Cutting the NHS to fund defence is bad politics and bad policy

Raiding £500m from the health and schools budgets to fund defence might please Tory MPs but the voters won't like it.

David Cameron and George Osborne have long rejected calls from figures such as Vince Cable and Liam Fox to end the protection of health spending in order to limit cuts elsewhere. But the NHS ring-fence is looking less secure today. Ahead of June's Spending Review, the Telegraph reports that Philip Hammond is in talks with the Treasury about transferring up to £500m from the health and schools budgets to reduce the expected cuts to defence. The Defence Secretary, you'll recall, has previously publicly demanded that welfare is cut again to protect the MoD. But with the Lib Dems vetoing any further cuts to welfare (bar those to pensioner benefits, which David Cameron has pledged to protect), Hammond has been forced to look elsewhere. 

Cameron has already demonstrated his willingess to raid other departments' budgets to fund defence by suggesting that aid spending could be used to meet the cost of peacekeeping and other defence-related projects. It's thought that the government would justify any decision to divert resources from health and education to defence by pointing to the hundreds of millions of pounds a year the MoD spends on health care for armed forces personnel and the education of their children. But while the move will prove popular with Tory MPs, who are furious that defence is being cut by 7.5 per cent, while aid is being increased by 37 per cent, it is likely to be judged less favourably by the public. 

As a ComRes/ITV News poll published in February showed, health and education are the two most popular spending areas, with defence trailing in sixth place (behind police and law enforcement, welfare and transport). It was partly for this reason that Cameron and Osborne chose to ring-fence the NHS and schools budgets. At last week's PMQs, Cameron made much of his commitment to protect health spending, contrasting it with Labour's decision not to pledge to do so before the 2010 election. "The right hon. Gentleman’s answer is to cut NHS spending, whereas we are investing in it," he declared. A decision to now do otherwise would offer Labour an easy political hit. 

It is also doubtful whether the NHS, which is already required to make unprecedented efficiency savings of £20bn over four years, should be cut for the purpose of reducing cuts to defence. The above-average levels of inflation in the health service mean that it requires real-term increases in spending just to stand still. But under pressure from his recalcitrant backbenchers and the National Union of Ministers, Cameron may yet give away. 

David Cameron with British soldiers based at Lashkar Gah in Helmand Province, Afghanistan. Photograph: Getty Images.

George Eaton is political editor of the New Statesman.

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I am special and I am worthless: inside the mind of a narcissist

There's been a lot of discussion about narcissists this week. But what does the term actually mean?

Since the rise of Donald Trump, the term “narcissistic” has been cropping up with great regularity in certain sections of the media, including the pages of this journal. I wouldn’t want to comment about an individual I’ve never met, but I thought it would be interesting to look at the troubling psychological health problem of narcissistic personality disorder (NPD).

People with NPD (which is estimated to affect about 1 per cent of the population) have a characteristic set of personality traits. First, they have a deeply held sense of specialness and entitlement. Male NPD sufferers frequently present as highly egotistical, with an unshakeable sense of their superiority and importance; female sufferers commonly present as eternal victims on whom the world repeatedly inflicts terrible injustices. In both cases, the affected person believes he or she is deserving of privileged treatment, and expects it as a right from those around them.

Second, NPD sufferers have little or no capacity for empathy, and usually relate to other people as objects (as opposed to thinking, feeling beings) whose sole function is to meet the narcissist’s need for special treatment and admiration – known as “supply”. In order to recruit supply, NPD sufferers become highly skilled at manipulating people’s perceptions of them, acting out what is called a “false self” – the glittering high achiever, the indefatigable do-gooder, the pitiable victim.

The third characteristic is termed “splitting”, where the world is experienced in terms of two rigid categories – either Good or Bad – with no areas of grey. As long as others are meeting the narcissist’s need for supply, they are Good, and they find themselves idealised and showered with reciprocal positive affirmation – a process called “love-bombing”. However, if someone criticises or questions the narcissist’s false self, that person becomes Bad, and is subjected to implacable hostility.

It is not known for certain what triggers the disorder. There is likely to be a genetic component, but in many cases early life experiences are the primary cause. Narcissism is a natural phase of child development (as the parents of many teenagers will testify) and its persistence as adult NPD frequently reflects chronic trauma during childhood. Paradoxically for a condition that often manifests as apparent egotism, all NPD sufferers have virtually non-existent self-esteem. This may arise from ongoing emotional neglect on the part of parents or caregivers, or from sustained psychological or sexual abuse.

The common factor is a failure in the development of a healthy sense of self-worth. It is likely that narcissism becomes entrenched as a defence against the deep-seated shame associated with these experiences of being unworthy and valueless.

When surrounded by supply, the NPD sufferer can anaesthetise this horrible sense of shame with the waves of positive regard washing over them. Equally, when another person destabilises that supply (by criticising or questioning the narcissist’s false self) this is highly threatening, and the NPD sufferer will go to practically any lengths to prevent a destabiliser adversely influencing other people’s perceptions of the narcissist.

One of the many tragic aspects of NPD is the invariable lack of insight. A narcissist’s experience of the world is essentially: “I am special; some people love me for this, and are Good; some people hate me for it, and are Bad.” If people with NPD do present to health services, it is usually because of the negative impacts Bad people are having on their life, rather than because they are able to recognise that they have a psychological health problem.

Far more commonly, health professionals end up helping those who have had the misfortune to enter into a supply relationship with an NPD sufferer. Narcissism is one of the most frequent factors in intimate partner and child abuse, as well as workplace bullying. The narcissist depends on the positive affirmation of others to neutralise their own sense of unworthiness. They use others to shore themselves up, and lash out at those who threaten this precarious balance. And they leave a trail of damaged people in their wake. 

This article first appeared in the 16 February 2017 issue of the New Statesman, The New Times