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Housing: one of the forgotten social determinants of health and wellbeing for persons with dementia?
The way the ‘G8 dementia’ summit was articulated by politicians and the media was that we are on a ‘war footing’ against dementia, with military metaphors aplenty like ‘battle’ and ‘fight’. After the Second World War, the Labour Prime Minister Clement Attlee gave Aneurin Bevan responsibility for two tremendously sensitive posts: health and housing. Housing was crying out for attention. As a result of the war, Britain had several million bomb damaged houses in urgent need of attention and the public had been expecting the establishment of a national health service since the Beveridge report recommended one in 1942. Housing remains a huge issue in policy directions to improve the health and wellbeing of those 800,000 (or so) living with dementia in the UK.
In public health there is a growing acceptance that health is determined not merely by behavioural, biological and genetic factors, but also by a range of economic, environmental and social determinants. A safe environment, adequate income, meaningful roles in society, secure housing, higher level of education and social support within communities are associated with better health and wellbeing. It is these determinants that are generally known as the “social determinants of health”. Adequate housing means safe, secure and affordable shelter. Housing also provides the place where we connect with the wider community through education, employment, and community networks. Health inequalities are the ‘differences in health status or in the distribution of health determinants between different population groups’. Those differences are inequitable when they can be determined as being unfair or avoidable. The social determinants of health are the collective set of conditions in which people are born, grow up, live and work. These include housing, education, financial security, and the built environment as well as the health system. So unsurprisingly housing is critical for living well with dementia.
There is evidence of marked differences in health and social service use between old people with and without dementia. The hundreds of dementia diagnoses probably comprise the most important predictor of long-term care among old people. In a six-year follow up-study in Finland, 70% of women with dementia and 55% of men with dementia were institutionalised. The research evidence on hospital use is somewhat contradictory: some studies indicate that people with dementia are more likely, and others that they are less likely to be hospitalised than those without dementia. Hospital stays tend to be longer for people with dementia, and certainly constitute a large proportion of admissions ultimately in the elderly in hospital care.
Housing problems that impact on health can arise for five main reasons:
- housing is not appropriately designed
- housing is poorly located
- housing is not secure
- housing is not affordable
- housing cannot be accessed at all.
Design for dementia is important because there are very substantial numbers of people with dementia living in every type of housing, and the numbers are increasing. It provides an exciting area in which multidisciplinary approaches can be fruitfully utilised, such as from architects, housing professions and neuroscientists. The levels of impairment experienced by different people will vary greatly. Some will be at the very early stages of dementia, and may not have even had a diagnosis. The issue of addressing “the diagnosis gap” is currently a powerful force within English dementia policy. Others will be seriously impaired and reliant on support from relatives or friends, perhaps supplemented by formal care at home. New housing should provide ‘lifetime’ or ‘barrier-free’ homes, embracing the principles of ‘universal design’. In keeping with this goal, the design process should address the needs of those with cognitive and behavioural impairment. Good design, many specialists feel, should begin at the inception of the project at sketch design stage.
Poor lighting can increase the incidence of hallucinations – especially if this creates lots of shadows. It is therefore important to be able to control both natural and electric lighting to prevent sharp variations in lighting levels, avoiding excessive brightness and shadowed areas. Furthermore, blinds can be useful for diffusing strong daylight, whilst for night time a simple bright central light source with carefully directed task lights are best. Many people with dementia will spend a lot of time simply looking out of the window, and if there is something to watch this can be life-enhancing. That is why it is often recommended that designers should try to ensure communal rooms have outdoor view of garden, and/or other locations where things are happening, e.g. a car park. Of course, expert opinions on such matters will vary, but it is a hallmark of an intelligent society that we can think about what could work best for people living with dementia. For many people, getting outside is possible and may be very important.
Prof June Andrews at Stirling, in “Dementia: finding housing solutions” (May 2013), describes that two-thirds of people with dementia live in their own homes or specialist housing, while one-third live in care homes. Most people with dementia say they would prefer to stay in their own home for as long as possible. Despite half of those who live in their own home living alone, the home can be the best place for someone to manage the consequences of dementia, particularly if accessible and adaptable housing to aid independent living. Adaptations, telecare, ambient assisted living and smart homes remain powerful constructs in English policy, reflected in a considerable R&D budget spend at EU level.
It is certainly an ambition for people with dementia to live independently and have access to support and advice services if they are diagnosed promptly. Many reach out to people living with dementia in the wider community, providing services such as floating support, assessment and delivery of adaptations and housing advice. The concept of a ‘dementia friendly community’ is indeed a wide-ranging one, but is not confined to a rather narrow scope of companies and corporations acting in such a way to be dementia-friendly to secure competitive advantage. It is hypothesised that dementia friendly communities will become one day in the planning and organisation of shared care in health and social care locally. When staff are equipped with the necessary skills, and there is continued investment in services, housing providers and home improvement agencies are able to assist with a wide range of housing choices for individuals with dementia. This includes making homes more accessible or more dementia-friendly or helping with moves to specialist housing. These organisations are also often able to help with day-to-day tasks such as shopping, household chores and organising domestic bills.
As an example, the Notting Hill Housing Trust in London has developed a dementia strategy, which sets out ways to raise awareness of dementia and encourage residents to seek help. The strategy has ensured their members of staff are informed about potential signs of dementia, which has led to innovation in practice and service delivery. Core to the strategy is a group of dementia champions who challenge colleagues and promote best practice. Housing organisations overall have a very good track record of providing specialist housing and delivering services that are designed to improve health and wellbeing, prevent falls and other accidents in the home and promote independence. Falls are of course hugely significant in the elderly, as individuals with osteoporosis in poor lighting conditions are particularly susceptible to hip fractures (which can lead to protracted hospitalisation). These housing services have been proven to prevent admission and readmission to hospital, allow rehabilitation after an accident or illness, delay the need for intensive care services and reduce the likelihood of emergency admissions.
One case study of an individual with dementia being supported to live independently in Extra Care housing highlighted savings of up to £17,222 a year to health and social care budgets. Housing organisations have also introduced assistive technology to ensure that people with dementia are able to stay independent and in familiar home environments. The report “”Extra Care” Housing and People with Dementia: A scoping review of the literature 1998-2008, Housing 21 (2009), on behalf of the Housing and Dementia Research Consortium with funding from Joseph Rowntree Foundation” by Rachael Dutton highlights the positive finding that there is mounting evidence that people with dementia living in ECH can have a good quality of life. However, the report also mentions“that some tenants with dementia can be at risk of loneliness, social isolation and discrimination.” Extra care can offer an effective alternative to residential care, and can delay or prevent the need for a move to nursing care. However, while many people with dementia have been able to remain in extra care housing until the end of their lives, “enabling all tenants, with or without dementia, to remain in place through to the end of their lives in extra care housing is not usually possible”.
Telecare solutions are a proven alternative to institutionalisation for people with dementia, helping individuals to retain independence and dignity and assisting their carers who might be unpaid family members, careworkers, or others. A range of sensors can be installed in the home, to support existing social care services, by managing environmental risks. These sensors include a natural gas detector, carbon monoxide detector, flood detector, temperature extremes sensor, bed occupancy sensor and property exit sensor. Should a sensor be activated, an alert is sent either to a monitoring centre or a nominated carer. Telecare supports both safety in the home and security outside the home – where 60% of people with dementia experience the risk of ‘wandering’ dangers. Dementia can be distressing for carers, as it places them under immense pressure to help. This leads to the often hidden problem of carers suffering psychologically and financially themselves. Telecare can potentially help relieve some of this pressure – enabling carers to take a well-earned break, secure in the knowledge that they will be contacted immediately if needed. Technology can also help staff to provide a safe environment for someone through flood detection, gas shut-off systems, pagers, and medication alerts.
As a frontline service, all housing professionals work with people who have dementia, most likely in the earliest, sometimes undiagnosed, stage but also as the illness progresses. Housing professionals will also be involved where a person with dementia may be able to return home after a period in a health or social care setting following a period of crisis. Inevitably, national policy also emphasises the need for a timely diagnosis to be able to anticipate or prevent “crises”. There are therefore housing staff who work with tenants who would benefit from an understanding of what the dementias are, how to identify the features, and what to do next in terms of referral and/or discussion with health or social work colleagues. However, there is no doubt that the approach of joining up health, wellbeing and housing is just the tip of the iceberg; there needs to be better awareness of the dementias generally, attention and resources for dementia-friendly communities, and a real attention to detail (such as design features and innovations of the home). But this is a marathon, rather than a sprint.
Together
Ed Miliband will need to engage a different spirit in 2015, seventy years after that needed for 1945. The Conservatives have become the presentational unit of multinational corporates, and many citizens of the United Kingdom resent this. Whereas instead decades ago, the Unions could be validly criticised as ‘holding the county’ to ransom, now it is the bankers. There is no proof for any ‘trickle down’ effect, where allowing millionaires to keep more of their income and wealth benefits the county at large. David Cameron strikingly did not win the General Election in 2015, meaning that he has been reliant on the Liberal Democrats ditching any principles to vote for legislation which is clearly totally illiberal, such as secret courts. Rather than working in the national interest, the Conservatives and the Liberal Democrats have been operating entirely in their own self-interest, doggedly pursuing policies which serious commentators have long criticised for being a perfect recipe for producing economic turmoil. Members of this Coalition confront serious issues with extreme arrogance and disregard for the facts, as demonstrated by Baroness Shirley Williams and Lord Clement-Jones in the recent section 75 NHS regulations debate in the House of Lords.
Labour has been blasted for not having any policies. This changed today, but don’t expect the BBC to cover any of them well, in the same vein as how they totally ignored the changes in legal aid and the NHS the point of absolute ridicule. Labour’s idea of a “Jobs Bill”, which introduces a Compulsory Jobs Guarantee, a paid job for every adult who is out of work for more than two years, is a serious way of addressing the problem of youth unemployment. Generally, unemployment has been creeping up under this Coalition, and the only reason there are so many in employment is that they are many more with very little employment rights, doing short term contract work to try to pay the bills. There is absolutely no economic case for the tax cut for millionaires, but the political case of nudging them into voting for a discredited Coalition is quite potent. The idea of requiring large firms getting government contracts to have an active apprenticeships scheme that ensures opportunities to work for the next generation is a very attractive one, and is very much in keeping with an idea very popular in the United States of making corporates behave like ‘responsible corporate citizens’. Indeed, Ed Miliband introduced this idea to an unconvinced general public in his now famous Labour Party Conference speech of September 2010 on ‘responsible capitalism'; this was clearly before we’d all even heard of ATOS and welfare benefits, corporates and phone hacking, fires, explosions and collapses in Texas and Bangladesh.
Also, a “Banking Bill” is much needed. The aim of this is to reate a real British Investment Bank on a statutory basis, at arms length from government and with proper financing powers to operate like a bank. One of the persistent criticisms of the current government, which Nick Clegg had criticised of Labour in 2010 but subsequently totally failed to address himself, is the issue of how to get banks lending to small businesses. Project Merlin is well known, and the purpose of this intended legislation by Labour is to support small and medium sized businesses, including across the regions of the UK through regional banks. Labour intends to provide a general backstop power so that if there is not genuine culture change from the banks they can be broken up, to put in place a “Code of Conduct” for bankers, and to toughen up generally the criminal sanctions against those involved in financial crime. Furthermore, Labour’s idea of an “Immigration Bill” is very noteworthy, given how Gordon Brown was caught famously unawares by Gillian Duffy in the now famous “Bigotgate” incident. Labour intends to double the fines for breaching the National Minimum Wage and give local councils the power to take enforcement action over the national minimum wage, extend the Gangmasters Licensing Authority to other sectors where abuse is taking place, and change NMW regulations to stop employers providing overcrowded and unsuitable tied accommodation and offsetting it against workers’ pay.
There is now a crisis in social housing, not least because the Thatcher government sold off valuable social housing stock during her period of government. However, unfortunately, we can’t ‘turn back the clock’ to his very socially divisive period for the UK. The economy has become too much on the side of exploitative private landlords, and Labour intends to introduce a national register of landlords, to allow local authorities to root out and expel rogue landlords, including those who pack people into overcrowded accommodation. Labour also intends to tackle rip-off letting agents, ending the confusing, inconsistent fees and charges, and to seek to give greater security to families who rent and remove the barriers that stand in the way of longer term tenancies. Labour fundamentally does not know to what extent the UK will be recovering by the time of the General Election in 2015. The public are already sick to the back teeth of the trite “the economy is healing” pathetic PR by the Coalition, particularly since the economy WAS healing in May 2010 before the Coalition totally destroyed it. Labour’s proposed “Finance Bill” would reintroduce a 10p rate of income tax, paid for by taxing mansions worth over £2m, stop immediately the cut to the 50p rate of income tax for those on the highest incomes to reverse cuts to tax credits, reverse the Tory-led Government’s damaging VAT rise now for a temporary period – a £450 boost for a couple with children, and provide a one year cut in VAT to 5% on home improvements, repairs and maintenance – to help homeowners and small businesses. Courageously, Labour intends to put in place a one year national insurance tax break for every small firm which takes on extra workers, helping small businesses to grow and create jobs
There is a growing feeling that the economy is fundamentally imbalanced towards the interests of shareholders in fragmented oligopolies, rather than the concerns of the general public. Labour wishes to introduce a Bill where it would abolish Ofgem and create a tough new energy watchdog with the power to force energy suppliers to pass on price cuts when the cost of wholesale energy falls. This would be a very popular move with many in the general public, not just traditional Labour voters. This legislation would require the energy companies to pool the power they generate and to make it available to any retailer, to open the market and to put downward pressure on prices, and force energy companies to put all over-75s on their cheapest tariff helping those benefiting to save up to £200 per year. The railway industry is another fiasco of the utterly discredited privatisation doctrine of the Conservatives. Labour intends to apply ‘strict caps’ on fare rises on every route, and remove the right for train companies to vary regulated fares by up to 5 per cent above the average change in regulated fares, and to introduce a new legal right for passengers to the cheapest ticket for their journey. Finally, many members have become increasingly irritated by the propensity of the Conservatives to call pensions ‘welfare payments’. Labour now has concrete plans to tackle the worst offending pension schemes by capping their charges at a maximum of 1 per cent; and to amend legislation and regulation to force all pension funds to offer the same simple transparent charging structure so that consumers know the price they will be paying before they choose a particular scheme.
So finally we are getting a sense of the direction of travel of Labour, and this is in stark contrast to the hapless ipeptidude and incompetence of the Liberal Democrats, UKIP and the Conservatives.
Despite the inaccuracies, Cameron's pitch was sufficiently effective to be of concern
I think the main danger in misinterpreting David Cameron’s speech, written by Clare Foges and colleagues of the Conservative Party (including presumably David Cameron), is to do so without viewing it from the perspective of a potential Tory voter.
Individuals who are ardent Conservative voters, one assumes, are not distracted by factual inaccuracies in the narrative (such as how many people on housing benefit are unemployed, or how much borrowing this current government is doing). Certain things might have stuck in the minds of potential voters, such as the idea of an unemployed person in a bedsit queue-jumping in the housing ballot ahead of a person who’d dedicated his or her life for decades. To such people, the prevalence of benefit fraud is immaterial. Cameron tried to produce a narrative of the rich being punished for being successful, in his characteristically patronising explanation of how income tax works for Miliband’s benefit. A caller on Iain Dale’s show last night on lbc considered that he might vote for the Conservative Party, having voted for decades for Labour. He felt that his ambitions as a worker had not been recognised by the Labour Party, and was sick of it. Rather than blaming Cameron and his team for tapping into this ‘aspiration’, Labour runs a genuine risk of pursuing evidence-based politics while simultaneously failing to capture the sentiment and feelings of workers of this country.
How this situation has come about is interesting, but it is patently obvious that it has not come about overnight. Cameron indeed would be right in thinking that such a voter is not overly concerned about what Prof Michael Sandel or Prof Jim Hacker have to say about public good or predistribution particularly; the mental masturbation over intellectual sociological ideas might lead to an even greater disconnect between Labour and its missing voters. It is clearly of concern that there are millions of voters who cannot remember why they did not vote in the 2010 general election, but it is fair to say, probably, that not all of them produced a protest vote on account of the expenses scandal. While talk of whether Andrew Mitchell will survive is of immense interest to the Westminster village, it is curiously not the allegation that he may have said “fucking” or “pleb” that is the problem with the focus groups, but the fact that the Conservative Party do not consider themselves at one with the general public.
This is why Cameron’s pitch was effective, as it was ‘levelling’ with the public in a way that they largely comprehend. Labour has its own arguments why it increased public spending, but it seems that there is no appetite for such a technical debate; however much Labour wishes to debate it, the Labour Party are generally not trusted with the public finances. While ‘One Nation’ talk might be appealing, even after the forty-sixth repeat, if Labour cannot be trusted to be in control of the public purse, the most they can hope for is a Lib-Lab pact. The dynamics of a potential future Lib-Lab pact are interesting, in that the vast majority of Labour voters would not wish to enter into a pact with Nick Clegg still at the helm of the Liberal Democrat party. It becomes 50/50 if it’s any leader but Nick Clegg, and still most Labour voters stubbornly feel that Labour politicians are better at running the economy than the Liberal Democrats. It can be tempting for Labour members to think that the NHS is a ‘make or break’ issue, but this policy has been evolving for some time, especially under New Labour, with the emergence of NHS Foundation Trusts and clinical commissioning. Labour voters are not likely to get angry over the pay packets of private directors of healthcare companies at the ballot box, but are more likely to resent the Health and Social Care Act if quality is seen to suffer. While the NHS remains branded as an unitary NHS, this is unlikely to be the case, and the Conservatives can justifiably continue, perhaps, with their strategy of either not mentioning it, or describing it as a ‘modernisation strategy’.
The legal aid cuts might be a more productive way for Labour to reach out to the strivers. For example, due to the managed decline of law centres on the high street, access-to-justice for housing, immigration, asylum, welfare benefits, and employment advice, inter alia, is compromised. This is hardly in the best interests of strivers? Strivers are unlikely to be impressed by trading off their rights not to be unfairly dismissed for some shares in a company which cannot produce a dividend unless it has distributable profits. It might be that strivers do not particularly care whether the Human Rights Act is abolished or not, although its abolition might help to return a Conservative government. Individuals may be inclined to think that so long as he or she is not affected by torture, privacy, or freedom of expression issues, they are unlikely to be touched by the Human Rights Act, especially if legal aid for such matters is abolished. Cameron has also perhaps succeeded in painting the Conservative Party as firmly footed in the “real world”. There are two major issues for why Ed Miliband has trouble on this: the spending of Labour “even during the good times”, and the thirst by Miliband for the application of sociological theories which have yet to be tested in practice. The empirical evidence for ‘Nudge’ of course has never been compelling, but there is a sense that the standards that Conservatives apply for themselves are not the ones they apply to Labour.
So it comes to something when David Cameron calls trade union leaders “snobs”, but no amount of hatred for inverted snobbery will deliver Miliband a landslide for the 2015 general election. Practical problems emerge if Ed Balls signs up for an austerity agenda indistinguishable from the Conservatives, not least in the sense that workers will wonder why on earth they are still supporting Labour. Miliband does not want to be seen in the lap of ‘vested interests’ codeword for ‘trade unions’, but likewise he has not embraced a redistributive tax system targetting the very highest earners yet. Trade union members contribute up to 40% of the funding of the Labour Party, but, like the debate on public purse handling, Miliband is unlikely to sway the minds of voters on this. It is not improved aspiration from the middle class and centre that will win Miliband the 2015 general election, but it will be working class leaving Labour in droves in finding their aspirations unaddressed. One term oppositions are extremely rare, and Labour finds itself in a difficult position in perhaps having to rely on the Liberal Democrats to form a government having spent the last five years in slagging them off. Cameron’s speech yesterday was full of statements all good lefties would have found contemptible, but it was clever in that it was sufficiently practical (for example, not mentioning the ‘bash a burglar’ policy) that it did offer a course for government. As others have pointed out, this is not a speech that Cameron can ever give in future, if he fails to deliver. The starting gun for the 2015 general election has most definitely been fired, and the first ‘hurdle’ takes the form of the OBR assessment in a few weeks time about the UK deficit. Cameron has given himself in a sense a suspended sentence, but there are strict conditions for his future behaviour.
Is this where the Big Society came from?
The explanation that the Big Society was an altruistic exercise to help the disadvantaged was clearly a non-starter from the beginning.
There has historically been a lack of clear account of where the Big Society in the UK came from. Notwithstanding its precise source, it was undoubtedly a massive political mistake to attempt to launch it on numerous occasions in a background of austerity and cuts and increasing unemployment. This was bound to lead to stories in the popular press about how people had lost their job, but were being invited to apply ‘for their own job’ as an unpaid volunteer. When you consider the Coalition’s attempt to introduce workfare, you can see how the policy mix became explosive.
This Coalition doesn’t do ‘organic’. For example, in the non-top reorganisation that constitutes the NHS Act, stakeholders were not consulted leading to the majority of the Royal Colleges, including the GPs shared by Clare Gerada, to oppose this key piece of legislation. We were introduced to the notion of the NHS Commissioning Board, and asked to learn to love the idea. In the same way, the Big Society is not about community investment where the ordinary public decides what programmes to flourish.
I believe a big mistake was for Lord Wei and his colleagues to mix and match social enterprises and venture philanthropy, and to repackage seductively as ‘The Big Society’, hoping nobody would smell a rat. The fact that this Coalition doesn’t do organic is manifest openly in the fact that the Big Society Bank will decide where to invest its money (rather, in part, our money as it comes from unclaimed account in the UK). It then decides where it wants to invest the money, and decide which metrics it wants to pursue to decide what a good outcome is. The investors will want something back for their money – doh.
It is particularly not clear where the architects of the Big Society got “their big idea” from. In the US, there has been a history of philanthropy, and indeed organisations in the US are successful are providing such services. Maybe Lord Wei got their inspiration from abroad. Housing cooperatives are well-known about, and serve as a a legal mechanism for ownership of housing where residents either own shares (or share capital co-op) reflecting their equity in the cooperative’s real estate, or have membership and occupancy rights in a not-for-profit cooperative (non-share capital co-op), and they underwrite their housing through paying subscriptions or rent.
However, looking at the small print of how or why we differed from the U.S. has been difficult, as we have never been given adequate explanation of how or if recipients of awards would repay their money, over what time scale, and with what rate of interest. The New York Co-operative does provide ‘some flesh on the bones’ where we are able to make some conclusions about how a co-op award may compared to a mortgage (see for example this well known article in the New York Times), but we need some detail on the operation of the Big Bank here to ensure that vulnerable people are not subject to a problem they cannot easily get out of. It is also interesting to note that further criticisms from the housing sector have already begun to emerge here in the UK. According to the Financial Times today, “Phil Shanks, director of SAF Housing, a fund for the provision of housing for those in need of extra care, said the Big Society Capital concept is flawed because it does not overcome the main concern that many institutional backers of social enterprises have: the security of funding for public services”.
The implementation of the Big Society has been a huge mess thus far, but like all its non-organic projects, unless there is better detail and more substantial support from those who do give up a lot of their time in the third sector currently, the Coalition will find a substantial failure on its hands. Hopefully, their other non-organic project, the NHS restructuring, will go better.
(c) Legal Aware 2012
Things mustn't get any worse: the new Labour dream?
“I’m Labour, or I was Labour, and I sympathise, but there’s no fairness, no fairness, it’s absolutely ridiculous. Millions of immigrants have come in and it’s making everything harder”, though there was also a firm and contradictory response: “I don’t think so, that’s all a bit of hot air. A lot of foreign workers do jobs British workers don’t want”.
These were the now immortal words uttered by Gillian Duffy in Rochdale.
2010 was indeed a far cry from this.
The 2015 election makes very grim reading for us. The Fabians’ “Southern Discomfort Again” pamphlet published today provides that,
“At the 2010 Election, there was almost a wipe-out of Labour seats in Southern England, where almost half of British constituencies are located. 13 seats were lost in the South East, 8 in the South West, 11 in the East, 14 in the West Midlands and 11 seats in the East Midlands, a total of 57 seats or nearly two thirds of Labour’s overall loss of 91 seats. Indeed, the Labour party now has no MPs whatsoever in Cornwall, Somerset, Wiltshire, Dorset, West Sussex, East Sussex, Kent, Essex, Suffolk, Norfolk, Cambridgeshire, Northamptonshire, Rutland, Warwickshire, Buckinghamshire, Hertfordshire, Gloucestershire, Worcestershire and Herefordshire.”
The Fabian Society published its long-awaited “Southern Discomfort Again” report today. The survey results and discussion are available here. Lord Giles Radice and Dr Patrick Diamond from Oxford were the co-authors. Lord Radice is pictured here in our meeting at 1 George Street, Westminster. SW1.
Our next election will be in 2015, 18 years away from Tony Blair’s dream of 1997. Tony Blair and Alastair Campbell were possibly at the right place at the right time, with a country absolutely sick to the back teeth of the Conservatives. Note that this is different to the current situation, where the Coalition, according to all the polling evidence, appears to be popular, as it has a credible policy for reducing the deficit, and, overall, the general public support the idea of people working together in the national interest, as evidenced by David Cameron’s populist speeches at Conference. Tony Blair tapped into a mood of optimism, and, more importantly, aspiration; and the county ran with it. The mood in 2011 is very different, and Labour has to recognize this. The buzzword now is ‘insecurity’, both in social and cultural terms. Gillian Duffy’s comments touch on one plank of this; immigration in itself, with its repercussions on employment. Actually, it touches on another plank, housing. Interestingly, Labour has become known as the party of the benefit scroungers, immigrants and the Unions. Clearly, Labour has failed to make the “globalism is good” argument, and the benefits of free movement of Labour was not even attempted by Phil Woolas MP in the last parliament.
Labour would therefore be advised to be sensitive to the feeling of insecurity by their voters. And who are their voters? For the first time, last Election, according to YouGov, the middle classes overtook the working classes in voting for Labour. It would be sensible to highlight the social implication of cuts, because there is the outside risk for Labour (and of enormous benefit to the country at large) that drastic benefit reduction might indeed ‘work’ without seeing adverse effects in unemployment. If the economy goes belly-up (we are assured by Cameron and Osborne, reflecting on Ireland inter alia, that it won’t), Labour will be home-and-dry. If not, it’s going to be ‘quids in’ for all involved in the Coalition; in particular, Nick Clegg MP. They will be able to play ‘well, it was unpleasant, but the country is much more better off now, and we can pay for more nurses and teachers now?’ card.
Labour should be ready for a long period of opposition, until proven otherwise. I feel that this will give Ed Miliband sufficient time to sort his team out. There are issues to be debated, such as the degree to which ‘creeping marketisation’, much despised by Ed Balls MP, will be avoided by Ed Miliband. As for the psychodrama, one can speculate ad nauseam on whether Ed Balls will support Ed Miliband, but the future direction taken by John Healey and Alan Johnson, for example in opposing NHS ‘privatisation’, will be necessary. There are some of course, perhaps Tony Blair included, who feel that some sort of corporate restructuring and business ethic in the NHS is needed. It may be there is a long haul ahead, which will give time for Ed Miliband to work Angela Eagle MP up from Shadow Chief Secretary to the Treasury to Shadow Chancellor, in time. As Alan Johnson MP readily admits, he is currently reading a primer on economics, but is possibly the best person to oppose the Comprehensive Spending Review as a politician at this particular moment in time.
We need to consider carefully why we lost an election. Whilst I am an ardent fan, I recognize that 13 years was quite long enough for people who felt that Labour had run out of steam following 2005-2007, and that Gordon Brown, whilst good at leading economics seminars (although he probably lost on the £6bn point, in fact) was not an inspirational leader. I feel that the lower middle classes feel disenfranchised, still have aspiration, but are faced with massive insecurities now, which the left need to address. Furthermore, Labour can’t duck away from the fact that, despite having successfully made in-roads into restoring its reputation, has become perceived as ‘economically incompetent’ again. Ironically, the report on waste in government, which Labour actually commissioned, was published today.
Liam Byrne and Ed Miliband will be trying to make sense of all of this.
Dr Shibley Rahman
Queen’s Scholar, BA (1st.), MA, MB, BChir, PhD, MRCP(UK), LLB(Hons.), FRSA
Director of Law and Medicine Limited
Member of the Fabian Society and Associate of the Institute of Directors
