Being "a bit anti-establishment"

In September I wrote a post about how I didn't feel like I was feeling what everyone else was feeling after the Queen died. I had some feedback on that post. My mum said it seemed "cynical". My friend Paul said I sounded "a bit anti-establishment". 

My first thought when Paul said that was "Only a bit?" Maybe it took me saying something out of step with the prevailing sentiment to show that I'm a bit anti-establishment. But I'm not going to deny it. I think there are a lot of problems with 'the establishment' and the way things are arranged in the UK.

I've been a republican for a long time - probably all my adult life. It's nothing personal about any member of the Royal Family. As another friend, Jon, said, the Queen chose to do the public duty side of her role, and I respect the Queen for playing the hand she was dealt and playing it well. But I don't have to approve of the way the deck was stacked. (What's the saying? Hate the game, not the player?)

I studied Politics at A-level, back when politics was comparatively boring. We spent a year looking at the British political system and a year looking at the American political system. That left me firmly of the opinion that the House of Lords should be abolished. This has current relevance if you can be a Prime Minister for a mere 44 days and still give a load of party donors paid jobs for life in the House of Lords. My preference would be to replace that unelected body with regional parliaments in England that have power devolved to them.

The American system seems to have gone horribly wrong in this century, but the idea of splitting powers between Congress (the legislature) and the President (the executive) is fundamentally sound. Having an elected President gives everyone a say in who holds the top job, unlike the incredible farce we have seen recently appointing a new Prime Minister.

In the last few years I have become an active supporter of Welsh Independence. Overall, you can see a trend in my thinking - a greater say in who governs with more direct influence for voters. A self-governing Cymru will mean more direct accountability to the people who live here. 

I was recently asked if I felt an independent Wales was viable - I replied asking whether the UK still feels viable. The person I was talking to is politically astute and told me for the first time in their life they felt truly fearful for the future. My feeling is increasingly framed as 'Can Wales afford to stay in the Union?', rather than 'Can Wales afford to leave?'

I have strong opinions beyond abstract proposals for changing political structures. I think all "necessities" - power, water, housing (to an extent), broadband - should be nationalised and run as public services to ensure everyone's needs are met. (I have heard an interesting idea that football clubs should be 'nationalised' and run for the good of communities. It's an idea that had some merit to it. Social institutions are important. However, I would start with the utilities and transportation.) 

I'd also support the idea of a Universal Basic Income, to remove financial stress from people and really free up creative endeavour and innovation. Wages would then reflect the value of a particular job in society and work would have greater inherent value. 

Universal Basic Income is a way to break the poverty cycle and reset our society. There is good evidence that the solution to poverty is actually to give poor people enough money to live on. That sounds so blindingly obvious it feels almost like sarcasm. But it's hard to argue against, unless you are willing to ignore all the research and cling to your prejudices that all poor people are stupid or irresponsible. Of course, some people might prefer the UK to be a nation of foodbanks and misery. They can keep voting Tory. I'm not going to apologise for wanting things to be better than that.

Don't know the writer; agree with the message

Because of its ever-presence in the lives of almost everyone who is alive, people forget the NHS was considered radical and revolutionary in its time. It was vigorously opposed by the Conservative Party of its day (and also by a lot of doctors!) and even now the idea of free healthcare available at the point of need is rare around the world. I believe in the NHS concept and believe it is worth defending, which is becoming increasingly necessary as it is being deliberately under-funded and privatised by stealth. 

My point about the NHS is that, generally, we can get used to radical approaches. Welsh Independence, or republicanism, or nationalising utilities, or Universal Basic Income, may all appear radical and unachievable. But so did the NHS when Aneurin Bevan first entered politics. 

So, having said all that, overall I'm happy to be described as "a bit anti-establishment". The only bit I would quibble with is the word "bit".

Barriers to project success - an exercise in found data

I love 'found data'. It's the inadvertent information that gets shared and can reveal something deeper about the world we live in. My annual Christmas card audits (the ACCAs) are an example. It's almost as good as 'found art'.

Some art I found previously...

This found data was from a project management course that I completed this month (June 2022). There were nine students on the course, which was conducted remotely over five non-consecutive days. Seven students were from the NHS, one was from a university and the ninth worked for a public sector body. The project management programme was PRINCE2, which is a methodology that has been widely taught (if not widely followed) for a number of years.

PRINCE2 has seven key principles that every project conducted in line with PRINCE2 is meant to adhere to. They are non-optional. The seven principles are:

1. Projects must have a 'continued business justification' - they need to be checked regularly to see if they are still viable and will provide a useful product and value for money
2. Projects should be informed by experience, incorporating lessons from other projects and ensuring lessons are learned during the life cycle of the project
3. Projects should have 'defined roles and responsibilties' in the project team 
4. Projects should be 'managed in stages' which includes a clear process for starting and ending projects
5. Projects should also be 'managed by exception', so higher levels of management are only really involved if circumstances change and projects are unable to go as planned
6. Projects should 'focus on products' - the result or outcome of the project
7. And finally, project management and design should be tailoured to fit the context of the project

The person leading the course used an interesting approach to get us to discuss (and learn!) the seven principles. He gave all of us seven votes and asked us which of the seven principles we thought were least likely to be adhered to in our workplace. We could assign as many of our votes as we liked to any of the principles, depending how difficult it would be to adhere to particular principles in our workplaces. That was 63 votes in total.

Now, bearing in mind who was on the course, I found the results really interesting.

Top of the pile, with 20 votes - almost a third of all the votes we were allowed - was the first principle: continued business justification. So, basically, the feeling was that once a project got started it was never checked to see if it was still needed. It would just carry on, regardless. It didn't matter if the landscape had changed, new evidence had emerged, technology had advanced or whatever. There was no stopping it. Projects might even get started without a business justification in the first place. It was somebody's pet idea and if that person had enough clout they could make a project happen.

Next in the pile, with 14 votes - which is the rquivalent of two votes from everyone on average - was 'defined roles and responsibilities'. When we discussed this, it was either people not knowing what they were meant to do, people higher up in the system micromanaging and interfering, or trying to get support from the 'not-my-job' brigade who just refuse to undertake roles in projects. 

Both 'focus on products' and 'manage by stages' earned 9 votes each. The focus of projects is often on the process rather than the outcome, and everyone seemed to have a story about a project that started without a defined intended outcome. Manage by stages also seemed to be a difficult one because projects get launched with very little planning and without a step-by-step plan for product delivery. 

Tailouring and learning from experience both earned 7 votes. There is common phrase about reinventing wheels that crops up regularly. I've noticed a reluctance of people in the NHS to learn from other organisations, or even from other teams in their own organisatrion. The default position is that whatever worked up the road couldn't possibly work here because our job doing the same thing is actually so much harder and more complex! It's nonsense, but it's hard to argue with people who find that belief convenient for several reasons.

And then, finally, 'manage by exception' got 4 votes. That seems to indicate that people do bring problems to those above them in the organisations. Mainly that's because they will have run out of money and are asking for more (he says, slightly cynically).

Mathematically adept readers may have noticed that the total adds up to more than 63 votes, so some people obviously got carried away and lost count of their votes. But the general trend feels true to the discussions we subsequently had.

I'm not arguing for the reliability of found data, and I recognise this is a very small sample size. But it does capture the perceptions of people about the barriers to running projects according to an established methodology. And actually, this kind of subconscious sharing of information may be more reliable than if people were asked under formal conditions to give an opinion. This is what people really think about trying to make projects work in these organisations. 

The "smoking gun" on that Aneurin Bevan 'quote' I investigated almost six years ago

Way back at the end of 2011 I wrote a post about the provenance of quotes, with three examples of quotes and stories that I felt were not authentic. A couple of months later I proved one of the stories - about the violinist Itzhak Perlman - was totally untrue, because I emailed his agent and got a reply debunking the myth.

One of the quotes was attributed to Aneurin Bevan. I could not find a source for it and the people who quoted it couldn't give me a source either. Then back in January 2015 I had the bizarre experience when I asked a Tweeter if they knew the source of the quote and they linked me back to my blog post questioning whether the quote was genuine. When I pointed that out they didn't bother to reply.

On and off I've noticed the quote still appearing on Twitter, often in this format:

And so to a few days ago when I got a mention on Twitter from a chap called Alex Marklew.  I had not heard of Alex before but he had written a piece on Medium.com about the same quote. In his tweet he acknowledged my "initial digging" around the quote and he linked to the original blog post and quoted from it.

Alex definitely went further than I did, fruitlessly scouring the biographies that I'd been pointed towards but hadn't had time to read. He also seems to have gone deeper into Hansard than I ever did. And, most excitingly, he has found the quote, except it was not said by Aneurin Bevan. It was a summary of Bevan's position by a British sociologist called Thomas Humphrey Marshall, who wrote 'Social Policy in the Twentieth Century' (published in 1967). Alex has the exact quote in its context in his article. Then in 1978, Marshall's line was quoted in a paper called 'Medicine, Health, and Justice: The Problem of Priorities', with the quote attributed to Bevan. Alex refers to this paper as 'Patient Zero' - the source of the quote as a false 'Bevanism'.

I think Alex Marklew has solved this mystery, which I never thought would be, and I'm grateful. It was one thing on my list of things to get round to one day and now I can cross it off without having to lift a finger.

The question now is, does it matter who said it? I mean, yes, in one sense it does because misattributed quotes are basically lies given false authority based on who allegedly uttered them. But the question is do we still agree with the message, regardless who says it? I do. I think this quote from Thomas Humphrey Marshall captures the essence of why healthcare should be freely available to everyone. I'm not too bothered that it was said by someone writing about Bevan and the NHS and not by the "Father" of the NHS himself (as seen in the meme photo above). But I'm glad I now know who we should credit with saying it.

Communications, innovation and choosing who to work for

The best content out there is always other people's, which is why I'm happy to be a signpost. Here are some interesting nuggets of workplace wisdom I have come across this week - one that is more general and some that seem very handy to people working in the NHS.

The first comes from Michael Katz, with his recommendation to avoid working for desperate clients. I like the analogy of visiting the supermarket with a rumbling tummy - you regret it later when you are full. When the crisis is over, your employer may feel differently than they did when they hired you back when they were at peak stress. Michael delivers it with his trademark wit - well worth a read.

I sent it on to my friend Matt because we have had discussions like this about clients who turn out to be difficult. One of the truest things I learned from Mark H McCormack's books is to not be afraid to fire your customers. Sometimes you have to sever the ties with someone who isn't paying you enough for the amount of hassle they cause. Matt and I agree on this and I knew he would like Michael's take on not working for the wrong customer.

Matt responded with two links of his own. The first to a blog by Seth Godin that talks about marketers being hampered by their own organisation. This really applies in the NHS, where everyone says we desperately need innovation and transformation but it's equally desperately hard to innovate and change anything.

Seth adds a bit at the end about knowing when to give up: Good marketers have "The willingness to quit what isn't working." Yes, we need to learn that, but it's tricky though because you're caught between throwing good time and effort after bad and the sunk cost bias of getting nothing back for all your expenditure. It's hard.

The second link was to a brilliant TED talk about how the 'rules' charities have to operate under limit their ability to actually tackle issues. Everything in this video is true for the NHS, with the newspapers ready to pillory any risks that go bad or salaries that are considered 'too high'. It's 18 minutes long, but worth watching.


Then finally something popped up in my Twitter time line that originally came from Helen Bevan, who does a lot around innovation and improvement.

We need to get good at this

I would like to see this happen because social learning and application must be the way forward for us in the NHS. Go into any office and the shelves are full of toolkits and learning papers full of ready to apply knowledge, slowly dessicating with neglect. We need a better way of talking and sharing. This slide seems to give us the evidence to try doing it differently.

Quotes from Raymond Williams, playwright and political thinker

Occasionally I read a quote that just leaps out and sticks with me. Often these are from quite unexpected sources - like when I read an article written by the Welsh health minister, Mark Drakeford, which included this quote:

“To be truly radical is to make hope possible rather than despair convincing.”

I liked that. In the political narratives around us, it all seems to be about despair - extremists, the pressures of migrants, the NHS at breaking point, the economy. Every party, or factions in parties, seems to be trying to convince us that the other side will bring ruin upon us. And we seem to be buying into this. The despair has become convincing. Hope seems impossible.

I've been called a radical a few times for my politics and theological world view. It's not a label I would use to myself. But then if I am going to be regarded as a radical, I want my lived out beliefs to be a radicalism that makes hope possible.

The person who said “To be truly radical is to make hope possible rather than despair convincing.” was a playwright and political thinker, Raymond Williams. This particular quote was from a book called Resources of Hope, which was published posthumously in 1989.

The internet - that great reservoir of quotes - has some more interesting thoughts from him, many of which I agree with, and some that have made me think about things, if nothing else. Raymond Williams was very interested in class and society, and also the moral bankruptcy of unalloyed capitalism, all of which I am interested in. So, here are some more thoughts, in his own words:

“Culture is one of the two or three most complicated words in the English language.” (Keywords, 1983)

“Real independence is a time of new and active creation: people sure enough of themselves to discard their baggage; knowing the past is past, as shaping history, but with a new confident sense of the present and the future, where the decisive meanings and values will be made.”

“We all like to think of ourselves as a standard, and I can see that it is genuinely difficult for the English middle class to suppose that the working class is not desperately anxious to become just like itself. I am afraid this must be unlearned.” (Culture and Society, 1958)

“What breaks capitalism, all that will ever break capitalism, is capitalists. The faster they run the more strain on their heart."

“It wasn't idealism that made me, from the beginning, want a more secure and rational society. It was an intellectual judgment, to which I still hold. When I was young its name was socialism. We can be deflected by names. But the need was absolute, and is still absolute.”

What leaders might really be for - the lesson of Sir Philip Dilley

I don't normally comment on current events, but the resignation of Sir Philip Dilley, the Chair of the Environment Agency who was on holiday in Barbados while half the country flooded out over Christmas, has prompted a thought around leadership.

Sir Philip has said in his statement that when he took the three-day-a-week position (that carries a six figure salary) he didn't realise he was going to need to be on call all the time. He has a point. The Environment Agency has a CEO and numerous directors (who are also presumably on substantial salaries) and quite what we would expect a sixty year-old to personally do in the face of such dreadful floods is unclear. The flak he got in the press for daring to take a holiday abroad with his family was unfair and I can see why he would be annoyed enough to quit. Who needs the hassle, when you've got a knighthood and presumably a decent pension from a career at the top in engineering?

But what Sir Philip illustrates is a tendency of public sector leadership that I've noticed in the part of the public sector where I work, namely healthcare. True, the Environment Agency is a little bit different to a large healthcare organisation, but the function he seems to be playing here is similar to what happens to many healthcare CEOs.

I've just completed an MSc module on the psychology of leadership, which has meant I've had to do some reading around the subject from a more scientific viewpoint rather than the usual 'inspirational' material that I normally think of when 'leadership' as a subject is mentioned. I was particularly interested in the idea that leaders emerge in a complex system and this often leads to conflict with leaders who are appointed to positions and given authority.

(Certainly, it's the case that when a person in a leadership position expresses a view in a meeting you will see people slyly look to the person who has emerged as a leader in the group to see what they think. You see this especially with clinicians listening to ideas from executives. They will look and see what Dr X or Nurse Z think about it.)

Healthcare is a complex system, or realistically, several complex systems that intersect and sometimes derail each other. Leaders often compete - for resources if nothing else. Competition is not necessarily to do with ego, just the natural outworking of trying to plan in unplanned systems.

Realistically, you look at some of the massive healthcare organisations out there and you quickly realise that no one person could ever lead such an operation. There is too much unknown and unknowable in the systems - and that's just the systems we know about, let alone the other things pulling strings that we have no real handle on.

So, what is the function of a leader in such a system? Well, on one level, it's to not lead. I have been immensely privileged to meet several healthcare CEOs and pretty much all of them sum up their leadership style as trying to get out of the way of the people who are doing the stuff, and maybe somehow helping to make life easier for them by smoothing down obstacles.

But there's another role for leaders as well. It's to be the person to blame if things go horribly wrong, as Philip Dilley has found out. Removing him does nothing to reverse the devastation of the floods or repair any of the damage, but we have found someone to 'blame'. He has now resigned and someone has paid for the calamity.

The same thing happens in healthcare. Since I started working in the healthcare sector every NHS Wales organisation has had at least one change of CEO. Some have had several.

I deeply respect the CEOs I've met, and have no reason to believe the ones I haven't met aren't just as good. I've known some leaders who have moved on under a cloud. But I think this is nothing to do with their competency or their attitudes. It's just a sad fact that the main role of a CEO is to take the blame if things go wrong and unfortunately the odds seem to be about 50/50 whether something beyond your control will go wrong on your watch. And if it does, it will be hard to stay on.

This might sound incredibly cynical. It's not meant to be. It could well be wrong, but it's just my perspective on leadership, as one of the led.

If you liked this you could read: The missing perspective on leadership

1000 Lives - a work retrospective

Today was my last day at 1000 Lives Improvement. It's been five years and it was definitely time to move on. However, it's hard to say goodbye to people you have worked with and grown to care about. As Cathy pointed out, five years is the same length of time I was at secondary school. It's longer than my niece has been alive! So, it is a significant chunk of time.

Anyway, here are some high points...

Count me in
This was a big campaign shortly after I started to maintain the momentum of the 1000 Lives Campaign in the new 1000 Lives Plus programme. This photo is notable for my mini-sideburns and the blue jacket that I wore a lot to work events.

The STOP Campaign
This was the first time we really built comms into a clinical change programme. The mascots were fun to develop, especially the catheter (first time round it looked really rude). STOP won a CIPR Pride Award - I wrote a report on it if you want to know more.

Champions for Health
Another big campaign, this time looking at improving the health of NHS staff and encourage them to become advocates for healthier lifestyles. I took part in the pilot. (Blue jacket in the photo!)

World Sepsis Day
One day I will blog about the car journey I had with Terence Canning, the Welsh ambassador for the UK Sepsis Trust. On that journey we coined a phrase that has appeared on numerous awareness-raising materials and has even been borrowed by other organisations. I had the poster on my wall by my desk at work as a reminder that good writing is often short writing.

We also interviewed Terence for one of the videos we shot for World Sepsis Day.

The International Forum - London
Probably one of my favourite weeks at 1000 Lives was manning the NHS Wales at the IHI International Forum in London in 2013, with my lovely friend Kelly. Almost unbelievably, having spent 15 hours a day in each other's company we ended the week better friends than when we started. On the way down we decided our names weren't Welsh enough so we adopted the names Iolo and Myfanwy. Little did we know those names would stick.

At the end of the week we posed by the London Bus they had in the main auditorium. You can see how tired we were.

Dr Olivia
Towards the end of last year I spent nearly six weeks working on placement in Aneurin Bevan University Health Board. What with a Daily Mail hate campaign against NHS Wales, rumours about ebola, and a grisly incident involving a possible patient, it was a chance to experience the deep end of NHS comms.

We also got to film Dr Olivia's Guide to A&E - Is it really an emergency? I'm not sure how many videos I produced while at 1000 Lives. It's well over 100. This is one of my favourites.



Publications
In the past five years I've written six annual newspapers (plus three others) and 14 white papers. These are the latest ones.

Legacy

I've left these on my desk to intimidate my replacement. 3 gold awards in 2 years is a pretty good return. (As the person who wrote the entries as well, I felt doubly satisfied with the wins!)

So, those are just some highlights. There were many more. It's been a good five years.

When you are your own citation

Three years ago I wrote about the difficulty I had finding a source for a quote by Aneurin Bevan. On and off I've kept trying to find the source, especially when it pops up on Twitter like it did tonight.

So, I asked for the source of the quote and had a surreal sensation when someone replied citing my blog post from 2011. That's the blog post which basically says there is no known source and the person who used the quote at the event where I heard it the first time doesn't know where it is from.

I'm fully expecting the next response to be a link to the white paper where I was forced to fudge the authenticity issue that led to my original blog post.

If anyone does know where that quote is from, I would love to know.

Don't keep calm - get angry

I have been political in the past on this blog, but reading ‘To Isaiah’ by Dr Don Berwick this week has stirred up some more feelings of agitated anger towards some of the things being perpetrated by our ‘compassionate conservative’ government.

Don Berwick is an inspirational figure in the field I am currently employed in and was hand-picked by President Obama to introduce the reform of the American healthcare system so villainously and stupidly opposed by right wing America. ‘To Isaiah’ is the commencement address to the graduating class at Harvard University medical school. That sounds dull. It really isn’t.

There are three quotes in Don Berwick’s address that have particularly struck me. The first is by Antoine de Saint-Exupery:

“To become a man is to be responsible; to be ashamed of miseries that you did not cause.”

I am deeply ashamed – mortified to the point of anger by the on-going widening inequality between the rich and the poor in this country. I feel helpless with barely controlled rage when smarmy Dave Cameron and his equally clueless toffee-arsed chums bleat on about how they understand that life is hard for ‘hard-working families’ but ‘we’re all in this together’. I find it shameful to be living in a country where job centre managers are being given suicide prevention training because of the numbers of desperate people they are seeing each day. It hounds me to the core.
The second quote is from the late Senator Hubert Humphrey:

“The moral test of government is how it treats people in the dawn of life, the children, in the twilight of life, the aged, and in the shadows of life, the sick, the needy, and the handicapped.”

So, how are we doing on this? How are the people living in the shadows? I tweeted recently how thousands of people are being denied disability living allowance under tough new governmental rules – and how, hypocritically, millionaire David Cameron and his wife Samantha claimed DLA themselves when their disabled son, Ivan, was alive.

I felt sorry for David Cameron when Ivan died. But I wonder what kind of bereaved father would wilfully turn the screw on parents who are going through the same experience of living with a disabled child.

Let’s be clear – the austerity cuts, the assault on the NHS, the denial of basic services to the community and particularly to the poor and needy are only ideological. They stem from a Tory conviction that the rich should not have to ‘subsidise’ the poor, that you are not your brother’s keeper, that if your neighbour only has one cloak you should take it from him if he owes you money, that compassion is only due to those you consider ‘deserving’, that the market is the divine authority and that the poor will always be with us so why bother trying to change things.

A remark on Twitter caught my eye today – on forming a government the Conservative’s priority was dismantling a working NHS. The rotten-to-the-core irredeemably corrupt banking system, which has yet again been exposed for the criminal racket it really was, attracted no attention. Bankers caused the global economic crisis that has been handily used as cover for the undermining, underfunding and destruction of the welfare state infrastructure. Have bankers been punished? Have they even been investigated?

There was an alternative to austerity – close the tax loopholes that allowed huge thieving companies like Goldman Sachs and Vodafone to pay less tax than the average corner shop. Deals were cut between HMRC and the accountants in those companies that were as unscrupulous as anything the traders at Barclay’s have been up to recently. Did the Tory government act when these came to light? Well, you know the answer to that.

And that gives the lie to the necessity of the austerity cuts. That gives the lie to the necessity of further impoverishing the disabled, the blind, the ill and the poor. That emphasises how these swindlers and conmen in government are in cahoots with the conmen and swindlers in the city and how the deliberate removal of what amount to a pitiful percentage of government expenditure, but means everything to the needy, is motivated by nothing more than an ideological, implacable hatred of ‘scroungers’ and ‘spongers’ by the wealthy.

This has happened by carefully and calculatingly distracting people. Firstly by the mythical debt that we had to pay off – although nobody I have ever asked could tell me exactly who this debt was owed to. Then by the righteous anger directed at the rioters, most of whom were uneducated dumbass kids from the worst of London’s sink estates. Then, by the wickedness perpetrated by journalists, although once that crept close to the government’s door it has been far less of a soapbox issue for politicians. And then by the Jubilympics, the endless stream of Union Jack tat, and the artificial excitement encouraged by a government led by a man who wanted everyone outside at street parties rather than paying attention to what was going on.

All this has happened in a haze of denial – encouraged by the incessant variation of a common theme: Keep Calm and Carry On. This ubiquitous message, to be quiet and shoulder the burden and just get through to the sunny lands promised on the other side of the long, hard, trek to freedom, is a meme that keeps coming back, and very convenient it is too. It appeals to the British stoicism, the ‘mustn’t grumble’ brigade, the ‘it’ll turn out alright in the end’ wishful thinkers.

But, no! We shouldn’t keep calm and carry on. We should get angry and change things.

This thought-train started by reading ‘To Isaiah’ (although much of it had been brewing for a while). I want to end with an original line from Dr Don Berwick that I found irresistibly prophetic:

 “A nation that fails to attend to the needs of those less fortunate among us risks its soul.”

Where is our soul?

Political blog post: unemployment

One of the unexpected side-effects of working in a job tangentially linked to public health is that I keep discovering new things. I’ve become a gatherer of noteworthy trivia and factoids that actually scare me when I think about them.

One of the more shocking was this: chronic worklessness has an equivalent debilitating effect on a person’s health as smoking 20 cigarettes a day. That means that if someone is unemployed for a long period of time, they are statistically more likely to die at a younger age than someone with a job – to the same tune as if they puffed a packet of death-sticks every 24 hours.

We know the effects of smoking, and most sensible people would support a total ban if any government had the balls to do it. Lung cancer is a truly horrible way to die. I've seen it kill someone I care about, so I know that. But we don’t see the wasting disease of the soul that is unemployment in quite the same way – its impact is hidden.

And yet draw a map of disease and early mortality in any part of the country and the map will always follow a pattern: low mortality = poverty = high smoking = high obesity (i.e. poor nutrition) = low child birth weight = chronic or prolonged unemployment = poor housing = higher cancer rates, more heart diseases, more illness per se.

Poverty and suffering from ill health go hand in hand on any public health map drawn up ever.

And poverty and worklessness go hand in hand on any demographic map drawn up ever.

Just before Christmas the Government announced it was going to put over £400m into efforts to tackle ‘problem families’ – i.e. dysfunctional families with ‘feckless’ dads, tearaway teens, benefits cheats and criminal genes. This wasn’t new news, but it was reported as such. The Government previously said it was going to spend over £300m in October. Inflation means everything costs more a few months later.

A Daily Mail article that ran in October carried the headline “How Britain's Shameless families cost the taxpayer £8bn every year.”

It went on to say:

“The summer riots have convinced the government that drastic steps are required to tackle a hardcore of workless neighbourhoods where no-one has a proper job.

The coalition says Labour’s welfare legacy means there are many parts of Britain where three generations of families have never worked and live a life funded by state benefits.

Some neighbourhoods, particularly in inner cities and on large estates, are so blighted by long-term unemployment that no-one on a street has a job and children never see anyone getting up and going to work.”

We have a scenario, then, where generations of young people are growing up in workless households, where to be unemployed is the norm. There’s a reason for that. Good jobs – and by that I mean jobs that will enable you to pay the rent or mortgage, buy nourishing, nutritional food, pay for insurance, pay for heating and lighting, clothe your kids and yourself, and maybe have enough left over to pay for a monthly night out at the cinema – are hard to come by.

Whose fault is that, exactly?

According to Government, and reproduced faithfully by the bleating Mail, Labour’s welfare policies are responsible for “three generations of workless families”.

I know it feels like forever since Tony Blair’s New Labour victory in 1997, but that wasn’t three generations ago. It must be linked to whoever was in charge before Tony.

And what is Labour’s record when it comes to employment, anyway? One of the sea-changes in British politics came after the Second World War. The newly-installed Labour Government is still, I think, the only British Government ever to state a commitment to full employment. There would be jobs for people as Britain rebuilt itself – that was the plan.

It was ambitious, but it wasn’t a pipe-dream. It was founded on an ethic that saw the social good in employment. Work wasn’t just about earning money – or even a cynical exercise in keeping the population occupied. Work was something that drew communities together. If the majority of people in a community work in local business or manufacturing, it creates cohesion. Never mind the individual health benefits that we now know accrue from being engaged in work.

Another sea-change was the Thatcherite revolution of the 1980s. The privatisation of national industries – gas, telecoms, electric – were all justified using economic arguments. Nationalised industries were inefficient, they had too many employees, they were monopolies that kept prices high.

So they closed the pits and the steelworks, the mills and the mines.

Interesting story – when my Dad was 16, my Granddad had a word with a friend and got my Dad a job at the steel mill that loomed above the small Welsh village where he grew up. Dad had other ideas – he wanted to study medicine and become a doctor, but many of his contemporaries went to work there.

In many respects, Dad chose a hard path. Studying medicine was even more brutal in the 60s than it is today – and I know enough junior doctors to know it’s pretty brutal today. He worked long hours, and later in hospitals and as a GP worked all hours of the day and night caring for people.

But he wasn’t thrown on the scrapheap when the steelworks was shut down in the name of efficiency in the late 1980s. He wasn’t forced, like so many people in their late 40s, to retrain for a new career and cross your fingers there would be work at the end of it. Being a doctor was a stressful career choice, no doubt about it. But he wouldn’t have traded places with the people facing an uncertain future before a retirement in penury.

That’s the thing about ‘efficiency’ – it’s only a benefit in the short-term to the balance sheet of the company. In the long-term, and we’re talking the inter-generational long-term, the social efficiency of keeping ‘inefficient’ industries going is far greater.

So, now the Tories are irked that billions are being spent on benefits for workless communities. Well, you reap what you sow.

Of course, the middle class tax-payers who senselessly vote Tory and equally senselessly read the Daily Mail are regularly up in arms about the work-deprived communities their taxes now subsidise. But Tory policy created those areas blighted by unemployment. Here’s an idea: Stop voting for the short-term, slash-and-burn, quick-buck opportunists.

The history of Tory economic policy is about short-sightedly sacrificing social capital and infrastructure for a few pence. There was never a golden egg they weren’t willing to kill the goose for. As a frivolous example, in the 60s they axed hundreds of picturesque railway routes throughout Britain, never thinking that one day heritage railways could potentially be money-spinners. (The Severn Valley railway once ran through the Ironbridge Gorge into the heart of Shrewsbury – think what that would be like as a tourist attraction now!)

When you are blinkered by the balance sheet you only see the money you will ‘save’, not the opportunities you will miss out on.

That was the 60s. In the 80s they hammered heavy industry – creating poverty blackspots that have drained the public purse for decades in the process.

What are they doing now? Youth unemployment is heading towards an all-time high. Incidentally, so are domestic fuel bills – ending those monopolistic nationalised industries certainly didn’t work in the consumers favour. The NHS is in a process of privatisation; with plans to corral off half of NHS beds for paying customers.

We’re told the NHS, like so much else, has to change because it is ‘inefficient’. But there are different ways of defining 'efficiency'. The NHS is actually very efficient at delivering a central element of what makes a society civilised – care at the point of need for all members of society, regardless of their economic status.

That principle is a bottom line worth more than any balanced books will ever be.

Some other bits of writing & stuff

Occasionally I engage in some self-promotion.

A pessimistic article I wrote for When Saturday Comes has attracted at least one angry commentator detracting my status as a Shrewsbury fan. Surprisingly I'm less than bothered.

I don't usually plug stuff I've written for work, but I was involved in the creation of a recent white paper about the guiding ethos in the NHS, and whether its founder, Aneurin Bevan, would recognise it. I found it fascinating to write it and maybe you'd find it interesting.

While we're on the subject of work stuff, I had the privilege to direct some information videos about work being done to prevent falls among elderly and infirm people back in May. They're now online, so if you want to rate my ability as a documentary film-maker, you can watch them here. I suggest the ones filmed in Cardiff and Llanidloes - if you like dogs you have to watch the one from Llanidloes. (I was helped massively by a very talented cameraman / editor - this is his website.)

'Fair' spending cuts will hit the poorest hardest

So, the news today was that it looks like the "fair" spending cuts are going to hit the poorest hardest.

Weeeeeeelllllll, who could have seen that coming? What, nice Mr Cameron and his true blue tory chums are going to further marginalise the marginalised. Shock! Horror! Surely not...!

Well, yeah. Because tories play to type. Conservatism in its very nature is about preserving the status quo. And the status quo is that there are rich people and there are poor people. And the rich people want to stay rich and the poor, well who cares, they're not important, or 'respectable', or stimulating the economy.

Since taking power the tories have announced they are going to 'liberate' the NHS, with a document that within the NHS is regarded as privatisation in all but name. The tories have used a notable tax-dodger to review public expenditure and identify wastage. Oh, and they upset middle class people by threatening to cut child benefit - which nice Mr Cameron resolutely and passionately declared they Would Not Do.

Last week I heard an interesting presentation by the boss of Mori, the opinion pollsters. He said that broadly speaking a majority of people liked the idea of a 'big society'. The problem was only a handful of people wanted to be the people serving others in the 'big society'.

Which reminds me that last year when I worked in the charity sector, some people I worked with got excited about David Cameron's idea that charities could partner with government to deliver services. 'How great!' they cried. 'A government who will work with us.'

They were idiots. This 'partnership' is a scheme to get charities to shoulder the costs of caring for the poorer ends of society when government withdraws. It's not partnership - it's the government saying "We don't want to do this any more... over to you! Yay now we can afford a tax cut at election time to our chums in the City!"

The thing is charities are unreliable. They don't have secure income streams. There is huge variation in what they can do on the ground in different areas. They rely on goodwill to get through most of the time. And they are feeling the pinch as a result of the recession.

Yeah, let's use them. What a brilliant idea.

Now you could say, "Well, Jon, it's obvious where your political sympathies lie and you just have an antipathy towards tories. This is your excuse for laying into nice Mr Cameron and his liberal desperate sidekick, who are both saying the figures have been skewed and the poor won't really get screwed. Where's the fair and even-handed reportage that we ought to have on this blog?"

You know what, no. No balance. I don't need to say anything when international slime-hound Rupert Murdoch is sticking up for Cameron. That's all the balance we need.