George Osborne speaks on EU reform at the Open Europe/Fresh Start conference on January 15, 2014. Photograph: Getty Images.
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Osborne would be the most hawkish foreign secretary in modern times

The Chancellor remains an unashamed neo-conservative and a champion of military intervention. 

The Tories may have trailed Labour in the polls for three years (today's YouGov poll has them six points behind), but they already appear to be measuring the curtains for another term in office. In this week's Spectator, James Forsyth reports that George Osborne is planning to become Foreign Secretary if the Tories win the next election. The story has been dismissed as "ludicrous" by allies of the Chancellor but it seems eminently plausible. 

As James writes, EU renegotiation would be the defining mission of a second term Cameron government and it would make sense for Osborne, the PM's closest ally and the Tories' most admired political brain, to lead it. Indeed, with hindsight, the Chancellor's recent speech on the subject to the Open Europe/Fresh Start conference looks like an application for the job. The word in Westminster has long been that William Hague will not serve another term as Foreign Secretary if the Tories remain in office and it would be remiss of the party not to prepare a successor (although who would take Osborne's place is another matter. Arise, Sajid Javid?). 

Janan Ganesh, Osborne's biographer, wrote last year: "Never a public performer, he is in his element in Brussels’ back rooms. One Foreign Office mandarin says he is more engaged with the EU than William Hague, the foreign secretary. Some of this is purest necessity – it is the Treasury’s burden to see off regulatory raids on the City of London – but he has taken to the work with surprising vigour."

But while discussion has focused on the potential costs and benefits for the Chancellor of taking on the Brussels behemoth, it's worth noting something else: Osborne would be the most hawkish Foreign Secretary in modern times. Alongside his fiscal conservatism and social liberalism, Osborne's neoconservatism forms the core of his political identity. With the exception of Michael Gove, there is no cabinet minister more committed to the doctrine of humanitarian intervention. 

In an article for the Spectator in 2004, he described himself as a "signed up, card-carrying Bush fan" and retains close ties with the US right. During a Commons debate on the Iraq war in 2003, he praised Labour MP Nigel Beard for making "an excellent neo-conservative case for the action that was taken". Again, with the exception of Gove, there was no greater champion of intervention in Syria. 

In another Spectator piece, "While England Sleeps", he wrote: "We did not choose the War on Terror it chose us. We could try to walk away from it now. We could distance ourselves from America, say the Iraq war was a mistake...But it would not save us. For remember the words of the Madrid bombers before they set out to kill 200 innocents on their way to work: 'We choose death while you choose life.' With people like that it can only be a case of them or us." 

As Foreign Secretary, Osborne would not determine Britain's foreign policy (that remains the responsibility of Cameron) but he would help to shape it. Rather than acting as a brake on intervention, as the realist William Hague often has, the Chancellor would be an accelerator. At a time when the electorate and an increasing number of MPs (of all parties) are resolutely isolationist, it is worth considering what Osborne's arrival at Kings Charles Street would mean for British foreign policy. 

George Eaton is political editor of the New Statesman.

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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.