If you thought our politics were turbulent before, they’ve hit rock bottom now, the epitome being the debacle in the House of Commons on Wednesday and its continuing aftermath. The Conservatives suddenly started caring about democracy when they’ve done their best to wreck it over recent years and not everyone is buying the weak Speaker’s rationale of MPs safety concerns for his improper intervention. Yes, MPs should be able to go about their business without threats to their safety and yes, besides the shocking Cox and Amess murders there have been recent threats to MPs, but it seems to me these are being exaggerated and are mostly London-based. In a rare moment of insight, Amol Rajan, in their endlessly plugged Radio 4 Today podcast, suggested that they journalists need to reflect on their role in making MPs’ lives intolerable. Another major incendiary factor is demagogues like Suella Braverman and Lee Anderson wheeling out their racist bile in right wing media like the Telegraph and GB News. It took a while but at least we heard on Saturday afternoon that the Whip was removed from Anderson, giving rise to speculation that the Conservative party will split even more, with some defecting to Reform and Sunak being forced to call an election. This tweet captures how these issues go way beyond politics: ‘It’s a Molotov cocktail of polarisation, a nosedive in the quality of public debate, and an erosion of trust in institutions meant to serve the public good. This isn’t just about politics; it’s about the integrity of our societal fabric being shredded by those at the helm, who seem more interested in weaving a narrative of division than in stitching together a tapestry of diverse voices’.
But what’s also being overlooked re threats to MPs is that people are increasingly frustrated at elected representatives not listening to them (quite a few have AWOL MPs who don’t respond to communications and have zero constituency presence) but especially because draconian ‘public order’ legislation has removed or weakened legitimate avenues of protest. Stella Creasy, the MP for Walthamstow (N E London) wrote a reasonable account of the challenges in the Guardian but she seems an example of a conscientious and hardworking MP, not one of the disengaged ones. ‘Public life is drowning in hate, and violence and harassment towards political representatives is increasingly being normalised. Unless we take responsibility for addressing this, the outcome will not simply be that the loudest voices and largest wallets win: democracy will lose’. Lose even more, perhaps she should have said.
Meanwhile, Rishi Sunak, still robotically trotting out soundbites about sticking to his ‘plan’ and Labour going back to ‘square one’, has had to dodge missiles and negative evidence of his government’s performance from numerous quarters including the recent byelection results and news that we are now in recession (which ministers and some media sources called ‘light’ or ‘technical’ recession). He soon has Rochdale to navigate and possibly another because Scott Benton, MP for Blackpool South, lost his appeal against the 35 day Commons suspension for offering to lobby ministers on behalf of the gambling industry.
Business Secretary Kemi Badenoch’s sacking of Post Office chair Henry Staunton is mired in controversy following Staunton’s fightback with his own recorded version of events surrounding the government’s intentions for sub-postmasters’ compensation. Liz Truss is an embarrassment to UK, in Washington spouting far right rhetoric and deep state conspiracy theory, the latest Tory Sunak is too weak to rein in. Commentator Matthew Stadlen tweeted: ’Liz Truss had done enough damage already but she’s becoming a menacing figure. A former British Prime Minister cosying up to Steve Bannon is a dangerous moment for British politics’. This tweet sums up the situation pretty well, I thought:’Sunak is PM in name only. Cameron dominates the air waves whilst Anderson, Mogg, Badenoch, Braverman & co run amok. Truss struts her stuff in the US with the Bannon brigade -whilst Sunak & his PR team desperately channel Disneyland fantasy via promo videos’.
It’s not only his promo videos, of course: it’s also Sunak’s tv interviews and appearances, the most egregious of which must be his recent ‘People’s Forum’ on GB News (itself contrary to Ofcom rules though this toothless regulator will do nothing about it). This claimed that its audience was a general selection of the public but later it emerged that they were mostly Conservative voters but even they weren’t impressed with the way Sunak had dealt with their questions, some saying they would not vote Tory at the general election. Journalist John Crace summed up his performance: ‘An hour that had passed quite quickly. If totally pointlessly. Because we hadn’t learned any more about Rish! than we already knew. That he’s just not very good at this sort of thing. He can’t connect with people. He lives in a parallel world to the rest of us. Whatever the questions, he gives the same boilerplate answers. He doesn’t believe what he’s saying, so why should we? He’s merely going through the motions. Someone should have a word. For his sanity as well as ours. It’s going to be a long eight months. Not all of us are going to get out of it alive’.
It’s noticeable, especially at Prime Minister’s Questions in the Commons, that Sunak relies heavily on the slippery politician’s technique of stressing how important an issue is (which does succeed in buying some challengers off, like Laura Kuenssberg with Therese Coffey this morning) without actually saying what he/she is doing to resolve the problem in question. This is the technique he used when challenged about the postmaster compensation payments and in yet another challenging sphere, when he turned up, suited and booted, of course, at the National Farmers Union annual conference. Farmers have long felt ignored by this government yet ‘Sunak told farmers: “I have your back” and waxed nostalgic about the bucolic British countryside and his experience milking a cow. But after years of very unpopular post-Brexit trade deals and a bungled agricultural transition from EU farming payments, it didn’t feel like this charm offensive landed. The response from the farmers in the hall was muted at best’. Given this technocrat’s conduct, I’d dread to think what he’d be like if he didn’t have whoever’s ‘back’.
Given the flak rightly directed at him in recent times, wouldn’t you have thought Rishi Sunak would have been less proud of publishing his tax return which showed him paying effectively only 23% on income of £2.23m? Of course people in his position can afford clever accountants to access all manner of loopholes not necessarily apparent to the rest of us, but in this case it seems the low amount was due to low capital gains tax rates and investment funds being US-based. ‘The tax return will raise questions about why Sunak appears to hold much of his wealth in the US rather than the UK…. Sunak’s personal wealth and his links to the US have been a sensitive issue for the prime minister. A former Goldman Sachs banker and hedge fund manager, he joined one of India’s richest families when he married Akshata Murty, the daughter of Narayana, the billionaire founder of Infosys. Robert Palmer, the executive director at Tax Justice UK, blamed the UK’s ‘broken tax system’, whereby income from wealth is taxed at a far lower rate than that emanating from work. Quite so, and perhaps commentators should use the term ‘unearned income’ more rather than alluding simply to a beneficiary’s ‘earnings’.
If the state of the microcosm UK is dire, that of the macrocosm (the global situation) is nothing short of alarming, with the Ukraine war entering its third year, the Gaza conflict still raging and the worsening uncertainty brought about by climate change and so on. Although we could speculate as to why it took so long, the death of Russian dissident Navalny still came as a shock, prompting further challenges as how the world deals with dictators like Putin. Added to which a Trump victory in the next US election looks quite likely. None of this is good for our mental wellbeing.
Back in the UK, the NHS is never far from the news. The junior doctors began their 11th strike and despite the health secretary’s desperate attempt to get the public on the government’s side, many patients, even those waiting for treatment, are sympathetic to the doctors and not towards the intransigent government. According to the latest Ipsos poll, one third of Britons feel that the NHS is the most pressing issue, ie not immigration/’small boats’, which the Tories are fond of quoting being the major concern from their mostly fictional ‘doorstep’ exchanges. Besides Labour leaping onto these latest findings, the Lib Dem leader Ed Davey (who’s been largely silent since his role in the Post Office scandal came to light) captured what many must be thinking: ‘The Conservative party can never be trusted with the NHS after their appalling legacy of record waiting lists and crumbling hospitals. The country is crying out for more GP appointments, yet Rishi Sunak spends his time peddling culture wars to keep his own MPs happy’. On a separate point, no article or interview about the NHS seems to be considered complete without a handwringing comment from the head of NHS Providers, NHS Employers or the NHS Confederation: I’ve long wondered why on earth three separate bodies are thought necessary. Job creation?
Besides the doctors’ strikes, there are several issues profoundly worrying to those who care about NHS standards and about it remaining in the public sector. One is (previously discussed in this blog) NHS England’s determination to ramp up the use of unregulated and inadequately trained ‘physician associates’ in order to plug the gap fully qualified medics should be filling. Bad mistakes made by these PAs have been recorded but the government and NHS seem committed to PA recruitment, going against the spirit of the NHS Constitution because there’s no information for patients about them. If you ever get an actual appointment with a GP, how do you know they’re a doctor or just a PA? You don’t unless you ask.
Still on the subject of GPs, a substantial study (apparently previous ones have been much smaller scale) has now shown what we’ve surely known all along – that seeing the same doctor regularly (as per the old ‘family doctor’ practice) has much better outcomes for patients than (as now) seeing someone different every time. This clinician’s quote illustrates how current government policy actually works against best practice: ‘Currently, the intense workload and workforce pressures GPs are facing – as well as political agendas prioritising speedy access to GP services above all else – greatly limit the level of continuity we can offer’.
Besides the mother of the child who died, the launch of Martha’s Rule this week (a policy of facilitating a second medical opinion if a relative is concerned about the state of the patient) also saw Health Secretary Victoria Atkins feature in another series of car crash interviews. A less convincing interviewee and Cabinet minister it would be hard to imagine. She wrote about the government’s alleged ‘commitment’ in a Torygraph article, of which even the first paragraph is lies and cynical narrative, projecting failures onto the NHS rather than her ideological government which underfunds it and which wants to destroy it:
‘In 2019, we commissioned the first ever NHS patient safety strategy and we established the Healthcare Services Safety Investigation Body last October to help make sure lessons are learned when mistakes happen to better prevent those mistakes happening in future. We know there is more to do. As health secretary, it is my ambition and my responsibility to ensure that the NHS is one of the safest healthcare systems in the world. To do that, we need to focus on making our NHS faster, simpler and fairer. We cannot be blind to its failings. We must learn from its mistakes and work hard to fix them’.
Martha’s parents said: ‘We believe Martha’s rule will save lives. In cases of deterioration, families and carers by the bedside can be aware of changes busy clinicians can’t. Their knowledge should be treated as a resource. We also look to Martha’s rule to alter medical culture: to give patients a little more power, to encourage listening on the part of medical professionals, and to normalise the idea that even the grandest of doctors should welcome being challenged’
I hope the media and clinicians will monitor how Martha’s Rule goes and whether it is indeed rolled out in every hospital. A mystery to me is why we never hear any more about the NHS Constitution, which championed patients’ rights and responsibilities and which I’m pretty sure gives this right to a second opinion. Yes, Martha’s Rule will formalise this and give it a much higher profile, but patients and relatives need properly informing about it because it can’t be taken for granted that they know.
If physical health care is precarious in this country now, mental health services are even worse, and hardly a week passes without news of underfunded services and severely ill patients falling between the ever-widening cracks. Norfolk and Suffolk NHS Foundation Trust has been in the news before, but the inquest into death of Ellie Woolnough is one of many that have occurred with grim regularity for people under this trust’s care. Again, as with the seeing one GP issue, we see the NHS and government engaged in the opposite of good care, rushing to discharge patients prematurely and limiting contact with the when it’s well known that severely ill patients are often at greater risk of self-harm and suicide on discharge from hospital. Stretched resources will be a substantial reason for this but the opacity of this system was flagged up by the coroner – significant when one of the key changes following the mid-Staffs scandal years ago and the ensuing Francis Report was commitment to a ‘duty of candour’.
‘The coroner said the trust’s evidence had “more holes than Swiss cheese”. He said its failure to retain the recording of the call amounted to a “very serious” breach of its duty of candour… The Campaign to Save Mental Health Services in Norfolk and Suffolk says the trust continues to be in a crisis sparked by austerity driven cuts in 2013. Its calls for a public inquiry into the trust’s failures were amplified last year when a review found 8,440 “unexpected” deaths among its patients or those it recently cared for’. These numbers are just shocking. ‘An NSFT spokesperson said the trust is on a rapid and much needed journey of improvement’, for example they have a new Chief Executive with a good track record. But the Care Quality Commission needs to be regularly monitoring this trust’s performance – it’s unfair that friends, relatives and mental health campaigners have to endure terrible losses and keep making the same points.
Last week saw the broadcast of ITV’s dramatisation (by palliative care doctor Rachel Clarke and award-winning dramatist Jed Mercurio) of Breathtaking, Clarke’s powerful account of how NHS staff were failed during the pandemic. Clinicians were struggling with intense workloads, lack of PPE and suffering burnout when (as we later learned) the PM, ministers and staff were partying and doing corrupt deals on PPE which wasn’t even effective. ‘The Department of Health and Social Care issued a statement asserting that: “Throughout the pandemic the government acted to … prevent the NHS being overwhelmed.” This oft-repeated lie about the NHS having been protected by Boris Johnson’s government is perhaps the most egregious of all. All of this poses uncomfortable questions about the role of NHS England in facilitating the government’s pandemic narratives. You expect politicians to dissemble, but the NHS is meant to have a statutory duty of candour. So how could some of its most senior figures have stood up and denied the self-evident PPE shortages and the traumatising breakdowns of normal care?’
So many, despite it being a tough watch, praised this series to the skies and had strong emotional reactions, especially those who lost someone close to them. The Times reviewer, Johanna Thomas-Corr said: ‘…watch it. Just watch it. It is precise, controlled, enraging and moving and, despite its smaller focus — a dozen doctors and nurses in one hospital over three timeframes — opens out into something much larger. It is based on Rachel Clarke’s memoir of her experiences as an NHS consultant and the two other writers, Jed Mercurio and Prasanna Puwanarajah, both have medical training, which lends it palpable realism…The medics realise quickly that there is a chronic shortage of PPE, then that a situation is developing in care homes and, eventually, that misinformation about empty hospitals is spreading over the internet. Again and again they are ignored by managers who insist they are following “national guidance”, that cursed refrain. Once again we have monolithic top-down leadership disregarding the experiences of people on the front line.. A tough watch, but one that deserves to win all the awards’.
Alarmingly, councils are being urged to sell off assets in order the plug the massive holes in their budgets, prompting a Financial Times journalist, Edwin Heathcote, to lament the loss of civic pride involved in this process. Symbols of civic identity he cites include the Old War Office in Whitehall, now yet another luxury hotel, Admiralty Arch soon to follow suit and all over the country libraries, public loos and magistrates’ courts are all up for grabs. ‘Talk about short term thinking’, he opines: ‘Helsinki is building huge public libraries, Tokyo is commissioning architects to design public loos – but we are asset stripping the public realm for a quick buck… when amenities in which citizens have pride are stripped away, a sense of alienation fills the void’. And clearly this is very bad for our mental wellbeing. Just in the last few days we heard about the sale of the famous Post Office tower in central Londonfor £275 million to MCR Hotels, a group that already owns around 150 hotels. But why on earth do we need yet another luxury hotel in central London?
Finally, the Museums Association reports the good news that 57 community-based projects have been chosen by Historic England from 380 applications made in the latest round. We often hear about large projects and institutions getting funding but these are small projects likely to be very meaningful in their areas. ‘Historic England chief executive Duncan Wilson said: “There are so many hidden histories to uncover here in England. Every community has a story to tell and we want to hear them. This is the strength of our Everyday Heritage grant programme, which funds projects that are community-led and really engage with local people by empowering them to research and tell their own stories.” The projects funded in the latest round include a scheme to co-create a touring exhibition telling the story of Gypsy, Roma and Traveller (GRT) communities living in Greensand Country in Central Bedfordshire. The year-long project will take place on three local sites, where children and families from GRT communities will be creating content alongside visiting artists, forming a body of work to be shared with the public’. Amongst those London-based will be the story of the 1984 nursery workers strike in Islington, the community-focused history of Kingswood House in Dulwich – a Victorian ‘castle’ in the middle of a council estate, the Old Fire Station in Stoke Newington and the history of a Canning Town pub which became a leading live music venue, playing host to Iron Maiden and Dire Straits and helping launch music careers including Depeche Mode and bands like Paul Youngs’ Q-Tips.
Politics and mental health - the missing link? 