In defence of the Freedom Pass

Leaving a question mark over the future of the Freedom Pass will strike a blow to Labour’s electabil

Of all the things conceived and delivered by the London Labour movement, it is the work to implement the Freedom Pass that makes me most proud.

The future of the Freedom Pass has given Labour members in London an important decision to make about the future direction of policy in the city.

An honest difference of view between myself and Oona King has opened up over this issue at members' debates in Croydon and Brent. Asked if the Freedom Pass should be means-tested, Oona has argued that "If there is a choice, then I want the money to go to the poorest, not to pay for the richest like Prince Charles to go free" and "If you are the mayor and you have got less money coming in, you need to ensure the average pensioner can have the same experience or better than those richer ones . . . you need to accept means testing."

I disagree. On such a fundamental question, it is necessary to give a clear answer: that the Freedom Pass is safe. If I am selected as Labour's candidate and then elected as mayor, I will oppose any attempt to means-test the Freedom Pass. I will defend the concessionary schemes.

I never expected to hear in a Labour mayoral selection that we should consider means-testing the Freedom Pass. It is a catastrophic mistake, a gift to our opponents, including Boris Johnson. We must have a clear bottom line -- and a universal Freedom Pass should be part of it.

This strikes at the heart of electability. A London Labour candidate going into an election with a question mark over the Freedom Pass, such as being open to the idea of means-testing it, would damage Labour. Either Boris Johnson will use it as a stick with which to beat Labour, posing to the "left" of the Labour candidate, or it will open up territory that assists those who want to erode travel concessions.

In both circumstances, it is a direct blow against Londoners and would make it harder to win.

I will oppose any attempt to means-test the Freedom Pass and defend the Freedom Pass.

The Freedom Pass unites people across London. It is particularly crucial in the outer boroughs, one of the areas where its take-up is greatest. The latest figures show 51,691 Freedom Passes issued in Barnet for older Londoners and 5,903 for disabled people, for example. Another 43,791 in total have been issued in Bexley, 63,671 in Bromley and 48,827 in Havering.

Older people make up a significantly high proportion of voters and are therefore vital to our support.

There is already concern that the national bus concessionary scheme may be under threat from government cuts.

It is not the super-rich who would be affected by means testing. You are unlikely to find billionaires or members of the royal family taking advantage of the Freedom Pass. To save any meaningful amount of money, the cut-off point for the means test would not be for multimillionaires, but for individuals on much lower levels of subsistence.

The cost of administering means testing could only be offset by placing the cut-off way below the richest. The question for anyone toying with the notion of means-testing something like the Freedom Pass is: where would you draw the line?

And why stop at the Freedom Pass? There are many universal services and benefits that could also be threatened, such as free bus and tram travel for under-18s -- which the Tories have already previously tried to remove.

It is a more profound issue even than that. Some services are best delivered universally or with universal concessions for key groups. That ensures broad support for services -- such as public transport -- that would otherwise be much easier to cut by right-wing governments.

The more widely people use public transport and see the benefits, the more the city moves freely and the biggest number of people possible will have a stake in maintaining those services.

The Freedom Pass is so popular with older and disabled Londoners and their families that Boris Johnson was forced to adopt our plan to extend the Freedom Pass to 24-hour operation (though he has failed to secure its 24-hour operation on many rail services).

For Labour to succeed in 2012, it must have a strategy for winning based on protecting Londoners from the combined assault of the economic situation and a government whose policies will worsen its impact.

That is why I will not toy with ideas like means-testing the Freedom Pass, and why I will support other universal services and benefits that make our society fairer and stronger.

Ken Livingstone was mayor of London between 2000 and 2008, and is currently campaigning to be Labour's candidate in the 2012 London mayoral election.

Ken Livingstone is the former Mayor of London.
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British mental health is in crisis

The headlines about "parity of esteem" between mental and physical health remain just that, warns Benedict Cooper. 

I don’t need to look very far to find the little black marks on this government’s mental health record. Just down the road, in fact. A short bus journey away from my flat in Nottingham is the Queens Medical Centre, once the largest hospital in Europe, now an embattled giant.

Not only has the QMC’s formerly world-renowned dermatology service been reduced to a nub since private provider Circle took over – but that’s for another day – it has lost two whole mental health wards in the past year. Add this to the closure of two more wards on the other side of town at the City Hospital, the closure of the Enright Close rehabilitation centre in Newark, plus two more centres proposed for closure in the imminent future, and you’re left with a city already with half as many inpatient mental health beds as it had a year ago and some very concerned citizens.

Not that Nottingham is alone - anything but. Over 2,100 mental health beds had been closed in England between April 2011 and last summer. Everywhere you go there are wards being shuttered; patients are being forced to travel hundreds of miles to get treatment in wards often well over-capacity, incidents of violence against mental health workers is increasing, police officers are becoming de facto frontline mental health crisis teams, and cuts to community services’ budgets are piling the pressure on sufferers and staff alike.

It’s particularly twisted when you think back to solemn promises from on high to work towards “parity of esteem” for mental health – i.e. that it should be held in equal regard as, say, cancer in terms of seriousness and resources. But that’s becoming one of those useful hollow axioms somehow totally disconnected from reality.

NHS England boss Simon Stevens hails the plan of “injecting purchasing power into mental health services to support the move to parity of esteem”; Jeremy Hunt believes “nothing less than true parity of esteem must be our goal”; and in the House of Commons nearly 18 months ago David Cameron went as far as to say “In terms of whether mental health should have parity of esteem with other forms of health care, yes it should, and we have legislated to make that the case”. 

Odd then, that the president of the British Association of Counselling & Psychotherapy (BACP), Dr Michael Shooter, unveiling a major report, “Psychological therapies and parity of esteem: from commitment to reality” nine months later, should say that the gulf between mental and physical health treatment “must be urgently addressed”.  Could there be some disparity at work, between medical reality and government healthtalk?

One of the rhetorical justifications for closures is the fact that surveys show patients preferring to be treated at home, and that with proper early intervention pressure can be reduced on hospital beds. But with overall bed occupancy rates at their highest ever level and the average occupancy in acute admissions wards at 104 per cent - the RCP’s recommended rate is 85 per cent - somehow these ideas don’t seem as important as straight funding and capacity arguments.

Not to say the home-treatment, early-intervention arguments aren’t valid. Integrated community and hospital care has long been the goal, not least in mental health with its multifarious fragments. Indeed, former senior policy advisor at the Department of Health and founder of the Centre for Applied Research and Evaluation International Foundation (Careif) Dr Albert Persaud tells me as early as 2000 there were policies in place for bringing together the various crisis, home, hospital and community services, but much of that work is now unravelling.

“We were on the right path,” he says. “These are people with complex problems who need complex treatment and there were policies for what this should look like. We were creating a movement in mental health which was going to become as powerful as in cancer. We should be building on that now, not looking at what’s been cut”.

But looking at cuts is an unavoidable fact of life in 2015. After a peak of funding for Child and Adolescent Mental Health Service (CAMHS) in 2010, spending fell in real terms by £50 million in the first three years of the Coalition. And in July this year ITV News and children’s mental health charity YoungMinds revealed a total funding cut of £85 million from trusts’ and local authorities’ mental health budgets for children and teenagers since 2010 - a drop of £35 million last year alone. Is it just me, or given all this, and with 75 per cent of the trusts surveyed revealing they had frozen or cut their mental health budgets between 2013-14 and 2014-15, does Stevens’ talk of purchasing “power” sound like a bit of a sick joke?

Not least when you look at figures uncovered by Labour over the weekend, which show the trend is continuing in all areas of mental health. Responses from 130 CCGs revealed a fall in the average proportion of total budgets allocated to mental health, from 11 per cent last year to 10 per cent in 2015/16. Which might not sound a lot in austerity era Britain, but Dr Persaud says this is a major blow after five years of squeezed budgets. “A change of 1 per cent in mental health is big money,” he says. “We’re into the realms of having less staff and having whole services removed. The more you cut and the longer you cut for, the impact is that it will cost more to reinstate these services”.

Mohsin Khan, trainee psychiatrist and founding member of pressure group NHS Survival, says the disparity in funding is now of critical importance. He says: “As a psychiatrist, I've seen the pressures we face, for instance bed pressures or longer waits for children to be seen in clinic. 92 per cent of people with physical health problems receive the care they need - compared to only 36 per cent of those with mental health problems. Yet there are more people with mental health problems than with heart problems”.

The funding picture in NHS trusts is alarming enough. But it sits in yet a wider context: the drastic belt-tightening local authorities and by extension, community mental health services have endured and will continue to endure. And this certainly cannot be ignored: in its interim report this July, the Commission on acute adult psychiatric care in England cited cuts to community services and discharge delays as the number one debilitating factor in finding beds for mental health patients.

And last but not least, there’s the role of the DWP. First there’s what the Wellcome Trust describes as “humiliating and pointless” - and I’ll add, draconian - psychological conditioning on jobseekers, championed by Iain Duncan Smith, which Wellcome Trusts says far from helping people back to work in fact perpetuate “notions of psychological failure”. Not only have vulnerable people been humiliated into proving their mental health conditions in order to draw benefits, figures released earlier in the year, featured in a Radio 4 File on Four special, show that in the first quarter of 2014 out of 15,955 people sanctioned by the DWP, 9,851 had mental health problems – more than 100 a day. And the mental distress attached to the latest proposals - for a woman who has been raped to then potentially have to prove it at a Jobcentre - is almost too sinister to contemplate.

Precarious times to be mentally ill. I found a post on care feedback site Patient Opinion when I was researching this article, by the daughter of a man being moved on from a Mental Health Services for Older People (MHSOP) centre set for closure, who had no idea what was happening next. Under the ‘Initial feelings’ section she had clicked ‘angry, anxious, disappointed, isolated, let down and worried’. The usual reasons were given for the confusion. “Patients and carers tell us that they would prefer to stay at home rather than come into hospital”, the responder said at one point. After four months of this it fizzled out and the daughter, presumably, gave up. But her final post said it all.

“There is no future for my dad just a slow decline before our eyes. We are without doubt powerless – there is no closure just grief”.

Benedict Cooper is a freelance journalist who covers medical politics and the NHS. He tweets @Ben_JS_Cooper.