The Moral State We’re In

THE MORAL STATE WE’RE IN

A MANIFESTO FOR A 21ST CENTURY SOCIETY

Julia Neuberger

Introduction

1 The Elderly

2 The Mentally Ill

3 The Young and Vulnerable

4 The Prison System

5 The Outsider

Bibliography

Index

Acknowledgements

Copyright

About the Publisher

INTRODUCTION

In March 2004, a wonderful story appeared in The Guardian headed: ‘Q. How many care workers does it take to change a light bulb? A. Ask a risk assessor.’*

The Department of Health had devised an advertising campaign to attract people into becoming care workers that showed a care worker reaching up to put a new bulb in for an old man–without any obvious assistance. The advertisement read: ‘If you could do the small things that make a big difference, you could earn a living in social care.’ But many care workers say they are not allowed to change light bulbs–not on their own, at least. One local authority said it might take four people to do it: one to hold the ladder, one to turn off the electricity at the mains, one to stay with the old person, and one to change the light bulb. This is to comply with both Health and Safety rules and electrical safety legislation, but it obviously leads to some considerable difficulties. It is this kind of risk aversion–extreme though this case is–that this book is about: rules and regulations, well founded, well meant, even theoretically sensible, that yet lead to an extraordinary situation in which a care worker cannot change a light bulb for fear of the consequences, and which makes the lives of vulnerable people more difficult than they need be.

This is an extreme example, but it is not unusual. For six years I was Chief Executive of the King’s Fund, a charity devoted to the health and healthcare of Londoners, with a watching brief for the National Health Service as well. During that time–and indeed before–I have watched bemused as we have apparently become less and less caring for, or even aware of the suffering of, the most vulnerable in our society. This is not to say that there are not hundreds of thousands of people who, every day, carry out acts of kindness for a variety of people in trouble. Nor is it to say that we are bad people, or uncaring–though we may be–or insensitive to the needs of others, or incompetent, or somehow unaware in other ways. Nor is it to argue, as religious leaders have often done, that we have become selfish–though that, too, may be partially true. I believe that something else is going on: a complex pattern of interacting ideas, events, the Zeitgeist, and personal human attitudes that has somehow allowed us to reach this position. In this book I hope to tease out some of the contributing factors by examining what has happened to some of the most vulnerable groups in our society–the elderly, the mentally ill, children in care, offenders, and asylum seekers.

As I began the thinking for this book, I realized that I was not alone in my concerns. I was astounded by the number of people of all political persuasions, all backgrounds, classes, and creeds, who told me I needed to write it, that it was somehow important. They were not necessarily going to agree with me, but they believed we needed to ask ourselves some questions, and that the stories in our daily newspapers, the material with which we argued over politics–insofar as anyone did any more–or social issues or economics suggested some deep-seated problems in thinking about how we might sort our society out.

Concerns varied. There was a passionate concern about how we treat the elderly in our society, about the welfare of people with mental illness, and about what happens to children in care.

There was also a widely expressed view that our penal policy is a mess: we are putting more and more people into prison, but we have less and less idea about whether we are trying to punish, rehabilitate, contain, or simply forget about them.

Then there was a growing body of opinion that felt our policies towards asylum seekers were plain cruel, that if we could not sort out our immigration and appeals system then it was hardly fair to blame those who were trying to come to the UK, even if some were–to use the jargon–economic migrants rather than true refugees.

These are some of the issues that concern many of us–and may also touch us directly. The proper care of our elderly relatives is an issue that we all have to face at some time. Many of us know someone with mental health problems, and we may ourselves have had some period of depression or some other relatively minor mental illness and so will have seen first-hand something of what the system offers (or fails to offer) by way of help and support. Most of us will have read horrendous stories about children in care and what happens to them when they leave–we may even have experienced this ourselves. We may also have read about, or have first-hand experience of, ex-offenders, some of whom will have been in care and many of whom have mental health problems. And whilst most of us will not have direct experience of today’s asylum seekers, many of us may know someone whose family came to this country as refugees.

What kind of society is it that locks up those with mental illness in prisons, rather than placing them where they can get help and care, that fills them up with drugs but shows them little kindness?

What kind of society is it that allows our young care leavers to gain access to the criminal fraternity so easily and denies them the support of mentors and befrienders in their late teenage years and early adulthood?

What kind of society is it that makes so little effort regarding ex-offenders that many of them feel so unsupported that they fall back into offending for want of anything else to do?

What kind of society is it that locks up children from asylum-seeking families, that fails in its duty of kindness towards the stranger, and that fails to recognize the rights of children, who are in no way to blame for their lot?

And what kind of society is it that fails so lamentably to protect older people from abuse whilst also failing to offer proper long-term care for those who need it?

We have made it more difficult to help such people. Part of this book will examine why it is so hard for ordinary people to help those less fortunate than themselves–the kid in care, the old lady next door whose life is getting tough. For, as a result of scandals surrounding some of our institutions–for example in children’s homes, schools, and foster homes–we do not allow ordinary people to help. For instance, an obsession–not wholly misplaced–with sexual predators has made it necessary for anyone who works with children to undergo a police check. Until recently it also meant that a child in the care of foster parents could not spend a night with a friend unless the friend’s parents agreed to undergo police checks too. The need for school teachers and helpers to be checked for their past record also means that those who might be willing to help on an occasional basis must also be checked by police.

Such vigilance in itself may be no bad thing. But the fact that we have become so stringent in our requirements for checks on those who work or have any relationship with children means two things: first, that children themselves are encouraged to be suspicious of adults in a way that may be quite unhealthy, both for themselves and for society as a whole; second, that those who are inclined to look after a child or young person who is distressed–who is, for instance, lost, or is being attacked by older children–will be very nervous of getting involved. Suspicion of motives has forced some people, particularly men, to restrain ordinary common decency and kindness. Yet many of our most troubled young people–though by no means all–have no regular, stable male role model in their households. Add to that an ever-growing worry over paedophilia and you have a picture of a society that wants to protect children from potential attack but which may end up by destroying valuable relationships between young people and their elders, purely because fear of sexual attack takes precedence over a belief in ordinary common humanity. When photographs of children at nursery school cannot be taken without parental consent, for fear of pornographic use, we have a problem. When we are so suspicious of adults’ motives in wanting to help a child that one cannot help in a school–even one’s own children’s school–without a thorough and lengthy police check, we may have a legitimate point of concern, but we will deter all but the most determined helpers.

Our fears are not wholly unfounded. We have, in recent years, lived through the Soham murders and through a series of scandals surrounding children’s homes and special schools. In the USA, one smart California nursery was thought to be the centre of a wave of bizarre sexual and other attacks on small children. The Roman Catholic Church is still reeling from revelations about the number of attacks on young children by priests and from stories of violence and abuse by priests and nuns in Catholic-run children’s homes, about which senior church members knew and did nothing–or, worse, simply moved the offending priests or nuns on and did nothing to protect the children or heal their wounds. Yet, for all that, such a level of protection of children will lead to them being unable to trust anyone. Anyone accused of an attack on children is likely to go underground. The situation may well arise in which those who want to help children whose own families may be the worst abusers, or children whom circumstances have let down in a big way through parental death or family breakdown, are deterred by the bureaucracy through which they have to go. It is as if we are trying to create a risk-free society, which we know in our heads and our hearts is impossible. The result is that we restrict and regulate, hoping to make terrible things impossible whilst knowing we cannot, and, in the process, deterring the willing and the kind.

Then there is the unwillingness of many nurses to do what they once did best–holding the hand of an elderly person and dispensing simple TLC–through fear of being accused of assault; or being unwilling to offer a dying person a drink in case they choke, thereby risking legal action against themselves or, more likely, the hospital. The bureaucracy involved in serious untoward incidents, as they are called, is now so enormous that many senior nurses spend huge amounts of their time in filling out forms, making a nonsense of their nursing and caring roles in an increasingly risk averse culture. Professionals have become polarized into those who do case management–including when things go wrong–and those, more junior, who do the actual caring. Because of the requirements of the Health and Safety Executive, nurses cannot even lift an elderly person who has fallen out of bed: they often have to be left until suitable hoists can be found.

None of these things is necessarily wrong in itself. But the cumulative effect of a risk-averse culture results in an erosion of simple human kindness. A nurse will put a line into an elderly person for drugs to be given intravenously, but she will not hold a hand or stroke an aching back. An ordinary decent man, in his thirties say, with energy and skills that could be put to good use working with young people, will give a charitable donation to Childline or to the National Society for the Prevention of Cruelty to Children, but is unlikely to sign up to a mentoring scheme that would give him regular contact with an individual disturbed and deprived 14-year-old boy: it is simply too much trouble to go through the checks. If the man is himself gay, then official doubt and suspicion will be all the greater. If he is heterosexual and wants to mentor a girl, yet again suspicions are aroused–and his computer will be checked for pornographic images.

Aversion to risk pushes out common sense, and the smallest of risks now takes precedence over what we used to call kindness and care. The result is that the kindness one sees in hospitals often comes from porters and care assistants rather than from senior staff. Similarly, kindness to people with severe mental health problems often comes more from the owners of the cafes in which they sit for much of the day, or from the staff in public libraries, than from the nurses and outreach workers who are in a position to really extend a hand. This is not because of ill will or lack of feeling but because the system is increasingly unwilling to allow nurses and carers to take on any risk. An arm around the shoulders might be thought to be common assault. An invitation to have a meal might be seen as some of kind of sexual lure. And so we reach a situation in which social care assistants are told that it will take four people to change a light bulb for one vulnerable old person, whilst one of the teachers’ unions has called for an end to school trips for fear of accidents after three children have died in recent years.*

Risk aversion has made for part of the difficulty and has increased a natural human reluctance to get involved. That reluctance has been exacerbated by urban living. Many city dwellers lead isolated lives, in contrast to the sense of community still possible in rural or suburban areas, and have an unspoken, unofficial code of not interfering in each other’s lives. This means that those in trouble can become totally alienated. Around Christmas and New Year, when many of the regular support services close for ten days at a time, the needy can find themselves totally unsupported. No friends, no family-and the reluctance of strangers to get involved. Kindness is in very short supply.

That reluctance will grow unless we look carefully at why we have deliberately allowed this culture of risk aversion to grow, why we are so suspicious of sexual motives, and why we no longer trust the stranger. And this requires examining our own personal experiences. If we fall in the street, it is the stranger who picks us up and dusts us down. If we have a car crash, it is the stranger who calls the police and stays with us to give comfort. If we are mugged, it is the stranger who all too often gives us the wherewithal to get home. If we suddenly become distressed, or ill, or overcome with fatigue, it is often the stranger who carries our bags, asks if we are all right, and offers to take us to the Accident and Emergency Department of the local hospital. Of course there is always risk: the person who carries our bags home may proceed to burgle the house; the person who takes us to the emergency room after we have been raped may turn out to be the rapist. But these are exceptions. There are still people out there who give up their seats on the underground or the bus to older people. There are still people who pick you up and dust you down. And yet we are making it more difficult for such people to do good deeds. Why, as evidence grows that crime is down, are we ever more fearful, ever more timid?

To answer this, I think we have to look in detail at some of the major inquiries that have been carried out into abuses of the vulnerable. In each section of this book, I shall try to examine some of the reports, the newspaper stories, and the official responses to such inquiries looking for clues as to why we are increasingly reluctant to get involved and why that reluctance may have its root, at least in part, not only directly within ourselves, but also in the culture we have created for ourselves with the best of intentions: to protect the weak and to deter the aggressor.

Today, it seems we have a desire to do everything possible. We want to stretch the limits: cure the incurable, reach the unreachable, do the undoable, explore the inaccessible, travel to the most exotic and impossible places. Yet at the same time we have never been so internally reflective, so obsessed with ourselves and our feelings, so dedicated to understanding ourselves. Our gaze runs both to the furthest horizons and into the deepest recesses of ourselves. Yet by our desire to go to the extremes in medical treatments we often cause damage and bring suffering, as well as sometimes achieving miraculous cures. By our desire to go to the furthest reaches of the world we may cause environmental damage or destroy the lives of those we encounter. And, as we look deeper and deeper into ourselves, we lose the will to think beyond ourselves to others, lose the inclination to help others, to serve others, to work for others, to look into the middle or near distance. We fail to deal with what we find at our feet or in our communities.

This is, of course, a huge generalization. Yet our obsession with self–which may not necessarily be selfish but is perhaps self-indulgent–does lead to some strange behaviour. As the death of Princess Diana recedes into the middle distance, it is hard to remember the reaction many people had to it. Yet a walk through London’s parks in those days immediately after her death was a curious experience. All over, there were groups of people–largely women–sitting in small groups, often round a lighted candle, contemplating, reminiscing, remembering, memorializing. But they were not, after the first few minutes, thinking of Princess Diana. Their grief, though real and genuine at the time, was not truly about the death of the fairy princess. This was something quite different. They were remembering themselves, grieving for those they had not grieved for before, remembering mothers, fathers, siblings, even children, remembering the grandparents whose funerals they had not been allowed to go to. This was a sentimental wash of grief, hitherto unexpressed and even unrecognized. But the mood was not one of enormous sadness over Princess Diana’s death. The sadness was for them, and it played out as something truly self-indulgent. It also meant that those participating were looking inward, at themselves and their experiences, one of the curses of our age, rather than thinking about what outward action they might be taking to improve things for others worse off than themselves.

This, perhaps, has been the most dramatic recent example of group behaviour that caused a combined rush of sentimentality and genuine grief. Self-indulgence was combined with necessary grieving processes, sometimes much delayed. Yet the light was not shone externally. We were not looking to see who else might be suffering, or why. Instead, the light was directed inwardly, on ourselves. What we felt became what mattered. When the Queen did not come straight back to London from Scotland, we complained–irrespective of what her feelings might have been, or her desire to protect her two grandchildren. The Queen needed to be back at Buckingham Palace because we wanted her there. It was an astonishing example of the triumph of the group desire for personal gratification over common sense and understanding. Yet part of this desire to look inside ourselves is precisely what leads to that lack of a longer, more measured view. Though psychotherapy has brought great gains, it has encouraged an emphasis on personal priorities over those of the group; and whilst counselling has made a huge difference to many people with a variety of mental health problems, as a tool for everyday self-examination it can, at worst, lead to an inability to act.

What has happened might be argued to be an unfortunate confluence of events–or of intellectual and emotional pressures. At the same time that individualism became paramount, the then Prime Minister, Mrs (now Lady) Thatcher was alleged to have declared that there was no such thing as society and consumerism hit its heights, making the consumer king, rather than the citizen. Concurrently, the obsession with introspection grew in intensity, combined with a political and philosophical view that the individual should control what happened to him or her. The combination of all these factors led to a distaste for looking at the welfare of society as a whole. As a philosophy, utilitarianism–the doctrine that the correct course of action consists in the greatest good for the greatest number–was held in severe disrepute. Individual endeavour was what was needed. Utilitarianism might deter the huge efforts, for huge gains, of the talented entrepreneur. Society looked less at the welfare of the whole and more at the welfare of the individual, whilst the intervention of the state was seen to be less than desirable, and often less than benevolent to boot. In addition, it was perhaps inevitable that a utilitarian state found it difficult to deal with minorities of whatever kind since it was predicated on the idea of a one-size-fits-all approach to the world. There was little appreciation that minorities might choose not to fit, something that needs to be remembered when ideas about multiculturalism are becoming unfashionable and the opposing idea that we should all comply with something uniquely British is growing again.

This contrasts curiously with a strongly held belief in the values of the National Health Service, the only truly universal service in the UK, used by everyone. The NHS was predicated originally on the idea that the best possible care would be provided for the greatest number of people. It encapsulated utilitarianism at its height, in an immediately post-war world in which having a population fit enough to work well to rebuild Britain was a priority. The original view was that universal health care would lead to a country in which everyone would be healthy and less state care would be necessary. It did not work out like that; indeed, pressures on costs have continued throughout the history of the service. The NHS expressed a philosophy–these days a series of values which do not wholly fit together–about the obligation of society to look after the sick and the needy. We pool the risk, and we share the care and the responsibility. Despite worries about quality and standards, and worries as to whether the service will be there for us when we need it most, the NHS is still highly trusted and much loved, even though there are concerns about its ability to provide a service fit for the new millennium. The welfare state may have its difficulties, but the UK population still believes in it. The way it works may change: there needs to be greater choice, greater acknowledgement of diversity. But by providing health services relatively cheaply and efficiently to the whole population, the NHS is part of the glue that holds British society together.

For we are individuals now. We demand things. We go for the personal. We understand our own needs. The idea that we might not be able to have what we believe we want and need is anathema to us. We have become demanders, not citizens; we look to ourselves rather than to society as a whole. This tendency is not new, but it has acquired far greater weight. The words so often uttered, particularly by elderly people, until just a few years ago, that ‘I have had my turn, it’s someone else’s go now’ are becoming rare. We see no need to moderate our demands. We see no reason to say that we have had our share. It is no longer about our fair share, but instead about when we feel-as autonomous individuals-that we have had enough.

The idea of an obligation to society, beyond the demands we ourselves wish to make, has become unfashionable. Utilitarianism is out of the window, as is mutualism. We are into understanding ourselves, into self-improvement, into improving our homes, our looks, our minds. Our view of faith is also increasingly individualistic. We choose the elements of faith that suit us. Individual salvation is part of the appeal of the evangelical movement. Personal salvation is the carrot held out. But the requirements which our faiths put upon us to consider others may get less than their fair expression. Despite all the surveys demonstrating widespread belief in God, despite the huge readership of religious books and the increasing attendance at evangelical churches, the idea of social solidarity-about evening up the inequalities, about making a difference to groups or individuals who suffer-has taken a battering.