The Welfare Debate: Getting Out What You Put In

By Ben West.

In the current circumstances, full employment may seem an almost absurdly ambitious goal (and it’s certainly a long-term project) but it’s certainly a goal that any government worth its salt should be working towards. An economy with large numbers of people on benefits is not something to aspire to or to defend; it is a symptom of a failing economic policy – something that Labour ought to be clearer on, and reminding voters of every day.

Those suspicious of Labour’s proposal today to link benefits to past contributions by reviving the ‘contributory principle’ have every right to be. The Trojan horse of ‘reform’ is often used as a means of attacking the system and the people who use it. We must be clear: irrespective of how much or how long someone has paid in for, JSA should always be enough to allow someone to live in dignity while they find a job – and that includes ensuring they’re able to cover transport to look for work and can buy decent clothes for an interview, rather than the current system of tests and box-ticking that leaves recipients infantilised, patronised and degraded.

But the idea of reciprocity is fundamental to the legitimacy of the entire system. When FDR signed the Social Security Act in the US, he remarked that,

The way we protect the system of social insurance over the long term is by ensuring that the broadest possible range of people have a stake in it. Once a public service (see council housing, schools) becomes stigmatised or its use confined to the least influential and most marginalised, it’s only a matter of time before it comes under attack and eventually abolished.

This emphasis on universalism is one of the things that makes the systems of places like Germany and Sweden so resilient. White-collar workers on £50,000 can be confident that if they lose their job, they will be able to collect the equivalent of 70% of their average income until they find a new one. Crucially, the fact that so many do so without social stigma, or without being treated like a feckless idiot at a job centre, means that they are considerably more likely to defend the rights of those less well-off who happen to find themselves in the same boat.

Again though, we should be realistic about today’s announcement. A tax on banker’s bonuses isn’t nearly enough to get us there. To be convincing, the policy needs to be part of a wider set of policies designed to address the structural inequalities that lead to low wages and unemployment in the first place. This needs to include a commitment to gradually raising the minimum wage to a living wage, proper employment rights for agency workers, regulation of private landlords, and above all else, a coherent system of vocational training which ensures that those in the most precarious service-sector jobs are valued and respected in the employment market.

The end goal needs to be a high wage, high skill, high productivity economy, rather than one where we accept poverty wages and unemployment as facts of life. Labour needs to avoid the trap where we fetishise benefits that, while currently a necessity for many, merely paper over the structural inequalities that create poverty and unemployment in the first place. Just as high numbers of long-term recipients on JSA is a symptom, not the cause, of our economic malaise, Income Support is a public subsidy of poverty-wage employers that this country can ill-afford.

As a Labour party, we shouldn’t be scared to articulate it in those stark terms – using the principle of reciprocity to restore dignity and respect not just to the social insurance system, but to the economy as a whole.

Ben West is a Young Fabians Member.

Why We Need Young Councillors

By Ryan Jackson.

This March I attended Young Labour’s annual national youth conference in Leicester and I was pleasantly surprised by the number of delegates who were involved in one way or another in local politics. I was quietly re-assured by the number of young elected councillors – re-assured that local branches were actually selecting younger candidates.

However, one would expect to find young councillors somewhere at a political conference (for young people), surely?

I believe that there is still a message to convey to our local party branches about who is ‘fit’ to be selected as a council candidate, and ultimately be a councillor. Inevitably, there is the ‘experience issue’.

The experience issue is one that I can understand, however it’s also one that is too often used in a prejudicial way. What does one define as ‘experience’ – experience good enough to represent your local townsfolk? If there’s one unique thing that young people do have experience of – it’s of being a young person in their respective local authority.

There is an abundance of experience on every local council, and every bit of it is valuable. But is this ‘experience’ good enough when around a third of your population is under the age of 30? Can we say that our local authorities are representatively making decisions that affect us? Statistics from my own local authority, Wakefield, show that 36% of the population is under the age of 30.  As a crude age-based calculation, that should equate to around 23 councillors being under the age of 30 if the council were to be representative of age. Wakefield falls drastically short.

But in reality, councils need to be representative in many ways. Being a Labour councillor shouldn’t just be for retirees or public-sector workers. (Though of course, the importance of the experience that these people bring should never be underestimated.) Young people in politics really do want to change the world and it’s that drive, determination, and passion to serve that should be equally as important.

Yes, the role of a councillor has its many challenges. And for a young person, just being a candidate can have its fair share of challenges too. But it’s these challenges that we should overcome together, with the help and guidance of our local parties as well as our individual resolve. We’ve seen in young Labour councillors such as Josh Newlove of Tranby in the East Riding of Yorkshire and Kate Taylor of Devonport in Plymouth just what a refreshing impact younger members can make, and I’d be proud to have either of them represent me in my local council chamber.

As the chair of a local Young Labour group, I hope more young people than ever before not only get the chance to, but are selected to stand and represent our diverse party in our local authorities. I want to go into the next set of district and city council elections backing a good number of formidable young candidates who passionately want to serve their local communities and help shape the future of our councils.

Ryan Jackson is a Young Fabians Member and Chair of West Yorkshire Young Labour.

Focus on Health & Society Series: Can the NHS become a successful business?

By  Richard Stebbing with additional comments by Adebusuyi Adeyemi.

In the latest installment of the Focus on Health and Society Series by the Health Network, Richard Stebbing looks at whether the NHS can become a successful business.

If the NHS were a normal business, then given its tumultuous performance so far in 2013, its share price would have probably fallen. Of course the NHS is a business, but given it is in the business of protecting the nation’s health, with its fortunes so closely woven to that of the Government it is a unique one. We know that the NHS is underachieving in terms of productivity and it is under pressure to be financially prudent in the face of ever increasing demand; whilst the recent findings of the Francis Report on Mid Staffs have underlined how factors of care and compassion cannot be discarded. Therefore we must consider how the NHS can be a more successful for its customers, employees and employers. Its shareholders, customers and investors, try figure out who’s who! Answers on the back of a postcard.

Making sure people are good at their jobs and doing jobs that are needed

So, considering the NHS is like a modern business. Considering it rewards key staff for good performance and it evolves, developing new areas of business. One glaring deficient area is in retraining or making redundant staff that are no longer required in their present roles. Now the premise of cutting necessary staff from the NHS is one that rightly fills many with dread. However cutting unnecessary staff – well that is something that makes good business sense – especially good business sense when it is us that is employing them, and that this is public money that can be used for ‘better’ things. Ask almost anyone that works in the NHS and they will tell you that administration is bloated and can be reduced. A solution is restructuring and reappraising NHS non-frontline teams and making staff reapply for these new roles if reductions in team numbered are deemed necessary. If we are serious about the NHS being a productive, successful business, then unnecessary staff is an opportunity cost that has to be considered.

Adapting GP surgeries for the 21^st century

Most people now use the internet as the basis for all communication and arrangements in their social and professional life. Yet for most people the most advanced aspect of NHS services is receiving a text message reminder for that upcoming appointment or renewing their prescription online. Yes, yes, we know the more technologically savvy are messaging on other platforms like Whatsapp and Facebook. Still, there is significant inefficiency and wastage in not making adapting more services and logistics in the NHS to take advantage of internet technology.

For example, create a web-based GP booking as the default booking service. It is simply inefficient to have the default method of booking as phone-based when the technology for patients to complete web-based forms on their symptoms and select available appointment time slots exists online. Crucially this would mean that patients can book appointments 24/7 – i.e. when they fall ill – rather than when the GP surgery is open. This would reduce this burden for administrative and supporting staff in GP surgeries, especially in the 15 minute window when a GP surgery opens, and would mean that these staff are freed up to help the running of the surgery in other ways throughout the day.

Such a system could also be used to coordinate bookings with specialists and consultants, which if made more interactive, could help patients attend and cancel appointments they cannot make thus ideally meaning that these appointments could be allocated, say via email, to other patients in need at short notice.

Another simple idea is allowing patients to register with a GP online. When the process essentially involves proving one’s address via an official letter and completing a basic health questionnaire, why does this have to be done in the GP’s surgery? Doing this online would save time for the patient, who might otherwise have to take time out of the working day, and also GP surgery staff.

Using technology to aid patients in self-care

Another area where technology can be embraced is around patient self-care. In 2011 I (Richard) had the misfortune to contract Bell’s palsy for around 3 months. My GP at the time was helpful and gave me some printed information on the condition. However I received no information/advice around necessary items of self-care that I would need to undergo, such as taping one’s eye completely shut on a nightly basis.

I found useful information in this area, by a chance YouTube search after a few days, and research for this article demonstrates that similar information is also available for other conditions. Given that most patients do not master aspects of self-care on day one (for the record I was waking up each morning with my eye un-taped and open at first); technology here can help reduce patient follow-ups and can help them recover quicker and better. This also embraces technology; this form of advice needs to be more interactive than a piece of paper. So why not have health professionals email relevant self-care information to patients? I am not suggesting that patients are emailed arbitrary links, but why not have NHS-branded self-care videos either using actors or volunteering patients under supervision? It would be cheap and very useful to many patients. It would also save on GP printing costs! Isn’t the NHS in the business of being useful to its investors, shareholders and customers?

Richard Stebbing is a Young Fabians Member and Adebusuyi Adeyemi is Chair of the Health Network.

For more information on the Young Fabians’ Health Network email Adebusuyi: healthnetwork@youngfabians.org.uk.

Are BAME voters the key to a Labour victory in 2015?

By Johnson Situ.

‘I am Labour for Life’! Time and again I hear this phrase on the doorstep from minorities, everyone from first generation immigrants to the student finding her political identity. Supporting Labour has become so woven into some communities that it has become almost a rite of passage for many of the second generation immigrants. The facts certainly point to an overwhelming support for the Labour party with figures still showing over two-thirds of the BAME community are progressives. The question is, at 14% of the population does this group of the electorate provide the final piece in regaining Downing Street in 2015. Certainly the push by the Tory party in recent years to incorporate ethnic minorities highlights the battle ground for the increasing influence of BAME votes. It might have come as a surprise to the general public that Grant Shapps decided to launch the Tory attack on marginal seats in a Hindu Temple, but it confirms the growing influence ethnic minorities have on elections.

We can look across the pond and the growing influence of ethnic minorities within the Democratic Party. Some may argue it has been recently aided by having a charismatic talisman, but from JFK in the 60′s to Clinton in the 90′s, the minority vote has come out in force to elect progressive Democratic candidates.  It is true to say that Democrats have been able to position themselves as champions on issues that ethnic minorities traditionally care about with progressive policy on issues such as immigration and civil rights. Clinton’s reform of the education system in the 90’s provided many children of ethnic minorities the chance to get a good start in life and crucially increased poling numbers within minority communities.

If Labour is to win in 2015 the BAME vote will prove pivotal. As the 2011 consensus points out,  minorities have started migrating en mass to key marginal seats. Harrow West provides the perfect example, a safe Tory seat from 1945 till the 97 election, it’s proved resilient to swings across the country in the last election and many have recognised the number of ethnic minorities doubling in the constituency in the last 20 years as more than coincidence. Critically Labour wining in 2015 hinges on the party taking key marginal seats. Whilst we consistently maintain an average of 65% of the BAME vote, we take this bloc for granted at our peril. The London Mayoral election goes to show the possible pitfalls, as this was the first time in recent years in which the minority vote for a conservative candidate rose from the previous election.

In short whilst there are similarities between the role played by BAME voters in the US and the UK, the Democratic Party can target the support of just fewer than 30% of the country, double the amount the Labour party can hope to engage with in the UK. The challenge for us as a party will be to win back seats we lost in 2010. Part of that effort will be engaging with our base within those seats and across the country. As a party we need to take ownership of the discussions over immigration but more importantly to ethnic minority groups in the UK we need to continue the fight on the living wage and demystify some of the complex policy areas such as the Economy and the Healthcare system that so many of these communities care about.

Johnson Situ is a Young Fabians Member.

The Role of Local Councils In the Arts

By Arry Tapiheroe.

Austerity politics have been proven to show no bounds. Virtually every parts of the society has been affected by the recent cuts. The creative, education and arts sectors are no exceptions. In fact, these are arguably one of the worst hit areas despite having played no significant parts in the financial crash which necessitated the cuts.

The most prominent example of these cuts is the cuts which will affect Newcastle. As most former industrial cities, Newcastle has not had it easy in the wake of the Great Depression in the 30s and the Thatcherite reforms in the 80s. However, it’s always had a cultural heart to it. The Theatre Royal, which was first opened in 1837, is still currently operational. If anything, the city has been through a major cultural renaissance in the past 10-15 years.

What has been proposed here is a cut of roughly £100 million, spanning 3 years. Along with culture and arts funding, the cuts will also affect children services, elderly care, swimming pools, libraries and general upkeep of parks and streets. This is where the role of local councils comes in. When faced with a choice between providing care to the elderly and services for children or provision of culture and art, what should be the council’s guiding principle?

What is unclear is the actual power of local councils, especially regarding the amount of revenue local councils actually get from council tax. The proportion of revenue from council tax is low compared to the central government grants and centrally levied business rates. Central government also has legislation which would cap the amount of council tax it could levy. This, along with the abolition of centrally distributed council tax benefit and lower central government grants means that the council is now facing an even tougher spending choice. In a way, councils are very beholden to the central government.

Setting aside the issue of funding to theatres, museums and libraries, there are still other areas where councils could have a significant role. Namely by providing the environment which will benefit the creative sector without showing any apparent competition with the so-called core services. An example of a council leadership which could be applied rather quickly is the promotion of local markets.

Local markets can be set up by providing venues with low rates to provide local artists and craftsmen the platform to show and sell their work. These markets should be very similar to current Christmas markets around the country. The major difference is that these markets should be geared towards collaboration and access. Funding should be flexible, such as taking percentage from sales instead of charging rent, and sponsorships should be encouraged. A major obstacle of pursuing such simple ideas is the fact that such ideas are not sexy and cannot be capitalised easily by politicians. Sponsorships and patronage could play a part in ensuring more media coverage and that these markets would have an impact. There would be a fine balance between having a commercial markets and having something for the local community. This needs to be addressed as per case-to-case basis.

The role of councils in providing services for art and creative industries is currently being gutted systematically to serve an ideology. This ideology pits the funding and services for arts against the so-called core service. Setting aside the issue of the actual power of local councils to change the amount of funding available, there are ways for the councils to lead smartly to both engage the local economy and the local creative industries and arts.

Arry Tapiheroe is a Young Fabians Member.

Talk of the 99% and the 1% is Disingenuous

By Chris Grezo.

In some ways, the Left is a victim of its own success. Thanks to the toil of progressives over the decades and centuries, policies that were once thought of as radical nonsense are now part of the basic consensus across the political spectrum: free education for children, state pensions, universal healthcare, votes for non-land-owners, national insurance, the weekend, social housing, sick pay and so on. The last two centuries of Western history have been marked by victory after victory for progressives.

But of course with each victory won, there is one less battle to be fought, and one less segment of society that needs the Left. A good example of this is the demise of the Liberal Party in the 20^th Century. Once the largest party in the UK, it shrank and dwindled to nothing after its main goal of votes for women was achieved. The liberal men and women who had supported the party no longer needed it, as they had attained what they wanted, and the party became irrelevant.

Where once the Left was clearly aligned with the vast majority of the population, it now finds itself more frequently fighting the corner of minorities. When it comes to the simple, tangible issues, the majority have what they want out of politics. You can no longer be fired for having a working class accent, your boss isn’t allowed to pinch your bottom, you won’t starve to death if you lose your job, you don’t have to doff your cap to aristocrats, there’s a legal minimum wage, and so on.

Many of the battles that progressives have left are more nuanced than in the past, or affect less people. Take the need for better regulation of the financial sector. This is not a clear, simple issue like universal healthcare. Almost no one really knows what is meant by “better regulation”, and it’s not a very tangible issue, despite its importance. It’s very hard for an ordinary person to feel the passion about financial regulation that an ordinary person might have felt about universal healthcare in the 1930s. Or take the poor treatment of disabled people by our current right wing government: the sad fact is most people aren’t affected by this, and it won’t change their voting habits.

The reality is that in 2013, only a third of the population feel strongly about contemporary left-wing issues, about a third feel strongly right wing, and everyone in the middle doesn’t really care. In some ways, this is something the Left should celebrate. The fact that people are so comfortable that they don’t need to think about politics is a sign of how things have changed for the better over the last century. But obviously this isn’t a very satisfying state of affairs for us left-wingers who make up a third of the population. There are important goals yet to be achieved: we need more social workers to stop kids being abused, better educational opportunities for the underprivileged, better treatment of the disabled,  a penal system that reforms prisoners, and many other important changes. But with so many people benefiting from previous progressive victories content to slumber in front of their TVs, it’s difficult to rally the crowds or get anyone to listen.

 And so left-wingers long for days gone by, when it was the masses against the classes, the people against the elite, everyone pulling as one. This leads to the wishful thinking of the so-called “99%”. Many left-wingers use this rhetoric to try to get everyone on side, to kid themselves that “the people” all want left-wing policies. Difficult debate is avoided: it’s instructive to note the increasing use of the phrase ‘super-rich’ instead of ‘rich’. The phrase is used because arguing for more tax on the super-rich offends almost no one, because the term applies to almost no one. But that’s just a cop out; higher taxes on the 1% are not going to solve all our problems. Left-wing policies require a lot more sacrifice than pressing a magic button labelled tax-the-super-rich.

Even moderate left-wing policies require higher taxes not only on the super-rich, but on the rich, and the upper-middles classes too. If, like me for example, you would like to decrease class sizes in failing inner-city schools to give the kids there a fair chance at life, you are committed to spending a very large amount of money. And that’s just one of a huge range of policies us left-wingers want. Many of these policies require sacrifices on the part of the top half of society to help the bottom half. And that’s why a huge chunk of the population hate these policies: because they don’t want to make that sacrifice. Contemporary left-wing issues are not about surfs who make up 99% of the population battling against the oppression of the Lords in their manors – those days are gone. Contemporary left-wing issues are about the fact that a family earning £100K a year while living in the leafy suburbs don’t want to shorten the length of their skiing holiday to pay for extra teachers at a grubby inner-city school that they’ve never heard of. And it’s disingenuous to pretend otherwise. We are not the 99%, we are the 30%.

Chris Grezo is a Young Fabians Member.

Focus on the Creative Industries Series

By Victoria Prior.

In the first of  our Focus on the Creative Industries Series, Victoria Prior introduces us to the new Creative Industries Network. 

This is the inaugural blog for a new series from the Young Fabians Creative Industries Network. CIN for short, you’ll be pleased to hear. An inaugural blog should be something a bit special. It should entice and intrigue. Surprise and gain support. However, the Chair of CIN (that’s me, hi!) can’t think what to put.

Should I talk about the funding crisis that’s decimating local arts activity? Surely you’ve heard about that already, ad nauseum, probably from me. Maybe, I should say how Michael Gove seems to be persisting in removing all joy and creativity out of children’s lives. Teacher’s lives, too. Ooh, what about the fact that due to UKBA having a little trouble distinguishing posterior (so to speak) from elbow, talented individuals from other countries are finding it difficult to work in Britain. You can see the Daily Mail now, ‘Johnny Foreigner, coming over here, forcing us to listen to exquisite music and watch lovely ballet’. And what do our kids get? The recorder if they’re lucky (not even that if Gove gets his way).

Perhaps I should write about the events we’re planning. Chances for you to meet those you most admire in the industry. People you might like to work with. Opportunities for debate on the issues that matter most to the creative industries. Research that will lead into a pamphlet. A pamphlet to be presented just a little differently from what you’re used to…

I could tell you about the other three members of the Creative Industries Network team; Marielle, Kieran and Tess. I could say how excited we get when people get in touch with ideas. I’m definitely going to congratulate them for all their hard work and support so far. And I’ll mention how thrilled we’ve been with the response from Young Fabians. I might even go so far as to confess about the happy little dance I do whenever an e-mail comes in pitching a research idea, or offering an amazing contact. So why don’t you set off the dancing, and say hi to us at creativeindustriesnetwork@youngfabians.org.uk Go on, we’d love to hear from you!

Victoria Prior is Chair of the Creative Industries Network.

Why Labour should pay no attention to social mobility

By Colm Flanagan.

Everyone agrees that social mobility is ‘a good thing’ – last year all three party leaders gave speeches on the topic, and it appears to be at the heart of what Cameron’s ‘strivers’ are about. Conventional wisdom would tell you it is the new centre ground, or perhaps just the old centre ground that never went away, and if we don’t make social mobility ours, and win the argument on it, we’re doomed to fail.

But unlike other issues which there is cross-party consensus on, such as universal access to contraceptives, and free tap-water in restaurants, it is not clear that everyone means the same thing when they talk about social mobility, and there is a risk that it could mean something almost exactly opposite to what the Labour Party should be trying to achieve.

At its very worst, pursuing social mobility means you accept that there are some fulfilling, stimulating, well-remunerated jobs, with reasonable hours which scarcely impede family life, are physically undemanding and give good pensions – doctors, say. On the other hand there are jobs which are undesirable in every single possible way – pay, conditions, status, the lot – and that’s just the way it is.

All social mobility is in this universe is ensuring that a higher proportion of the sons and daughters of people in category B get jobs in category A, without ever addressing the issue that jobs like those in category B exist at all. Proponents of this approach rarely acknowledge that this will invariably mean consigning the children of parents in category A to jobs in category B, as it is never advocated that more high quality jobs are created, so some displacement of accountants’ children to the scrapheap must be necessary if social mobility is to take place. Rarely too, is it articulated that all the best ways of making a living are not actually salaried jobs obtained through good qualifications and a string of internships, but the best job is to simply own stuff which produces an income, whether that be a trust fund or property – most of the benefits of working with none of the downsides.

No, in this world of social mobility, the sum of human happiness is not increased by one jot, but people are happier with the system, because they feel now success has been earned and deserved, rather than inherited, and, in theory, it works better, because category A jobs are more important and need people of higher calibre to perform them.

In fact, before we waste a second on social mobility, we should be doing two things. First, we should be looking at the politically easy, but technically difficult question of how we can create more category A jobs. This was Ed Miliband’s focus in the second half of his speech on social mobility to the Sutton Trust last year, where he focused on Britain’s need to create career paths for the 50% of young adults who don’t go to university.

But it also means making the politically difficult, but technically easier decision, of spreading the pros and cons of jobs more evenly, so we no longer live in a two track society. Once this happens, it will still be important to have social mobility policies in place, because nobody should be pushed into becoming a lawyer if they would get a lot more satisfaction from being a mechanic, or a dinner lady if they would prefer to be an optician, but it wouldn’t be such an urgent issue – it would be a matter of individual preference rather than a matter of social justice.

I cannot express strongly enough how inconsequential social mobility is while our economy is so deeply unfair in so many other ways. The entire debate about social mobility looks like a Tory game of musical chairs, a hollow Ponzi scheme where the hope of your children bagging one of the glittering prizes means you put up with a system which keeps you poor.

If you want to continue to pursue social mobility and hold it dear as an aim, fine, don’t let me stop you. Make ability the sole barrier of entry for every profession, instead of the shaky system of guilds, contacts and luck which exists today. Just don’t coming crying to me when your children weren’t bright enough to make it in your ruthlessly meritocratic society and their lives are miserable.

Colm Flanagan is the Young Fabians’ Political Education Officer.

This is one of several views that will be debated at the Social Mobility roundtable:

Young Fabians Social Mobility Roundtable with Rt Hon. Alan Miliburn, former Labour Cabinet Minister & Independent Reviewer on Social Mobility and Child Poverty. 

The Young Fabians are delighted to announce an exclusive opportunity to partake in a roundtable discussion on social mobility with the Rt Hon Alan Milburn, who currently serves as the Independent Reviewer on Social Mobility and Child Poverty. This is a fantastic opportunity for you to have your say on this crucial issue and help inform the debate on how we ensure the next generation can do better than the last. The event will take place in Parliament on Tuesday 26th March between 6:45pm-8:15pm.

We have 20 spots available for this roundtable (10 male & 10 female), so if you are interested in partaking, please email the Young Fabians Networks Officer Rayhan Haque at rhaque@youngfabians.org.uk.  In your email, please can you state in no more than 150 words, what social mobility means to you and one idea that you think will make a big difference to creating a more socially mobile society.

Focus on Health & Society Series:Leadership and the NHS

By  Richard Stebbing.

In the latest installment of the Focus on Health and Society Series by the Health Network, Richard Stebbing looks at Leadership and the NHS.

Recent events in health policy, from the NHS Reforms to the Francis Report, have raised the question of how the NHS should be led in order to make the NHS truly world-class and to ensure that episodes such as the Mid Staffs scandal do not happen again. Whilst the desire for good leadership exists it appears that at the heart of many NHS institutions there is a considerable gulf between leading managerial staff and clinical staff which is causing bad decisions to be taken and for the morale of NHS staff to be broken in the process.

By now it is well known that the NHS is facing a desperate period financially. Record numbers of patients come through the doors of NHS buildings, and the health service appears to be ill-equipped financially to deal with such demand. The Nicholson Challenge of £15 billion in efficiency savings by 2015 – i.e. cuts to NHS services – has attempted to address this problem.

However it seems that the implementation of the Nicholson Challenge has been poorly led, without long-term thinking and clinical foresight with regard to the consequences of cutting key services. For example we know that since the Nicholson Challenge was introduced patients are facing longer waits for, or simply not being given, vital operations such as hip and knee replacements, cataract removal or hernia repair. This comes at an incredible long-term cost and risk – patients’ quality of life without these operations will suffer and as their body continues to not be repaired they may be unable to work and therefore contribute to the economy. Furthermore as conditions worsen the chance of needing emergency surgery increases, and the worse a condition gets, then typically a patient will require greater recovery time in hospital.

There is a logic to imposing financial restraints in the NHS to generate stability, especially when considering that shoddy financial management has blighted leaders in the NHS during the early 2000s – for example NHS Peterborough PCT which saw 4 Chief Executives in one year – however it seems ethically concerning that a Chief Executive should put the long-term health of patients and the NHS at risk by implementing such short-term cuts to services. Bad managerial decisions are being taken, often in isolation from clinical colleagues, which are likely to be running up a bill for the taxpayer in the long-run, whilst decreasing the quality of life of patients. Furthermore as we read last week with the case of Gary Walker, senior managers and Chief Executives in the NHS who refuse to make these bad decisions are being dismissed – bad decisions, again, being made.

As highlighted in the Francis Report this ‘isolationist’ style of management at Mid Staffs allowed a negative culture to develop which had a devastating impact on the quality of care on offer to patients, with clinical staff feeling unable to raise concerns and effectively feel decapitated from the running of their workplace. The positive performance outcomes of some Trusts[1], such as Cambridge University Hospitals Foundation Trust and the Royal Free Hampstead NHS Trust, during this period, however, illustrate that strong, collaborative management can yield positive results. In part, these examples often hinge on innovative solutions being generated between Board and clinical leaders which emphasise both efficiency and care-centric processes.

The current NHS Reforms will put GPs at the centre of NHS commissioning – however there are clear concerns that they do not want to be leaders[2], nor that they are adequately prepared for this role[3]. So what alternatives are there? If a detachment and a lack of teamwork and collaboration between NHS Board managers and clinical staff is the cause of a negative culture with the potential for serious implications on the quality of care provided to patients then this has to be addressed. In terms of leadership at the top of NHS hospitals, CCGs etc. then we need to be encouraging health professionals to take leadership/management roles and preparing them adequately, such as with health economic and management training. If we can develop leaders of this calibre, who ostensibly have a foot both in the camps of the ‘professional’ manager and the clinical staff then it is likely to help foster a positive working culture of collaboration and partnership between the managerial and clinical staff in a hospital. This is similar to the model often used in Europe where experienced clinical staff often move into running hospitals and this has happened successfully in the NHS. Dr Peter Carter (now leading the RCN) was a psychiatric nurse who later ran NHS North West London Mental Health Trust for over a decade having developed a skillset in management. It is these dual professionals who are best placed to effectively lead in the NHS and help generate the positive working environment necessary to address concerns raised by Francis and stimulate a progressive approach to making sustainable efficiency savings

It’s time to speak up for the male victims of rape

By James Hallwood.

Reports from Syria of routine rape against men and women is a reminder of the unspoken prevalence of the rape of men and boys in areas of conflict. Yet for the harrowing nature of this, and despite how widespread it is, awareness and support are truly minimal. Often categorised as ‘torture’ rather than ‘rape’, so many men around the world are silent victims of unbelievable acts of sexual cruelty.

Given that rape against males is a regular component of wars across all continents, it is surprising that there has been so little research into this. Dr Lara Stemple of UCLA School of Law has been at the forefront of raising awareness at the prevalence of the sexual abuse of males in war zones and has done much to ask why international institutions are seeing rape as a crime that only affects women.

76% of male political prisoners in 1980’s El Salvador attested to sexual torture, 80% of men in a concentration camp in Sarajevo reported being raped, 21% of men seeking help at a London centre for Sri Lankan torture victims spoke of sexual abuse, 22% of men in Eastern Congo had suffered from sexual violence. A clinic dealing with refugees in Uganda gave the shocking figure that 8 out of 10 women had been raped and 10 out of 10 men had suffered the same crime. Men are routinely raped in Iranian prisons while the disgusting actions by Lynndie England in Abu Ghraib show abuse against men can just as easily be committed by women and the West, no-one has a good record on this.

It is clear that these figures are only the tip of the iceberg. Societal stigma is enough to silence many of these men. Just like many female victims of rape, the men who survive these ordeals are often deserted by their spouses. An aid worker helping men recover from rape reported how wives of victims responded:

“They ask me: ‘So now how am I going to live with him? As what? Is this still a husband? Is it a wife?’ They ask, ‘If he can be raped, who is protecting me?’ There’s one family I have been working closely with in which the husband has been raped twice. When his wife discovered this, she went home, packed her belongings, picked up their child and left. Of course that brought down this man’s heart.”

The strong gender roles enforced in many societies make being a male victim of rape all the more taboo: Men fear no longer being perceived as ‘men’.

Abandoned by family and society, many of the male victims of rape are unable to ask for help, not just in dealing with the psychological scars but with the very literal injuries sustained from repeated sexual abuse. Many men are subjected to constant gang rape, penetrated with blunt objects and forced to give oral sex to soldiers. Survivors are often limited to a restricted diet, bleed incessantly and, worse still, fear asking for help in case they are arrested for homosexual behaviour. At this very moment, men are suffering and dying from these horrific injuries in silence.

International institutions should be able to step in where national governments fail, but they have so far seemed reluctant to do so. Dr Stemple applauded United Nations’ Resolution 1325 call to support women and girls in conflict zones but pointed out that much of its work neglects to look at sexual violence against men and boys. Failing to have a gender neutral definition of rape meant that male victims were operationally invisible. After much campaigning this definition was changed, but there is much still to do to change the culture of organisations that deal with rape.

Dr Stemple cites a literature review of 4000+ organisations that deal with rape in war zones: only 3% mention male victims in their informational material, and few are equipped to deal with the particular needs of men who come to them for help.

Across the globe men and women, boys and girls, are victims of the most disgusting sexual crimes imaginable. Few of the victims report this, many face stigma and shame, and the help any of them are offered is usually minimal at best.

It’s time that governments, international bodies, charities and people openly accept– in war zones sexual abuse rarely distinguishes between men and women, our response should likewise be to help all victims of these heinous crimes.

There remains a blanket of silence when it comes to the taboo of male victims of rape. More awareness, more research and more support is needed.

The perpetrators rely on the shame and particular stigma of being a man forcibly subjected to other men, we must break the silence: It’s time to speak up for the men who are raped in war zones.

James Hallwood is Secretary of the Young Fabians.