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Featured image and above developed by the wonderful Yoke Health Art Agency

The purpose of the NHS is to help a healthy and unhealthy population get better and better and better. Not to police and pen an underclass, or to use that underclass as a ‘lesson to us all’

The NHS and particularly A&E departments have become places where people who have been economically excluded try to re-find a human relation to the world. They come in not just with illness and injury but with questions that medical staff aren’t resourced to address. Lillian Greenwood MP who spent 12 hours in A&E  observing staff and patients at the QMC can be contacted here

Let’s be right here, we’ve allowed this to happen: paradoxically we’ve put in more security and surveillance and training to gatekeep access to services but we haven’t yet begun the job creation and housebuilding that would change the pressure on the NHS

The idea of an underclass is a powerful example of how a tool of social description becomes a weapon of social segregation.

Who would want to be in that social group? What are the benefits of membership of the underclass?

You don’t need to vote. You probably want to but it’s getting difficult to stay on the electoral register

You may not be working for an employer directly instead be employed by an  agency  You are a in a category of people who are seen as the reason why everyone else has problems so it’s hard for you to present an alternative and inclusive viewpoint.

You will be judged as a problem by gatekeepers of services and will not be given direct access to the services you need: ironically, taking you out of the normal process is costly and you will be made accountable for that by decisions and changes you will not be informed about.

You may or may not rent or own your home and it may or may not feel secure.

Where you live may have very high proportions of betting shops, charity shops, takeaways, off-licences, poor transport and communications if you’re in a former mining village.

You may not be seen as someone with whom anyone should have any social contact with because of your status  in society so your viewpoint is suspect.

You will not be given credit, literally or in financial terms for reliability as you are automatically assumed to tell lies, be of bad character and have an angle.

No-one is on your side because you are wrong about everything.

One of the things that concerns me is how easy it is to conflate loss of job or home with loss of a positive social identity.

It is too easy to remove social legitimacy from an individual or a group by denying them a job and a house and a sense of local connection.

Is that what happened in Germany in the 1930s?

In Germany, in the 1930s, Leni Riefenstahl, documentary maker for Hitler, tricked, danced, acted, edited and propagandised for Hitler’s regime: a very sad example of a golden ticket

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given to an individual, a talented woman who believed her own progress, however successful she was, was impeded by the power of Jewish critics.

Leni’s creativity, social mobility, artistic and film making skills allowed the insupportable extermination campaign of the Hitler regime. Here are the places where the jews want to live, look, it’s not all bad, thus embedding moments of her ignorant ambivalence in documentary making in a moment of actual social destruction, so the language of creation, Prometheus Unbound (What Man Can Do With Energy):

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“He [the Aryan] is the Prometheus of mankind, from whose shining brow the divine spark of genius has at all times flashed forth, always kindling anew that fire which, in the form of knowledge, illuminated the dark night by drawing aside the veil of mystery and thus

Psychology & Society, 2011, Vol. 4 (1), 7 – 26 10

showing man how to rise and become master over all the other beings on earth.” (AH-2 (262) 3/10)

becomes the way those terrible  moments of  silencing were constructed. These people would not be allowed to speak for themselves any longer.

And isn’t that what we’re doing by allowing other people to speak for to mediate, even, strangely, to advocate for the ‘weak, the vulnerable…the very underclass of British society?’

We’ve never got to grips with these terrible injustices and protecting parliamentary democracy is at the heart of this. So it’s important to vote and  to understand why.

After the war Leni was let off in a way that speaks volumes. War crimes and criminals were pursued by jewish people in all our names and although we reconstructed our society we didn’t reconstruct in a way that would lift us all.

Memories that should have been admitted and acknowledged into a multi racial notion of parliament, house building and allocation, education and NHS welfare state development and international governance have instead been picked up by the ‘white heat of technology’ and turned into money making markets that are turning out to be as discriminatory as social segregation for insurance providers,  employment and housing associations and agencies.

Cradle to cradle we are ‘assets’ of interests that we have colluded with to construct (as ‘at first they came for the immigrants who built the welfare state and I did nothing… who have  had terrible problems with passporting and belonging. The hatred of institutions against certain groups of people (the idea of ‘passporting’ people coming out of Nazi Germany) began to be used in the 1980’s in the employment and housing benefit service. Claimants had a passport but no-one realised what was happening to the human rights of the people who were being passported. They were being turned into an underclass, their homes and jobs and aspirations to stability off the economic agenda.

The development of passporting to UK tourists to still fascist states after the second world war, a passport can be questioned and reviewed at any time. So they came for the people on benefits and I said nothing.

And now they’re coming for the young people who don’t conform to the algorhythmic perfection of what a young person should be and we’re angry that our young people’s life chances might be affected.

There’ve been calls for a regulator as the deep machine algorithms that make checking criteria (and so decisions), have been proved to make discriminatory assumptions about people that will affect their life chances. But it’s been happening to generations of people since the second world war and we’ve taken too long to recognise that we need to make parliament a place for everyone to be recognised and heard.

Ordinary people who run and manage agencies obediently used the increasingly automated  tools of compliance (Gangmasters Licensing, the Swedish derogation where agencies sidestepped employment contracts),  without considering their wider social impact. Tools becoming weapons against people whose rights were simultaneously being eroded.

I think that the abuse of groups of individuals who are classified as an underclass for manipulation purposes steers a very fine line between abuse and modern slavery. It’s a continual act of aggression which takes but gives the barest minimum back.

We’ve seen the abuse of workers by Sports Direct and others and this is because we’ve accepted automated financial metrics, automated views of who we are in a way that’s too passive. Parliament is now listening to workers in the gig economy. Well done those people!

The implications of trying to get away with pretending a holocaust wasn’t happening, either then or now are documented in Denial, a new film.

And I think the idea of an underclass contains in it elastic and inelastic memories of slaveries, holocaust, unresolved crimes that haven’t been properly resolved after the second world war.

I worked for one of these agencies to find them new sources of business and was appalled that the ‘gang labour‘ (and here I mean the hard working individuals used to pick and sort the rubbish) who came to the agency in good faith, believing if they got a job and worked hard that they would get a good reference, that they would be able to open a bank account, save and find a good place to live.

These employees  were  treated like the rubbish they sorted by the management.

The agency wasn’t going to help them in their personal housekeeping to develop a meaningful life with proper connection and relationship with other institutions. When employees put down that they were employed by that agency and gave the agency telephone number as their contact no for banks, landlords, future employers, the agency wouldn’t answer these calls. Not our responsibility. We have no financial association with these people, can’t reference them, can’t vouch for them. We are an agency and they are registered with us. That’s all.

Can you imagine the impact that that would have on these people’s lives?

The idea that there is such a thing as any human being being described as trash expresses this legacy and failure to confront that an underclass comes from exclusion to the things we all love and thrive with.

How on earth can the NHS deal with social rejection on that scale?

The NHS It isn’t here to herd or pen or surveil or control an ‘underclass’ that has been created by a market against all the assumptions of the welfare state but you can see how it’s happened.

It’s sad to say this, especially now when we’re all looking to save the NHS but the welfare state was a wonderful vision that relied on an underclass of black and immigrant workers. It was conceived by our socialist visionaries on a feudal, golden ticket theory of social mobility so the hospitals, houses, transport, utilities,  communication and education system would be serviced by that underclass who would be gatekeepered out of access to council houses and professional level jobs. In many ways the private system was seeking ways to deconstruct it from its very first brick.

It’s been challenged from the very beginning because it wasn’t created to enfranchise everyone, the immigrants who came to fight the second world war, to build the roads, the schools the houses, the utilities were always excluded.

The story of nurses in the  NHS  has been documented in the BBC Black British contribution season.

The resources of the welfare state and the council estates of the welfare state were created through a command top down notion of control and power that has its origins in the feudal system and the colonial and imperial history of countries across the world.

Council houses  in the fifties, sixties and seventies weren’t fairly allocated to immigrant families and immigrant families had to work four or five times as hard as their white neighbours in lowly paid jobs to be able to save and buy their homes. And they were still excluded.

And that’s what’s happened on a massive scale across the council estates when the mines closed. The mines provided rail into the communities but when the mines were closed the transport and communication infrastructure was never properly developed to allow these communities to regenerate. We have gambling shops and takeaways and charity shops: all easy things to pop into a place instead of culture. And then we get

culture and reality TV and research that say that it has found genetic reasons as to why there’s more crime in these areas…it’s because these people can’t control themselves.

The problem is if you have a bad diet,  have increasing encroachments on your identity without respite and then you’re told you’re a category that needs certain drugs or treatment how do you make a rational choice?

If we start from a better place to think these people are maybe

grieving loss

of their homes, jobs, aspirations, futures.  Not

they have big appetites (and it’s genetic).

Not  that they’re greedy, can’t control their desire for drugs and alcohol and can’t keep a job, can’t manage their relationships….

Eek. It feels like lies to me. Lies to make money.

Hospitals are only as good as the  power to empower communities around them is.

If we permanently disable certain communities and tell them we can’t afford them then we’re lowering the expectations, productivity and success for everyone.

We’re creating dysfunctional and unexpected reactions and responses to initiatives from the top down.If we’re not caring for everyone throughout their lives how can doctors be sure that the treatment they give to one patient will be replicated? How can patients be sure that they’ll always get the best treatment, that they have that right?

In an increasingly personalised medicinal world with this notion of an underclass will they only get the medicine that’s appropriate to someone of their status?

Because that’s what importing the US notion of underclass has done to our sense of community and society. We really have people who believe that they are morally and socially superior to others because they have economic resources and strength.

It’s not real strength.

It’s the kind of beat up a homeless person sleeping in a tent because they’re vulnerable, because you can kind of strength that hospital A & E departments witness increasingly that we need to call to account and change.

Because of the ideology of the market, instead of a taken for granted service that all the parametrics seek, it could be argued that no one ever gets the same thing twice in the NHS.

And though it’s deeply philosophical (it’s true that in an absolute sense you can’t ever step into the same river twice, (but actually that’s probably nonsense), when it comes to services and processes and their contribution to community wellbeing, the NHS needs consistency to grow.

Change is nothing,  the NHS needs growth (not the cancerous, dysfunctional kind) reflecting a civilised society with very high aspirations that is warm and open and strong and cares. Growth means being stable and able to respond and learn.

There’s always a pressure to get more for less from more and unless you know, say that two medicines might work well together, you’ll probably get the one…..

How has that happened? Well, briefly, because we’ve allowed A&E departments and TV reality shows to conflate social issues with social negation. The poor old A& E department because it has always been walk in, free access during the 1970’s 80’s, 90’s and noughties became the place where people with social problems because they were increasingly excluded elsewhere in society, began to congregate.

The problem is that this has been used in a negative way to undermine the possibility of trust and reciprocity in the ideal of ‘free at the point of delivery’ in the NHS.

Because, instead of facing the problems that Harold Wilson recognised with the “white heat of technology” that was coming in the 1960’s, successive governments have allowed development of the technologies and the people who grow the technologies with subsidies and positive discrimination but have neglected the more important and harder work of recognising that beyond this one manifestation of human possibility is a harder one of how to integrate all these new gains for a bigger vision of society that helps everyone.

Automation is now seen as the prize of the most able rather than understanding that the gains that the early adopters and makers have are financed by the social exclusion of the majority. That we are all, whatever our social background or social status, living in a beta society masquerading as the finished thing.

So when the coal mines were closed down instead of research into transport and communications into these marooned communities we had heritage and lottery funding to create cycle paths and country parks. And charity, betting shops and cheap booze with inferior food and takeaways in the hearts of these towns and villages. Very rich charities managing the mental health problems due to this social exclusion.

And we do nothing. We watch it happening.

Instead of jobs the cultural and economic compromise made in the UK has been to exploit the notion of agency working  and all the fantastic benefits of flexibility, training, mobility and skill development. We could use agency working to implement apprenticeship and learning and training for 2, 3 and 4 day a week jobs for everyone to support the automated economy. We would do well to talk to everyone an include everyone in this at every age and stage of life.

Instead of this agency working was and has been used in the most iniquitous way against migrant and the unemployed in the UK. It’s absurd that first, second and third tier agencies and contractors manage both employment and services, a ‘worldwide model’ that  everyone uses and interprets to suit themselves.

It really hits home when you consider the possible reason why things go so badly and apparently ‘unexpectedly’ wrong. When Jo Cox MP was murdered by Thomas Mair on 16th June 2016, it made me think about the whole sub contracting environment.

Why? Because one day I was on a train in London and I found a folder. I briefly looked inside and handed it in, not thinking about it really but on the train home, rang someone who works in procurement and realised that it was a list of dangerous people who lived in social housing that had been put together for a contractor by a group of housing associations.

Now dangerous people can become more or less dangerous over time. A notion of dangerous can be real, perceived or untrue. The problem that anyone has when thinking about social housing  is that the ground going back to when it was built was:

a) based on racially selective housing allocation in the first place. So after the second world war when black people and other immigrant groups came over to fight and man and woman the new NHS they weren’t, in the main, offered access to social housing, so they had to privately rent and save and buy, becoming more middle class than working class.

b) the social offer after the second world war was also a slap in the face to jewish survivors of the holocaust who were also, in the main, expected to buy their own houses even though social housing had been lauded as the beginning of a social revolution,

so when you think about the dismantling of the idealism of the NHS, it was being dismantled from the moment it was created in the same way as council housing has been coveted by speculative markets that were supported by strong groups in society that used social respectability to imply that there were no jewish or black people in need in Britain (when quite obviously there were and are).

But by the time I found those excel sheets there had been probably thirty years of a developing consensus and a silencing of alternative viewpoints of what social housing was and could be but by the same token, to be in social (no longer called council we imported the US and Canadian labels at the same time that we shut down very successful and locally embedded working class comprehensives in Nottingham (like Player ), the government pressure was on councils to look to the  US looking at American solutions to our ‘inner city problems’ which, unfortunately, embedded an individualised approach to social problems premised on underclass ‘traits’ and behaviours.

My problem and the connection I’m making to the creation of an underclass, the excel sheets and Thomas Mair who viciously stabbed and killed MP Jo Cox is:

  1. Social housing was abused by allocation policy and selling to people who would become multiple landlords create a place where only people with problems would be housed during the Thatcher, Major and into the Blair and Brown eras

2)     By the 1990’s (in 1991 a category called Limiting Long Term Illness was introduced into the census. This category wasn’t for unbiassed investigation into social cohesion and constructive ways of looking at social mobility, it became a weapon against those who mainly happened to be unemployed, redundant and on low income in social housing because it was part of a wider process of contracting our services throughout the welfare state an across society generally.

3) The contracting out of services relies on trust and security of information. Often it works but the problems can be where unexpected individuals and groups can intercept information. In the case of me finding that excel list and in the case of Thomas Mair being groomed by far right groups, I’d ask the question was Thomas Mair ‘known’ (but so not known) to institutions and agencies as a possibly dangerous person? Or consequently, as a vulnerable person. Thomas Mair (like the killers of Lee Rigby) were both dangerous and vulnerable to grooming.

4) Dangerous and Vulnerable seem to hold hands in this brave new quantum algorithmic world because both categories are people that this system has disenfranchised and some people continue to profit from without a consequent sense of morality or purpose except making money for themselves.

We’re all the poorer for it.

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