Melanie Phillips

7 January 2013

How the welfare state undermines altruism

Published in: Daily Mail

Share |

More than five years ago, the death of 17-month-old Peter Connelly, identified at first only as Baby P, shocked the nation. 

The child had suffered more than 50 injuries over an eight-month period at the hands of his mother, her boyfriend and his brother, all of whom were jailed for causing or allowing the death of a child.

What so appalled people was not just the cruelty of these three but the neglect and incompetence of the social workers, health officials and police officers in Haringey, North London, who, despite seeing the child on some 60 occasions, had nevertheless left him to his terrible fate.

The Director of Haringey children’s services, Sharon Shoesmith, was sacked — although subsequently the Court of Appeal held that she had been unfairly dismissed. In a rare interview, she has now said she contemplated suicide in the wake of the controversy and is living on benefits because she is unemployable.

Such remarks will strike many as self-serving, turning herself into the victim, rather than the child her department so catastrophically abandoned. However, although her absence of contrition continues to jar, she makes a fair point that, while she was vilified, no one in the NHS or police lost their job over the way they, in turn, failed Baby P. 

But this is all-too common in welfare services. Scandal follows scandal — and  yet hardly anyone ever seems to be held  to account.

Another example occurred at Mid-Staffordshire NHS Trust, where over three years from 2005 between 400 and 1,200 patients died needlessly as managers ruthlessly cut costs — particularly nursing numbers — to meet targets the Labour government laid down to win ‘foundation’ hospital status.

Doctors were diverted from critically-ill patients in order to deal with less serious cases to meet the target of discharging all patients from Accident & Emergency units within four hours of admission. 

Vulnerable patients were left starving, in soiled bedsheets or screaming in pain. Some became so dehydrated they drank from flower vases. And those nurses who tried to protest were threatened by others.

According to accounts leaked at the weekend, the report on the scandal by Robert Francis QC due out this week will call for an overhaul of regulations to ensure poor managers are weeded out, and better training for nurses and healthcare assistants.

Apparently, the report will damn not just the Mid-Staffordshire management but a ‘culture of fear’ from Whitehall down to the wards, as managers became fixated on meeting targets and protecting ministers from political criticism.

Countless families in Mid-Staffordshire have been left grieving for loved ones who were, in effect, killed by the National Health Service. Justice surely required sackings going right to the top and maybe even criminal prosecutions. 

Yet astoundingly hardly any of the executives who presided over the scandal was disciplined. The hospital’s director of nursing was suspended from the nursing register and then chose to retire. 

Complaints about 41 doctors and at least 29 further nurses were sent to their professional bodies, yet none has been struck off.

More jaw-droppingly, others — including Martin Yeates, the Trust’s former chief executive, who refused to give evidence to the inquiry on medical grounds — have subsequently been appointed to other senior positions in the health sector.

Cynthia Bower was chief executive of West Midlands strategic health authority, whose year-long inquiry into the Mid-Staffordshire Trust wrongly rejected its alarmingly high death rates as a statistical error.

Yet one month after this report was produced, she was promoted to run the Care Quality Commission, the health and social care regulator — only to resign last February after severe criticism of the Commission’s failure to police hospitals and care homes. Well, there’s a surprise.

Most astonishing of all, Sir David Nicholson, who ran the health authority responsible for supervising Mid-Staffordshire from August 2005 to April 2006, went on to become the chief executive of the NHS.

He was recently appointed to run the NHS Commissioning Board, the key new body created to oversee GP services.

Sir David blithely dismissed the Mid-Staffordshire scandal as a one-off problem rather than a symptom of systemic NHS failings. His position is now surely untenable.

But how could he and others responsible for this scandal ever have gone on to top NHS jobs? This is surely not so much a National Health Service as a national madhouse. 

The short answer is that state-run services invariably put managers first and the public last — because as passive recipients of the Welfare State, the public have no leverage over it.

The people running welfare services are accountable not to those recipients but to the State that pays their wages and keeps the funds rolling in regardless.

They use such feather-bedding to look after their own interests, protect their political paymasters’ backs — and do what those paymasters tell them.

The result is the pernicious ‘tick-box culture’ which focuses on targets that enable politicians to boast of false achievements rather than address people’s real needs.

Just as this was the bane of Mid-Staffordshire, so it was in Haringey. Sharon Shoesmith’s great defence was always that ‘correct procedures’ had been followed; she even produced a pie chart to ‘prove’ her department’s effectiveness.

The Mid-Staffordshire scandal most certainly was not a one-off. As the Health Secretary Jeremy Hunt has acknowledged, there have been four NHS scandals since then, with many other patients being shockingly neglected, bullied or abused. 

Without doubt, even more such horrors are occurring in the hospital service, with more Baby  P-type abuses taking place under the noses of social workers, health officials and police officers. 

Part of the reason is loss of competence. Social work had the stuffing knocked out of it decades ago when it replaced specialist child care officers with general social workers. For their part, the police have become frighteningly demoralised by top-down bullying and control. 

And nursing lost the plot more than a decade ago when it decided that feminism meant ‘caring’ was demeaning to women. 

Yet the shocking extent of the cruelty, neglect and sheer absence of humanity now on show in the health and social services surely tells us something else. The notion that state-run services are the only way to ensure compassion is totally wrong. Altruism is a moral concept — and it is morality which has gone missing here.

Far from engendering altruism, the Welfare State has all but destroyed it. Altruism comes from acting against one’s own  self-interest in a spirit of vocation. 

But the Welfare State has created a culture of entitlement. In the NHS, this has fostered an attitude among many staff that patients should be grateful for what they get. That, in turn, has encouraged a resentment which dehumanises those whose needs are seen as overwhelming. 

This is seen most starkly in the systematic ill-treatment and neglect of elderly and incapable patients.

In social services, meanwhile, the obsession with equality has replaced professionalism with a paralysing political correctness. The result is that when ethnic or sexual minorities commit abuses, these offences are invariably ignored.

The Welfare State — and most particularly the NHS — is seen as the ultimate example of compassion. In fact, it leaves patients and clients powerless, while protecting and even rewarding gross incompetence, and worse, by staff. 

That’s why inquiry after inquiry follows scandal after scandal. And it’s why reform of the kind demanded by this week’s Francis report is not possible without a far more fundamental change of approach.

The Government must stop bowing down to the sacred cow of the NHS and rethink the basis of the Welfare State if care services are to become, in the Health Secretary’s words, ‘worthy of a civilised country’.

Altruism and compassion have to be, once again, enabled rather than stifled.

And no amount of self-justification by Sharon Shoesmith or hand-wringing over Mid-Staffordshire NHS Trust will bring that about.


About Melanie

Melanie Phillips is a British journalist and author. She is best known for her controversial column about political and social issues which currently appears in the Daily Mail. Awarded the Orwell Prize for journalism in 1996, she is the author of All Must Have Prizes, an acclaimed study of Britain's educational and moral crisis, which provoked the fury of educationists and the delight and relief of parents.

Read full biography


  • The World Turned Upside Down
  • Londonistan
  • The Ascent of Woman
  • America's Social Revolution

Contact Melanie

Melanie Phillips
Daily Mail
Northcliffe House
2 Derry Street
London W8 5TT

Contact Melanie