The ever-tightening squeeze on social care is just one way in which austerity is affecting my patients.
Florrie’s multiple sclerosis has, over the past 30 years, caused increasing spasticity in her legs. Her gait now consists of a protracted sequence of micro-shuffles, each leg advancing barely a few inches in any one stride. It looks alarmingly precarious; she keeps herself from falling by holding on to furniture as she goes, or by steadying herself with a wheeled frame.
Her speech, too, has been affected. Words tumble out in an incredibly rapid stream, running into each other. It’s unintelligible to most people. Having known her for years, I can make out every third word, which is usually enough to work out what she’s saying from the context.
Amazingly, she still manages to live at home with her cat, supported by her grown-up daughter, Ellen, who lives a few miles up the road, and by the package of care visits contracted by social services and delivered by a private agency.
That package of care had been stable for ten years – until now. It was Ellen who told me the story: how two unfamiliar women from social services had come round and interviewed Florrie on her own for 15 minutes. The first thing Ellen knew about it was when a letter arrived advising that, following the “review” of Florrie’s needs, her package of care visits was being halved.
I agreed that this hardly constituted a fair assessment. I rang social services to make my views known. A beleaguered manager undertook to review the “review”, but indicated that there was unlikely to be a different outcome. Their budget has suffered punitive cuts year-on-year; meanwhile, demand for care is going in the opposite direction. Some things have to give.
The ever-tightening squeeze on social care is just one aspect of Crumbling Britain affecting my patients. We’ve been hearing much about the Windrush generation and the “hostile environment” against immigrants that Theresa May inculcated during her time at the Home Office. Equally scandalous is the “hostile environment” experienced by people claiming health-related benefits. So many of my patients have been penalised in the transfer from Disability Living Allowance to the new Personal Independence Payment (PIP), or when their Employment and Support Allowance (ESA) has come up for review. Gareth, a diabetic amputee, lost the Motability car that once enabled him to get around. Mary, affected by both arthritis and chronic mental ill-health, was recently told that – tah-dah! – she is fit to work again, so will no longer be entitled to financial support. And they are just the latest two.
According to the disability charity Scope, successful appeals against PIP and ESA decisions have reached record levels – 69 per cent are now being overturned in claimants’ favour. This may speak of gross incompetence by the outsourced assessment agency, which gets so many of its initial medicals wrong. Or more sinisterly, it may reflect a deliberate government policy to refuse all but the most clear-cut cases, and force everyone else either to battle through the appeals process or simply give up. It’s a hostile environment either way.
There are myriad other erosions: operations that are no longer routinely funded; medications no longer available on the NHS that have to be bought instead, irrespective of income. Waiting times are lengthening inexorably, stoking frustration and anxiety among already unwell patients.
I recently met up with an old friend, Jim, who trained as a GP alongside me back in the 1990s, and who, like me, had relished practising during the Noughties. It is remarkable to think back to that era, when as a result of the sustained investment under Tony Blair and Gordon Brown the NHS had truly come to rival the responsiveness of the private sector for the first time. Jim has just resigned from his practice and won’t work as a doctor again, finally burned out after battling for his patients’ causes in a system in which overload and chronic stress has become the norm.
“I know it will get better again at some point,” he told me. “It has to.” He gave a shake of his head. “I just can’t hang on long enough waiting for it to come.”
In November, London’s mayor Sadiq Khan described the borough of Barnet as one of the “crown jewels” Labour was hoping to capture from the Tories in the 2018 local elections. “If Barnet does not succumb, it will be a surprise,” wrote the London journalist Dave Hill in January. The following month, a source in the Tory government seemed to confirm his optimism by predicting a “wipe out”.
Yet in the early hours of 4 May 2018, around 5.50am, Labour activists at the count realised that the Conservatives had not only held the borough, but increased their majority .
So what happened? At about 15 per cent of the population, Barnet has one of the largest Jewish communities in the country. Labour is in the grip of an anti-Semitism scandal. Could the two possibly be linked?
Barry Rawlings, the leader of the Barnet Labour Group, thinks so. “I want to speak directly to our Jewish brothers and sisters,” he said in a statement after the result became clear. “I am extremely grateful to all members of the Jewish community who cast votes for Labour yesterday.
“But too many didn’t. It wasn’t because they disagreed with our manifesto, but because they felt the Labour Party has failed to deal with anti-Semitism at a national level. They are right.”
For Labour party activists who have spent the past months enduring rancid abuse online due to their campaign against anti-Semitism, this feels like vindication. While individual incidents of anti-Semitism have been stalking the party for years, frustrations came to a head in March after it emerged that Corbyn, while a backbencher, had defended a mural that used anti-Semitic tropes (Corbyn has expressed his sincere regret about failing to look more closely at the mural). The Labour MP John Mann tweeted: “Those who called anti Semitism a smear cost Labour badly last night. A Jewish member for more than 60 years told me on the doorstep he couldn’t vote Labour in Barnet yesterday.”
Under the headline ‘Barnet voters sent stark message to Jeremy Corbyn’, the Jewish Chronicle reported a “revolt” by Jewish voters. When Barnet’s individual wards are examined, it’s clear that those with large Jewish communities are backing the Tories. Golders Green and Garden Suburb, historically Jewish wards, both returned three Conservative councillors. Voters in Finchley Church End and Mill Hill, both home to a fast-growing Jewish population, also opted for the Tories.
It’s also worth noting that these wards returned Conservative councillors in 2014 as well, when Jeremy Corbyn’s leadership was just a twinkle in John McDonnell’s eye.
