Care and its opposite

Like many others, I’ve been appalled at the UK government’s reaction to the covid-19 crisis, watching on in horror as a rotating combination of the incompetent, the over-promoted, the keen but under-prepared and the downright nasty take centre stage at the daily Downing Street car-crash briefings. The lack of surprise that this is the case, given the Brexit ultras that are in charge, does not subtract from the horror of the show.

The gap between competence and need in terms of public policy is rarely more evident in the aspect of the crisis over social care, i.e. care provided outside the NHS. Care workers have always been at the frontline of the advance of the virus, both more exposed to it as a result of needing to travel to work and unable to observe social distancing rules while doing their jobs, as well as potentially playing a key role in the spreading of the virus. Yet this week we learn that people have been transferred into care homes, including from hospitals, without being tested as regards whether they have been exposed to the virus; and that social care providers are still among the desperately forgotten when it comes to PPE and, crucially, what little testing is being done. Giving out badges is indeed not enough in days like these.

In both cases, this is entirely symptomatic of a situation in which the image of a care sector that is ‘well prepared’ for the crisis is the product of presentation, news management and spin rather than on-the-ground reality. It is also reflective of the fact of casual racism towards black and minority ethnic people being more likely to catch, and die, from the virus not because of some or other genetic factor but because they are more likely to be key public service deliverers, both in a care context and in a public transport one, and because our policy-making process remains substantially indifferent to their needs.

The other reason why this situation has been allowed to go on is because it reflects the herd immunity policy that marked the early days of the UK government’s approach and which still does, albeit now by stealth – and which also accounts for the planned indifference to social care providers: herd immunity requires the young and the resilient to catch the disease and build resistance to it, and care workers are found often among this part of the population. The outcome of such a policy – social care workers, and indeed the BAME population, being expendable and the more numerous deaths of elderly people which result being regarded as collateral damage – represents a truly abhorrent government at work. Make no mistake, the government and its policy advisers who are exploiting the confounding lack of intelligence among UK government ministers see the deaths of substantial parts of the population as mere by-products in its eugenics project.

As some journalists have spotted, there is a link between Brexit warriors and those who are trolling on Covid-19 in the name of liberty and personal freedom and agitating for the earliest possible end to the lockdown. That link lies in ending the demand for carers, many of whom come from overseas – and including from central and eastern Europe – and who have managed to find work in the care sector as the result of free movement of labour. Ending free movement causes evident problems for such sectors – except, of course, where a virus happens to come along and, where unchecked as a result of the application of ‘herd immunity’ policies, reduces the labour requirement as a result of the decline in the elderly population.

The policy outcomes of ending free movement lie most evidently in public perception in terms of raising wages – though the impact of free movement on wages, even in ‘semi-skilled’ and ‘unskilled’ areas was always marginal – about a penny off the hourly rate, according to the NIESR research. The bigger, but less well-understood, desire to end free movement lies in the argument that it is low productivity that is holding the UK back as a global leader in innovation and technological development. Only by ending free movement and thus the source of labour for low-productive sectors, so the theory runs, will productivity gains accrue to the economy: confronted with shortages of labour, employers will be required to automate tasks thus raising productivity and establishing technological advantage. Perhaps unsurprisingly, this doesn’t actually turn out to be the case: research into robot automation in manufacturing highlights the key role for public policy – in terms of national strategies, taxation policies, availability of subsidies, etc – in explaining the incidence of robotisation after relative wages are controlled for. The answer – as always – lies in a more sophisticated analysis of the problem than can be supplied by simple demand-and-supply economics alone. And, unsurprisingly, strong public leadership on this issue isn’t exactly , going on the record of neoliberalism over the last forty years, listed among the UK’s strengths.

Regardless of the semantics at today’s political lobby briefing about whether the UK would accept a extension of the transition period (@13.12) [and now confirmed that it won’t] or whether, in the circumstances, the EU, with its mind on other priorities, is simply tired of the whole process and no longer cares either way, the issue remains that the UK’s response to Covid-19 remains intrinsically tied to its policy on Brexit. That’s not a surprise since the adviser himself – now apparently back at work after ending a period of self-isolation – is one and the same. Back to business, indeed.

When all this is over, there does need to be a public inquiry into the government’s actions in response to covid-19; specifically its indifference to the unnecessary deaths of thousands of UK citizens in the pursuit of a dogmatic policy supported by a minority of enthusiasts the goal of which becomes ever smaller in the light of the major health and social care concerns that now face us. Further than that, however, the reckoning (I’m increasingly of the view that there is a Billy Bragg quote for everything!) that we need to have as a nation needs to take stock of the need to do things differently and expressly that the politics we espouse must be better focused. Neoliberalism has long had its day; but, if anything good can come out of the current existential crisis, a revitalised democracy, green economics and policies that put the achievement of people’s potential first must be in the driving seat.

[Edit: 19/04. Interested to see the Sunday Times‘s Insight team has produced a story today documenting the mis-steps of the government in addressing the virus (£) in February. It’s behind a Murdoch paywall, so I haven’t read it, but I’ve read enough reportage on it to understand something of the negligence it raises. The question remains one of whether that negligence was simply lazy, careless incompetence or whether something more malevolent was at work. Both at the same time are, of course, entirely possible outcomes given the different personalities involved.]

The Immigration (Health) Surcharge: another subscription to populism

One of the, perhaps, lesser items in this week’s budget was the 56% hike in the annual Immigration (Health) Surcharge, from £400 to £624. The new amount is curiously precise. Its (currently) stated purpose is to ensure that migrants pay the ‘full cost of use’, although the government stated this only last October as being £480. The only reference to a figure of the order to which the IHS will rise is, curiously*, an article in the Mail on Sunday quoting £625. I don’t want to drive traffic there, so here’s the Full Fact briefing on the issue which also cites it.

The somewhat unchristian origin of this particular IHS is the 2015 Coalition Government’s moves to ensure that ‘temporary’ (note carefully, with regard to the hostile environment) migrants ‘make a proper financial contribution to the cost of their NHS care’. As the accompanying Press Release went on to document, the surcharge was part of the 2014 Immigration Act whose aim was to deliver an immigration system that ‘works in the national interest’ specifically, amongst others, as regards ‘reducing the pull factors which encourage people to come to the UK for the wrong reasons’ – i.e. ‘health tourism’. Given the dates, we can see this very much as part of clumsy official government rhetoric which turned out only to feed the 2016 referendum vote – and which, of course, still continues.

Now, according to the government itself, ‘health tourism’ costs the UK c. £100-£300m/year – an interesting figure in the light of the Budget’s estimates of a gain of £335m/year from the measure (although this is presumably additional to the sums already being raised) – but pretty small beer, really, in the light of the annual NHS budget. And against which we should also offset the costs of the health tourism engaged in by UK citizens ourselves – it being cheaper to have your teeth sorted by Lithuanian dentists, for example, was one of the major areas of interest in Tom Chesshyre’s look at budget airlines in How Low Can You Go?

But the surcharge of course has only a tangential relevance to the NHS. In a hospital, if you encounter people from other countries, they’re far more likely to be treating you than sat waiting in the queue with you: as regards the ‘consumption’ of health services by people from the European Economic Area, it’s worthwhile recalling at length the exhaustive work of the government’s own Migration Advisory Commission into this issue (para 22):

EEA migrants contribute much more to the health service and the provision of social care in financial resources and through work than they consume in services. EEA workers are an increasing share of the health and social care workforces though these sectors employ greater numbers of non-EEA migrants. There is no evidence that migration has reduced the quality of healthcare.

The NHS is of course funded out of taxes, also paid by migrants – who, we should remember, don’t get to vote in general elections on how their taxes are spent. When all new migrants – including those coming to work in the NHS – have to pay both the Immigration Surcharge and taxes, this is really taxation without representation (x2).

The Surcharge is paid, as part of the process of applying for a visa, into the Treasury from which it goes to any number of spending projects. The sum is paid, up front, and for the full length of the visa, by all those seeking a visa and regardless of whether or not they use the NHS during their stay or even, critically, if they have private medical insurance anyway, thus meaning that – outside of the arrangements between private medical insurers and the NHS – they would have no call on the NHS during their stay in the UK. It is most emphatically not, therefore, a ‘charge on people using the NHS’. Though that is, of course, the shorthand which the government would like people, including the commentariat, to use. The citation of the NHS in its context is simply to use the NHS as a political tool against immigration, to play on people’s fears as part of the hostile environment and to turn us against each other.

Furthermore, it’s not paid by those in the UK on visitor visas or in the country for less than six months – so it’s pretty clear that it doesn’t actually even do the main job required of it to ‘stop people abusing the system’.

The Immigration (Health) Surcharge is instead, essentially a tax on people coming to the UK to work – and one which, according to the Institute for Government, makes the UK already a more expensive destination than any of Australia, France, Germany or Canada. For a single person, a three-year visa, including all fees, now costs some £5,250 before you even step into the country. On top of the unwelcoming, anti-migrant nature of much of our political discourse, and over an extended period now, the stated aim of the new immigration policy to attract the ‘brightest and best’ seems likely to stand simply instead for welcoming ‘those who can afford to come’. And there is, perhaps, not necessarily any link between being able to afford to come and ‘brightest and best’.

And, more seriously, given pay rates in the public sector, neither is there any link between skills and ‘brightest and best’. Any sort of rise in tax on people coming to the UK to work will, inevitably, lead to staff shortages in critical services. The universality of the English language, at a time when the UK is becoming less welcoming, is, in this context, quite clearly our enemy. And ‘the brightest and best’ who could come here will, most likely, choose instead to go to Canada, or Australia.

None of this should surprise about a bystander government whose budget aims to inoculate the UK economy, but not its people, against the effects of coronavirus and whose aims – in respect of the virus itself – seem to be to let it ravage through and take the hindmost, according to Peston, or in the words of the Telegraph, that it might even be ‘mildly beneficial in the long-term by disproportionately culling elderly dependents’ (sic). Neither should that be a surprise given Johnson’s kite flying on the issue while sat on the GMB sofas last Thursday morning. The Cabinet has clearly seen papers floating this very approach and the source of those, even post-Sabisky, is quite clear. And unelected.

Who was it who once warned people not to fall ill, or grow old, under a Tory government?