Hospital(ity)

What happens when angels of mercy go walkabout, leaving patients bereft? Why, the boss of the Royal College of Nursing weighs straight in. If his angels are too busy, Dr Peter Carter wants patients' families on the ward and on the job as well, looking after lonely grannies in distress. "Somehow we have sleepwalked, in some parts of society, into assuming this is someone else's responsibility." Cue predictable outrage over this NHS betrayal, plus even more predictable warnings about lowered standards. It's a hospital's job to care and tend, we're told. It's what nurses are for. And the last thing we want is upmarket union leaders passing the buck. But pause: let's take a short trip.

Three times in the last 12 years I've seen what happens in Spanish hospitals when my grandchildren are born. What's that at the side near my daughter's bed? It's a bunk. Her husband isn't merely there for the birth; he's on the spot night and day, bringing this, fetching that, always on hand while she recovers. That's normal, totally expected. Active paternity service, not paternity leave. And now my Spanish grandson has broken his arm rather badly in two places. He's in pain. And, in quite another hospital, the bunk is there again. His mother spends two nights with him, comforting, reassuring, nipping out to buy food, a stabilising presence in an unsettling world.

Which means I too remember how, a few years back, I was in trouble myself, bleeding internally and causing manifest alarm. A Spanish ambulance shrieks through the night. Another hospital to the collection. I'm dosed and monitored non-stop behind curtains in A&E. And there's an airline-type seat beside the bed there. My wife can try to sleep close by. The next morning I'm wheeled upstairs to a small ward – and of course there's another recliner seat close by. The guy to my left, just recovering from open heart surgery, has visitors almost 24/7. They're a bit noisy; they come and go constantly – but hey, join the party. What's the point lying around feeling sorry for yourself? The gang's all here.

And the deeper point, revealed time and again, has absolutely nothing to do with cost-saving – or with graduate angels too proud to plump a pillow. The Spanish experience is instinctive and positive. It doesn't make family involvement a passed parcel of sneaky budget savings. It says, simply, that this is what family life is all about. Hospitals aren't carved up between them and us. Hospitals are more joint community centres in a society used to doing the right thing.

Long ago, as a child, I was in a faraway Nottinghamshire hospital for well over a year: visiting hours, on Saturday and Sunday, 2.30pm to 5pm. My mother, a widow without any hope of a car, had to travel 20 miles via three separate bus journeys to see me. Get there for two-thirty. Get out at five. That's your lot. In retrospect it seems cruel and pointless – but still somehow natural. The mystique of medicine says life is a waiting room. Doctor knows best. Nurses have duties: please keep out of their way.

Of course you can produce due justifications as required. But in fact there's a more fundamental chasm opened here. We pay for and bang on about the NHS because it has almost god-like status. Leave your flowers on the altar and go. Family care ends at the hospital door. Busy professionals are taking over now. Thank you, and good night.

That's a generalisation, of course: it can't wrap millions of cases in a single bundle of blame. But how does any society go truly big on compassion or cohesion when families are deemed a nuisance, a fact without a function? And what does it say about families when they not only accept that divide – but bristle at the thought of bridging it?

Race and Riots

IF THERE was any consolation to be had from the recent English riots, it was that they did not pit one racial community against the police (as in Brixton and elsewhere in the 1980s), or one such community against another (as in Bradford and elsewhere in 2001). Yet the density of black people among the rioters suggests that race played some part, even if few politicians are keen to contemplate it. Just what that role was is a matter of great concern to thoughtful black Britons.

Black people make up slightly less than 3% of the British population. But in the CCTV snaps of rioters that the police in London, Birmingham and Manchester have put on the internet, slightly more than half seem to be black. Many of the areas in which rioting took place, such as Tottenham, Hackney and Brixton, are largely black. In Scotland, Wales and north-east England, which have small black populations, there was no rioting.

Poverty can only be part of the explanation for this pattern. While blacks are, by and large, poorer than whites, Bangladeshis and Pakistanis are poorer still. There was no disorder in areas with large Asian populations, including in London; CCTV pictures suggest there were few Asian looters. (The fact that the trouble coincided with Ramadan might—or might not—be a factor in this quiescence.)

The black community suffers other, older and perhaps related problems, too. Black children are disproportionately likely to be excluded from school, and black adults to go to prison (see chart). African-Caribbean males are a special worry. African-Caribbean boys do much worse in school than African-Caribbean girls or African boys. The most recent available analysis of GCSE results by race and sex, which was done in 2009, shows that 56% of African-Caribbean boys got five A-C grades at GCSE, compared with 65% of African boys and 70% of African-Caribbean girls (for all pupils, the figure was 74%).

This is sensitive stuff. Many of the black leaders who are prepared to talk about it do not want to be quoted. They tend to home in on three issues, two of which affect white people too.

The first is family breakdown. David Lammy, the MP for Tottenham in north London, where the first riots broke out, and whose father left when he was 11, has spoken movingly on the subject. He points out that, while family breakdown is increasingly prevalent in white society, it is far more common among blacks: 65% of black Caribbean children in Britain grow up in a single-parent family; nine out of ten of those households are headed by women. Children brought up in one-parent families are more likely to take drugs, drop out of school and end up in prison.

A second concern is culture. Tony Sewell, whose charity, Generating Genius, promotes maths and science among black boys, fingers the rap and hip-hop music that MTV popularised from the 1980s: “Black popular culture used to be based on spirituality and social justice…Now we have a music that glorifies violence, materialism and sex.” Lindsay Johns, a writer who mentors young black people in Peckham, south London, adds another bugbear: “achingly PC educationalists, who call ghetto-speak ‘culturally rich’ and ‘empowering’. Rubbish. It’s a mashed-up, debased language that spectacularly disables our young people, because nobody will give them a job if they talk like that.”

The shortage of other role models and templates of success in the black community makes its youngsters especially susceptible to these influences. Yet they reach others too. “Black male culture is powerful stuff,” says Mr Sewell. Firms use black street culture to sell fashionable goods such as trainers. As a result, he says, it has far more sway among other ethnic groups than it did 20 years ago. “Youngsters in other communities want to be part of it; so if it is a problem for the black community, it becomes a problem for everybody.”

The third issue, which is particular to ethnic minorities and perhaps black people above all, is racism, or the perception of it. The unrest in Tottenham began at a protest against the killing of an armed black man by police; some blame police racism for the ensuing violence. At the Samuel Lithgow Youth Centre in Camden, north London, Jessica, a black 13-year-old girl, says her brother was searched twice on a recent shopping outing: “It doesn’t look as though they’re going for any other race.” Stephanie, a 17-year-old girl of Bulgarian origin, concurs. When she hung out with a mixed-race bunch, the police used to search the black boys and nobody else, she says. Official figures lend some credence to these anecdotes: in instances unrelated to terrorism, blacks are five times more likely to be stopped and searched than whites by London’s Metropolitan Police.

Even if the police are more likely to pick on black boys, both the police and society as a whole are far less racist than in the past. Yet history lingers. A teacher says, “Everybody in the black community is told constantly that they’re victims. Parents think the police are racist, the teachers are racist and the establishment is racist. And they tell that to their kids.” If people believe the law to be racist, some may not regard breaking it as morally wrong.

These problems may be entrenched, but they are superable. Mr Sewell’s outfit has helped 40 black boys from tough schools to get into top universities. Leaders of Tomorrow, the mentoring scheme with which Mr Johns volunteers, has helped students get scholarships to some of the country’s best independent schools. Katharine Birbalsingh, an outspoken teacher, is trying to start a new “free school” to combat underachievement in Lambeth, one of London’s poorest boroughs. And, as Mr Lammy points out, “Tottenham has just had its best exam results ever. Most kids in Tottenham weren’t rioting. They were getting good GCSEs.”

Blair On The Riots

Both David Cameron and Ed Miliband made excellent speeches last week and there was much to agree with in what they said. None the less, in the overall commentary on the riots, I think we are in danger of the wrong analysis leading to the wrong diagnosis, leading to the wrong prescription.

There were some proximate causes of what happened that are relatively easily dealt with. The police are under huge pressure. If they go in hard, they fear inquiry, disciplinary action and abuse. It's all very well to say that they should just follow the rules. The police need to know they have strong support from politicians and public. When the riots first occurred, they would have been naturally anxious as to how heavy to be. Once they saw the country behind them, they rallied.

But my experience with the police is they need 100% backing. Otherwise, you're asking a lot of the officer on the ground in a tough situation.

Then, some of the disorder was caused by rioters and looters who were otherwise ordinary young people who got caught in a life-changing mistake from which they will have to rebuild.

However, the big cause is the group of young, alienated, disaffected youth who are outside the social mainstream and who live in a culture at odds with any canons of proper behaviour. And here's where I don't agree with much of the commentary. In my experience, they are an absolutely specific problem that requires deeply specific solutions.

The left says they're victims of social deprivation, the right says they need to take personal responsibility for their actions; both just miss the point. A conventional social programme won't help them; neither – on their own – will tougher penalties.

The key is to understand that they aren't symptomatic of society at large. Failure to get this leads to a completely muddle-headed analysis.

Britain, as a whole, is not in the grip of some general "moral decline". I see young graduates struggling to find work today and persevering against all the odds. I see young people engaged as volunteers in the work I do in Africa, and in inter-faith projects. I meet youngsters who are from highly disadvantaged backgrounds where my Sports Foundation works in the north-east and I would say that today's generation is a) more respectable b) more responsible and c) more hard-working than mine was. The true face of Britain is not the tiny minority that looted, but the large majority that came out afterwards to help clean up.

I do think there are major issues underlying the anxieties reflected in disturbances and protests in many nations. One is the growing disparity of incomes not only between poor and rich but between those at the top and the aspiring middle class. Another is the paradigm shift in economic and political influence away from the west.

Each requires substantial change in the way we think and function.

However, I would be careful about drawing together the MPs' expenses row, bankers and phone-hackers in all this. We in politics love the grand philosophical common thread and I agree with Ed Miliband on the theme of responsibility.

I became an MP in 1983. Then, MPs were rarely full time, many didn't hold constituency surgeries and there were no rules of any bite governing expenses or political funding. So the idea that MPs today are a work-shy bunch of fraudsters, while back then they were high-minded public servants, is just rubbish: unfair, untrue and unhelpful.

Likewise with the boardroom. I agree totally with the criticisms of excess in pay and bonuses. But is this really the first time we have had people engaged in dubious financial practices or embracing greed, not good conduct? If anything, today's corporations are far more attuned to corporate social responsibility, far better in areas like the environment, far more aware of the need to be gender- and race-balanced in recruiting.

Britain gives generously to those in need abroad: faster and more than many other nations. At a time of cuts, our aid budget – which saves countless thousands of lives – is being protected. There is criticism but the remarkable thing is not how much but how little. The spirit that won the Olympic bid in 2005 – open, tolerant and optimistic – is far more representative of modern London than the criminality displayed by the people smashing shop windows.

And here is what I learned in 10 years of trying to deal with this issue. When I visited the so- called "bad areas", whether in Liverpool, Bristol, Birmingham, London or elsewhere, what I found was not a community out of control. What I found were individuals out of control in a community where the majority, even in the poorest of poor parts, was decent, law-abiding and actually desperate for action to correct the situation.

In witnessing the lifestyles these individuals have, I found two things came together. First, there was a legal system overwhelmed by the nature of the crime committed by these young people, buttressed as it is by gangs and organised crime.

Second, these individuals did not simply have an individual problem. They had a family problem. This is a hard thing to say and I am of course aware that this, too, is a generalisation. But many of these people are from families that are profoundly dysfunctional, operating on completely different terms from the rest of society, middle class or poor.

Most of them are shaping up that way by the time they are in primary school or even in nursery. They then grow up in circumstances where their role models are drug dealers, pimps, people with knives and guns, people who will exploit them and abuse them but with whom they feel a belonging. Hence the gang culture that is so destructive.

This is a phenomenon of the late 20th century. You find it in virtually every developed nation. Breaking it down isn't about general policy or traditional programmes of investment or treatment. The last government should take real pride in the reductions in inequality, the improvement in many inner-city schools and the big fall in overall crime. But none of these reaches this special group.

By the end of my time as prime minister, I concluded that the solution was specific and quite different from conventional policy. We had to be prepared to intervene literally family by family and at an early stage, even before any criminality had occurred. And we had to reform the laws around criminal justice, including on antisocial behaviour, organised crime and the treatment of persistent offenders. We had to treat the gangs in a completely different way to have any hope of success. The agenda that came out of this was conceived in my last years of office, but it had to be attempted against a constant backdrop of opposition, left and right, on civil liberty grounds and on the basis we were "stigmatising" young people. After I'd left, the agenda lost momentum. But the papers and the work are all there.

In 1993, following James Bulger's murder, I made a case in very similar terms to the one being heard today about moral breakdown in Britain. I now believe that speech was good politics but bad policy. Focus on the specific problem and we can begin on a proper solution. Elevate this into a high- faluting wail about a Britain that has lost its way morally and we will depress ourselves unnecessarily, trash our own reputation abroad and, worst of all, miss the chance to deal with the problem in the only way that will work.

Looters Are Scum