Labour tuts at the Tories' "public school-boy games" over Europe

The afternoon's Europe debate is purposely designed to discomfit Labour. But Miliband's high-minded opposition is a risky strategy.

Parliament will this afternoon debate Britain’s relations with the European Union. The argument, it is safe to say, will not be terribly focused. The motion is that "this House has considered the matter of Europe." Doubtless, by the end of the day, after a fashion, it will have.

Of course the real purpose of the session – called by the government – is to allow Tory MPs to flaunt their newfound unity and to jeer at Labour discomfort. Now that the Prime Minister has promised a referendum on the UK’s membership (which is very popular with his backbenchers) and Ed Miliband has resisted doing the same (which makes many on his side uneasy) the Conservatives feel they are finally on the front foot on European issues and intend to plant their other foot into the opposition as hard as they can.

There are people on the Labour and the Lib Dem side who despairingly agree with the No. 10 analysis. One senior Labour figure calls his party’s position "ridiculous" on the grounds that "we can’t go into an election in opposition to the people." A Lib Dem strategist comments wryly that Cameron’s manoeuvre means effectively that "he has adopted pretty much the position that we had at the last election." (Clegg is the only major party leader with a pedigree of promising in/out EU plebiscites.)

There is residual confidence in the Miliband and Clegg camps that Cameron’s European position will unravel when it bumps into practical obstacles to delivering a deal in Brussels that Tory MPs can stomach. (As a sign of trouble on the horizon, Germany’s foreign minister has fired a clear warning shot at Downing Street.) Besides, Tory MPs are never satisfied with Cameron for long; some new grievance comes along soon enough.

But since the Prime Minister’s speech last week had a noticeably tonic effect on the party it is easy to see why Downing Street has decided to pour out another dose of the same heady brew. Labour’s approach to all this is, I gather, to play it long and high-minded. Miliband knows that Cameron’s position is designed exclusively by the short-term demands of party management and fear of Ukip. That, the Labour leader calculates, is a weak position whichever way you look at it. Under such circumstances, when the government is caught up in desperate short-term tactics, the opposition should be in the business of looking far-sighted and responsible – a sensible government-in-waiting.

Miliband’s aides are keen to point out that the very existence of today’s debate is a sign of panicky tactical machination in Downing Street. Why, they ask, should parliament spend its time kicking around the idea of a referendum that currently only exists in the hypothetical realm of a Tory majority government in 2017. Are there no more pressing foreign policy issues around? (Clue: Cameron himself is in Algeria this afternoon.)

It is all rather reminiscent of George Osborne’s decision to confect a separate Welfare Benefits Uprating Bill, carved out of the many announcements in last December’s Autumn Statement. The underlying policy – a real terms cut to the rate at which social security payments annually rise – did not require its own triumphal procession through parliament. The Bill was devised entirely to discomfit Labour and generate as much heat as possible around the question of the opposition’s addiction to welfare profligacy. (As it turned out, the public mood was more nuanced, with some evidence of a backlash against the Chancellor appearing to relish the prospect of picking poor families’ pockets.)

The view from Team Miliband is that this afternoon’s Europe debate is just another example of Cameron and Osborne playing, in the words of a senior aide, "snarky little public school-boy games" when they should be thinking of ways to fix the economy and look after the nation’s long-term strategic interests. It is a fair point. But, whether Miliband likes it or not, much of what goes on in the Palace of Westminster resembles games of varying degrees of shabbiness and cynical subterfuge. Voters don’t particularly respect that aspect of our politics – most of the time they don’t even notice. But tutting in disapproval from the sidelines in the hope of looking statesmanlike is a risky strategy in any competition.

Labour leader Ed Miliband addresses workers at Islington Town Hall. Photograph: Getty Images.

Rafael Behr is political columnist at the Guardian and former political editor of 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.