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How Labour broke the NHS – and why Labour must fix it

Successive attempts by Labour and the Tories to update the service have done more bad than good. It's time to put the NHS in intensive care.

It is an awkward fact for many on the left that the partial privatisation of the English National Health Service – started by the New Labour government in 2003 and enthusiastically accelerated by the current Tory-led coalition – has been such an apparent success. When Tony Blair came to power in 1997 the service was struggling, particularly in terms of elective (non-urgent) care. Like all GPs, I often saw my patients having to wait up to 18 months for routine operations.

New Labour’s initial diagnosis was of inadequate resources: public spending on health as the party returned to power was roughly 5 per cent of GDP, substantially lower than in every other developed nation. Blair’s stated ambition was to bring this percentage up to the European average; more money, it was believed, would solve the problem. Labour set about the task with gusto. Gordon Brown’s first Budget in July 1997 heralded an immediate injection of £1.2bn into the NHS, with real-terms spending to rise year on year thereafter. At the same time, Labour began to dismantle some of the previous Conservative government’s experiments with “marketisation” – ending GP fundholding (under which some family doctors operated budgets on behalf of their patients) and re-emphasising collaboration over competition between different parts of the system. For me, as for most ardent supporters of a public-service NHS, they were optimistic days.

Yet by the time of the 2001 election, New Labour was facing accusations of failure to reform. Despite the extra investment in health, service improvements had been frustratingly slow to materialise and were incremental in scale. In addition, there was a worrying new trend. Just as they were doing with the education of their children, the increasingly prosperous middle classes were opting out of state health-care provision in ever greater numbers. Over a few short years it had become noticeably more common for patients in my reasonably affluent corner of southern England to declare they had enough spare cash, or had private insurance (often included in their employment package), and would like to use it to sidestep lengthy NHS waiting times. In an era when most of us swallowed Brown’s “no more boom and bust” myth, and there was a sense the good times might just keep rolling on, we appeared to be sleepwalking towards a US-style health-care system, where those with sufficient resources could get swift access to private treatment, leaving the rest to make do with what the public service could manage to provide.

The danger, as Blair realised, was in the medium to long term: the departure of the middle class would undermine the social contract on which the very idea of a national health service depends.

These were the considerations that led to the extraordinary spectacle of a Labour government adopting a policy direction not even the Tories had dared to explore. The NHS had to become so responsive and user-friendly that there would be no incentive for anyone to go elsewhere. In short, it must be able to compete with the private sector – and the way to do that, it seemed, was to make it “compete”.

To begin with, the Blair government’s approach was to “market-make”; and so, from 2003, successive waves of independent sector treatment centres (ISTCs) were opened throughout England. Run by private companies for profit, ISTCs were contracted (often on very favourable terms) to provide solely NHS elective procedures, creating extra capacity in the system to bring down waiting lists, and at the same time forcing existing providers to polish up their act if they wanted to hang on to any of their more “profitable” work. In parallel, the best NHS hospitals were able to apply for the new foundation trust status, which freed them from public-service constraints to operate more like private businesses.

Out of this market-making grew a new logic: that as well as deliberately inserting private provision inside the NHS, the health market should be opened to external competition. In 2009, in what transpired to be its dying days, New Labour introduced the “any qualified provider” (AQP) initiative, which allowed the private sector to undertake NHS work outside the ISTC programme. It is under AQP that the vast majority of my patients who require elective procedures now choose to spurn both our local district general and the ISTC in favour of referral to the nearby private hospital run by Circle.

The coalition government seized on the inroads made by New Labour. As well as cementing competition for work on a case-by-case
basis under AQP, Section 75 of their Health and Social Care Act 2012 makes it obligatory for commissioners to put every new NHS service (above a trivial size) out to tender. Analysis of data up to 2013 shows more than £12bn of NHS contracts were awarded to private companies during the first three years of the coalition.

On the face of it, the drive to compel competition has done what it was supposed to do (albeit at vastly increased administration costs, with contracts being negotiated, invoiced and monitored by armies of bean-counters on all sides). Much elective NHS care nowadays is provided within weeks, not months or even years. This is unquestionably good for patients. And fears for the future of the social contract have receded: where is the advantage in going private when you can get your operation paid for by the NHS at the same independent hospital?

The health insurance industry has adapted to the new realities, offering cheaper products that pay out only if the NHS should be unable to provide treatment within a specified time frame. With the fall in disposable income that has accompanied austerity, it is once again relatively unusual for my patients to request private referrals. One way or another, the NHS has remained the franchise to which most people look when they have an elective health-care need.

Why then is there a renewed row over NHS privatisation in the current election campaign? It has often been said (by both Labour and the Conservatives at different times) that patients don’t really care who provides their treatment, as long as it’s convenient, of good quality and funded out of general taxation. Surely Ed Miliband should be claiming credit for Labour having been bold enough to go where no political party had ever dared tread? And why is Andy Burnham, the shadow health secretary, publicly committed to repealing the Health and Social Care Act, with its compulsion to competitive procurement?

Burnham is resurrecting the language of the past, articulating a desire to see the NHS as the “preferred provider” of most services, and labelling the 100 days of this election campaign as the last chance to save this concept. Is this simply a belated restatement of an ideology that the left is now embarrassed to have renounced during its most recent years in government? An ideology, furthermore, whose time has been and gone?

The answers to those questions lie in the nature of the problems now facing the health service and how the privatisation agenda has created barriers to tackling them. This is where things begin to get complicated, which is why politicians generally shy away from trying to air them in the media, preferring to fall back on meaningless soundbites such as X billion pounds’ additional spending, or Y thousand extra doctors and nurses. Let me take you on a whistle-stop tour.

The first thing to appreciate is that commercial competition was a response to the NHS’s historically poor performance in providing timely access to mundane, high-volume procedures: cataract removals, joint replacements, gall bladder operations and so on. These elective cases are all discrete episodes: there’s a single problem and a definable clinical activity that will close the case. There are also readily quantifiable measures by which performance can be rated: most obviously, the length of the waiting list.

Markets can work well in this sort of scenario, particularly if risk can be mitigated by excluding complex, often very elderly patients in poor general health with multiple chronic diseases, who are more likely to experience unpredictable and expensive complications. The problem is, with every passing year, there are more and more of us living to become just this kind of patient – patients the private sector doesn’t want to do elective business with at NHS tariff prices, and for whom the old NHS is therefore the default source of help.

The second issue is that these elderly patients with multiple health problems are also presenting to the NHS’s other major arm – urgent-care services – in ever greater numbers. Their health is fragile and they are prone to frequent exacerbations in underlying chronic conditions such as heart failure or lung disease. Otherwise trivial illnesses can have a devastating impact – a simple urinary infection will, in a matter of hours, render a frail and elderly patient completely “off legs” and unable to look after him or herself. Social circumstances are often precarious, patients widowed or living with an equally vulnerable spouse, with far-flung and busy families unable to provide a rapid response should the home situation suddenly deteriorate.

When a patient of this kind becomes unwell, unless significant nursing and social care can be parachuted in at a moment’s notice to shore up community treatment (and at present they can’t) he or she is heading for hospital. Once the person is an inpatient, it can take an unconscionable length of time to help them rehabilitate, and for the social-care system to reinstate or augment a package of care that will allow them to be discharged. Beds get filled; beds get “blocked”.

The third factor is the changed face of NHS urgent-care services. There are all sorts of things one could say about this but here’s the fundamental point: when someone with anything more than a completely straightforward illness becomes unwell, at some stage you are going to need an experienced clinician to decide how to manage it. When I began in practice in 1990 there were only three places you could turn to if a crisis arose: your GP (day or night), the ambulance service, or A&E. The system was understood by virtually everyone and the vast majority of contacts went through their GP first. This, crucially, introduced a highly trained professional at the earliest stage of the process. GPs are thoroughly at home managing uncertainty and negotiating complexity, and we kept a vast amount of work away from hospitals.

Nowadays there is a plethora of other entry points into the urgent-care system – the NHS 111 helpline, walk-in centres, out-of- hours (OOH) services (now mostly provided by private companies) and minor injuries units. NHS 111 and, to a variable extent, the others employ either non-clinical staff operating a risk-averse computer algorithm, or clinicians who are junior and inexperienced. The net result is that the first time many patients encounter an experienced clinician is long after they’ve been admitted to hospital. The opportunity for community management, if it existed, has been lost.

These are the principal forces behind the flurry of declared major incidents this January, which led to hospitals up and down the country closing their full-to-bursting doors. Our own district general remained open – just – but in a continual state of black alert (which is every bit as bad as the name suggests). All elective surgery was abandoned and extraordinary measures were employed to free up every scrap of capacity.

If we want to do anything other than lurch from crisis to crisis, the whole system will have to be reconfigured. Hospitals, GP surgeries, community nursing, OOH, NHS 111, the ambulance service, walk-in centres and minor injuries units are all nominally NHS bodies and should, in theory, be able to work together to ensure only patients genuinely in need of acute hospital care are admitted. The problem is, in our present-day competitive NHS, each entity is trying to protect its budget and ensure its own performance meets the benchmarks by which it will be judged next time its contract comes up for renewal. Perverse and protectionist behaviour ricochets round the system, the easiest solution often being to admit a complex patient and let their care become the responsibility of the hospital. And that’s before you try to bring social care into the mix, which is integral to the project of supporting unwell patients in their homes but which historically has been provided by local government out of a completely separate (and even more pressured) budget.

It is in this incredibly complex and messy situation that Circle – the first private company to be awarded a contract to run an NHS district general hospital, at Hinchingbrooke in Cambridgeshire – announced recently that it will walk away. It’s not that a commercial company can’t run a modern acute hospital; there are half a dozen such private facilities in London (though nowhere else in the country is affluent enough to sustain one). It’s that the kind of money the NHS is offering is woefully inadequate to mitigate the risk to the private sector of unpredictable and ever more intense surges of demand, exacerbated by perverse behaviour elsewhere in the system. Circle is going back to running its controllable elective AQP business, licking the wounds that it has sustained from its adventure into the NHS acute sector.

We made a concerted effort in our area a couple of years ago to solve the problem with urgent care. Most of the big players – our district general hospital, all local GP surgeries, the ambulance service, OOH and the walk-in centre – joined together in an effort to run the newly recommissioned service. This would have aligned the interests of all parties better and should have led to some creative solutions. However, under Section 75 regulations the procurement had to be competitive, with each of the nine eventual bidders being judged on quasi-objective grounds that were rooted largely in process and that weighed only things that could readily be measured. Such is the fear of litigation under competition law that there is simply no latitude for commissioners to use common sense or professional judgement to prefer a bid on the grounds that it is a good idea and exactly what the local area needs. Our bid narrowly lost out to a company based several hundred miles away.

As well as this structural bar to commissioning joined-up working, competitive procurement is eroding the goodwill and loyalty that the NHS has historically enjoyed from its workforce. The firm that won the contract in our area now runs the out-of-hours service and urgent-care centre adjacent to A&E. It has struggled to appoint a local clinical director (the post is still vacant a year in). Many staff who supported out-of-hours provision for years have walked away, so alienated do they feel; each week, the company has to fly or chauffeur clinicians and drivers from elsewhere in the country just to keep what is at times a skeleton service going. Turnover is high and those local staff who continue to work under the new regime are weary of the constant appeals to step into the breach to fill rota gaps.

Staff and doctors who once willingly responded to requests for assistance leave their phones unanswered when they recognise the number of the rota administrator. A rich but unquantifiable resource, which might be called the public-service ethos in the NHS, has been squandered in front of our eyes. Even at this stage it may be too late to recapture it.

The deleterious effects of a competitive marketplace have been loudly argued by opponents of privatisation throughout the past decade. Yet according to one commissioner with over 20 years’ experience of health-
service procurement, no one in government had any vision of how the competition agenda might degrade integrated systems of care for patients with multiple diseases. The
focus was unrelentingly on improving elective care – the NHS’s low-hanging fruit – with fingers crossed in the forlorn hope that the changes being made wouldn’t destabilise the rest of the service.

Of the major parties contesting the forthcoming general election, it is Labour that seems to understand the issue, and it is this that underpins Andy Burnham’s pledge to repeal the Health and Social Care Act and to legislate to exempt the NHS from EU competition legislation. Integrated care is the only game in town and it can only be delivered within projected levels of spending by well-configured public services that have been freed from the fragmentary consequences of enforced competition. That said, Labour finds itself in an embarrassing position: the party that began privatisation has to explain why that process – which has, after all, resulted in improvements in the elective-care arm of the service – is simultaneously incompatible with meeting the present-day challenges the NHS faces.

The Conservatives, by contrast, are silent; the NHS was conspicuously absent when they announced their six key manifesto areas. Having gone into the last election promising no more top-down reorganisations of the service, and having then presided over arguably the most damaging such reorganisation in the history of the service, they may quite reasonably believe that nothing they say on the subject will be trusted. They may also have calculated that the complexity of the problem defies exploration in our soundbite-dominated culture and that saying nothing will allow them to continue business as usual, should they be re-elected. If so, that would be a cynical continuation of the approach that has created the mess we are all dealing with.

Burnham is right: this election does represent a fundamental decision point as to how our NHS will develop or degrade in the future. We need to know, well in advance of the poll, where each party stands on this important matter. And having declared its approach, whichever party goes on to lead the next government must somehow be held to keep the promises on which it has been voted into power.

Dr Phil Whitaker is an award-winning novelist. He writes the New Statesman’s Health Matters column

This article first appeared in the 27 February 2015 issue of the New Statesman, Russia vs the west

MARTIN O’NEILL
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The new young fogeys

Today’s teens and twentysomethings seem reluctant to get drunk, smoke cigarettes or have sex. Is abstinence the new form of youth rebellion?

In a University College London lecture theatre, all eyes are on an elaborate Dutch apple cake. Those at the back have stood up to get a better look. This, a chorus of oohs and aahs informs me, is a baked good at its most thrilling.

In case you were wondering, UCL hasn’t rented out a room to the Women’s Institute. All thirty or so cake enthusiasts here are undergraduates, aged between 18 and 21. At the third meeting this academic year of UCL’s baking society, the focus has shifted to a Tupperware container full of peanut butter cookies. One by one, the students are delivering a brief spiel about what they have baked and why.

Sarah, a 19-year-old human sciences undergraduate, and Georgina, aged 20, who is studying maths and physics, help run the baking society. They tell me that the group, which was set up in 2012, is more popular than ever. At the most recent freshers’ fair, more than 750 students signed up. To put the number in perspective: that is roughly 15 per cent of the entire first-year population. The society’s events range from Great British Bake Off-inspired challenges to “bring your own cake” gatherings, such as today’s. A “cake crawl”, I am told, is in the pipeline. You know, like a pub crawl . . . but with cake? Georgina says that this is the first year the students’ union has advertised specifically non-drinking events.

From the cupcake boom to the chart-topping eminence of the bow-tie-wearing, banjo-plucking bores Mumford & Sons, the past decade of youth culture has been permeated by wholesomeness. According to the Office for National Statistics (ONS), this movement is more than just aesthetic. Not only are teenage pregnancies at their lowest level since records began in the 1960s, but drug-taking, binge drinking and sexually transmitted infections among young people have also taken significant dives. Drug use among the under-25s has fallen by a quarter over the past ten years and heavy drinking – measured by how much a person drinks in an average week – is down by 15 per cent. Cigarettes are also losing their appeal, with under-25 smokers down by 10 per cent since 2001. Idealistic baby boomers had weed and acid. Disaffected and hedonistic Generation X-ers had Ecstasy and cocaine. Today’s youth (which straddles Generations Y and Z) have cake. So, what shaped this demographic that, fairly or otherwise, could be called “Generation Zzzz”?

“We’re a lot more cynical than other generations,” says Lucy, a 21-year-old pharmacy student who bakes a mean Welsh cake. “We were told that if we went to a good uni and got a good job, we’d be fine. But now we’re all so scared we’re going to be worse off than our parents that we’re thinking, ‘Is that how we should be spending our time?’”

“That” is binge drinking. Fittingly, Lucy’s dad – she tells me – was an anarchist with a Mohawk who, back home in the Welsh valleys, was known to the police. She talks with deserved pride about how he joined the Conservative Party just to make trouble and sip champagne courtesy of his enemies. Lucy, though decidedly Mohawk-free, is just as politically aware as her father. She is concerned that she will soon graduate into a “real world” that is particularly hard on women.

“Women used to be a lot more reliant on men,” she says, “but it’s all on our shoulders now. One wage isn’t enough to support a family any more. Even two wages struggle.”

***

It seems no coincidence that the downturn in drink and drugs has happened at the same time as the worst financial crisis since the Great Depression. Could growing anxiety about the future, combined with a dip in disposable income, be taming the under-25s?

“I don’t know many people who choose drugs and alcohol over work,” says Tristan, a second-year natural scientist. He is one of about three men at the meeting and it is clear that even though baking has transcended age it has yet to transcend gender to the same extent. He is softly spoken and it is hard to hear him above a room full of sugar-addled youths. “I’ve been out once, maybe, in the past month,” he says.

“I actually thought binge drinking was quite a big deal for our generation,” says Tegan, a 19-year-old first-year linguistics undergraduate, “but personally I’m not into that. I’ve only been here three weeks and I can barely keep up with the workload.”

Tegan may consider her drinking habits unusual for someone her age but statistically they aren’t. Over a quarter of the under-25s are teetotal. Neither Tegan nor Lucy is dull. They are smart, witty and engaging. They are also enthusiastic and seemingly quite focused on work. It is this “get involved” attitude, perhaps, that distinguishes their generation from others.

In Absolutely Fabulous, one of the most popular British sitcoms of the 1990s, a lot of the humour stems from the relationship between the shallow and fashion-obsessed PR agent Edina Monsoon and her shockingly straitlaced teenage daughter, Saffie. Although Saffie belongs to Generation X, she is its antithesis: she is hard-working, moral, politically engaged, anti-drugs and prudishly anti-sex. By the standards of the 1990s, she is a hilarious anomaly. Had Ab Fab been written in the past couple of years, her character perhaps would have been considered too normal. Even her nerdy round glasses and frumpy knitted sweaters would have been considered pretty fashionable by today’s geek-chic standards.

Back in the UCL lecture theatre, four young women are “geeking out”. Between mouthfuls of cake, they are discussing, with palpable excitement, a Harry Potter-themed summer camp in Italy. “They play Quidditch and everything – there’s even a Sorting Hat,” says the tall, blonde student who is leading the conversation.

“This is for children, right?” I butt in.

“No!” she says. “The minimum age is actually 15.”

A kids’ book about wizards isn’t the only unlikely source of entertainment for this group of undergraduates. The consensus among all the students I speak to is that baking has become so popular with their demographic because of The Great British Bake Off. Who knew that Mary Berry’s chintzy cardigans and Sue Perkins’s endless puns were so appealing to the young?

Are the social and economic strains on young people today driving them towards escapism at its most gentle? Animal onesies, adult ball pools (one opened in west London last year) and that much-derided cereal café in Shoreditch, in the East End, all seem to make up a gigantic soft-play area for a generation immobilised by anxiety.

Emma, a 24-year-old graduate with whom I chatted on email, agrees. “It feels like everyone is more stressed and nervous,” she says. “It seems a particularly telling sign of the times that adult colouring-in books and little, cutesy books on mindfulness are such a massive thing right now. There are rows upon rows of bookshelves dedicated solely to all that . . . stuff.” Emma would know – she works for Waterstones.

From adult colouring books to knitting (UCL also has a knitting society, as do Bristol, Durham, Manchester and many more universities), it is hard to tell whether the tsunami of tweeness that has engulfed middle-class youth culture in the past few years is a symptom or a cause of the shrinking interest in drugs, alcohol, smoking and other “risk-taking” behaviours.

***

Christine Griffin is Professor of Social Psychology at Bath University. For the past ten years, she has been involved in research projects on alcohol consumption among 18-to-25-year-olds. She cites the recession as a possible cause of alcohol’s declining appeal, but notes that it is only part of the story. “There seems to be some sort of polarisation going on,” Griffin says. “Some young people are actually drinking more, while others are drinking less or abstaining.

“There are several different things going on but it’s clear that the culture of 18-to-25-year-olds going out to get really drunk hasn’t gone away. That’s still a pervasive social norm, even if more young people are drinking less or abstaining.”

Griffin suggests that while frequent, sustained drinking among young people is in decline, binge drinking is still happening – in short bursts.

“There are still a lot of people going to music festivals, where a huge amount of drinking and drug use goes on in a fairly unregulated way,” she says. It is possible that music festivals and holidays abroad (of the kind depicted in Channel 4 programmes such as What Happens in Kavos, in which British teenagers leave Greek islands drenched in booze and other bodily fluids) are seen as opportunities to make a complete escape from everyday life. An entire year’s worth of drinking, drug-taking and sex can be condensed into a week, or even a weekend, before young people return to a life centred around hard work.

Richard De Visser, a reader in psychology at Sussex University, also lists the economy as a possible cause for the supposed tameness of the under-25s. Like Griffin, however, he believes that the development is too complex to be pinned purely on a lack of disposable income. Both Griffin and De Visser mention that, as Britain has become more ethnically diverse, people who do not drink for religious or cultural reasons – Muslims, for instance – have become more visible. This visibility, De Visser suggests, is breaking down taboos and allowing non-mainstream behaviours, such as not drinking, to become more socially accepted.

“There’s just more variety,” he says. “My eldest son, who’s about to turn 14, has conversations – about sexuality, for example – that I never would’ve had at his age. I think there’s more awareness of alcohol-related problems and addiction, too.”

De Visser also mentions the importance of self-image and reputation to many of the young non-drinkers to whom he has spoken. These factors, he argues, are likely to be more important to people than the long-term effects of heavy drinking. “One girl I interviewed said she wouldn’t want to meet the drunk version of herself.”

Jess, a self-described “granny”, is similarly wary of alcohol. The 20-year-old Liverpudlian, who works in marketing, makes a bold claim for someone her age. “I’ve never really been drunk,” she says. “I’ve just never really been bothered with alcohol or drugs.” Ironically, someone of her generation, according to ONS statistics, is far more likely to be teetotal than a real granny at any point in her life. Jess says she enjoys socialising but her nights out with close friends are rather tame – more likely to involve dinner and one quick drink than several tequila shots and a traffic cone.

It is possible, she suggests, that her lack of interest in binge drinking, or even getting a little tipsy, has something to do with her work ethic. “There’s a lot more competition now,” she says. “I don’t have a degree and I’m conscious of the need to be on top of my game to compete with people who do. There’s a shortage of jobs even for people who do have degrees.”

Furthermore, Jess says that many of her interactions with friends involve social media. One theory put forward to explain Generation Zzzz is that pubs are losing business to Facebook and Twitter as more and more socialising happens online. Why tell someone in person that you “like” their baby, or cat, or new job (probably over an expensive pint), when you can do so from your sofa, at the click of a button?

Hannah, aged 22, isn’t so sure. She recently started her own social media and communications business and believes that money, or the lack of it, is why her peers are staying in. “Going out is so expensive,” she says, “especially at university. You can’t spend out on alcohol, then expect to pay rent and fees.” Like Jess (and as you would probably expect of a 22-year-old who runs a business), Hannah has a strong work ethic. She also has no particular interest in getting wasted. “I’ve always wanted my own business, so for me everything else was just a distraction,” she says. “Our generation is aware it’s going to be a bit harder for us, and if you want to support yourself you have to work for it.” She also suggests that, these days, people around her age have more entrepreneurial role models.

I wonder if Hannah, as a young businesswoman, has been inspired by the nascent strand of free-market, “lean in” feminism. Although the women’s movement used to align itself more with socialism (and still does, from time to time), it is possible that a 21st-century wave of disciples of Sheryl Sandberg, Facebook’s chief operating officer, is forswearing booze, drugs and any remote risk of getting pregnant, in order to get ahead in business.

But more about sex. Do the apparently lower rates of sexually transmitted infections and teenage pregnancies suggest that young people are having less of it? In the age of Tinder, when hooking up with a stranger can be as easy as ordering a pizza, this seems unlikely. Joe Head is a youth worker who has been advising 12-to-21-year-olds in the Leighton Buzzard area of Bedfordshire on sexual health (among other things) for 15 years. Within this period, Head says, the government has put substantial resources into tackling drug use and teen pregnancy. Much of this is the result of the Blair government’s Every Child Matters (ECM) initiative of 2003, which was directed at improving the health and well-being of children and young adults.

“ECM gave social services a clearer framework to access funds for specific work around sexual health and safety,” he says. “It also became a lot easier to access immediate information on drugs, alcohol and sexual health via the internet.”

***

Head also mentions government-funded education services such as Frank – the cleverly branded “down with the kids” anti-drugs programme responsible for those “Talk to Frank” television adverts. (Remember the one showing bags of cocaine being removed from a dead dog and voiced by David Mitchell?)

But Head believes that the ways in which some statistics are gathered may account for the apparent drop in STIs. He refers to a particular campaign from about five years ago in which young people were asked to take a test for chlamydia, whether they were sexually active or not. “A lot of young people I worked with said they did multiple chlamydia tests throughout the month,” he says. The implication is that various agencies were competing for the best results in order to prove that their education programmes had been effective.

However, regardless of whether govern­ment agencies have been gaming the STI statistics, sex education has improved significantly over the past decade. Luke, a 22-year-old hospital worker (and self-described “boring bastard”), says that sex education at school played a “massive part” in his safety-conscious attitude. “My mother was always very open [about sex], as was my father,” he says. “I remember talking to my dad at 16 about my first serious girlfriend – I had already had sex with her by this point – and him giving me the advice, ‘Don’t get her pregnant. Just stick to fingering.’” I suspect that not all parents of millennials are as frank as Luke’s, but teenagers having sex is no longer taboo.

Luke’s attitude towards drugs encapsulates the Generation Zzzz ethos beautifully: although he has taken MDMA, he “researched” it beforehand. It is this lack of spontaneity that has shaped a generation of young fogeys. This cohort of grannies and boring bastards, of perpetual renters and jobseekers in an economy wrecked by less cautious generations, is one that has been tamed by anxiety and fear.

Eleanor Margolis is a freelance journalist, whose "Lez Miserable" column appears weekly on the New Statesman website.

This article first appeared in the 05 February 2015 issue of the New Statesman, Putin's war