Skip to content

Poverty should not always be with us

Depression 

In the last month I have taken up a new responsibility as a Trustee of the Joseph Rowntree Foundation. It’s an organisation I have long admired and I am delighted to have the chance of being part of its mission to tackle UK poverty.

The Joseph Rowntree organisations have been working in this field for well over a century. What we mean by poverty in 2017 is, in some ways, very different from when those organisations started their work in the first decade of the 20th century.  However despite undoubted progress on some fronts, poverty remains a scourge on the face of British society which continues to call for action.

I have three drivers for wanting to focus on this issues. The first is personal.  I am very lucky to have enjoyed many advantages in life, in my upbringing, my education and the options which have been open to me in my professional life. It is not so long, however, since, particularly my father’s family in South Wales, experienced poverty in the wake of mass unemployment in the 1930s. The narrative of that experience was crucial in forming my values as a young person and in setting a belief that a key goal of social policy should be to eliminate both the material and psychological distress engendered by poverty.

The second driver is a reflection from 30 years working in health and care is to what a large extent poverty drives not just material disadvantage but a wider range of other life outcomes: poorer health, poorer education, poorer work, poorer housing and poorer participation.  Poverty stacks the odds against individuals and communities across a range of issues.  Tackling poverty is key to addressing so many other social problems.

The final motivator comes from my particular professional experience in the ten years I have worked in the field of mental health. There is a strong relationship of cause and effect between mental ill health and poverty.  Poverty and social disadvantage are for many a consequence of mental ill health in large part due to the impact mental illness has on a person’s chance of getting or keeping a job.    At the same time the chances of developing a mental illness are much higher amongst higher amongst people and families in poverty with the psychological impact of poverty being a significant risk factor for mental health problems.

The shape of poverty does not stay still. Some laudable progress has been made in recent decades in reducing child and pensioner poverty but, sadly, other issues have come to the fore.  A number of challenges stand out.

There is a troubling concern about the growth of the working poor and the inability of large number of people, despite the introduction of minimum and living wages, to sustain a decent quality of life while in work. There are many issues behind this, some relate to issues around costs, such as housing, as well as to problems with income.  These problems have got significantly worse with the restraints on wage growth since the last Recession and are further exacerbated by the increase in inflationary pressures since Brexit.

It is also a great worry to see a growth in the concentration of poverty in families affected by disability. While much progress has been made in promoting the better participation of people with disabilities in the labour market there is clearly still a major issue for individuals themselves and for carers.  Some of the issues are clearly reinforcing.  If you are already in poverty and have a disability or a caring responsibility there is a double level of disadvantage.  Benefit reform has been particularly punitive on people with disabilities.

Tackling poverty has, in my view, three requirements. The first is to make poverty visible.  JRF has done an excellent job over the years in marshalling the evidence and data on the nature and causes of poverty in the UK.  As well as the facts there is a need for human stories, what poverty means on a day to day basis for the people who live with it.  Those stories have been so crucial for changing opinion in other causes such as attitudes on mental health.

The second is to build and develop the evidence base for what works and supporting those who wish to use that evidence base in practice.  Action is needed at many different levels but as in many areas of public policy there seems to be a particular opportunity to look at interventions which are place based and which bring together the contribution of different agencies.

The final ingredient is helping to create the political will for change. Poverty should be something which is seen by public and politicians as intolerable in our society.  Sadly. however, it is often too easily tolerated, in part because it is invisible, in part because it is convenient to blame people in poverty themselves for the circumstances they find themselves in, in part because it feels too difficult to do anything about it.   None of these are a good enough excuse.  Campaigning for change needs to be a matter of head and heart.  Research and evidence create the case for change and promote solutions.  However time and time again it is an emotional reaction to an event such as Grenfell Tower, or to the sight of people sleeping on the street or forced to use food banks which creates the real momentum for change.  Participation is also crucial.  People in poverty, for a variety of reasons, are some of the most excluded from the democratic process.  Politics is a numbers game and as we’ve seen very clearly with the youth vote, democratic participation can have a positive effect on political agendas.

Back to my South Welsh roots. In the 1930s The Prince of Wales, the future Edward VIII, visited the South Welsh valleys and saw at first hand the impact of poverty and mass unemployment.  He was moved by what he saw and famously commented “something must be done.”  We need the same revelation in our leaders in respect of poverty in 2017.  We can all be part of making the case.

 

Remember, Remember 1st July

101 years ago today thousands of British soldiers stood prepared to climb out of their trenches and take part in what was hoped to be a decisive attack on the German lines in front of them. Within minutes of the start of the attack many lay killed or injured in what remains, and I hope will always remain, the bloodiest day in British military history.  Of 116,000 British and Empire troops who took part in the battle on 1st July 1916, 57,470 became casualties and 19,240 were killed.

Last year, as part of my Western Front cycle, I spent a couple of days on the Somme battlefield.   The saddle of a bike provided an excellent viewpoint to appreciate the landscape in which so many brave young men were sent to their deaths.  I have also just finished reading Jolyon Fenwick’s excellent “Zero Hour” which describes the story of that day and the countryside in which it was fought with the help of a series of maps, contemporary accounts and panorama pictures from the front line positions from which the attacks were launched.

In only two parts of the front: Mametz and Montauban were the British successful in holding at the end of the day the positions they had set out at the beginning of the day to capture.  Elsewhere the attacks either failed at the outset, driven back by the intensity of the German machine gun and shell fire, or hard won gains had to be abandoned later in the day when the original attackers became overwhelmed and attempts to reinforce new positions were given up.

The underlying story of the day was similar across the front. Generals had been hopelessly optimistic about what the attack might achieve.  The British bombardment, while full of “shock and awe” for those witnessed it was of insufficient intensity to deliver a knockout blow to the German defensive positions which, in any case, were deeper and more extensive than anticipated.  Finally the timing of the British assaults gave the German defenders in many cases a crucial period of time to emerge from their positions and set up a deadly network of machine guns.  As a result in many sectors of the front the British troops emerged from their trenches into a sea of bullets.  In this context the attackers didn’t stand a chance and many were killed before they had even got out of their trenches.  It took months to retrieve the bodies of those who fell and for some no identifiable physical remains were ever found.

The day was full of the most incredible courage. Perhaps nothing epitomises this more than the attack of the Ulster regiments on the Schwaben Redoubt, the strongly fortified German position near Thiepval.  With an element of surprise and through immense bravery they managed to capture the position and open up the genuine possibility of a breakthrough.  However, as was the case elsewhere, it was not possible to reinforce the position and by 10pm it had had to be given up.  A moving memorial marks the position today.

Some of the poignancy of this day related to the nature of the army which took part in it. This was the outing of Kitchener’s New Army, the thousands of young men who had left civilian life at the beginning of the War to meet the call to serve King and Country, driven by both by patriotism and by the wish to escape the mundaneness of everyday life.  The army was full of Pals Regiments; new units recruited from the same place, young men who had joined up at the same time, often encouraged by employers or civic leaders.  Much of the idealism which had brought those young men together was challenged to its roots on that first day of the Somme although what remained was a deep commitment to those sharing that common experience.

News of the conflict in the First World War was heavily censored. “Forward in the West” was the first headline in the Times.  However the news of the scale of the loss could not be kept hidden for ever.  Too many families were affected and news trickled back through and formal and informal channels about those who had survived and those who had lost their lives.  This was one of the first battles in history with some official filming of the action.  Geoffrey Malins film The Battle of the Somme, which included footage of the explosion of the massive mine at Beaumont Hamel, was seen by over a million people.  It opened up some of the reality of modern warfare to the civilian population and established a tradition of battlefield coverage which we now take for granted.

To finish some comment is necessary on the conduct of the Generals and the part they played in such a calamitous loss of life. The First World War brought enormous challenges in effective battlefield leadership, in particular given the absence of voice command, which before and after would allow Generals to direct operations in real time.  In essence once started the Generals were fairly powerless to alter the course of events.  However they could control the strategy and preparations and serious mistakes were made in overestimating the power of the British artillery and underestimating the remaining strength of the German positions.  Most galling was the naïve optimism of some, not all, commanders and the apparent willingness to tolerate such enormous casualties for such small gains in territory or strategic advantage.  The tone was set from the top and Douglas Haig’s comment when notified that casualties for the day had reached 40,000 “This cannot be considered severe in view of the numbers engaged, and the length of the front attacked” illustrates a contempt for the value of individual life which was repeated across military leaders in the conflict.  As we have a taste of today there is something deeply dangerous when such a gap grows up between those leading and those led and where false certainty is imposed on situations where none can legitimately exist.

We may be past the centenary now but the anniversary of the first day of the Battle of Somme should be a constant reminder of the horror and futility of war. For many years I sat each Sunday in church near the memorial to Frederick William Wood, son of the vicar of Headingly and member of the Leeds Pals.  The same age as my grandfather he was one of those 19,000 British soldiers who died on that day.  There are days in history we should never forget.  1st July 1916 should be one of them.

Who cares for the carers?

Nurse-rubbing-her-forehead-in-hospital

It was timely and appropriate to hear at last week’s NHS Confederation Conference from staff involved in the immediate response to last month’s bomb attack in Manchester. The stories of the commitment of NHS staff in responding to the needs of those were affected by the blast were truly inspiring.  It was also important to reflect on the psychological and emotional strains which such events place on staff and to recognise what we need to do support them.

However I was also struck that this story was not one just about exceptional events such as the Manchester bombing, but had much greater significance in reminding us about the underlying nature of clinical work and how we address what is needed to promote staff wellbeing and resilience.

We have two reasons for needing to do so. First the values of the NHS should reinforce in us a strong commitment to looking after our staff, as we always say our most valuable resource and one which is doing, day in day out, a difficult and psychologically challenging job.  The work of clinicians and others who are involved in directly supporting patients work in constant proximity to distress, suffering and death.  Inevitably this has an emotional cost, particularly when combined with the sense of responsibility which staff will feel about the impact of their own actions on what happens to patients. We need to recognise this much more explicitly in our public discourse about the delivery of healthcare.  We are not making widgets.

The second reason, is, as researchers like Michael West have clearly demonstrated, that there is a close correlation between staff engagement and wellbeing and the quality and effectiveness of care. His analysis of the results of the staff survey shows clearly that Trusts with better scores for staff engagement also do better in relation to patient satisfaction and for certain measures of clinical quality.  Poor engagement correlates with burn out and we should all be concerned at the finding in the latest staff survey that 37% of staff report having taken a period of absence in the last 12 months due to work related stress.

These issues matter all the more in the context of the very significant pressures we face on workforce and staffing. Whatever our efforts the pipeline for new supply of clinical staff will not address easily the likely gaps we will face across a range of clinical disciplines over the next 5 years, gaps which Brexit and other factors are only likely to worse. Initiatives around retention will be key if we are to find a way through.

Pay will be a key issue and I welcomed the suggestion made by the Secretary of State at the conference to argue the case for lifting pay restraint for NHS staff. The worsening differential between NHS staff and workers in other parts of the economy must be a serious concern and without some attempt to address this, our workforce problems will only get worse.  It goes to say, of course, that any increase must be fully funded and not add to the financial problems of providers.

However alongside pay we must also prioritise the agenda of staff wellbeing. The question of the psychological dynamics of clinical work has long been an area of interest for my Trust.  This starts, as I highlighted earlier, with a recognition of the psychological and emotional wear and tear of caring roles and the need to invest in approaches which help staff feel supported.

Michael West sees good engagement underpinned by two ingredients: job resources such as the degree of control staff feel over their work, systems of reward and recognition and the extent to which staff supported by their organisation and personal resources around individual’s resilience and ability to process stress and distress.

There is a long established tradition of work discussion groups which provide a safe, confidential, multidisciplinary and non-hierarchical forums for staff to come together and deal with the issues they encounter in their day to day clinical practice. A number of models exist, Schwartz Rounds and Balint Groups being amongst the most well-known and there is a good body of knowledge about how they support staff wellbeing and engagement.

At the heart of both approaches is the issue of empathy and compassion, the ingredients which above all others distinguish excellent care. The ability, in the words of Ken Schwartz, whose legacy led to the creation of Schwartz rounds, to deliver the small acts of kindness which make the unbearable, bearable for patients and their families. Such approaches are followed in many NHS organisations but should, I would argue, become mainstream.

At a time when our NHS faces unprecedented demands what is, in the scheme of things, relatively modest investment in protecting the wellbeing and engagement of our staff must be a top priority for leaders. Without them we have little chance of meeting the challenges ahead.

 

A follower of things historical

julius-caesar-roman-britain-vintage-ladybird-book-history-series-561-first-edition-dust-cover-1959-4[ekm]298x452[ekm]

My love of history started very young with the Ladybird book of Julius Caesar and Roman Britain. It has been a lifelong pursuit, the subject I studied at university and a major source of ongoing interest ever since.  Furthermore, it has been, I would argue an immensely practical training for the career I have pursued.  For how can one plan for the future without what, and just as importantly, why and how things happened in the past?

History, our ability to develop a collective understanding of who we are as individuals and groups and how we have been shaped by what has happened to us is at the heart of what makes us human. It is a crucial intellectual discipline in itself but also a critical part of understanding many other issues, medicine and healthcare to give but one example.

History operates at two levels. The first is the process of research: the discovery and analysis of records and other sources of evidence; the sifting of truth from falsehood; the piecing together of a story from disparate facts.  Historical periods come in two varieties.  Those like the ones I studied at niversity where sources and data are thin on the ground and where the process of reconstruction can, at the best, be only partial.  Those like our own times where there is too much information and the challenge is to spot the wood for the trees.

The other level of history is broader and more strategic. The task here is to draw together evidence to construct a wider narrative about what has happened in the past and what it means for us in the present.  This can involve, at times, opening up new aspects of inquiry or recasting the traditional interpretations of events or bringing new models of thinking to the task of how we look at the past.

All subjects are, in their own way, ideological but history is explicitly so. George Orwell’s adage that “He who controls the past controls the future” is highly relevant and has often been at the heart of the motivations of those who have written or commissioned history.  Ideological bias has always to recognised but, I would argue, it has not always been a bad thing.  Marxist historians have brought many prejudices to the history they have written but they have also been responsible for a healthy willingness to broaden the focus of historical enquiry away from the rich and powerful to include the lives of ordinary people.

To finish this blog I wanted to share six of the historians whose work I have most appreciated. It was hard to stop at six but here goes.

My first choice has to be the Greek historian Thucydides whose account of the “History of the Peloponnese War” is one of the first pieces of serious historical writing which attempts to describe events and their causes. It remains gripping history two and a half millennia later.   The description of Pericles’ famous Funeral Oration provides a fascinating and powerful insight into the values and tensions of the first democratic society.

My second historian is Eric Hobsbawn whose four volume of the rise of industrial capitalism and modern society in the two centuries between 1789 and 1989 is monumental in the sweep and depth of its historical perspective. The last volume “The Age of Extremes” is a fascinating account of the last century, the scale of change in human life it entailed and the brutality it unleashed as part of those changes.

Third up is Roy Porter, originally a historian of the 18th century but one whose reputation is based on his work in describing the history of medicine and significantly that of mental illness.  His landmark book “The Greatest Benefit to Mankind” is a fascinating account of the history of medicine, both in terms of the tracking the scientific progress made by medicine but also the also the social role and motivations of those who have practiced medicine.  His extensive writings on mental illness are well worth reading, in particular for its determination to create a place for the lost voices of those who have been affected by mental illness in the past.

My next choice is the American historian Barbara Tuchman, one of the best historical narrators I have come across, whether in “August 1914”, her brilliant account of the first month of World War 1, “A Distant Mirror” an account of the 14th century and the Hundred Years’ War through the lens of the life of the French nobleman Enguerrand de Coucy of “The March of Folly”, a set of essays which prove Voltaire’s dictum “History does not repeat itself, men do.”

“Montaillou”, by the French historian Emmanuel le Roy La Durie remains one of the most fascinating historical bookds I have ever read. Due to the survival of the amazingly detailed records of the Inquisition, La Durie is able to reconstruct, in microscopic detail, the life and beliefs of a 13th century village in the Pyrenees which is gripped by the Cathar heresy. Such an insight into the daily lives, let alone thoughts and beliefs of past generations is rarely possible.  The past is indeed “a foreign country”.

It would be unsurprising for me to finish with a Welsh historian, John Davies. His “Hanes Cymru”, written in Welsh but available also in England provides the best and most integrated account of the history of my own nation.  As this blog has tried to argue, history is essential to all sense of identity, particularly the identity of nations, however small.

Others will have their choices but all the six I have chosen I value not just for what they have to say about the past but what they can contribute to an understanding of the present.

We live in an uncertain times and that makes history, for me, an ever more essential area of study. For if we do not know where we have come from, how can we judge where we are going?

 

 

 

 

No alternative – next steps on the Five Year Forward View

NHS Building 

The refresh of the Five Year Forward View, published on Friday, gave all of us in the NHS our marching orders for the priorities in navigating the next two crucial years in the service’s history. The original 5 Year Forward View was one of those rare genuinely strategic moments, inevitably Friday’s publication was tactics.  Like most of the key pronouncements in the Stevens’ era it was worth reading and, in my view, made the most of a difficult hand.

The abiding message was more of the same and quite right too. The original Five Year Forward View prompted an unprecedented level of consensus on what needed to change if we were to deliver a sustainable health and care system which could withstand the demographic and other pressure of the next 20 years.  Some progress has been made in delivering that vision and, however difficult the current circumstances, now is not the time to draw back.  However, given the scale of financial and workforce pressure in the system, delivery is not straightforward.

The Refresh is clear about the givens. Brexit is Brexit and the money is the money.  Whatever happens will happen within the funding committed in the Comprehensive Spending Review and the next two years are the toughest ones in the settlement.  There is little room for investment in the double running of services and activities which would smooth the process of transforming services, very little room to deal with anything new or unexpected such as a genuine flu epidemic, very little scope to address the financial pressure on NHS staff, especially at the time when Brexit will exacerbate staffing pressures, and very little room to get anything wrong.  It’s not impossible but the margins are immensely tight, as anyone of us involved in driving a STP delivery plan is more than aware.

However that is the hand which Simon Stevens has been dealt and which he, in turn, has to get the NHS to operate within.  Unless political pressure plays out with a different dynamic than it has over the last 6 months, and something did shift on social care, then the chances of new money remain very low.  There are, though, some important commitments which might make a difference.

First there is a clear and consistent set of priorities: finance, A&E, primary care, mental health and cancer.  In the circumstances these make sense and I am pleased to see the commitment to mental health followed through again although there is still much to do to make the funding flows required to deliver the Mental Health Five Year Forward View objectives clear and transparent.

Second there is a recognition that something else has to give in the form of waiting time targets for some routine surgery and treatment. This will not be without cost for individuals who will face longer periods of distress and anxiety as they wait for treatment, something which in mental health, without historic waiting time guarantees, we are all too familiar with.  There must also be a concern that this is the beginning of a process by which the NHS consolidates as a universal service around urgent care.  Nonetheless in the circumstances it may be the least bad thing to do.

Third there is the commitment for budget flexibility in relation to the rollout of new drug treatments. This will again not be without cost but I have long felt that it was unjust that new drug treatments and the commercial interests of the pharmaceutical industry trumped basic access to care in areas such as psychological therapies.  Unless we see substantial new growth in future funding for the NHS we will need, in any case, to see a radical overhaul of thresholds for approving new drugs and treatments with a much greater emphasis on those with a genuinely transformational impact and less space for “Me toos”.

Finally it was interesting to read the intention to put the nail in the coffin of QoF which the Refresh describes tactfully  “as an approach which has run its course”. As I remember from the time, its intentions were well meant but as a mechanism for driving genuinely health improvement it has become discredited. Hopefully there will be better ways of spending £700 million.

It takes until Chapter 8 until we reach the issue of Workforce and yet nothing could be more significant, both to managing short term pressures and to longer term hopes of transformation. Workforce pressures and issues have been central to some of the biggest financial and quality challenges over the last couple of years, epitomised by agency staffing.  They perhaps have a bigger profile in the Refresh than they did in the original Five Year Forward View but the NHS has a consistent record of not giving workforce the attention it is due.  That cannot be the case over the next couple of years.

There are three challenges. Keeping the numbers on track at a time when retention may be difficult with ongoing pay restraint and the impact of Brexit.  Reskilling the existing workforce to work in the very different ways required by new models of care, perhaps the part of service transformation which mental health took longest to get right in respect of the closure of the long stay hospitals.  Finally the challenge of maintaining staff morale and wellbeing when anxiety is high, pressures are increasing and pay restraint likely to continue.

As we enter the new financial year it is a good time to take stock on where we’ve got to. The Refresh deliberately accentuates the positives and, despite the pressures which most of us can feel trying to manage the system, it is right to celebrate some of the significant achievements of the last year including the introduction of the first waiting time targets for mental health.  In the last year the NHS and its staff have shown great strength, commitment and resilience to achieve what they have in such difficult times.  While the direction of travel still remains the right one it will take a lot more hard work and resilience to get to the final destination.

 

Don’t roll over Beethoven

Rhine 15 038

 

Serious music started for me with Beethoven. I remember listening with wonder to the record of Fifth Emperor Piano Concerto I was given as a Christmas present in 1974.  Shortly afterwards came the symphonies which remain some of my favourite works and which kindled a lifelong interest in and passion for classical music.   However many times I have listened to them they remain works which never fail to move me.

It is only more recently, however, that I have got know very much about Beethoven the man and the details of his life, most significantly in reading Jan Swafford’s superb biography and visiting over the last couple of summers some of the places most associated with the composer.

The story of Beethoven’s life is a story of the sublime and the ridiculous and a story of how some of the most moving and majestic artistic creations of all time were born in the midst of much personal sadness and distress.

He was born in 1770 in Bonn, the son and grandson of a musician. It is still possible to visit his birthplace, full of fascinating artefacts from his life. His family was Flemish in origin hence the “van” rather than “von” in his name.  He had a youthful talent although one which was not promoted with the success of Mozart.  Nonetheless he gave his first public concert at the age of 7 and was heavily involved as a teenager in the music of the court of the Elector of Cologne.  The Bonn in which Beethoven grew up in the 1780s was a centre for Enlightenment (Aufklärung) and the values of the Enlightenment are a lodestar for Beethoven’s view of the world.  Nowhere is that more in evidence than in the famous Ode to Joy in his 9th Symphony.

In 1792 he left Bonn for Vienna, never to return. Vienna home to Haydn and, until the year before Mozart, was the centre of the musical world and the most likely place where a budding talent such as Beethoven would find opportunities for performance and patronage.  However, while it was his home for the rest of his life Beethoven never developed a love for the city or its inhabitants, commenting “from the Emperor to the bootblack the Viennese are worthless.”

Beethoven was relatively successful first as a piano virtuoso and increasingly as a composer, attracting the interest and the financial support of a number of wealthy patrons. His talent, unlike that of some composers, was recognised in his own lifetime although it never made him a wealthy man, especially later on in life when he was supporting his nephew Carl.

It was in the first decade of the 19th century, in the midst of the Napoleonic Wars that Beethoven started writing the works which changed the shape of music and established his reputation as one of the greats.  The seminal work was probably his Eroica Symphony, premiered publicly in 1805, a symphony initially meant to have been dedicated to Napoleon and unlike any orchestral music which had come before conveying an unique sense of power and tension.   In a remarkable period of creativity over the next decade he followed it with many other signature works in many different musical forms, orchestral symphonies, an opera, piano sonatas, string quartets all of which remain some of the most significant works in the whole of the classical repertoire.

DSC_0044It was as well that Beethoven was a successful musician because in few other ways was he a happy or fortunate man. His mother, to whom he was devoted, had died before he left Bonn after a long and painful illness.  His father, a mediocre musician who took out his disappointment and a fair amount of the family income in drink, died shortly afterwards.  He remained close to his brothers, but his relationships with them and their families, as with many of his friends and associates were difficult, full of misunderstandings and fallings out. Beethoven, who remains one of the greatest exponents of the idea of humanity, struggled with the day to day challenges of human relationships.  He never married.  Finally the adoption of his nephew Carl, the wrangling for custody with his sister-in-law and Carl’s eventual attempted suicide provided the ultimate tragedy of his life.

He suffered too from bad physical and mental health for much of his life and from the early 1800s began to lose his hearing. Beethoven frequently suffered from depression and in a remarkable surviving document, the Heiligenstadt Testament, addressed to his brothers but never sent, he hints at a desire to take his own life but ends with a commitment to live with suffering for the sake of his art.

In his later years Beethoven was for various reasons less prolific but there stand out a number of works which are amongst the greatest masterpieces of the western canon. His 9th Symphony is perhaps the most famous with its choral finale based on Schiller’s “Ode to Joy.” When it was first performed in Vienna the totally deaf Beethoven had to be turned to see the audience applauding his creation.

The 9th Symphony was composed in Baden, a picturesque little town, just outside Vienna where Beethoven went for a number of summers to compose.  We visited Baden last summer and the beautiful Helenental along which Beethoven himself would walk his mind full of the music, which he could only hear in his head.  It was a very moving day to follow in the footsteps of a musical genius and hero.

Franz Schubert, himself no slouch as a composer, said “Who can do anything after Beethoven?” In literature it is probably Shakespeare who most sublimely captures the essence of the human character and condition. In music, without a doubt, it is Beethoven.

Paying the piper Calling the tune

fairtrade

In the midst of challenges we are facing as a society today, is a sense that the model of 20th century capitalism which did so much to generate the prosperity which we have enjoyed since the end of the Second World War, is no longer working to our interests. Inequality is growing, wealth is becoming ever more concentrated and economic growth is no longer able to deliver a sense of benefit for all.  Multinationals seem able to outmuscle national Governments and dictate the terms on which they contribute to society through taxation.  Capital is mobile and business models shift relentlessly to create increasingly insecure forms of employment.  And, as I highlighted in my last blog We Robots, if we are concerned now wait until we see the impact of mass automation on both unskilled, and increasingly skilled, jobs.

It is hard to see where these changes will lead to. Socialism remains discredited and, as events in the last year illustrate, the wider public, and in particular those from communities most left behind by processes of economic change, are increasingly dissatisfied with what the traditional political system has to offer by way of solutions.  While, personally, I believe that popularism and protectionism have nothing to offer to those on whom they most target their enticements, there is very clearly an issues to address.

In all of this there is an important question of agency. If believe the world needs to change, to what extent are we prepared to modify our own actions to contribute to that goal? Political actions are important, but we also have an important role as consumers, in particular if we act in sufficient numbers.

There are important precedents. The intellectual argument to abolish slavery in British dominions was won a long time before measures were passed to end it.  Political pressure and the work of campaigners such as William Wilberforce  were crucial but so were the actions of many individuals prepared to boycott sugar, demand for which had been the engine house in the growth of slavery.  Nelson Mandela was vital to the end of Apartheid in South Africa but so was the boycott of South African goods.  Fairtrade, initially a fringe movement aimed at offering the producers of tea and coffee a fair return for their products, has now become a mainstream economic activity with its distinctive logo visible all across our supermarkets.  Where consumers come together capitalism does listen, perhaps at times quicker than politicians and Governments.

With at times some resentment or, more often, gentle mockery from my family I have tried to align my decisions as a consumer with my beliefs. At times, such as with Fairtrade, it has been gratifying to be part of a growing movement for change.  On other issues, such as boycotting Amazon, on the grounds of not paying tax in the UK and their exploitative employment practices it has felt harder work.  In all the cases, however, I have felt it has been the right thing to do, however many others are prepared to act in a similar way.

I am not claiming that consumer power, in itself, can solve all the problems in the world but it can make a contribution and it provides an important statement that people are prepared to make some sacrifices on behalf of their moral and political beliefs.

Individuals will vary in what they think is most important to try to influence in their actions as consumers. For me there are three general priorities.  First is an assurance that companies I buy from are prepared to make their contribution to society through corporate taxation.  Second is a desire to support companies which treat their workers fairly in terms of both pay and working and conditions.  Linked to that is, increasingly, a desire to support those activities which value human labour and to avoid unnecessary automation and self-service.  Finally has been a desire to support activities and goods which respect the environment, either because they are produced locally or because they are, in others ways, environmentally sensitive in the way they are produced, distributed or delivered.

I recognise my principles are not the same as those of others. I am not a vegetarian or vegan but I respect those who do not buy meat or other animal products for reasons of principle.  Similarly I was prepared to pay for my children’s education, initially because it was clear to me that state system was seriously failing one of my sons. I know others would feel strongly that private education reinforces inequality.

Some will argue that such choices of principle are easy for someone like me, who is pretty well off, to make. I am sure that is a valid point and I would not wish to be critical of those for whom price has to be the sole determinant of their purchasing decisions because they do not have the income to do otherwise.  I would, however, be more critical of those who have the income to make choices which align with their principles but still choose not to.

Consumer action needs support, most significantly in terms of information and signposting. The media and campaigning groups have an important role to play in exposing the actions of companies and explaining how things really work.  The tax affairs and employment practices of multinational companies is scarcely general knowledge and my own judgements and actions have been helped by those in the media, and increasingly on social media, who have set out the facts on particular issues.   Good branding can also help, something which the Fairtrade movement has exemplified.

The Germans have an expression “Man ist was man isst”, “One is what one eats.” If we believe in agency then we have to believe that our actions are important and our principles are worth some sacrifice when required.   On our own we are powerless but with others we can make a difference.  However someone has to make the first move and others have to follow.