Something for nothing: a dangerous mentality. Especially in government

There’s often talk of the science of business. In reality, though, it’s all about instinct. This is particularly true among many senior executives who just know their gut feel is somehow enlightened and leads them to excellent judgements, hidden to others.

So rather than laws and principles, business tends to spew out aphorisms. “You never get a second chance to make a first impression.” “There’s no such thing as a free lunch.” And, particularly relevant here, “you never get anything for nothing.”

Just because they seem neither deep nor inspired doesn’t make these sayings untrue. In fact, they are often about as good a guide to what actually happens in business as anyone gets. One would, therefore, expect any reasonably experienced businessman to know them. One might even expect a political party pretty much in hock to business interests to be familiar with them too.

That makes it slightly ironic that our present government, here in Britain, spends so much time trying to convince us that you really can get something for nothing.

Generally, the people accused of trying to get something for nothing are the poor or disenfranchised. It’s people who are dependent on benefits, or who are asking for a little more to make ends meet. Business leaders or Tory Ministers are quick to condemn them. And yet that’s precisely the approach Tories are taking to some of the most important parts of our society.

It seems to be their philosophy towards the NHS, for instance. Their mantra is “get more for less.” You can actually do that, for a while, as you drive out inefficiencies. But we’ve been driving them out for a good twenty years or so. There comes a point where you’re not cutting out fat any more, you’re cutting into muscle or even bone.

But the government keeps going. It’s demanding that junior doctors do more work at weekends, so that we can move to a seven-day NHS. But it expects them to do that for no extra money.

Can you imagine one of the great consultancy companies, or financial advisers, or even lawyers agreeing to do extra hours for no more money? Surely the government, so close to such people, knows that they’d never wear it. What makes them think others would go along with it?

Another key element in the government’s healthcare strategy is to get more care delivered outside hospitals. In particular, by the social care sector. So it’s a concern that Britain’s biggest chain of care homes, Four Seasons Health Care, is apparently in serious financial difficulty, with only a few months of cash left ahead of it.

A home run by Four Seasons Health Care

A concern, but not a surprise. Social care is funded by local government, and central government has been starving municipalities of funds. Inevitably, that’s working through to the care providers, like Four Seasons. Again, it’s simply a matter of trying to get something for nothing: social care able to relieve the pressure on the NHS, for less money than it had in the past.

One of the factors that’s made life so hard for the care home sector is the government’s promise to move the minimum up to a level that will make it the “national living wage.” There is a thing called the “living wage”, calculated by independent bodies, and it’s substantially higher than the government’s “national” version. But even the lower level is hard for social care to absorb.

And yet the government has to see wages of the lowest paid rise, to justify why it’s cutting the support it gives them at the moment, through so-called tax credits. 

Follow the reasoning carefully: the Tories want to cut the benefits, justified by moves towards a living wage, even though their target for wage rises falls far short, and in any case they don’t intend to help out the care homes who are suffering, and on whom they depend to take cases from the NHS.

Sound like voodoo economics to you? That’s because it is voodoo economics. No one believes in it, not even the government. It’s all based on the idea that you can get something for nothing, which it knows it can’t.

So basically it’s just a smokescreen. It’s cutting back the state and leaving people dependent on it in even worse conditions than before. All the rest is just words to cover up the onslaught.

Meanwhile the Tories’ friends and paymasters are doing just fine, as top pay continues to rise astronomically.

Maybe there is such a thing as a free lunch after all…


And an update: The UK government has now made an 11% offer to junior doctors. I don’t want to be curmudgeonly, and I’m pleased the offer's been made, but I have to say that it’s an admission that the Tories had it wrong before. Besides, it would be good to see something done for other groups than doctors – such as workers on or little above the minimum wage.

The NHS: as safe as ever in Tory hands

Labour lost the UK general election on 7 May, in part at least because it kept harping on about issues that were beginning to bore the electorate.

It constantly denounced zero-hour contracts, for instance, which tie up employees but not their employers: the former can’t take other work, but the latter aren’t obliged to offer them any work, or any pay, on any particular day. Many voters, including some on zero-hour contracts who found them attractive, but mostly those who have never experienced such arrangements, started to find it tedious that Labour kept denouncing them.

Even worse, though, was the NHS. The Labour message was clear. Let the Tories back and you may lose the National Health Service. This may astonish some in the United States, where the NHS has a bleak reputation, but on this side of the pond, a great many people value that institution highly and would like to be able to rely on its being there, in the event they ever need it.

On the other hand, Labour kept repeating the dire warnings and it began to turn voters off. “Yes, yes,” they seemed to be responding, “you’ve said all that before. How about changing the record?”

The previous government, which was a coalition between the Conservatives and the Liberal Democrats, claimed to be protecting the NHS. Its funding, it claimed, would be protected. When other budgets were cut, NHS finance would remain sacrosanct, and even grow.

The Labour Party questioned this claim. First of all, while it was true that funding was increasing, it was not increasing in line with the specific inflation of the healthcare sector, where the availability of increasingly effective but increasingly expensive treatments puts budgets under pressure. Nor, and this was a much more significant problem, was it increasing in line with increasing demand for healthcare: an ageing population, which is additionally beset by growing numbers of chronic conditions such as diabetes, heart disease and obesity, is generating constantly growing demand for care, for diseases that start earlier and last longer than before.

Worst of all though, and above all dangerously hidden, is the consequence of what on the surface seems to be a positive idea. There is increasing pressure for treatment to take place outside the hospital environment. Care in hospitals tends to be far more expensive, and it’s an environment which is often demoralising to patients and even unsafe – they’re surrounded by other sick people, after all – and it makes sense to treat in the community as far as is possible.

Unfortunately, a great deal of community care takes the form of social care, for which the NHS is not responsible. It’s handled by local government – and that sector has absolutely not had its budgets protected. So to maintain the kinds of levels of social care the new initiatives require often means calling on the NHS to fund an increasing proportion of it. Those outflows from the NHS are certainly not covered by the allegedly protected funding arrangements.

This week, Norman Lamb, Liberal Democrat Member of Parliament, came out with a dramatic statement that the NHS would crash within two years without a massive injection of funds from the government. Interestingly, Lamb is well-placed to make that judgement. He served as a minister of health in the last government. So he was part of the team that set the NHS on its downward spiral.

It’s great to have his warning now, though it might have been more helpful if he and his colleagues had pulled out of the government and brought it down while there was still time to do so. But, I guess, there was no other way they were likely to get ministerial portfolios, and that matters too. Not as much, to me, as saving the NHS, but perhaps as much to them.

Addenbrooke's (Cambridge University Hospital)

Now we learn that Addenbrooke’s hospital in Cambridge, a world class centre for medical research as well as acute treatment, is being put into what are known as special measures. It’s failing to maintain proper standards of safety. It’s the 26th NHS Trust in special measures, out of 160 in England. One in six.

One of the reasons care at Addenbrooke’s isn’t safe is that it can’t afford to maintain adequate staffing levels on wards. Which is perhaps not surprising, since it’s losing £1.2m a week. But let’s remember the Tories are maintaining funding to the NHS, which is safe in their hands.

It might be time for the people who were so switched off by talk of the NHS during the election campaign to see if they can drum a little interest in the subject again. If Norman Lamb is even partly right, they may not have much time to wait.

And – who knows? – perhaps after that they might find it in themselves not to regard zero-hour contracts as quite as monotonous as they thought either.