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In place of fear

A new Bevan agenda,  by Roger Warren Evans

The Other Four Fears, continued....

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The fear of ill-health

Bevan’s primary legacy to UK society remains the National Health Service.  And the 2002 Labour Government is right to put health service provision at the top of its political agenda.  The perceived decline of the NHS is undoubtedly a source of deep anxiety to many of our fellow citizens.   

There has in truth always been an element of ambiguity in this anxiety.  Fear of ill-health has always been compounded by fear of “the Doctor’s bill”, fear of the Prescription – namely, the fear of impoverishment arising from the arbitrary occurrence of ill-health.  There is now the additional worry that ill-health will threaten household finances, mortgage payments, HP instalments, perhaps even school fees and insurance premia.  There are many healthy people who do not fear ill-health as such, but who nevertheless fear the financial implications of ill-health.  It is not the job of the State to protect people against financial imprudence: households becoming unwisely over-committed should not be bailed out by the State.  But the removal of the primary fears of being left without medical treatment in the event of ill-health, and ruined by medical bills, should be removed by the provision of a reliable and comprehensive public health service provision.

Labour has made a firm commitment to the retention of a comprehensive, tax-funded health service.  Debate has raged for many years about the most desirable technique for providing “health insurance”, and that matter is now settled, for the foreseeable future.  But that is arguably the less important issue.  In terms of anxieties, the issue is subtly different, and it turns on Labour’s success in persuading our fellow-citizens to think in terms of health and not illness, in terms of prevention rather than cure, in terms of cultivating good-health rather than the “pathological” alternative of examining remedies for every malfunction.  All the indications are that, if the caring style of the midwife and health visitor could be cultivated more widely within the NHS, rather than the stern authoritarianism of the medical profession, people would be happier, less anguished, less anxious, in matters of their health.   

This idea is coming to the fore in several different ways, and it should be cultivated.  Well Woman clinics, Heart Disease campaigns, breast-cancer screening are all programmes which focus on states of health rather than illness.  Doctors are being encouraged to prescribe exercise regimes at local health clubs or leisure centres, if such exercise would be more effective than conventional medicine.  There is a new concern with maintaining the health of pensioners, rather than simply treating illness when and if it arises.  Attention is being refocused on the retention and provision of smaller, local “cottage hospitals” to supplement the large “factory” general hospitals, whose size has come to be dictated by the economics of medical provision.  Hospital doctors have been extremely influential, as a profession, in securing the construction of larger and larger General Hospitals, and their disadvantages are coming to be more widely understood.  

A new study, backed by the BMA, argues for the more extensive use of nurses in local surgeries for every “first consultation”, with a community nurse giving initial guidance to patients, and arranging a doctor-consultation only if strictly necessary: many initial complaints can be dealt with in other ways.  There is convincing survey evidence to suggest that the overwhelming majority of patients (80%-plus) would be perfectly content with such arrangements.  Already, there is one truly socialist element in the NHS which continues to be extremely successful, namely the attendance of a Health Visitor upon every new-born child, for the first year of that child’s life.  This is a mandatory universal provision to support the new-born child, regardless of the income or status of the parents. 

This focus on countering peoples’ anxieties argues for a changed emphasis in health policy.  The media are allowed to focus too easily, day-in day-out, on actual treatment disasters.  That has the effect of building up public discontent, and eroding the confidence of potential patients.  Socialists should focus, not just on “putting things right” but on changing the whole perceived framework of ill-health throughout society.  After all, Aneurin Bevan would have observed that fear lies precisely in the quality of our apprehensions and expectations.  The corrosive effect of fear can cripple many people who never, in the event, encounter actual illness.  It is not enough to make the trains (i.e.  the operations,  the X-rays, or the injections) actually “run on time”.  Socialists must cultivate throughout society a new confidence, within the minds of all our fellow-citizens, that a comprehensive non-contributory health service will always be there for them.   That perception is not merely an add-on, a footnote: it is the very key to eliminating the corrosive fear of ill-health throughout our society. 

Finally, we need a coherent environmental policy, majoring on the concept of removing environmental health risks.  Anxiety is rising about the adverse effects of environmental pollution (in particular for children, and pregnant mothers) is becoming a powerful political driving force.  This is to be differentiated from wider concerns with inter-generational equity, and the Thatcher formulation, “We are but leaseholders of this planet”.  Intergenerational equity, of balancing the interests of present and future generations, has long been an element in socialist thought, but it does not resonate with our fellow-citizens: it is too abstract and cerebral.   

The central psychological, and therefore political, problem lies with the health effects of environmental pollution.  Nothing mobilises local public opinion more effectively than a protest against a polluting incinerator, or waste-tip, or chemical plant with unacceptable levels of emission.  The continuing staffing weaknesses of the Factory Inspectorate can make matters worse, when issues are reported in the media. 

We must act to counter these anxieties.  This means increasing public health resources generally, increasing the number of inspectors and initiating high-profile anti-pollution prosecutions.  The prevailing public perception of public health intervention is that it is “too little, too late”.  We should step-up the use of environmental audits as part of the routine planning application process, thus securing local Press coverage for the issue.  And we must take noise pollution seriously, as the intensity of noise in our cities increases, particularly as air travel continues to escalate.   

These health-related measures are even more important as policy priorities than waste-recycling, which is not perceived as a health issue.  They are even more important than street cleanliness, which is perceived more as a matter of public decency and pride, rather than a health issue.  They are a more immediate concern that global warming, as generators of fear in the minds of our fellow-citizens.  Labour has in the passed reaped dividends from such public health initiatives, like the Clear Air Act.  Socialists can do so again. 

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The fear of Unemployment

“Unemployment” is a most complex phenomenon, and still poorly understood. It was Nicholas Ridley, when a Tory Minister in the 1980s, who infamously said that the fear of employment was “only in the mind”, seeming to dismiss it for that reason.  But there was an element of truth in what he said.  For  all fear lies in the realm of expectation, “in the mind”.  And fear must be addressed politically as a distinct phenomenon, quite independently of the phenomenon to which it relates.   

In the case of unemployment, it is rarely the loss of the job itself which generates anxiety, although it is possible to imagine such circumstances.  What is feared is the loss of income flowing from unemployment, the disruption of family and social life triggered by loss of income, indeed for some the perceived loss of social status in becoming “unemployed”.  Our society has become one in which the employment system, the realm of paid-work, constitutes the primary network for the socially-acceptable distribution of wealth, and the primary source of social status and perceived self-worth.  “New” Labour chose deliberately to reinforce that institutional emphasis.  Gordon Brown has committed his entire political reputation to the cultivation of paid “work” as the primary institution of society.  Our educational and examination systems are being systematically changed into an institutional network for the training of employees.   Educational qualifications are construed principally as passports to higher salaries.   

Nor is this emphasis “wrong”, in any political or absolute sense.   It is evident that all societies need to encourage productive activity rather than wasteful inactivity.  All evidence suggests that an active body of citizens is much more likely to be prosperous, successful, confident, capable of solving the multitudinous problems of their very survival.  Gordon Brown’s zealous cultivation of “work” is certainly not misplaced. 

Yet the very success of the work ethic has had some adverse consequences.   There are many casualties.  More and more people now fear the very prospect of being without work, unemployed – indeed, that fear is perhaps now more corrosive than it ever was, even in the “Great Depression” of the 1930s.  For most of our fellow-citizens now have much more to lose than they did then, if unemployment strikes.  And the fear of unemployment, by casting its shadow before it, can depress consumer demand, which in the modern consumer economy is fatal to its success.  That is one of the factors inhibiting the revival of ailing Japanese economy. There is no doubt that all modern societies face a growing problem, not only with unemployment, but with the fear of unemployment. 

As the Liberals’ Yellow Book famously asked in 1929 - What is to be done?   I believe that socialists have a vital contribution to make to the answer.   First,  we should gradually reduce people’s dependence upon work-systems as the primary network for the distribution of wealth.  We must deploy the power of the State to assist our fellow citizens.  In certain sectors, the public tax/benefit system should perform a wider function, by way of the payment of universal, non means-tested benefits.  The universal Child Benefit, an earlier socialist innovation, remains a glittering success, and it should be retained.  But Child Benefit should be supplemented, for any parent remaining out of the labour market to look after young children full-time, by a substantial Guardianship Allowance (not less than £5,000 pa at current rates): that would meet the “second-wage” requirement of most families, and reduce family dependence upon the paid-work system.  Gordon Brown, with his “Working Families Tax Credit”, has been misled by his obsession with the paid-work system: a Guardianship Allowance would be more dignified, and would be far more effective in calming peoples’ fears.   

We should pay School Attendance Allowance to all children remaining in full-time education above 16, thus reducing still further their family’s dependence on paid-work.  We should create a new system of repayable Student Support Benefit for the 18+ year-olds, not structured as a Loan but triggering an obligation to repay (with interest) only by way of an Income Tax supplement, related by a fixed percentage to any actual Income Tax subsequently payable.  The weight of parental contributions to higher-education costs should be significantly reduced, thus leaving more resources with parents, for their own purposes.  If the Benefit-funded student did not graduate or achieve an appropriate qualification, the Benefit re-claim would simply be written off.  If the graduate spent life in very low-paid employment, or unemployed, or in voluntary work, the Benefit might never be repaid in full. The graduate who joined a monastery, on an unpaid basis, and who never paid any Income Tax, would be under no obligation to repay the Benefit at all.  But those who could afford to repay, over their lifetime, would be legally required to do so, making the repayments as a tax.  Upon the graduate’s death, however, any Benefit re-claim would be written off, and would not stand as a claw-back against the estate.  

These measures would all reduce the relative significance of paid-employment as a wealth-dstributor, allowing the State to share that function more extensively.   But secondly, we should devise new forms of “employment security”, and stand firm against the idea that particular jobs should simply be “more effectively protected”, or conserved.  Tony Blair has been widely criticised for his attack on Continental welfare-state systems, for the inflexibility of their labour markets – but he is in the right.  Indeed, there are disturbing signs that the UK trade unions, influenced by the apparent success of Continental trade unions, may be reverting to this form of job protectionism.  Yet these conventions and legal devices, which indeed do still characterise many Continental countries, are themselves destructive, weakening national economies and obstructing desirable social and economic change.  Nothing should be done to prevent employing organisations (in both the private/market and public/managed sectors) reducing their workforces if their management considers it necessary do so: indeed, all obstacles to rapid change should be dismantled.   

How then, is the fear of unemployment to be allayed?   We need new, and more sophisticated, forms of collective reassurance.  As socialists, we must ensure that the financial burden of these changes falls on the shoulders of those best able to bear it, namely (a) the employer and (b) the State.   Workers should not bear the burden.  In France, although the rate of unemployment remains persistently high (at 10%), there is no sign of consumer demand being weakened by the fear of unemployment.  That is because Unemployment Benefit is held at high-levels, paying a high proportion of a worker’s prior salary for a period of nine months.  

This suggests that in the UK we should introduce, in place of Redundancy Payments, a new form of Adjustment Pay, payable for six months following any termination of employment (unless for gross misconduct).   Responsibility for paying Adjustment Pay would in the first instance lie with the employer, and it would not take the form of a lump-sum: rather, the employee should simply continue to receive periodic wages, post-Tax and post-NI, precisely as before but without having to work during the adjustment period.   The employer would have an incentive to find each worker alternative employment, because upon the identification of comparable alternative employment, the obligation to pay Adjustment Pay would cease.  The funding of Adjustment Pay would be the subject of negotiation between the government and employers’ organisations, perhaps with the Government making contributions to a Common Fund, to pay adjustment pay in the event of an employer’s failure or liquidation.  Employers would have a great deal to gain from this change - (a) it would replace the Redundancy Payments system entirely; (b) it would remove the social and public opprobrium associated with “destroying jobs”;  (c) it would drastically reduce the number of Industrial Tribunal proceedings for unfair dismissal, most of which end up in any event with lump-sum payments of less than six-months’ wages; and (d) the conscientious employer could reduce its liability still further by assisting its employees to find suitable new job, e.g. by appointing an employment agency to work on its behalf.  

The certainty that Adjustment Pay would be payable in the event of dismissal, and that the life of no household could be disrupted at less than six months’ notice, would make huge inroads into the fear of unemployment, without going as far as the expensive French commitment. 

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The fear of parenthood

Many will be surprised to see these concerns expressed as anxieties, as a fear which needs to be countered.  But I contend that we now face precisely this phenomenon.  Birth-rates are falling, well below the rate of population replacement, and that in turn is increasing migratory pressures.   Again, the French example is instructive.  Young parents are well supported, unaffected by apprehensions of poverty (admittedly as spin-off from De Gaulle’s expansionist ambitions to build a France of 100 million citoyens).  Other Continental welfare-systems also make much more generous provision than the Uk for the care and support of children: in the UK, “child poverty” is one of the long-term scandals which Labour is already addressing, and will continue to address. 

Reluctance to procreate, or the deferment of child-bearing, is not merely the consequence of financial stress.  Apprehension about assuming long-term mortgage commitments may be much more than financial.  Higher standards of living enhance the sheer enjoyment of the single life, and even persuade established couples to defer conception.  There are even worries about the likely adequacy of available state education services, either generally or in particular neighbourhoods.  There is even emerging a form of fashionable pessimism, an expressed reluctance “to bring children into this world”, praying-in-aid the hazards of civil disorder and environmental degradation. 

Why should socialists be concerned with this phenomenon?  The rationale for such intervention is threefold.  First, insofar as these anxieties are financial in origin, they reflect inequality in the enjoyment of a basic human function, namely child-bearing and child-rearing, and it is right that socialists should seek the right way to intervene.  Second, there is anecdotal evidence that the financial liabilities of parenthood are now becoming so onerous that they can fuel resentment, both between partners and between parents and their children, contributing to family breakdown and even divorce, with its adverse consequences both for the families affected and for the wider society.  Third, insofar as these anxieties prejudice the interests of child in such circumstances, it is a proper socialist concern to uphold the interests of the child.   

Several categories of measure overlap this policy concern. 

ü      Good peri-natal care:  UK standards have clearly fallen below other European levels, in spite of the quality of the Health Visitor service;  this must be addressed in the course of NHS reform.   

ü      Child Benefit, Guardianship Allowance:  Greater certainty about child-related financial support would greatly reduce the anxieties both of would-be parents and new parents themselves. 

ü      High quality state education.  The primary case of state education is not itself related to this “New Bevan Agenda”.  Properly understood, it arises from the entitlement of each child as a young citizen to be educated, to fulfil full personal potential - not from some imagined right of parents to “have their children educated”.  But if the quality of all state education could be maintained at a high and consistent level, there is not doubt that parental anxieties would be allayed, and tensions in society greatly reduced.  State education should extend, in my view, to the provision of formal educational provision from the age of four onwards, which would certainly assist with parental work-commitments.  But I remain unconvinced that the State should subsidise other nursery and child-minding facilities, under the age of four.  I advocate the payment of a state Guardianship Allowance, permitting one parent to look after such young children themselves. 

ü      Reduce the parental burdens of higher education.  For children over-16, the State should give parents much more support, and intervene to assist them with the undoubted burdens of financing all later education – I have advocated elsewhere both a School Attendance Allowance (already implemented on a trial basis) and Student Support Benefit (a further modification of the Student Loans Scheme). 

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The fear of Old Age

This is the oldest and most corrosive fear of all, and it remains with us.  In poorer societies, with weak state systems, this is the fear underpinning high birth-rates, and the determination to ensure that the family will support parents in their old age.  The fear perssists: even the wealthy may harbour the fear that they will lose all their wealth, and have to face old age in impoverishment.  Indeed in our own ways we all seem to fear the loss of usefulness, the loss of earning power, the prospect of being unable to maintain the wherewithal of life in old age.  In this case, the diagnosis is straightforward, and cannot be greatly embellished.  The question is - “What is to be done about it?” 

The fear is in part addressed indirectly, in other ways, by overlapping policy initiatives.  For example, a health service which succeeded in satisfying all citizens that the old would at all times be properly treated regardless of old age, would greatly reduce the incidence of anxiety generally.  For it is not only the aged who fear the inadequacy of public provision - it is their offspring and other members of their family, upon whom the financial burden of NHS failure might fall, if it were to occur.  Evidence of such failure therefore has an unsettling effect in two ways, increasing anxiety levels.  While 75-year-old Grandma may fear for herself and her future, her 50-year-old daughter may well fear both for the effect of her mother’s inadequate care upon the well-being of her own family and the prospect of the same thing happening to her, when she reaches 75.  Media reports of old people disregarded by the NHS can have a complex “anxiety effect”, rippling out to other age-groups.  Fears interact, and play upon each other. 

But the principal concern lies with old age pensions, coupled with the fear (for a home-owning society) of being forced to sell “the family home” to pay the costs of life’s final stages.  Labour has not yet found satisfactory means of countering either of these fears.  It is true that the Government has greatly improved the actual standard of living of today’s poorer pensioners, by using a means-tested minimum income guarantee: that is an important achievement, and should not be disregarded.  

But this does little to counter the fear of impoverishment in old age, as it affects the 30-somethings, 40-somethings, and 50-somethings.  Here, it is now quite apparent that the only satisfactory solution will be the reinstatement, as a matter of egalitarian socialist principle, of a satisfactory State Old Age Pension.  And by that I mean (at current monetary values) the equivalent of £7,500 per annum for each person, eliminating the marriage-abatement introduced in 1927.  Every pensioner-couple should be entitled to receive £15,000 pa by way of a flat-rate, non means-tested pension, at current monetary values.  With a less-than-complete contribution record, that pension would be correspondingly abated.  That pension would be indexed to the average wage, thus ensuring that pensioners always shared in any rise (or fall) in the society’s overall standard of living.   For my part, I accept that the full State Old Age Pension should not be payable until the age of 67, although I recognise that many socialists will dispute that.  Provision should certainly be made for limited payments to be made from 60 onwards, as of right and with predetermined consequences, thus facilitating the acceptance of low-wage or part-time work in the period 60/67.   And the private pensions industry would be well-placed to sell supplementary pensions package, facilitating earlier full retirement, if required.  

This change-of-direction will be difficult to achieve, because Labour has devoted so much effort since 1997 rowing away from it, in the direction of funded private-sector provision.  That has already proved a will-o’-th’-wisp, a chimera.  Those aspirations, which were rejected by many socialists as a matter of principle, have now been falsified as a matter of fact.  The Thatcherite juggernaut has finally ground to a halt, with Labour Ministers tragically at the controls.    

As a variation on the private-pension theme, Labour’s 2001 Stakeholder Pension scheme has been in part successful, driving down the City’s plundering of pension-funds by way of commission and management-fees.  But it is already clear that the Stakeholder Pension, a contributory private pension regulated by the State, will be unsuccessful in meeting the growing pensions gap, at least if it remains on its present footing.  Socialists should oppose the payment of any substantial subsidies into the scheme, just to salvage it.  The weakening of the Stock Market, the disaster of Equitable Life, the withdrawal of employers from final-salary pension schemes, and the dramatic effect of disclosure on the perceived stability of private pension schemes have all eroded public confidence.  Now, to all the other fears of old age must be added the well-founded fear of pension-fund collapse.   

Only the State can counter these deep-seated worries, this corrosive fear.  It is not a matter of debating whether or not society “can afford it”.  Relieving all our citizens of their principal anxiety about old age is a precondition of a decent, liberal, human, society.  The socialist priority is to create a social order in which this primordial fear of old age is finally laid to rest. 

Compared with the central importance of this socialist commitment, other measures fall into insignificance.   But there are nevertheless two other measures which I commend, and which would strengthen the confidence of the middle-aged, in all their futures.   

First: National Savings should be expanded to cater for supplementary personal pension provision.  NS should accept personal savings contributions on the footing that they would carry an attractive guaranteed flat-rate of interest, which might in current conditions be 5% (in this respect analogous to the present Pensioner Bonds, although with interest-rates capable of adjustment from time to time).  NS would be free to invest the proceeds elsewhere, to earn higher-rates of interest to offset the cost of the guarantee.  But the State would give to the saver the assurance of a guaranteed cumulative rate-of-return.  Savings could not be drawn out until after the age of 55, after which they could be withdrawn at any time, for expenditure or for conversion into annuities to supplement the State Pension from age-60 onwards.  There may be a case for permitting National Savings to offer state-guaranteed annuities, thus enhancing public confidence still further. 

Second: Many pensioners are concerned with the risk of “losing their home”, if they have to enter public residential care, and are required to sell the property to meet the costs of residential care.  There is real anxiety abroad about this, affecting many families.   The Government has so far refused to do anything about this fear, and I recognise that it is difficult to find any convincing “socialist” reason for intervening.   

Nevertheless, given the widespread incidence of this fear, I consider that Labour should take action.   We should give to every one of our fellow citizens the absolute assurance that, whatever medical or other vicissitudes old age should bring, they will never re required to sell their principal private residence.  Even the non-socialist United States has decided not to require the sale of the principal family home, in the administration of welfare benefits: if other funds run out, the family home is protected, and the cost-risk passes to the State.  As a matter of common-sense, this would be an effective way of reducing the uncertainties of old-age.  We should do the same. 

”In Place of Fear”, 1952.  Aneurin Bevan’s perceptions are still alive, provocative, and capable of generating socialist strategies for the next generation.  I get tired of learned lectures entitled “Whither Socialism?” or “The End of Socialism”.  The challenges of socialism are live and urgent, and demand the greatest resources of ingenuity and energy that we can muster. 

End 

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