Labour claims its idea of "whole-person care" can make crucial NHS savings. Photo: Getty
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Labour says joining up social care and health can plug the NHS budget shortfall

The Labour party says it would make savings in the NHS through joined-up services; what does this tell us about its approach to health policy in austere times?

The NHS can be the Labour party's most powerful weapon, but also its biggest stumbling block. While the party gains a great deal of warmth from the electorate for being associated with protecting the health service and its core value as being free at the point of use, and having been its founder, this also makes it vulnerable to criticism if it ever wants to so much as tweak its outlook or plans for health policy.

While the Conservative party, whose NHS reforms have been particularly controversial and unpopular, particularly among doctors and health workers, frenziedly attacks the opposition on the record of the Labour-led Welsh NHS, the Labour party has been beavering away attempting to figure out how it can maintain its reputation for being the party of the NHS while governing under austerity, if it reaches government in 2015.

The shadow health secretary, Andy Burnham, who served as health secretary when Labour was last in government, has been pushing his plan for “whole-person care” for a long while. The most basic definition of this rather clunkily-labelled plan (I’ve always thought it sounds a bit like a weird euphemism for undergoing general anaesthetic), is joining up health and social care, for a more holistic approach to caring for patients throughout their lives, and to stop physical, mental and social care being in separate compartments.

Today, the shadow care minister Liz Kendall is to lay out how joining up health and social care would be used by Labour to make savings in order to fund the shortfall in the NHS budget.

Burnham and his team have long been calling the “whole-person care” idea “efficient”, as well as a better service for the individual patient. He told me in February that the policy is “actually about efficiency” and “spending money we already put into the health and care system much better than we currently do.”

Hinting at Ed Miliband’s initial reticence over the plan – there was a time during the last Labour party conference when it was widely-thought Burnham would be reshuffled – Burnham also said in my interview that he was “assuming that there’s going to be no huge amounts of money for health and social care”, and asked “how do we get much better results for people from what we’re currently putting in? Whole-person care comes from that quite hard-headed assessment of the future outlook of public spending.”

The shadow health secretary also chuckled that upon nearly elbowing Ed Balls in the face at a football match they both took their children to, the shadow chancellor gave such a scowl that a man next to them joked: "I think you’ve just lost the NHS £10bn there in the next spending review". But jokes and violence aside, it's no secret that Balls, and Miliband, have been wary about Burnham's plans, reportedly blocking his idea to hand NHS cash to councils earlier this year.

However, this is the first time Labour’s health team has said its joined-up approach will specifically make savings to plug the apparently imminent “black hole” in the NHS budget. This suggests that the policy has finally received support from Miliband and Balls – indeed, Kendall’s announcement comes a few days after the shadow chancellor ruled out an estates tax or a national insurance hike as sources of funding.

In her speech today, Kendall will say:

Huge cuts to social care are piling further pressure on local hospitals. £3.5bn has been cut from local council care budgets since 2010 and a quarter of a million fewer older and disabled people are getting vital services like home care visits, which help them get up, washed, dressed and fed.

It will be a choice between care going backwards, with fragmented services and money wasted under the Tories – or Labour's plans to fully join-up the NHS and social care so we get the best results for users and the best value for taxpayers' money.

Labour still needs to clarify exactly how this policy will go towards patching up the £2bn shortfall in the NHS budget in England next year alone predicted by health officials, and also whether it is the best approach to the costly strains of an ageing population. But it seems that what it has achieved is some agreement between those holding the purse-strings in the party and Burnham – who is said privately to support an estates tax – and his health team.

Anoosh Chakelian is senior writer at the New Statesman.

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Misogynoir: How social media abuse exposes longstanding prejudices against black women

After decades as an MP, Diane Abbott finally spoke out about the racist and sexist abuse she faces. But she's not alone. 

“Which STD will end your miserable life?” “This is why monkeys don’t belong here.” “I hope you get lynched”. These are just some of the many messages Seyi Akiwowo, a Labour councillor in Newham, told me she has been sent over the past three weeks. Akiwowo has received reams of violent and racist abuse after a video of her suggesting former empires pay reparations to countries they once colonised (and whose resources they still continue to plunder) went viral. She doesn’t expect everyone to agree with her, she said, but people seem to think they’re entitled to hurl abuse at her because she’s a black woman.

The particular intensity of misogyny directed at black women is so commonplace that it was given a name by academic Moya Bailey: misogynoir. This was highlighted recently when Diane Abbott, the country’s first and most-well known black woman MP and current shadow Home secretary, spoke out about the violent messages she’s received and continues to receive. The messages are so serious that Abbott’s staff often fear for her safety. There is an implicit point in abuse like this: women of colour, in particular black women, should know their place. If they dare to share their opinions, they’ll be attacked for it.

There is no shortage of evidence to show women of colour are sent racist and sexist messages for simply having an opinion or being in the public eye, but there is a dearth of meaningful responses. “I don’t see social media companies or government leaders doing enough to rectify the issue,” said Akiwowo, who has reported some of the abuse she’s received. Chi Onwurah, shadow minister for Business, Innovation and Skills, agreed. “The advice from social media experts is not to feed the trolls, but that vacates the public space for them," she said. But ignoring abuse is a non-solution. Although Onwurah notes the police and media giants are beginning to take this abuse seriously, not enough is being done.

Akiwowo has conversations with young women of colour who become less sure they want to go into politics after seeing the way people like Abbott have been treated. It’s an unsurprising reaction. Kate Osamor, shadow secretary of state for International Development, argued no one should have to deal with the kind of vitriol Abbott does. It’s well documented that the ease and anonymity of social media platforms like Twitter and Facebook have changed the nature of communication – and for politicians, this means more abuse, at a faster pace and at all hours of the day. Social media, Onwurah said, has given abuse a “new lease of life”. There needs to be a concerted effort to stop people from using these platforms to spout their odious views.

But there is another layer to understanding misogyny and racism in public life. The rapid and anonymous, yet public, nature of social media has shone a light on what women of colour already know to be a reality. Dawn Butler MP, who has previously described racism as the House of Commons’ “dirty little secret”, told me “of course” she has experienced racism and sexism in Parliament: “What surprises me is when other people are surprised”. Perhaps that’s because there’s an unwillingness to realise or really grapple the pervasiveness of misogynoir.

“Sometimes it takes a lot of effort to get someone to understand the discriminatory nature of peoples’ actions,” Butler explained. “That itself is demoralising and exhausting.” After 30 years of racist and sexist treatment, it was only when Abbott highlighted the visceral abuse she experiences that politicians and commentators were willing to speak out in her support. Even then, there seemed to be little recognition of how deep this ran. In recent years, the Labour leader Jeremy Corbyn has been ridiculed for having a relationship with her in the 70s, as if a black woman’s sexuality is both intriguing and laughable; people regularly imply she’s incompetent, despite having been in Parliament for three decades and at the last general election increasing her majority by a staggering amount; she has even been derided by her own colleagues. Those Labour MPs who began the hashtag #PrayforDiane when she was off work because of illness spoke to a form of bullying that wouldn’t be acceptable in most workplaces.

These supposedly less obvious forms of racism and sexism are largely downplayed or seen as unrelated to discrimination. They might be understood through what influential scholar Stuart Hall called the “grammar of race”. Different from overtly racist comments, Hall says there’s a form of racism that’s “inferential”; naturalised representations of people - whether factual or fictional - have “racist premises and propositions inscribed in them as a set of unquestioned assumptions”. Alongside the racist insults hurled at black women politicians like Abbott, there’s a set of racialised tropes that rely on sexualisation or derision to undermine these women.

The streams of abuse on social media aren’t the only barrier people of colour – and women in particular – face when they think about getting into politics. “I don’t think there’s a shortage of people in the black community who put themselves forward to stand for office, you only have to look at when positions come up the list of people that go for the position,” Claudia Webbe, a councillor and member of Labour's ruling body the National Executive Committee told me. As one of the few black women to hold such a position in the history of the Labour party, she knows from her extensive career how the system works. “I think there is both a problem of unfair selection and a problem of BME [black and minority ethnic] people sustaining the course." Conscious and unconscious racial and gender bias means politics are, like other areas of work in the UK, more difficult to get into if you’re a woman of colour.

“The way white women respond to the way black women are treated is integral,” Osamor says, “They are part of the solution”. White women also face venomous and low-lying forms of sexism that are often overlooked, but at times the solidarity given to them is conditional for women of colour. In a leaked letter to The Guardian, Abbott’s staff criticised the police for not acting on death threats, while similar messages sent to Anna Soubry MP resulted in arrest. When the mainstream left talks about women, it usually means white women. This implicitly turns the experiences of women of colour into an afterthought.

The systematic discrimination against women of colour, and its erasure or addendum-like quality, stems from the colonial racial order. In the days of the British empire, white women were ranked as superior to colonised Asian and African women who were at different times seen as overly sexualised or unfeminine. Black women were at the bottom of this hierarchy. Women of colour were essentially discounted as real women. Recognising this does not equate to pitting white women and women of colour against each other. It is simply a case of recognising the fact that there is a distinct issue of racial abuse.

The online abuse women of colour, and black women specifically, is an issue that needs to be highlighted and dealt with. But there are other more insidious ways that racism and sexism manifest themselves in everyday political life, which should not be overlooked. “Thirty years ago I entered parliament to try and be the change I wanted to see,” Abbott wrote. “Despite the personal attacks and the online abuse, that struggle continues.” That struggle must be a collective one.

Maya Goodfellow researches race and racism in Britain. She is a staff writer at LabourList.