I support the current government’s attempts to reform the UK welfare system, which resembles a road to bankruptcy paved with good intentions. However, I take issue with unsympathetic narratives in the press mocking the supposedly undeserving poor, with ‘dole scrounger’ and ‘bogus asylum seeker’ caricatures firmly embedded in the national psyche. Pejorative stereotyping masks what really matters — worsening inequalities, and how politicians are actively complicit in this process.
The number of poor children has risen recently,1 yet two-thirds are from working households.2 Over-represented among them are the children of migrant workers,2 whose parents are often on the minimum wage or zero hours contracts, and experiencing hardship and poor health.3 Meanwhile, what remains of the indigenous working class is disenfranchised, with employers opting instead for the migrants. Youth unemployment continues to rise,4 challenging the wisdom of making older people work longer.5
The loss of the middle class
Analysis of social inequality has historically compared the ill-fated post-industrial working class with a thriving middle class. However, in recent years the latter has, almost imperceptibly, shrunk numerically and in influence, not least because traditional domains like teaching, academia, and health care now pay so little.6 By contrast, successive governments have championed the very rich: staggering bankers’ bonuses and boardroom pay continue, seemingly oblivious to performance. The world’s super-rich have flocked to London, which has, bizarrely, become their tax haven. The parallel social engineering is evident, especially in and around the capital. Prime Central and West London residential property is now almost exclusively owned by new money from overseas, much of it lying empty due to ‘buy-to-leave’.7 The next tier of wealth, high-earning professionals, gentrify once-edgy inner-city areas.
A similar story is played out in the commuter towns of the Home Counties like the Hertfordshire hamlet in which I practise. Respectable but sterile and of no interest to old money or oligarchs, it nonetheless housed a diverse cross-section of the middle class, including professional and managerial cadres, when I first arrived here. Two decades on, virtually every working-age householder is in finance, a homogenisation testifying to the diminished prospects of anyone who isn’t.
Consequences of inequality
These trends are relevant to health care. In the book The Spirit Level, we see how very unequal societies, even if the average per capita income is respectable, suffer poorer health due to social tensions and higher rates of depression, drug and alcohol misuse, teenage pregnancy, obesity and its consequences, including diabetes, and violence and its fallout, including imprisonment.8 Increased deprivation fills our surgeries and emergency departments.9 Doctors and other health professionals are among the ‘squeezed middle’ whose pay erosion means that health care is no longer an economically viable career choice. As the government continues its decade-long public sector pay freeze, it must consider the consequences. UK medical graduates are an intelligent, diverse cohort with a coveted degree. Many are from South Asian families whose conservative reputation belies remarkable adaptability, for it is quite common for each of the last three generations to have been born on a different continent. Faced with economic prospects far less propitious than their parents, let alone comparable professions were they to remain in the NHS, I predict that many may emigrate or be otherwise lost to medicine, which I assume is understood by those indefatigable supporters of the free market in government.
Welfare reform will only succeed if there is, in parallel, critical reappraisal of that unfettered free market, a failing system exponentially enriching the top 1% to the detriment of others. Suspicion of the left has led to voting in a government more the voice of international plutocracy than Middle England, but an opposition in tatters doesn’t bode well for having the checks and balances necessary for a democracy. My argument is more about practicality than morality, important as the latter is. Banks, multinationals, and non-doms operating in the UK and paying little or no tax deny legitimate revenue to the government. Raising the minimum wage was a good move, and the next target should be sickness benefit claimants, where even a modest increase in numbers returning to work would yield a far greater dividend than increasing the yacht collection of hedge fund managers. Tellingly, Europe’s most successful economy, Germany, doesn’t court the world’s funk money. Conversely, recent months have seen wide coverage of the fate of a European country whose combination of low manufacturing output and wages, over-generous welfare, and a political class bolstering its own privileges while turning a blind eye to widespread tax evasion led to a point of no return. Not to the same extent, perhaps, but what ails Greece is relevant to the UK.
- © British Journal of General Practice 2015