Though 2016 is often held to mark the dawn of the post-truth age, it must be said that the 2010-2015 coalition government had a nice line in rhetorical liberties. The Coalition’s policies resulted in swingeing cutbacks, marketisation of public services and outsourcing. The deliberate and vicious theme of ‘austerity’ – with its earnest 1940s echoes, it’s black-and-white heroics and stoicism in the face of a necessary reductions in butter rations, was used as a device to justify an ideological dismantling of the welfare state.
As the Prime Minister with the job of selling this to the public, David Cameron endlessly repeated that spending on health and social security effectively depends on another section of the economy – therefore, without the “hard growth” in GDP, health and provision of social welfare would be unaffordable. This went more-or-less largely unchallenged, right the way through to Cameron’s own ‘hard exit’ in the aftermath of the Brexit vote in 2016. As an assertion, it is, of course, completely wrong.
Healthcare and welfare adds to the economy, both in the short-term, but also in the long-term. The creation of the NHS in 1948 drove continual innovations and groundbreaking discoveries, from the fitting of artificial hips, through to the blossoming of a huge, and highly profitable, pharmaceutical research sector. Provision of healthcare drives the development of science. It has never been the case that improvement in health has not driven economic development: it is crucial to demographics, or in crude Marxist terms, the basis for reproducing capital.
To put this in a more prosaic way, it’s time to start thinking of the social and healthcare infrastructure in much the same way we think about the provision of public transport. Both can be spurs to investment and rapid economic development. But it is possible to deny proper funding to a railway system, just as it is possible to deny proper funding to a health system. In some ways, the NHS in 2019 has a similar level of delivery under financial stress to that offered by British Rail by the late 1980s. But in both cases, it creates conditions of crisis around this lack of investment. In the early 1990s it could be the clogged roads and roadbuilding programmes which sacrificed huge swathes of countryside, whilst in the 2010s, it’s the way emergency departments and hospital beds are swamped due to strain elsewhere in the system.
For the railways, it was only privatisation, and the need to pump money and subsidy into an artificially created market, which finally resulted in the government opening the coffers, resulting in a massive increase of public spending. It isn’t hard to imagine that the NHS could face a similar future.
If we want to present an alternative real-life vision, the time has come to counter David Cameron’s argument directly. We don’t want to see the solving of the ongoing problems of the NHS as somehow dependent upon the City of London’s profitability. To develop an expansionist economy, we need to see an expansion of healthcare and universal provision of benefits, to develop an economy where human potential can be developed. Structurally, the shape of national insurance as a universal system needs to be resolved, and the concept of cradle-to-grave provision restated as a crucial part of a set of constitutionally-guaranteed social minimums. The separation between social care and health care has to be eliminated.
The idea that people’s benefits can be sanctioned for arbitrary transgressions is wrong, but the biggest misconception is possibly that the basic benefits for a whole set of circumstances are currently enough to avoid abject misery and Dickensian levels of personal indebtedness. It is not just that benefit sanctions make it impossible to live, it is also that the benefits themselves are usually at levels which are designed to force people to struggle. Unemployment benefits, for example, are set at a level whereby anyone with usual financial commitments would immediately begin to drastically struggle after just a few weeks. Even the Liberal Democrats want to ‘reform’ the way that benefit sanctions work, but entirely neglect the way that the benefits system by default tries to starve people back to work, to the detriment of general wellbeing and security.
The endless shunting of the retirement age towards 70 years, a feature of public life in the UK since the 1990s, has become the ghost in the room that no-one wants to mention – a quiet menace, lurking almost the edge of vision. In fact, it signposts a set of crises and social conflicts to come.
In some ways, it’s really very simple. If we want a state of peace within society, a new social settlement, then to be a citizen of the UK, maybe a federal UK, must include a firm assurance of good provision of health and social services, of pensions and welfare provision. This sense of chronic insecurity is referred to by Will Davies, in his book ‘Nervous States’ as presenting an existential challenge:
‘…divisions are not merely economic, but have required a bodily and existential dimension: people’s lives are being shaped by divergent health, life expectancy and encounters with physical and psychological pain. Pessimism emanates most strongly from bodies that are ageing faster and suffering more.’
With the right framing, the expansion of welfare offers a point whereby self-interest can merge with social justice. The priority placed upon occupations in the caring sector has to increase, in order to improve the care that we, and our loved ones, are going to receive. This means pay rises and adjustments to pay scales, to enable nurses and care assistants to earn the kind of salaries which reflect their importance.
In addition, it has become crucial that the care sector should be formed around guilds, as a way of enabling professionalisation and establishing continuing development of best practices. If we would like to expand the welfare state in the UK, to make it a driver for economic growth and social cohesion, the implication for migrants is that not only should they be allowed to work and live in the UK, but they should expect to receive the kind of career development and professional development which would allow them to reach their potential. Expanding the welfare state and the care sector is a process which would allow for the kind of integration so lacking in a casualised economy.
The question of local provision needs to be resolved. In some cases, this calls for reversion to the planning-based structures of the 1970s. In other cases, this may call for more technologically-based approaches. The expansion of universal provision can include new forms of universal provision. One idea would be to provide an NHS app which includes a regularly allocated number of free-at-use appointments for different therapies and fitness services. Healthcare and welfare can provide a stimulus to local economies.
The main point here is to counter the atmosphere of suspicion and the chronic sense of insecurity – which has some basis in material in material reality, especially since the financial crisis in 2008. This is all crucial to recovering a sense of meaning, to forge a common understanding of what our collective ties consist of.
The financial basis for this needs to be sustainable and might require careful planning. But health is worth paying for. Convincing the public that expanding collective provision of all welfare services should be as much a part of a serious socialist programme as anything relating to expansion of public ownership. There are many ways in which this could be done, but it requires political will.
In 1982, the GLC manifesto, written by the late, great Robin Murray, included much that was groundbreaking and much which is simply accepted nowadays, but among the long list of commitments was one about:
‘using technologies which interact with human skills; making goods which are conducive to human health and welfare; working in ways which conserve, rather than waste resources. We believe that these initiatives – which constitute a fundamental rejection of the values inherent in capitalist production – must be supported.…’
A reinterpretation of health as a social good is long overdue. It’s currently Labour’s ‘missing link’ – the glue between public ownership and a social settlement. The welfare state is broken, and only a re-invention will fix it. Succeed, and we capture both hearts and minds.