An Unequal Society and Hospital Services

Peter Mandelson famously set a marker for New Labour when he said he was intensely relaxed about people getting filthy rich. Carwyn Jones has said that the status quo is not an option for the configuration of Welsh hospitals. There may seem to be no connection between these two propositions; but the first sets the context for the increasing inequality of life in Britain and the second, I shall argue, is a consequence.

Continuously since 1975 the earnings of the top 1% in Britain have grown as a multiple of average earnings – from a multiple of 5 to a multiple of 40. To a very dramatic extent we have become a more unequal society.

Because of this much increased inequality the top 1% now has lifestyles and expectations entirely disconnected with the rest of society with whom they merely co-exist. When those lifestyles have negative impacts on the rest of us the 1% is so detached as to be oblivious.

Hospital consultants on average incomes of around £100,000 just reach the top 1% of Britain’s income earners – actually they may feel quite impoverished in their social milieu. In England they have successfully restricted entry to the profession so as protect their earnings. It has become an established norm that it is unacceptable to expect a hospital consultant to work more than one weekend in 12. How, it is asked, can professional life be compatible with family life if any more weekends are required. There seems no recognition that armies of workers on the minimum wage staff our factories, shops, restaurants and call centers each and every weekend.

So strong is the assumption that no-one in the top 1% should be required to attend a workplace on too many weekends that in England hospital services, such as Accident and Emergency, have been concentrated into fewer and fewer locations so that a single consultant can manage a large clinical team and do so for only one weekend in a three month rota.

In Wales we have been lax over the past decade. We have been insufficiently attuned to the inevitable and increasing inequalities of modern life. We have not yet concentrated our hospital services to suit the needs of the top 1%. As a result an A&E consultant in Wales is still required to work one weekend in three. When vacancies are still available in England it is not surprising that hardly a single vacancy can be filled in Wales.

The conclusion of the Welsh Government is that we must mimic practice in England: concentrate A&E Departments into fewer locations so that consultants work fewer weekends. All sorts of reasons are given: patient safety, working time directives, a better gender balance in the workforce. Actually it all comes down to a more unequal society in which the lifestyles of the few begin to dictate the restrictions placed on the many as we trudge further afield for the hospital services which were once local.

Paul Griffiths is a local government consultant and councillor.