficult to achieve a high enough level of folate from diet alone, so taking supplements or eating foods fortified with folic acid is a sensible option for women intending to become pregnant. It is the recommended option for women about to become pregnant.

In 1992 the Department of Health in England advised women to take folic acid supplements before pregnancy to reduce their risk of having a baby with a neural tube defect.  The problem is, as the study showed, most women don’t take them.  Another problem is that women don't necessarily know they are going to be pregnant, and sometimes they don't know initially that they are pregnant - so they don't take the supplement from the right time.

The current recommendation is that every woman considering pregnancy, and up to the 12th week of pregnancy is advised to take a folic acid supplement, or pregnancy specific vitamin supplement providing 400μg every day,   and that they should eat a diet rich in folates and folic acid from foods naturally containing the vitamin or from fortified foods.

But even with these recommendations, many women do not take folic acid supplements in early pregnancy, and it is argued that routine fortification of flour with folic acid is a simple way to increase folic acid intake for everyone.

Many countries have introduced mandatory fortification of flour with folic acid, resulting in  significantly reduced  numbers of neural tube defect births.  So why has the UK been so cautious?

The UK has been cautious in recommending this for a number of reasons. Firstly, although folic acid supplements can correct the anaemia caused by vitamin B12 deficiency, this masks the ongoing damage to nerves caused by B12 deficiency until irreversible nerve damage occurs. Older people are most at risk because uptake of vitamin B12 from diet reduces with age.  There is also conflicting evidence that folic acid might increase the risk of colorectal cancer in older people. This then is a balanced judgement of potential harms to some of the population against the proven benefits in pregnancy outcome.  There is, however, little evidence for this potential harm.

There is little evidence from countries with mandatory folic acid flour fortification that more people have developed nerve damage as a result of vitamin B12 deficiency since the flour had been fortified.

Thus, a key question is whether it would it make a fundamental difference if the UK followed some other countries in making folate-fortified bread mandatory. The answer from this study appears to be a resounding yes.

The authors of the study have estimated the number of pregnancies with neural tube defects that would have been prevented had the UK opted to fortify flour with folic acid in 1998—the year that the US adopted this policy (140 µg of folic acid per 100 g of cereal grain).

They used data on the number of diagnoses of neural tube defects and associated terminations of pregnancy for the period 1991 to 2012 from EUROCAT, a European network of registers that track birth defects, which includes the British Isles Network of Congenital Anomaly Registers (BINOCAR).

The prevalence of pregnancies with a neural tube defect during this timeframe was 1.28 per 1000 births. Most (81%) of the affected pregnancies were terminated.

But unlike the USA, there was no significant change in the prevalence of pregnancies with a neural tube defect in the 14 years between 1998 and 2012, nor were there any significant changes in the prevalence of spina bifida, anencephaly with or without spina bifida, or encephalocele, when analysed separately.

The researchers estimated that there would have been 2014 fewer pregnancies with a neural tube defect in the UK had the US policy been adopted: 1798 fewer in England and Wales; 152 in Scotland; and 64 in Northern Ireland. This equates to an estimated fall in prevalence of 21% between 1998 and 2012, they say.

In the USA, the prevalence of pregnancies with a neural tube defect has fallen by around 23% since 1998, and in Chile, where the level of flour fortification is even higher, at 2.2 µg/100 g, the prevalence has fallen by 36%.

“The failure of Britain to fortify flour with folic acid has had significant consequences,” say the researchers, who emphasise that its addition is “remarkably safe,” with fears that fortification might increase the risk of cancer not substantiated by the evidence.

The longer Britain holds back on this cost effective mandatory supplementation, the more affected pregnancies there are likely to be each year—around 150, nearly all of which would result in the birth of severely disabled babies, if the parents choose to go ahead with the pregnancy, they warn.

The researchers compare the current situation with thalidomide, which resulted in the births of 500 people with disabilities in the UK.

“Justifiably, steps were introduced to immediately halt the epidemic, and regulatory precautions were introduced to avoid another similar epidemic,” they write. “Unfortunately, no such sense of urgency has been applied to the prevention of spina bifida,” the authors say.

“It is a public health failure that Britain has not implemented the fortification of flour with folic acid for the prevention of spina bifida and other [neural tube defects],” they write. This failure “has caused, and continues to cause, avoidable terminations of pregnancy, stillbirths, neonatal deaths and permanent serious disability in surviving children,” they conclude.


Saturday, 12 December 2015

NHS 'winter crisis' due to Tory cuts.

The 'winter crisis' in the NHS is a crisis of the government's own making. It is the result of the real cost of the £20 bn efficiency savings forced on the NHS. This is the truth behind the headlines of bed-blocking. The bed shortage is because we don't have enough beds to cover increased demand over the winter.

This is the reality. OECD figures show that in England and Wales there are just 2.95 beds per 1,000 people. This compares with 6.37 in France, 7.65 in Austria and 8.27 in Germany. And before the Scottish Nationalist Party pipe up, the Scottish Government figures show their figure is down 21% compared to 2004. But England and Wales are way behind the 4.95 beds per 1,000 in Scotland. Nevertheless, Scottish hospitals have shed beds at a faster rate than almost anywhere else, with more than 5,000 disappearing in just seven years. In North Wales more than 400 beds have been lost over the last five years.

In response the government would say it is due to “ongoing changes in the way modern health care is delivered”. That is a euphemism for 'efficiency savings' - it means cuts in front-line services and it means a bed shortage.

The government will say that the NHS is 'treating more people faster than ever before'. This is a euphemism for getting them in and shipping them out fast but often before they are fully recovered, and a costly revolving door as patients are readmitted in A&E. This revolving door practice is not good medicine. It is costly and inefficient and delivers poor care.

English hospitals have lost 5 beds every day of David Cameron's tenure at number 10 Downing Street.


So as we wring our hands again at the 'winter NHS crisis' we will be told it is due to an 'ageing population' and a lack of 'care beds'. In the sense that this is true, it is only partly so because it is in the main due to cuts. Those cuts are the result of the £20 bn efficiency saving imposed on the NHS. Think what a further £22 bn will do because that is what the NHS are asked to find in the next five years. This madness should stop!

Monday, 7 December 2015

More for less is no solution in the NHS

The audacity of Chancellor Osborne knows no bounds. Having starved the NHS of much needed funding he now says: 'We have a clear plan for improving the NHS. We’ve fully funded it.'

Nothing could be further from the truth.

Britain's National Health Service is in a financial crisis with more Hospital Trusts in deficit and creeping privatisation eating at core provision.  Despite the government giving £3.8 bn funding up front, NHS England is expected to find a further £22 bn in efficiency savings over the next five years on top of the £20 bn already found. As shown in a previous article, this is affecting front line services with increased waiting times and bed shortages.

Mr Osborne wants to avoid last Christmas' headlines of an NHS unable to meet demand.

Last December, NHS England figures show, the numbers of patients waiting on trollies in A&E trebled from just over 13,000 to 38,848.  Now, the government is trying to avert another Christmas crisis by providing extra emergency funding. All well and good, but it is crisis management of a health service brought to its knees through lack of funding.

We are often told that the strains on the NHS are the result of an ageing population.  It is certainly the case that the proportion of older people has increased and will be increasing.  In 1991 15.9% were over the age of 65 -  now it is more than 16.5% (the 2011 figure). But this isn't the real cause of the NHS A&E crisis.  The NHS is under strain from inadequate resources and from efficiency savings that have eaten into the numbers of beds available. The NHS has been striving to do too much with less, for that is what efficiency saving means.

One of Mr Osborne's commitments is for cancer testing within four weeks. This is welcome if it can be achieved.  NHS England unveiled plans for the new cancer strategy back in February, with a view to saving ‘at least 8,000 lives a year’ through the 'early diagnosis drive'.  We can hope this works, but there are warnings that the system is already overloaded.

It should also be an imperative to ensure that the diagnoses are robust and safe.  There are suggestions this would require a doubling of the number of radiologists.

Earlier this year the Royal College of Radiologists reported that radiology departments "are under considerable pressure to minimise the number of unreported studies while facing additional challenges including shortages of consultant radiologists, other resourcing issues and ever increasing demand."

There is a chronic shortage of radiologists in the UK.  Comparison with other european countries is stark. With 48 trained radiologists per million population the UK has half the numbers in Germany (92) , Spain (112) and only a third of the number in France (130) .  The number of scans performed in the UK remains significantly below those in other countries for most tests. 

It is no surprise then that in some trusts there are tens of thousands of X-rays and hundreds of CT and MRI investigations waiting more than 30 days for a report.

Radiology departments are increasingly outsourcing their reporting work to commercial private companies and/or using expensive locum agency staff to minimise any backlog in unreported studies. These are expensive solutions which impact considerably on NHS finances. In the end it is unsustainable. 

Meanwhile, the chances of surviving five of the most commonly occurring types of the cancer in the UK trail at least 10 years behind many comparable European countries. One of the worst examples is lung cancer.  Survival has certainly improved. Where only 7% of patients survived in the 1990s in the UK this improved to 10% a decade later but this was still behind the 14% survival rate achieved in, for example, Austria in the 1990s. Almost 18% of patients diagnosed with lung cancer in Austria survive - twice the rate in the UK. The proportion of people with lung cancer dying within a year of diagnosis in the UK was 70%, compared with 65% in Denmark, 61% in Norway and 56% in Sweden.

In the past decade the survival rates for breast cancer is 81% in the UK – a level exceeded 10 years ago in Sweden, France and Italy.  It is clear that more can and should be done. 

Macmillan Cancer Support say that too many people are diagnosed too late, are shown a lack of compassion during their care and feel abandoned after treatment.  They call for more focus on reducing late diagnosis,  on prioritising the patient experience alongside clinical matters,  and more effort to enable patients to spend their final days in the place of their choosing and with free social care.  

At the beginning of this year NHS England announced that sixteen life-extending cancer drugs would no longer be available to patients in England after the NHS announced it would not pay for them through the Government’s flagship Cancer Drugs Fund. This was a drastic bid to cut costs, saving £80 million from the budget.

Meanwhile Osborne gives with one hand but takes out more with the other. An NHS under pressure to find a further £22 billion in efficiency savings by 2020 is unlikely to be able to meet the ever growing targets placed on it - more for less is not a solution. 

Thursday, 3 December 2015

Let's break the cycle of poverty and disease

The House of Commons Health Committee has called for urgent action on childhood obesity.  Childhood obesity is increasing at an alarming rate. One fifth of children are overweight or obese by the time they start school, and this increases to one third by the time they leave primary school.


The cost of childhood obesity is an example of the short-sighted madness of Osborne's austerity programme.  The consequences of obesity on health will cost more in the long run than any saving he makes by cuts in welfare and support.  It is a foolish strategy.  The Health committees report demonstrates this in stark terms.




The government spends just £638 m per year on obesity prevention, yet the cost to the NHS of obesity and its consequences coupled with type 2 diabetes is a staggering £13.9 billion each year, and the cost to the economy is estimated at £27 bn.

The Health Committee  are right when they say that childhood obesity is a complex problem which will need action across a number of areas.  They are right to highlight excess sugar consumption, and they are right to call for urgent action to deal with it.  They call for:
  • Strong controls on price promotions of unhealthy food and drink
  • Tougher controls on marketing and advertising of unhealthy food and drink
  • A centrally led reformulation programme to reduce sugar in food and drink
  • A sugary drinks tax on full sugar soft drinks, in order to help change behaviour, with all proceeds targeted to help those children at greatest risk of obesity
  • Labelling of single portions of products with added sugar to show sugar content in teaspoons
  • Improved education and information about diet
  • Universal school food standards
  • Greater powers for local authorities to tackle the environment leading to obesity
  • Early intervention to offer help to families of children affected by obesity and further research into the most effective interventions.
All these measures are necessary but insufficient unless the underlying social problem is also addressed.

Child poverty matters - it matters a great deal because it represents a crucial link in the causes of poor health.  Furthermore, childhood obesity is a major consequence of poverty.   It we really wanted to tackle childhood obesity we would also want to tackle childhood poverty.  But let's examine what that means.  It means ending poverty.  It means creating fairness in the distribution of wealth and opportunity. It means ending poverty wages and insecure jobs.  It means creating an economy with social objectives.  It means not only being tough on childhood poverty but also being tough on the causes of poverty.  We must stop the madness of austerity.

Mr Osborne in his autumn statement boasted about being 'the builders' - 'we are the builders' he declared.  But what has he built? He has created an economy predicated on poverty wages and insecure jobs.  If we are serious about tackling poor health we would end austerity.  Investment in health and social care is the best investment for future growth and prosperity - it creates a healthy, skilled, aspirational workforce.  Social and personal aspirations go hand in hand in creating a prosperous and fair society.  The aspirational generation of Thatcher's Britain was forged in the post war welfare state, not in the 'free' market neoliberal myth of opportunity.  Social housing, better education, better health, better support - these were the foundations of fair growth and prosperity.

The impact of child poverty is transgenerational. The problems of poor health are likely to affect the next generation too. The health costs to the nation will far outweigh the relatively paltry savings made now by cutting benefits. Yet the impact of the cuts is immense.
Standardized Mortality Ratio
 data from bmj; 1993; 307;1519-24

A simple measure of the likely effect of child poverty is to consider the impact of undernourishment during development and early childhood on the risk of cardiovascular diseases in later life.

One such measure is represented in the standard mortality ratio of adults born small and undernourished compared to those born well nourished (see figure). Those born small (<5.5 pounds) and undernourished are twice as likely to suffer from diseases such as diabetes and to die early from cardiovascular disease. It debilitates and shortens productive life.

This is one of the reasons why tackling child poverty is such a critical strategy. It can break the cycle of poverty and disease. Poor health blights a generation through poor educational attainment and poor job prospects. Poverty, bad housing and undernourishment create a cycle of poverty handed on across generations. The cost of the governments policies is difficult to calculate but over time with increasing burdens of poor productivity and burdens of ill-health and its impact on NHS resources will be immense. It is a foolish policy. It blights more than a generation.  Maternal nutrition matters. Maternal poverty matters. If we really wanted to break the cycle of poverty and disease we would not be pushing more people into poverty through austerity.

It is unfair that the poorest should suffer for a financial crisis that was not of their making. It is incredulous that we should make children suffer for it. But it is also bad economics.  The government should act on the recommendations of the Health committee but it should also stop driving poverty through austerity.  We need a strategy that sees the health of people as a vital investment and not a vicarious outcome of 'devil take the hindmost' market forces. We need a government that builds society, not one that destroys it.

Tuesday, 1 December 2015

The Emperor has no clothes

John Berger wrote that the poverty of ‘our century’ (he was referring to the 20th Century) is unlike that of any other. ‘It is not, as poverty was before, the result of natural scarcity, but a set of priorities imposed upon the rest of the world by the rich.’ He went on to say that the modern poor are not pitied but held responsible for their own condition.

We see this writ large in Cameron's austerity Britain.  The poorest are not only being made to pay the price for the failings of an irresponsible financial system, they also have been stereotyped as undeserving, work-shy and dependent on benefits.  It is a stern message without hope -  more poverty will drive them to help themselves out of poverty.  The Secretary of State for Work and Pensions has said as much - he wants to make those on benefits 'better people'.  It is as if the poor must be saved from themselves, or from 'welfare dependency' by a 'cold turkey' of reduced benefits.

So what of the banking crisis? Have lessons really been heeded? It barely gets a mention in the political narrative.

For a brief moment after the banking collapse there was a focus on the sins of the bankers, or a concern about the banking system.  A bit of fuss was made about bankers bonuses and about 'rogue bankers', but such a narrative itself avoided the real issue - the financial system itself.

The financial system remains politically unchallenged.  But a new economic and social narrative is desperately needed.  We really need to ask what the financial markets are for - or who they are for. 

For the best part of the last five years the focus has been on 'cutting the deficit' by cutting welfare.  It has been an amazing political trick - to rewrite the narrative.

Welfare did not create the financial crisis, but the poorest and most vulnerable are being made to pay, and as our social infrastructure in health and social care collapses  - starved of funding - we are asked to believe that more private equity is the answer.

It is a spiral down as social provision is removed to be replaced by private provision -  or the provision isn't replaced at all.  It is all about 'reducing the size of the state'.  

But consider the global position.  How can it be that so many live in poverty and in poor health when the world has the capacity to produce so much food, has the potential to ensure families are decently housed and educated, and has the capacity to raise the health and wellbeing of all? Why this doesn't happen is in large part because of the absence of political will. But there is another more important reason.

The answer is that the algorithms of our financial markets have no social or environmental imperative. 

The one thing politicians cannot do is bring themselves to tell us the truth about our financial system. They have placed so much faith in it - worshiped at the Alter of neoliberal 'free' market economics. They have given up their free will for a belief in the inevitable economic imperatives of free financial markets - God is made in the image of an algorithm driven market and the assumption of human selfishness.  There is no social objective - only that of accumulating wealth.

Many of us are familiar with the cautionary story by Hans Christian Andersen about two weavers who promise an emperor a new suit of clothes.  The suit he is told is invisible to those who are unfit for their positions. If they can't see the invisible suit then they are stupid, or incompetent.  The Emperor believes it, and his courtiers are too afraid to tell him the truth.

When the Emperor parades before his subjects in his new clothes, no one dares to say that he is naked until a child cries out, "But he isn't wearing anything at all!"

The neoliberal myth of ‘free markets’ is like the emperor without clothes. The global financial markets strut their stuff, buying and selling nothing at all to the tune of trillions of dollars. Imaginary boxes of nothing at all - or perhaps hope, greed, envy. The global markets work as long as we believe the boxes are full of something, or could be full of something. But they are not. They are empty. The greatest trick of capitalism is that it has valued nothing and sold it. It trades in it day in and day out, accumulating 'wealth'.

Yet so much of this activity creates no real wealth at all, no real goods or services. Only some 3% of the trillions held by British banks is ever invested in real production – in real businesses providing goods and services that we need. If we counted up the value of all the goods and services - the ‘real’ wealth -  it would amount to only a fraction of the ‘value’ of the transactions in the financial markets. It is a trade in imaginary wealth.

Politicians, like the emperor’s subjects, pretend that this isn’t so. But it is. And even when the system breaks down, they invest considerable effort in recreating the myth and refitting a new set of invisible clothing. Global financial capital rules, and only the ignorant would suggest otherwise.

Mr Osborne uses the term ‘we are the builders’. Sadly we are not. Where once we produced goods, we now import them. We have a massive balance of trade deficit with the rest of the world. London is the centre of the neoliberal myth, we depend on pretending the Emperor has clothes.

Global computer models, based on the worst instinct of mankind, selfishness, make thousands of transactions every second.  We have handed our financial well-being over to computer models, but the mathematics is not without its assumptions. They are philosophically and politically grounded. 

So how has this come about? The answer is the separation of the economy into two domains - the financial and the real.  Both should be part of an organic whole, but the financial markets operate with little regard for the real economy and with sparse regard for real need.

The real economy needs social objectives. It needs a healthy, skilled workforce. It needs infrastructure to work and it needs a stable local environment - the real economy needs social objectives as an integral part of the economy. But it also needs finance.

The global financial market trades largely in 'derivatives', futures, swaps - or some other terminology for the empty boxes -  the value of which are only loosely related to a real asset. It has little capacity for social or environmental strategy.

It is a massive gambling casino with betting on, for example, interest rate futures, where traders speculate on the future direction of interest rates, or the rise and fall of commodity prices or exchange rates.  It will bet on any aspect of 'price' that will move.  But rarely engages in building bridges or restoring the environment or tackling poverty.

But what about growth? Doesn't that help?

Relying on growth to reduce poverty is at best rather inefficient. How much growth does it need? In spite of massive 'growth' the poor receive but crumbs. Yet it has been the curse of the poor for so many decades that government has promoted 'growth' as a strategy.

The more wealth we can produce, the story runs, the more it will benefit the poorest.  The idea that there could or should be a social strategy for apportioning such growth appears to have been lost somewhere in the late 1970s - redistribution became a dirty idea, in part because it would mean taxing the 'wealth makers'. Taking from the rich and giving to the poor we are led to believe would be a disincentive to the 'wealth creators'.

Relying on growth alone without  strategies to achieve social redistribution of the benefits of that growth is unlikely to be effective. If our objectives are to make poverty history or to make the world a less unequal place in which to live, then we need something different in the way we do things. 

We need a new political-economic settlement that puts social objectives at the heart of economic activity.  This requires politicians, businesses and finance to work together to achieve fair growth. We need growth, not for its own sake, but for a purpose - the purpose of increasing well-being for all whilst protecting the environment on which we depend.  The Emperor needs a real suit of clothes.