Sunday, 24 June 2018

The Realpolitik of refugee families and health care funding


Whilst I have long held the view that nurses need to be more political in asserting their professional contributions, I usually try and steer clear of politics in my blog. However, last week a couple of news story topics made me pause and contemplate. So with your indulgence, I am using my blog this week to take a Realpolitik view of some of the issues that caused this pause. The first of these were the various stories of migration. 

Last Friday over 2000 people came together to celebrate the 70th anniversary of the 500 Caribbean migrants who came to Britain on the Empire Windrush ship. They were the first people to come here and help re-build post-war Britain. Of course whilst the anniversary celebration was a wonderful event, it was slightly marred by the recent experiences of this generation and the threats made to deport some of them. They were a generation of folk who had worked hard in the UK for all their working lives. Whilst their origins were in the Caribbean, many now quite rightly viewed themselves as British citizens. 

I also read about the hard line Italy was taking over refusing access to 224 migrants that had been rescued at sea by a German aid group. This was a week after Italy had already refused a ship containing 630 refugees to enter Italian ports. In a speech last week, Italy’s Deputy Prime Minster Matteo Salvini, also declared war on the Roma populations living in Italy and suggested that Italy should adopt policies on immigration similar to those of Donald Trump in the US. 

Like many others, I cannot help but express my repulsion at what was reportedly happening in the US with refugee children being separated from their parents and detained separately in immigration holding centres. United Nations human rights experts have described detaining children in this way ‘may amount to torture’. Whilst Trump has eventually reversed this policy, I feel sure it was only the sheer abhorrence of what was being done to children and reported internationally that gained this result. It was a new and despicable low even for someone whose behaviour and policy decision making appears so flawed and egocentric. Sadly it’s not just the US doing this. In case you missed it, here is a link to Brigid Delaney’s report on what is happening in Australia; it makes for grim reading. 

What made these news items even more difficult to comprehend was all of this was being reported in the week that also contained World Refugee Day. During the week, the Guardian newspaper ran a series of very powerful articles on the emergent migration crisis. On World Refugee Day they posted a List of the names of 34,641 people who had died while trying to reach Europe since 1993. It was a very powerful message. The List was compiled by the group United for Intercultural Action. This group represents 550 anti-racist organisations located across 48 countries. The number of deaths recorded is also likely to be much higher in reality, as many deaths go undocumented. Globally, there have been 60,000 deaths recorded since 2000.

Don’t get me wrong, like many others, I think these migratory movements need a solution. I don’t know what the solutions might be, but I do know that cruel and uncaring approaches are not the answer. Realpolitik might help here, and I don’t mean the Machiavellian and coercive approaches, sometimes associated with realpolitik, but those approaches based upon realism and pragmatism. Sadly I think there was more than a touch of Machiavellianism in the second political story to catch my eye last week. This was the announcement of a massive increase in funding for the NHS, based upon what we now know is unlikely to be a Brexit dividend but from a hike in taxation. 

The new funding proposal covers the next five years from 2019/20 onwards. It equates to £20bn more revenue in real terms compared with 2018/19. However, whilst this is welcome, the funding is for the NHS England commissioning budget only, so does not cover capital funding, public health, health education or social care. Many commentators were making the point last week that this additional funding will not do much more than keep the current services functioning. Perhaps more encouragingly, the funding requires the development of a 10-year plan to ambitiously: put the patient at the heart of how care is organised; develop a workforce empowered to deliver the NHS of the future; harness the power of innovation; have a focus on prevention; and achieve true parity of care between mental health and physical health. These are ambitions with which not many of us would argue. However, it takes time to educate and train the workforce. There are legislative barriers to integrated care that need addressing. And if the Government is truly wanting a different service-delivery model developed, then funding for social care must also receive a similar up-lift in the amount of money available. 

OK, thank you for indulging me in allowing me this occasion to comment on these challenging issues. Next week, I promise I will return to my usually politics-free approach to blog writing!