The Ministry of Fear

Holiday pleasures can't quite shake the sense of background dread at the state of the world - and the state of the NHS. But there is clearly appetite for resistance.

Rob Poole
25 July 2016

Image: Jeremy Hunt, kept on as Health Secretary by new Prime Minister Theresa May.

As I arrived in Southwold for the annual family gathering, I was puzzled by a plethora of red, white and blue bunting. Was it, I wondered, a touching gesture of solidarity with Nice (it was the day after the Bastille Day massacre)? Or was it, perhaps, an unusually extravagant celebration of Brexit, in a region heavily dependent on fishing and pretty antagonistic to the European project from the outset? Eventually I was told that the Town Council had originally purchased the bunting for the Queen’s Silver Jubilee in 1977, and brought it back into service for her 90th Birthday.

My grandmother grew up close to Southwold and I have extended family there (including, by marriage, a Conservative Mayor of the 1970s, whom I tend not to mention very often). My parents moved there in retirement. I have visited every year (bar one, which I regretted) since 1964.

Southwold is a Sunday feature cliché, crammed with journalists, celebrities, doctors and senior academics enjoying the classic English seaside holiday at exorbitant expense in pastel shaded beach huts. I do not care. It represents continuity in my life. It is a beautiful place and I love being there.

This year, amid early morning swims (not me, naturally), barbecues and cross-genre musical jams in the back garden, something felt wrong. New atrocities and fresh bad news kept stoking a background dread that jarred with pints of Adnams in the sunshine and crabbing at the harbour.

It was exactly the mood evoked by the first chapter of Graham Greene’s The Ministry of Fear. At the start of Greene’s book, Arthur Rowe goes to a charity fête in the middle of the London Blitz. A fortune teller tips him off to win the Guess-The-Weight-Of-The-Cake competition. Then someone tries to kill him. It is a mixture of surreal threat and the reassuringly familiar. About thirty family and friends were involved in our seaside holiday, and we thoroughly enjoyed ourselves. The awful state of the world probably heightened the pleasure of being together, rather than spoiling it. Nonetheless, the dread was definitely there.

I got talking to a woman who was serving me in a shop. She was a recently retired mental health worker. She talked with great enthusiasm about working in mental health services for decades. I mentioned the problems in the local NHS mental health trust, Norfolk and Suffolk NHS Foundation Trust. The organisation was placed under special measures over a year ago, after a damning report by the Care Quality Commission. This followed several years of campaigning by staff and patients. The campaign continues, because cuts have continued under special measures. While I was in Southwold the Trust announced a 3% reduction of staff in the latest attempt to balance the books. Cost savings have been previously achieved by re-grading the staff. The woman I spoke to had been re-graded twice, down two pay bands. From a financial point of view, she had no option but to retire as soon as she could. She welled up a little as she talked about her patients.

It is a disaster to lose experienced staff in the face of a recruitment crisis, but the Government appears oblivious. Existing problems in mental health nurse recruitment are about to be exacerbated by the removal of nursing bursaries. The right-wing coup in the Parliamentary Tory Party has left an inept, rigid and functionally unintelligent Secretary of State for Health in post. It is unlikely that the new Cabinet will be any better disposed to the NHS than the old one was.

After my last blog I was reproached by Dr Stephen Hunter (whom I greatly respect) for being hyperbolic. I have reflected on this, and I do not agree. These are serious times. Just like in The Ministry of Fear, everything looks normal, but it is not.

Confidence has collapsed and the economy is shrinking, but it does not show yet.

Norfolk and Suffolk are just an example. They are not the only NHS mental health provider that is in special measures. Here is Hugh Pym’s moderately worded BBC article from a few days ago about the state of NHS finances. It looks like worse services and more cuts are coming in England.

This is not inevitable. We should not just wring our hands about it. We need to speak up and, where we can, take action. I am not convinced that joining Paddy Ashdown’s liberal revivalist MoreUnited will do the trick.

The Labour Party is unlikely to be of much help in resisting the austerity-plus-Brexit policies to come. They are consumed by a conflict where the membership wants left-wing policies (combined with an attempt to win the electorate over to their ideas), and the Parliamentary Labour Party wants power so that it can do things (or at least keep their seats). The contradiction between policies and power is not new, but it will probably split the Labour Party this time. As a non-member, I think that in the long run a split will probably be a good thing. Unfortunately, in the mean time the entire Parliamentary Labour Party is far too busy plotting to do its job. For now, they are out of the game.

The struggle to preserve the NHS in general, and mental health services in particular, has to happen away from Parliament, where the impact of cuts is scarcely felt in any case. It is closely linked to the unresolved junior doctors’ dispute, particularly their resistance to the nonsensical and un-implementable ‘seven day service’.

Unprecedented problems require unprecedented responses. Maybe we should listen to the advice of Brother D in 1980: “agitate, educate and organise”. The slogan is dated, but Brexit, the junior doctors’ dispute and a huge increase in Labour Party membership tells us that there is an appetite for resistance out there. It does not have to be fighting in the streets. A bit of unity independent of political parties has to be a better option than passively watching another four years of destruction of public services unfold.

This piece is cross-posted from Khruschev's Shoe.

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