Don’t get carried away with headline fall in unemployment

Subtantial progress may not come until 2013

The drop in the latest unemployment figures is good news. It is the first time unemployment has fallen in ten months. But underneath the headline fall is bad news for women and some worrying trends that make substantial progress over the next year very unlikely.

Today’s fall in the overall jobless count masks a continuing rise in female unemployment, now higher than at any point since 1987. Since last month’s figures, there are an extra 8,000 women unemployed and 27,000 more women out of work for more than a year. In total, there are now more than a million women (1,136,000) unemployed, the highest since 1987 and a rise of 100,000 over the last year. Of those, over a quarter (29 per cent) of women (327,795) have been unemployed for more than a year.

Long term unemployment continues to rise, reaching its highest level since 1996. Overall, long term unemployment rose 26,000, the highest level since 1996, to a total of 882,821. While 1,000 men have left long-term unemployment, there are now 27,000 more women who have been out of work for more than a year. IPPR predicts there will be almost a million unemployed for more than a year by the end of 2012. There is a real risk that these people will struggle to take advantage of any upturn in the economy.

While youth unemployment has fallen by 9,000, there are still more than a million (1,033,440) young people (aged 16-24) unemployed, the second highest since comparable records began in 1992. Of those, 263,000 young people (aged 16-24) have been unemployed for more than a year. The Youth Contract has now begun, but it has a huge job to do.

Almost half a million (430,672) people over 50 are now unemployed, up 42,000 in the last year. More than 40 per cent of unemployed over fifties have been out of work for more than a year, up 13,000 over the last year to 189, 593. It’s going to be very tough indeed for over 50s out of work for more than a year to fund new jobs, even when the economy bounces back.

There has also been a rise in part-time work, which rose by 80,000 while the level of full-time employment fell by 27,000. There are now 1.4 million people working part-time because they say they cannot get longer hours.

Public sector employment contracted by 270,000 last year, while private sector employment increased by just 226,000. The resulting gap means rising unemployment. The economy is not being rebalanced by public sector job cuts because growth in the private sector continues to lag. There are actually 19,000 fewer vacancies in the economy than there were a year ago. Looking ahead, there is going to be a rise of 100,000 in unemployment this year, according to IPPR analysis of the latest forecast from the Office for Budgetary Responsibility.

This is already hitting the north of England hard. Over the last year, unemployment is up 22 per cent in the North West (an extra 57,000 out of work) and up 11 per cent in the North East (an extra 14,000 out of work). The chancellor is wasting the opportunity to boost national prosperity by ignoring the economic potential of the north.

The priority for the government must be to prevent long term unemployment, with a job guarantee, and to support women to get back to work, by prioritising childcare. There is light at the end of the tunnel, but that tunnel stretches well into 2013. Before it gets substantially better, it’s going to get worse.

Boarded up shops wait for redevelopment in the Hanley Shopping Centre in Stoke-On-Trent. Credit: Getty

Richard Darlington is Head of News at IPPR. Follow him on Twitter @RDarlo.

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Want to know how you really behave as a doctor? Watch yourself on video

There is nothing quite like watching oneself at work to spur development – and videos can help us understand patients, too.

One of the most useful tools I have as a GP trainer is my video camera. Periodically, and always with patients’ permission, I place it in the corner of my registrar’s room. We then look through their consultations together during a tutorial.

There is nothing quite like watching oneself at work to spur development. One of my trainees – a lovely guy called Nick – was appalled to find that he wheeled his chair closer and closer to the patient as he narrowed down the diagnosis with a series of questions. It was entirely unconscious, but somewhat intimidating, and he never repeated it once he’d seen the recording. Whether it’s spending half the consultation staring at the computer screen, or slipping into baffling technospeak, or parroting “OK” after every comment a patient makes, we all have unhelpful mannerisms of which we are blithely unaware.

Videos are a great way of understanding how patients communicate, too. Another registrar, Anthony, had spent several years as a rheumatologist before switching to general practice, so when consulted by Yvette he felt on familiar ground. She began by saying she thought she had carpal tunnel syndrome. Anthony confirmed the diagnosis with some clinical tests, then went on to establish the impact it was having on Yvette’s life. Her sleep was disturbed every night, and she was no longer able to pick up and carry her young children. Her desperation for a swift cure came across loud and clear.

The consultation then ran into difficulty. There are three things that can help CTS: wrist splints, steroid injections and surgery to release the nerve. Splints are usually the preferred first option because they carry no risk of complications, and are inexpensive to the NHS. We watched as Anthony tried to explain this. Yvette kept raising objections, and even though Anthony did his best to address her concerns, it was clear she remained unconvinced.

The problem for Anthony, as for many doctors, is that much medical training still reflects an era when patients relied heavily on professionals for health information. Today, most will have consulted with Dr Google before presenting to their GP. Sometimes this will have stoked unfounded fears – pretty much any symptom just might be an indication of cancer – and our task then is to put things in proper context. But frequently, as with Yvette, patients have not only worked out what is wrong, they also have firm ideas what to do about it.

We played the video through again, and I highlighted the numerous subtle cues that Yvette had offered. Like many patients, she was reticent about stating outright what she wanted, but the information was there in what she did and didn’t say, and in how she responded to Anthony’s suggestions. By the time we’d finished analysing their exchanges, Anthony could see that Yvette had already decided against splints as being too cumbersome and taking too long to work. For her, a steroid injection was the quickest and surest way to obtain relief.

Competing considerations must be weighed in any “shared” decision between a doctor and patient. Autonomy – the ability for a patient to determine their own care – is of prime importance, but it isn’t unrestricted. The balance between doing good and doing harm, of which doctors sometimes have a far clearer appreciation, has to be factored in. Then there are questions of equity and fairness: within a finite NHS budget, doctors have a duty to prioritise the most cost-effective treatments. For the NHS and for Yvette, going straight for surgery wouldn’t have been right – nor did she want it – but a steroid injection is both low-cost and low-risk, and Anthony could see he’d missed the chance to maximise her autonomy.

The lessons he learned from the video had a powerful impact on him, and from that day on he became much more adept at achieving truly shared decisions with his patients.

This article first appeared in the 01 October 2015 issue of the New Statesman, The Tory tide