In defence of monarchy

The revolution will not be televised – but the Queen’s Christmas Message will.

Tomorrow, as every December, I will fail to take part in a ritual that is dear, sacred even, to the hearts of many Britons. I will not join them when they make their annual act of implicit homage to a higher authority to whom, for most of the rest of the year, they pay little material allegiance.

The language involved in this ceremony is arcane, the accents and pronunciation frequently antique, and to those not brought up with due reverence, it seems bizarre, not to say totally irrational, that anyone should bow their heads in obeisance to this mystical, regal presence. Still millions will clear time from their day to be faithful to this time-honoured practice.

I, on the other hand, will not be watching the Queen's Christmas Message. Neither will I be buying any of the tastefully designed porcelain and china already being produced to mark next year's wedding of Prince William and Kate Middleton. To me, the most sensible attitude towards the monarchy was summed up succinctly by the late Leslie Nielsen in the first Naked Gun film. Nielsen's character, Lt Frank Drebin, is asked to explain at a press conference how the Los Angeles Police Department will deal with a forthcoming royal visit. "Protecting the Queen's safety is a task that is gladly accepted by Police Squad," he says. "For no matter how silly the idea of having a queen might be to us, as Americans we must be gracious and considerate hosts."

It is, indeed, a silly notion that an accident of birth should endow anyone with the hereditary right to be a head of state, and even sillier that the holder of that office should therefore be paid any particular respect, or even attention, because of his or her unearned position. Nevertheless, one of the batches of WikiLeaks had me entertaining what is, for a republican, a heretical thought: should we be glad to be reigned over by the House of Windsor?

The subject of the US embassy cable to which I refer was the Crown Prince of Thailand, the prospect of whose ascension to the throne caused several very senior figures to express concern. The members of the Thai Privy Council supposedly quoted did not, however, suggest that the Thai monarchy come to an end when King Bhumibol dies; rather, that it would be better "if other arrangements could be made". This was thought to mean that the Crown Prince's sister would make a better successor.

In a country that has alternated between fledgling democracy and military dictatorship, republicanism is a minority taste. The constitutional monarchy that replaced the absolute rule of the king in 1932 is widely regarded as having been pretty much the only stabilising factor ever since.

The fate of neighbouring Burma might well have been different in the decades since 1962, when the generals took over, had the British not exiled the last king, Thibaw, in 1885, and formally annexed the country to the Raj the following year. As Justin Wintle wrote in his biography of Aung San Suu Kyi:

The British may have done Burma a disservice by arbitrarily getting rid of its throne, however rotten it appeared both to the outside world and to many of its own subjects. With the throne went an entire societal matrix that at least held the Burmese people together. As in Thailand, in time this might have furnished a broader cohesion.

Instead, the only national institution left in Burma is the armed forces, the Tatmadaw, which are both the country's oppressor but also the vessel of its pride, having been founded by Burma's greatest hero (and Suu Kyi's father), the independence leader General Aung San.

This is not to say that there have not been many cases of kings or princes acting in bad, repulsive or even illegal ways. But as Bernard Lewis, the distinguished (and controversial) historian of the Middle East and Islam, told me when I interviewed him a few months ago: "Of the democracies that have been democracies for a long time and continue to be so, most are monarchies."

Such continuity is obviously a virtue. Yet couldn't we in Britain manage perfectly well to retain our democracy without the Windsors? Couldn't we have an elected head of state? While the late Roy Jenkins was still alive, we had the perfect candidate – witty, urbane, statesmanlike, with cross-party appeal, and a man who could be relied on to impart due gravitas to the ceremonial aspects of the job.

Who, though, would we end up with if we elected a president as figurehead today? It is hard to imagine a situation in which the winner was not either terribly divisive (Tony Blair – with New Labour hold-outs plus his natural constituency, the conservative vote, he'd walk it) or ludicrous (President Brucie? Don't count it out in this age when being a celebrity is all that counts).

Some readers will doubtless find even such a limited defence of monarchy unpalatable. I would argue, however, that it is in the true Fabian spirit, if not quite that of the NS's founders, Beatrice and Sidney Webb. For the Roman general after whom the movement was named, Fabius Cunctator – the Delayer – won his sobriquet for his habit of not striking until victory was assured. Ridding ourselves of the monarchy, only to find we ended up with something worse than the Windsors, who may be dull but have at least mostly been fairly worthy on the throne, would be just the kind of Pyrrhic victory the Cunctator would have avoided.

This kind of gradualism is, in fact, a very deeply ingrained British trait. And that is why tomorrow, and on Christmas days to come, the revolution will not be televised – but the Queen's Message will. I trust you will join me in not watching.

Sholto Byrnes is a Contributing Editor to the New Statesman
Photo: Getty Images
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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.