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Into the darkness: Trump, Brexit and nursing

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In the first of a series of blogs about how contemporary events in politics are affecting our healthcare system and nursing, Chris Hart provides an analysis of the broader context, particularly the similarities and key factors in the election of Donald Trump as US president and Brexit vote, as well as their implications for nurses.

On reflection, it should be no surprise. A reality TV star is now the most powerful person in the world. This, despite The New York Times describing Donald Trump as, “The most unprepared president-elect in modern history… temperamentally unfit to lead a diverse nation of 320 million people. He has threatened to prosecute and jail his political opponents, and said he would curtail the freedom of the press. We know he lies without compunction.”

They didn’t bother mentioning his misogyny and sexism, racist attacks on Mexicans and Muslims, bragging about sexually assaulting women - and able to do this because he is “a star” - his incitements to violence or paying $25 million to settle fraud allegations from 7,000 people related to his ‘Trump University’.

“The Ku Klux Klan praised his early cabinet appointments”

And those thinking Trump will be a different person as president from the narcissistic bully we saw campaigning need to increase their medication. The Ku Klux Klan praised his early cabinet appointments, his head of national security has stated “Islam is an ideology” and “not a religion”, and “fear of Muslims is rational.” The American Nazi Party welcomed Trump’s appointment of Steve Bannon as his chief strategist and were later filmed declaring, “Heil Trump”. Trump’s nomination to head the Environmental Protection Agency is a climate change denier.

Trump boasted his election triumph was going to be “Brexit times five,” and it’s no coincidence he wanted Nigel Farage as Britain’s ambassador to America. Both used ethnic nationalist manipulation as a key campaign strategy.

The Brexiteers’ and Trump’s victories mark a new, unprecedented triumph in UK and US politics. Not bound by the truth or even pretending to play by the rules of decency, neither had a clear plan or few coherent policies beyond “taking back control” or “making America great again.”

Both relentlessly attacked ‘experts’ whose evidence undermined the simplistic, often misleading political solutions central to their campaigns. Boris Johnson and Michael Gove compared opponents with political and economic expertise to those who wanted to achieve the aims of Nazi Germany or justify Hitler’s policies. Trump labeled his opponent a criminal and critics liars.

“The world feels very different post the Bexit vote and Trump’s election”

Old Etonian, Johnson, and public schoolboy and former stockbroker, Farage, denounced conspiracies among ‘the elite’. Billionaire Trump did the same.

Trump and Farage are a problem but the problem is the conditions that created their success, and was over 30 years in the making. The world feels very different post the Bexit vote and Trump’s election. But it’s not. Those conditions festered like a boil. Now the boil’s lanced. Trump was right in his description of the system being rigged against ‘ordinary people’, unnecessary job losses and income stagnation, politicians having abandoned the working class and acting for vested interests.

But both campaigns exploited a deep reservoir of fear and alienation, fuelling a dark, dangerous rage. Simmering cultural wars about race, national identity and exclusion have erupted that will infect every aspect of modern life. For example, similar increases in hate crimes to those seen in post Brexit Britain followed Trump’s victory. Their successes have invigorated Marine Le Pen in France and other far right politicians across Europe.

“For Johnson and co, “taking back control” was never about empowering and enriching Britain’s forgotten communities”

For Johnson and co, “taking back control” was never about empowering and enriching Britain’s forgotten communities or the disenfranchised. It’s about their political elite having the necessary control to rid itself of Europe’s human rights legislation, the checks and balances on the power of capital over labour, and on other areas such as environmental damage.

Theresa May’s refusal – like a 17th century monarch - to allow parliament a say in what Brexit actually means demonstrates who’s taking control. The new political climate was reflected in the fury directed at the judges who ruled parliament must initiate Article 50, triggering our departure from the EU, being labeled “enemies of the people.”

There’s little evidence Ms May’s policies will address the issues some Brexit voters raged against because few stemmed from the UK’s membership of the EU. Most were aspects of globalisation that equally affect Americans e.g. the free movement of finance and financial deregulation, corporate tax avoidance, privatisation of public services and wage stagnation, exacerbated by little or no investment in training, education, research or a manufacturing infrastructure.

“‘Austerity’ has seen UK productivity slump and a million public sector jobs cut”

In the UK, this was worsened by the Tories’ austerity programme. Renowned Cambridge economist, Ha-Joon Chang, says this was never really being about balancing the books but undermining the welfare state, rewriting the social contract between government and citizens and re-engineering the economy - more towards an American-style free market system.

Since 2010, ‘austerity’ has seen UK productivity slump and a million public sector jobs cut. The housing crisis has worsened. Inequality blights our society. 3.8 million people live below the poverty line, including 12% of people in work. Poverty creates ill health, which feeds into poverty. It’s a vicious circle. These are our patients.

The economic impact of actually leaving the EU makes a recession worse than 2008 likely. Whatever Ms May’s promises, this will hit the poor, vulnerable and sick even harder, simply because it’s the way our neoliberal economic system is structured. And that hasn’t been altered one bit by Brexit.

But as we shall see in the next blog in this series, the underlying theme of the Trump and Brexit campaigns was immigration and native nationalism. Fear of ‘the other’, of ‘immigrants’ taking jobs, services, housing and a desire to reduce it was a driving force in large sections of the respective votes.

“Gove and Johnson’s cynical promise of £350m going to the NHS, rather than Europe, disappeared into the sunset on the Brexit bus”

So what does this have to do with healthcare and nurses in the UK? There are a number of links, including the possible economic futures of our respective healthcare systems.

Gove and Johnson’s cynical promise of £350m going to the NHS, rather than Europe, disappeared into the sunset on the Brexit bus. Instead, the funding crisis facing the NHS deepened. One of Trump’s few policies was ending ‘Obamacare’, at a stroke removing healthcare provision from 20 million Americans.

We’re turning away from Europe towards an America that is economically far more unequal than the UK. Just as advocates of torture, increased surveillance, computer hacking, establishing registers of Muslim and admirers of Putin’s Russia are about to occupy the White House. So, are we also heading for more of an American style healthcare system?

“Plans are emerging for thousands of hospital beds to disappear”

There are huge holes in the NHS accounts. The head of the NHS has told MPs it will be receiving £2bn less than Theresa May claims. No new money was allocated either to the health service or social care in the autumn statement. Policies on waiting lists and A&E targets are relaxed and the strengthening of financial performance and accountability in 2016-17 becomes the key objective.

NHS finance managers have already warned patients are set to experience poorer care, longer waiting times and greater rationing. Plans are emerging for thousands of hospital beds to disappear. Maternity services and a string of A&E units are to be downgraded or even closed altogether. We are facing a shortage of 50,000 frontline staff and a £30 billion funding deficit by 2020.

“Less money for healthcare equals fewer nurses”

Yet, with social care budgets already slashed and Ms May’s government forcing through even further cuts in benefits, the pressure on healthcare will only increase.

One key factor in determining people’s voting in the presidential election was largely ignored. It was health. Less healthy Americans seemed most susceptible to Trump’s message, according to research by The Economist, especially in those crucial states where the vote was razor tight. And, as here, they’re the people most likely to be screwed by the new regime’s policies.

Put simply, less money for healthcare equals fewer nurses, earning relatively less and working harder. In this new world, buffeted by forces that appear out of control, nursing is facing its biggest threat since the inception of the NHS.


Next week: Government policy on the NHS and the consequences of Labour’s inability to provide an effective alternative

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