Wednesday, 11 May 2011

Staying Afloat: Homelessness in Winchester

Brian was abandoned at eight months old. Throughout his childhood, he bounced around foster homes, care services, and different social systems. He was adopted, but when his adoptive father died, he had no one else. He has had a string of drug addictions and relapses, but for now, he is clean. He was diagnosed with clinical depression, and has psychotic episodes. He also has a silver award from the Chelsea flower show. Brian is 34 years old, and he is homeless.

“Where I was originally from, I had an axe put through my door. I got my house robbed to bits. I got bullied. I ran away from home. All people get on the streets is the night shelter, or a hostel, which means if you’ve got a drink or drug problem, you’re never going to get clean because you’re stuck in a situation where it’s just never going to happen.”

For Brian, every day is a monumental struggle, as he attempts to get enough money to buy himself a cup of tea, or something to eat. As I talk to him, he rolls a cigarette in his grubby hands and his dog, whose name I don’t know, huddles and shivers in the gap between Brian and me as we lean on the windows of HMV.

“People get dealers coming to live in their house. They get scared. They’re forced to either sell drugs, or leave,” he explains, muttering afterwards. “Who would choose this life?” he mutters.

I have just told him about the Westminster City agenda to “cure” homelessness, arguing that providing food and shelter to the less fortunate “encourages” them to be homeless.

“Its bullshit” Brian argues, shaking his head. “I’ve been sleeping rough for years. People don’t choose to be homeless. A lot of people on the streets have got a lot of mental illnesses. How can they say they’ve got a choice?”

He’s right, but unfortunately, Brian’s story is nothing new. For years and years, there have been people like Brian sleeping rough, not knowing if they’re going to survive the next winter, or even the next week. And whilst there are people on the streets, there will always be systems in place to try and combat the homelessness cycle. And again, as long as these systems exist, there will be people both supporting and opposing them.

It seems that even people who have absolutely nothing are being affected by the government budget cuts. Michelle Price is Manager of the Winchester Churches Night Shelter, and as she hurriedly puts me in a room that is to be the new communal centre, complete with a coffee machine and a television, she rushes around, talking to a medley of construction workers, volunteers, and other administrative staff. The place is busy, and there aren’t even any residents. She sits down, then leaps up again, shouting goodbye to a fellow volunteer leaving for another town.

“Have you taken your bunny? HAVE YOU TAKEN YOUR BUNNY?!” She is referring to a chocolate bunny, much to my relief.

My main observation of this place is that it does not look like a night shelter at all. Instead, it looks more like a community centre, or a recreation centre, with open spaces, light and facilities to help people regain a modicum of control over their lives; Television, computers, Internet. Everything we know we take for granted. Even something as ludicrously arbitrary as a tea machine somehow seems like a luxury.

Compared to other shelters, this is like a five-star resort, with many shelters in the area getting rid of any comforts for housing space. A volunteer explained to me the differences between here and another shelter she had worked at, that instead of a seating space, shared rooms, IT suites or tea machines, it was more reminiscent of a psychiatric hospital from a horror movie; dark, barred off windows, and beds crammed in rows like army barracks.

“Sure they’ve got their capacity up, but are they doing anything other than giving them a bed? Are they helping them with their lives?”

I can’t help but feel the answer must be a resounding no.

Finally Michelle sits down, and explains with a heavy sigh the forthcoming reductions in their budget;

“Right now our funding is a third from the Hampshire Supporting People fund, a third housing benefit, and a third donations. I don’t know what the future is going to be like, but the Hampshire Supporting People Fund is going in the next 2 years, and with the current economic climate, donations are going to stop.”

It seems that this is coming at the worst possible time for the shelter, with records showing that they have had to turn away more and more people each year.

“I don’t think things are going to improve,” Michelle adds. “Most people come here because of family breakdown, abuse, or foster care. If you’ve been in care until 18 years old, when the support stops, where do you go? You have nowhere.”

The shelter has recently undergone massive changes, with the entire place under construction, with the money having been raised last year during their “Big Sleep Out” campaign, in which many residents of Winchester slept on the streets to raise money for the night shelter. The team has taken a voluntary hit, making their old offices into space for two extra beds, and making their new offices a smaller and cramped room.

The staff is not above taking risks to get results, with a viewing around the premises showing a bed in a room that technically should not be there,

“It’s listed as a crash bed, because technically we can’t have more than two beds in every room,” further adding “it’s not supported. We’re breaking the rules.”

It isn’t the first time the rules have been slightly broken, with an incredibly bitter winter of 2010 making most people living in houses cold and miserable, the homeless population were left to starve and freeze in alleys, but with a monetary contribution by the council, the night shelter was able to house and feed many more people than it is usually able to. Not enough, but the nature of the beast is that there is never enough.

Whilst there are concerns, here there is a general air of optimism. Spirits are high, and with the construction, people are hopeful. A resident, Stewart, happily bounds in telling his important news to anyone that will listen.

“I got an interview for the Prince’s Trust!” he squawks, running into his room to put his stuff down before disappearing off again. The Prince’s Trust is a voluntary organisation, which helps 19-25 year olds with courses of personal development, often if they are out of work, education or training. I’ve seen what the Prince’s Trust can achieve; Stewart’s interview can only lead to better things.

The shelter is not just a place of temporary accommodation, as their massive schedule maintains, they also offer a wide range of courses for personal development and rehabilitation.

It’s all very encouraging, but it’s a small help to a very large system of dysfunction, as the future of these courses is left unclear. Councillor Lucille Thompson is portfolio holder for communities in Winchester City Council, and with a sigh that I am all too familiar with by now, Lucille expresses her shock and disappointment at Westminster City Council’s plans. Concordantly, Winchester seems remarkably different.

“At the moment, we have no plans to reduce the spending on the homeless. We are increasing the options available.”

“We have approval for a program called Winchester Lets. It allows people on the streets to find houses that the estate agents might be reluctant to let to, instead going through the council, and having us pay the fees, claiming it back as benefits.”

The housing scheme offers council houses to those who desperately need them, but with a system like this, there are always problems. In this case, it’s that the waiting list comprises of three thousand people. Families and expectant mothers are high priority, and whilst this is of course understandable, with finite housing, people like Brian are left to wait years in band three. Not enough of a priority to house right away. Not so low a priority to have other options.

Lucille is the first to acknowledge the hundreds of problems like these;

“There is a lot more that can be done. We can always plough money into it, but we only have finite resources. Is this enough to cope? Inevitably, probably not, but we have to consider ways to address the situation with what we have.”

Despite fundraising, diligent volunteers, or even councils that want to help; the situation as it remains is in a downward spiral. Occasionally there is a flash of optimism; a renovated charity that could offer better opportunities, a teenager residing at a shelter who is excited about the possibility of getting himself back on his feet, a system willing to break the rules in order to give someone a place to sleep. All of this however, with its capability to lift people’s spirits, its opportunity to show people that perhaps things are getting better, all of it is brought to a hideous and sickening silence with the crystallizing image of a man, huddled against his knees, a hat at his feet containing a paltry 20 pence, nowhere to go but down.

Before I left Brian to continue his day as he had almost every other, struggling to maintain what little he had, he left me with a strangely insightful and prophetic warning;

“What the new government wants is what they’ve always wanted, to make us the enemy. If Winchester goes the way of Westminster, people who were criminals will be again, and people who aren’t will be forced to steal to survive.”

DOOMSDAY: How today’s NHS could be unrecognisable in four years.

It’s no secret that today’s current economic climate has not been particularly kind to the British National Health Service. Despite the government pledging to maintain NHS spending, in real terms the NHS will have to make £20 billion of ‘efficiency savings’ to stay financially even. Even considering regular reports, press releases, and political figures making their opinion on the matter very well known, none of these stories really stick. Instead, the public gets a bit worried, and is then quelled by terms like “efficiency savings”, or assurances that health services will not by government politicians.

Whether it is wishful thinking, ignorance, the news calendar, or lack of proper resources, the stories never progress, meaning that the real situation doesn’t get told. It’s a sad fact that every story that comes close to this very real doomsday scenario is also immediately shut down, whether by the aforementioned leaders, or the massive amount of news generated by other events produce. I’d be the first to agree that swine flu is important, or new cancer treatment is newsworthy. It’s also worth noting that in the recent months there have been several high profile stories that have taken precedence over the long term future of the NHS. For example, the death of Joanna Yeates, and the discovery of her body on Christmas Day is a tragic story that should definitely be told. Important world news must be reported. It can be argued that there is a sensationalist tendency in some tabloids, which means that difficult and complex issues like NHS reform may not be reported.

The issue is that high profile NHS stories have been in the news relatively infrequently. It is crucial for the public to understand what the implications of proposed NHS change means in the long term as well as the short term. Just a bit of warning, this is not good news. In fact it’s pretty depressing. But don't worry; it is, according to the Government, just pessimistic speculation. However, if that’s the case, its speculation based on the opinions of health care professionals, their professional organizations, such as the British Medical Association, Royal College of Nursing and Professions Allied to Medicine, plus think tanks like The Kings’ Fund and NHS insiders. Even the Chief Executive of the NHS is opposing the proposed ‘reforms’.

It all started with a White Paper, now a parliamentary Bill.

The White Paper, a government document proposing changes and future plans for the NHS is entitled ‘Equality and Excellence: Liberating the NHS. With sections like “putting patients and the public first” and ‘Autonomy, accountability and democratic legitimacy’, one could be forgiven for thinking that this paper is entirely devoted to making everything better. Indeed, superficially, it appears the only objective is for the good of the public. But there’s something lurking under the language. Something sinister and Orwellian. It doesn’t seem right, in this economic climate that there is cause for celebration in the proposals. We must examine what is meant by the repeated phrase;

“Increasing efficiency”

It’s right up there in the world of creepy double meaning. Just like the change from “Ministry of War” to “Ministry of Defence”, “Increasing efficiency” is one of those phrases you cannot dislike. Efficiency is good! And they are increasing it, which is a positive outcome because we get more? Right? Well, that may be true, but what it really means is “Cuts.”

The worrying parts of the White Paper consist of plans to, “liberate the NHS” .One clause explicitly deals with this liberation stating that the present Strategic Health Authorities, responsible for delivering regional strategic health planning to provide key high level care such as heart surgery, organ transplantation, neurological care and so on, will be dismantled. At the county level, the Primary Care Trusts, currently commissioning services on behalf of GPs and their patients, will be replaced by GP consortia. These consortia will be encouraged to purchase services directly from “any willing provider” on behalf of the patient. There will be financial incentives to consortia to buy services from the private sector, which means that in future diagnostics such as pathology tests, x rays, scans, really any type of operation that a company is willing to provide, can be bought from any provider.

Now, this may include the NHS, but it also might include ‘social enterprise businesses’, or private medical companies like Nuffield or Bupa. While this all sounds quite good, in reality hospitals will be left with difficult and expensive care, with the common, easy procedures being ‘cherry picked’ by the private sector.

This may liberate the NHS, in the sense that GP's may buy services at a lower price, saving money for the NHS. Unfortunately, due to how public finance and how the NHS works, it also takes money away.

NHS funding works on a cycle system, working with Strategic Health Authorities and Primary Care Trusts. It is hugely complicated, which is the problem with the NHS in general; it requires so much management because of all the services it provides. One must understand that Foundation Trust hospitals, whilst they are financed by the NHS, are a business. They need to make money (or revenue) by providing efficient and economical services for which the department of Health pays. A specialist hospital that focuses on heart surgery will often have chosen this focus in order to provide an essential regional service of a high caliber, generating income, as in NHS finance, the money follows the patient. E.g. Southmead Hospital in North Bristol is a leading renal unit, because it has developed this service to a very high level.

Hospitals also have to make money, to expand services and fund new buildings and facilities. Funding comes from the primary health care providers; GP's, who purchase services from the hospitals, which gives the hospitals money, which is provided by the Primary Care Trusts, whose focus is dealing with the money provided by the government and procuring services for patients. As I say; a cycle.

But this cycle is awkward. Money is lost in bureaucracy, but it does ensure that the right services are provided for patients. However, as demographic change, technological and pharmaceutical advances and diminishing resources collide, the costs are more than the money provided. A new MRI scanner costs more than £1million (An ordinary purchase).

The new White Paper has no incentive to buy services such as scans from hospitals. Instead, there is an incentive to buy from the third party providers, who offer this care more cheaply because they have much smaller overheads. This means that the Department of Health funds that were used to power the previously mentioned cycle, instead go in a straight line to third-party providers.

Presumably, the cycle therefore starves, and breaks.

This would be terrible on its own, but yet more factors exacerbate the situation. First, the conglomeration of GP’s called the GP consortia. With the White Paper, they are granted power that allows them to choose who to buy their services from, making competition inevitable between third-parties and NHS hospitals. And with the third-parties having better rates and lower overheads, the foundation trust hospitals would end up losing revenue. This proposes that should a hospital fail to balance its budget due to increased demand and inadequate funding, it will be allowed to ‘fail’. Also known as ‘going bankrupt’. However, the White Paper says nothing of what will happen to the patients or staff of the hospital.

Second, thanks to the economic climate, the NHS has to make ‘efficiency savings’ of £20 billion across the board. The official line by the government is that cutting administrations and management will mean that frontline clinical staff will be safe. However, NHS sources say that 75% of a hospitals budget is spent on staff, including management, and only 25% on consumables. They also say that 95% of staff are clinical, which means that if 20% of the budget is to be cut, where is this coming from? Well, clinical staff.

It is also worth stating that an average foundation trust has a similar budget to a FTSE 250 company, like WH Smith, the Daily Mail, and Easy Jet. No company that large would be able to function without a respectable amount of good managers, so even cutting management and administration would cause the workings of the NHS to suffer.

Whilst some jobs can be removed, people know that quality of care will suffer if too many clinical staff are fired, and financial success will suffer if too many administration staff go, both of which would undermine the governments standpoint. Instead, according to confidential sources, the plan of action is a jobs freeze. This means that vacant posts aren’t filled, and new posts are forbidden. No one is hired, and no-one is replaced. Staff will drip out slowly, care will suffer, and hospitals will be forced to stop certain services, specialist or otherwise.

But even with all of these actions, essential services and frontline staff will still be cut. With this, healthcare may become a postcode lottery. Hospitals with a catchment of less than 500,000 (government figures) may be classed as unviable, leading to their patients being absorbed into a larger hospital, which may be unable to deal with the influx of new patients. With this lack of hospitals in an increased catchment area, regardless of age, people will have to travel further for routine and emergency care. This means that it will be less of a postcode lottery, and more of a lottery as to whether people get to hospitals, or die in ambulances.

A final casualty of this fragmentation of patient care, brought about by the “efficiency savings”- competition, the stagnation of services available, and the lack of human resources, is patient records. When any NHS body delivers care, free at the point of delivery, but paid for by all through taxation, as it should be, records are kept. Regardless of where someone receives care, the healthcare professionals know one’s problems. One’s medical history is laid bare, greatly reducing the possibility of medical errors and actively improving care. If care is provided by third parties, records are unavailable to the NHS except by request. In an emergency situation, this may at best be a nuisance and at worst be life threatening. For example, a patient might need an emergency MRI, only to be severely injured because the NHS doctors were not aware of her heart pacemaker, inserted in a private hospital.

No healthcare system anywhere in the world has ever had to institute major systemic reform in an environment of diminishing resources and efficiency savings on a massive scale, whilst still maintaining patient care. No evidence exists to prove that this could happen, but a lot exists to prove that it couldn’t.

Aneurin Bevan, the post WW2 Minister for Health and creator of the NHS in 1948, said it should be the foundation of a welfare state ‘from the cradle to the grave’. In “liberating the NHS”, an organization we all rely on, NHS staff and patients have been hindered, handcuffed, and hung up to dry.

True Englishmen, Guns and Pride

Shooters, hunters, stalkers and gun users are a rare breed these days it seems. Whilst once they represented all that was “proper” and “British”, now they represent, in public opinion, nutters in flat caps. And green jackets. And occasionally, Wellington boots.

Back in July, in an attempt to meet some real life gun owners, and just maybe quell the stigma, I went on a very short journey to see what these people were really all about, whether the myth was abstract or blatant reality, and it was nothing short of a little scary. This is the story of how an attempt to do a rational article about people who own guns became something different entirely…something harrowing.

On a hot morning when the weather had already reached its peak, sticky and incredibly uncomfortable in a way that would make most people short tempered and crabby. And so it seemed right I was wearing shorts. Now, there’s nothing wrong with a man wearing shorts. Not the subtlest clothing, maybe, but I was hoping that the shabbiness of my appearance would distract whoever I was talking to, giving me the upper hand in any conversation. It was a risky move that has almost never paid off in the past, but I was still confident.

I was very aware that I was entering a shop that carried not just its outward appearances or scariness, but with it a huge world, full of controversy, anger, pride, pain, death and nationality. And I was wearing shorts. Admittedly, I was also wearing a satchel, with pens, paper and other things jingling and rattling inside which made me look like I was at least pretending to be an adult.

The heat inside the shop on Southgate Street in Winchester, was even more muggy than outside, which was if nothing else an incredible feat of engineering, considering I could see that they had air conditioning, and so instead of looking just slightly dishevelled, I looked like I had a horrible fever. If someone new met me, they would probably think I was about to die, or maybe have a dump.

The first noticeable thing about the store, officially called a “Gunmakers” was the incredible amount of green and brown. Everywhere. This was presumably to lull any animals that might wander into the store into a false sense of security, so that they are easier to hunt and kill in the faux woodland. One side of the store was covered in hanging clothes, green and brown jackets mostly, the sort that country folk use to…well, I don’t think anyone really knows. There were also a few shirts that frightened me, just because many of them resembled ones I wear much of the time. The horror.

Where there were not clothes, there were rows and rows of guns, and where there were not guns, there were counters of things to clean guns, things to re-load guns, things to make guns more efficient. The guns were behind glass counters and inside glass cases, much like rings in a jewellers shop, and given the prices, they were just as precious. I was under the impression that guns were cheap, but apparently a standard “J. Woodward & Sons 12 bore sidelock ejector, circa 1911, 29" barrels, fine condition, straight hand stock with double triggers” can cost up to £11,000. I don’t think I’ve even seen that much money in my whole life, and for a frame of reference, here are some other things you can buy for £11,000;

· Boston Whaler 160 Dauntless 2003 (A large boat)

· A 1962 Chevrolet Impala

· A Summer House (Can be used as a Home Office, Log Cabin or a Golf Shop)

But we’re not here to talk about owning a kickass boat, a bitchin’ car or a totally badass summer house/log cabin, we’re here about the gun men, the men without these boats, cars, or houses.

The startling thing was the distinctive lack of animal carcasses. This is to say, there were only two that I could see. Two?! I thought this was a gun shop, not a flower store. What happened to the manly feel that was introduced by the guns, and cemented by the abundance of flat caps? I felt cheated, jilted even, but before I even had time to complain, I was set upon by a man.

He had come as if from nowhere, gliding on a haze of hunting prowess and skill. Perhaps this was a skill he had developed over years of sneaking up on elk and bear in the Alaskan countryside, but whatever the situation, he was as silent as the breeze. He stood beside me and asked without a hint of kindness;

“Can I help you?”

“Yes. Hi.” I replied trying to sound professional, but probably sounding (and looking) like a giant dick. Not like a journalist at all. All the brown satchels in the world couldn’t save me; “I’m a journalist from the University, I’m doing an article on gun ownership, who uses guns, what they’re like, that sort of thing, and I thought this was a good place to start.”

His demeanour instantly changed, he almost seemed excited, “You’ve come to the right place,” he said, proceeding to laugh for a while, and then turning back to me, asking; “do you need any literature?”

“I’m sorry?”

“I have these things here.”

He pointed to a rack of pamphlets that contained information on hunts, gun prices, second hand guns and cartridge prices, which startled me, not because of the pamphlets, but because of the American man with the giant fucking shotgun pointed directly at my face. This, to say the least, was incredibly terrifying. To say the most; holy Jesus shit!

“Don’t worry,” he beamed at me, his lips curdling into a grim smile, “It’s not loaded.”

This was probably the most ironic thing I have ever seen, and I’ve been to a rainy wedding. He was standing about two feet away from me, in front of the counter, behind which stood a man in an apron, presumably another employee. He proceeded to hit the butt of the gun on the counter, dropping it through his fingers until it slammed down, making me jump like a terrified cat, staring into the face of a particularly vicious dog.

“See, there’s a rattling noise when I hit it” He said to the man behind the counter, before picking the gun up and aiming it at imaginary elk in the sky.

The man behind the counter repeated his procedure with the gun precisely, agreeing with him about the rattling, before handing the gun back and turning his sights to me as I awkwardly shuffled through different leaflets.

“So what’s this article about then?” He blasted.

I shuffled on the spot, trying to maintain his eye-line and look at my feet in the same instance. “It’s about the sort of people who use guns, why they do it, and why some people don’t like it and think they should be illegalised, that sort of thing. It’s all up in the air at the moment.”

He paused for a second, squinting his eyes in what I imagined to be contemplative fury. Guns surrounded me. It was not a good place for me to be nervous, or him to be angry.

“If guns are outlawed, only outlaws will have guns,” He replied.

“You stole that from us!” The American said, laughing. “I hope this article will have a positive stance?” he asked me, holding his gun by the trigger, resting it on his hip like some strange khaki-clad cowboy. This was a man wearing a blue pastel shirt and Birkenstocks and still I was sweating in fear. “Well I think it should be neutral. Journalistic integrity and all that, but it’s going to be from my perspective.”

The American laughed, and leant towards me, as though he were about to whisper a terrible secret into my ear, and I tried to resist the urge to look intrigued, and also resist the possibility of crapping myself;

“The French have been neutral for a hundred years, and look at them!”

I laughed nervously, undecided whether he was just having a laugh or committing a bit of causal mid-morning racism. I looked at the pamphlets whilst the man behind the counter tinkered with the gun for about half a minute before handing it back to the American, who proceeded to aim at imaginary elk once more, this time aiming a couple of inches to the right of my head across my shoulder, and pulling the trigger, resulting in a sinister click.

“You fixed it!” he said excitedly.

The man behind the counter leant his shoulder on a ledge, crossing his arms in satisfaction, replying, “That’s why they call me God.”