Review
Culture
Economics
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10 min read

The book Keir Starmer says you must read

Will Hutton’s This Time No Mistakes surveys the thinking that could solve Britain’s ills.

John Milbank is a theologian, philosopher and poet. A co-founder of the Radical Orthodoxy movement, he is an Emeritus Professor of the University of Nottingham.

Kier Starmer sits on a sofa, leaning forward and holding papers he is reading. Rachel Reaves sits and looks on.
Starmer and Reeves.
Labour Party

In the aftermath of a historic election, one could do worse than read Will Hutton’s second big ‘state of the nation book’, recently published. This Time No Mistakes is worth reading just for the succinctness and clarity of its politic-economic history of the United Kingdom since the industrial revolution, which it provides in its central chapters. Indeed, Keir Starmer says it is a ‘brilliant book... read it if you haven't already It may well take a sophisticated journalist to be able to do this so well: too often, even the best of academics cannot see the public wood for their private-obsessional trees.  

But it is doubly and mainly worth reading for Hutton’s prognosis of our ills and his recommendations for solving them. The new Labour government could do far worse than try to carry through Hutton’s proposals, which almost anyone of common sense and goodwill (including all Tories) ought readily to endorse. Indeed, if the next government managed to initiate even a half of what he suggests, this country could be placed back upon the right tracks.  

As to the history, which is crucial to the ultimate diagnosis: Hutton contends quite simply that Britain has been self-deceived by the peculiar nature of its industrial revolution, which was the first in history. It was largely a matter of private enterprise, partly enabled and later cushioned by empire, whose possession encouraged us to support an unqualified doctrine of free trade.  

However, all other nations, including the United States, both when they sought to catch up with the steam and rail revolution, and when they later co-pioneered the ones based on gas and electricity, and ultimately on nuclear and digital, from the outset depended much more upon state intervention to promote needed expertise, education and investment. The United Kingdom, by contrast, remained captivated by the mythical glory of its initial take-off.  

As a result, not just Conservative governments, but also Labour ones, right up to the New Labour one, and including the catastrophically misguided work of Margaret Thatcher (Hutton is admirably unqualified here) remained far too captivated by the norms of economic laissez-faire, ‘balancing the books’, a primacy of finance over production and obsessive Treasury concern with money, rather than productive wealth.  

The exceptions to this were the pre-World War one Liberal government and the post World War Two Labour one. Yet all the strong ideas implemented by the latter came from ‘New Liberal’ thinkers and not Labour ones: notably from Keynes and Beveridge. Labour on its own, by comparison, has tragically and disastrously oscillated between a desire to replace capitalism with some sort of command economy on the one hand, and simply leaving capitalism as it is, with a bit of welfare tinkering, on the other. More recently this has been seen in the contrast between Corbyn and Blair. 

It is at this juncture that Hutton proceeds to complement his political-economic diagnosis with a more purely political one. The split on the ‘progressive left’ is a catastrophe that has kept the Tories unfairly in power for much of a century. This split is both caused by and has prevented any reform of the first past the post voting system, which urgently needs to go.  

For this reason then, political economy and constitutional reform go together.  

As to the latter, we need proportional representation which would allow more reasoned debate instead of the inter-party squabble, alongside legally guaranteed local government and a different kind of informed, rather than overweening executive.  

As to the former, we need flexible planning, public-private partnership in investment, a national wealth fund, sectional trade union bargaining, the breaking up of cartels and monopolies and required social purpose and stakeholding, for every business and financial enterprise. 

One is tempted just to say hurray! But there are some historical and theoretical questions to be posed that may have hidden practical consequences.  

Better than trying to ‘balance’ the private and the collective, as if the self and society were in rivalry, is to take the more Continental (and early Blairite!) course of stressing that we are always ‘persons in relation’.

Hutton now backs Tawney besides Keynes. But do they say the same thing? For the latter, capitalism is a wild, amoral and dynamic beast that can nonetheless be politically tamed. In certain phases of the capitalist cycle only (as Hutton rightly sees) this will be about boosting demand, but in others it can mean lessening it and temporarily hurting workers.  

But Tawney, and Hutton clearly agrees with him, wanted a market economy permitting only useful and not merely acquisitive wealth. Given this ethical purpose it was for him possible for the market, aa a socialist market, to reach equilibrium, beyond extrinsic and always precarious state ‘management’.  

Just how precarious was seen in the 1970s. For Hutton, the lapse of Keynesianism in this decade was simply a matter of the triumph of the wrong ideas. To a large degree this is surely right, and yet it is not the whole story. Were it the latter, then neoliberalism might not have spread beyond Anglo-Saxon lands to Europe and South America.  

The other aspect is surely the reality that capitalism of its nature, as driven by the amoral search for profit, resists any prospect of a stable, social market. Achieving that and extending the corporatist order of negotiation between state, business and unions would have been the alternative way, instead of Hayekianism, to deal with ‘stagflation’. Rather than a competition between capital, labour and consumer for money that wasn’t there at the time, a fair division of spoils could have been consistently instituted by legally and culturally re-framing the firm and the market, something that would have immediately favoured a renewed degree of growth.  

Really, almost everything that Hutton writes indicates agreement with this sort of thing, including the recognition that of itself, capitalism is not actually dynamic (that comes from technology and culture) but tends to build up sterile finance in the interests of the few, rather than productive growth in the interests of the many. But in that case ‘ethical socialism’ is not just a set of ideals, as he tends to imply, but a mode of achievable practice.  

Similarly, a general mutualist national insurance approach to welfare, which he rightly favours, was not just a New Liberal advocacy as he claims, but deeply rooted in co-operative socialism and in Christian (especially Anglican) social thinking whose influence -- except silently in the case of Tawney -- goes unmentioned. Yet the very phrase ‘welfare state’ is Archbishop William Temple’s and Tawney’s social analysis, intended for the general public, concluded with an unabashed High Church ecclesiology! 

It is relevant here that Hutton speaks of the need to combine the ‘I’ with the ‘We’ and yet he clearly does not endorse just any old exercise of ‘individual agency’, even if he sometimes appears to do so, when defining the operation of the price mechanism as necessarily ‘wild’, after Adam Smith’s exclusion of commercial transactions from the immediate operation of social sympathy. Better than trying to ‘balance’ the private and the collective, as if the self and society were in rivalry, is to take the more Continental (and early Blairite!) course of stressing that we are always ‘persons in relation’ – at once within and outside each other, in a constant creative weave.  

Nothing could be further from Keynes’ despising of the proletariat and favouring of learned leisure, that John Ruskin’s revolutionary mystique of the artisanal. 

There are two deeper questions about Hutton’s approach. First, his excessive ‘idealism’, as with his analysis of the Seventies switch, may still underrate the difficulty of overcoming the power of entrenched interests – the need indeed not so much for class, as for popular warfare against plutocracy.  

Secondly, he tends to underplay a theoretical tension between secular and materialist thinkers, including New Liberals, on the one hand, and religious and Idealist thinkers like the first ‘New Liberal’, T.H Green on the other.  

The latter was much more like Alasdair Macintyre or Michael Sandel than like John Rawls, as Hutton claims: for by human ‘self-realisation’ he meant the ‘positive liberty’ of pursuing the objectively true ends of human flourishing: religious contemplation, artistic creation of genuine beauty, active citizen participation.  

By contrast, the secular New Liberals, including Keynes, tended to reduce the ethical good to the negative liberty of rights, private friendship and utility – often leading them to favour eugenics and to indulge in racism. Nothing could be further from Keynes’ despising of the proletariat and favouring of learned leisure, that John Ruskin’s revolutionary mystique of the artisanal.  

Hutton tends to express surprise that a Tory like Ruskin, or a reactionary like Carlyle, should have favoured the cause of the worker – and indeed in Ruskin’s case also espoused ‘communism’, as Hutton elides from the picture. But this is to fail to see how Tory Radicalism and even paternalism is actually a third strand in the kind of transformative thinking that we continue to need, was always a crucial influence on Labour and was a crucial element of the postwar settlement.  

If these thinkers indeed favoured ‘hierarchy’, then that was in part because they wanted more interpersonal and mediated chains of command, rather than brutally centralised and mechanical ones. Surely Hutton wants that also, as his excellent reservations about the use of Artificial Intelligence would indicate? 

There is a recognition that economic individualism usually ‘on the right’ is actually matched and encouraged by a cultural individualism usually ‘on the left’. 

This is perhaps the limit of talking in terms of ‘progressive’ versus ‘conservative’. Hutton harks back to the norms of the Enlightenment. Yet, as Richard Whatmore has shown, all the great British enlightenment thinkers came to think that pure enlightenment was failing.  

They saw its anti-religious fanaticism stance as challenged by the rise of new secular, nationalist and direct democratic fanaticisms, as supremely with the French Revolution. By ‘populism’, as we might now say! 

But they also already recognised that the breakdown of a rational peace had been encouraged by excessive consumer greed and by the over-implication of commerce in state borrowing (whose pre-enabling of industry in Britain, Hutton does not mention) and so also in war and empire.  

It was exactly in this context that the enlightenment thinker Edmund Burke began to consider the virtues of the longer-term embedding of enlightenment in Christianity and the importance of the medieval ‘gothic’ legacy of a corporate order binding social body to social body, rather than individual to individual via contract, mediated by the market and backed up by the state.  

In Burke’s wake, for example with the radical William Cobbett, much of the Nineteenth Century critique of economism, to which Hutton is the heir, was of a ‘Romantic’ and often ‘neo-medieval’ rather than purely enlightenment cast. (Hutton at times wrongly reads medieval ‘feudalism’ as ‘absolutist’ – a specifically early modern phenomenon.) This matters, because this tradition contains a stronger recognition that the centralising state (which the Enlightenment favoured as a substitute for the Church) can be just as alienating and anti-social as the uprooting market – even if, as Karl Polanyi later saw, one needs the power of the state today in order to restore the primacy of the social and of inter-human fellowship.  

Within the same current, there is a recognition that economic individualism usually ‘on the right’ is actually matched and encouraged by a cultural individualism usually ‘on the left’. And here Hutton is perhaps inconsistent – he definitely sees this, mentioning the dubious overriding of the universal by identitarian concerns,  and yet also recognises it somewhat uneasily, as it challenges certain ‘progressivist’ assumptions. 

 As a result, he rather disallows the validity of some populist concerns – ironically rather like the incomprehension of the older enlightenment in the face of the new revolutionary era. For example, concerns with the normative primacy of the heterosexual family and the enabling of family and children, with regional and national identity, with the academic ‘woke’ trashing of the entire Western legacy, with the exploitation and cultural disruption of excessive immigration, with ecological policies that simply override current human needs while doing little to assist the future of nature.  

The danger of these partial blind spots could be a continued failure of the roughly ‘communitarian’ Left, or the sensible Right, to win over the mass of the people to their cause. For they must be won over if not just the United Kingdom, but humanity as a whole, is to have a decent future.  

Towards building that future, no one has contributed more, or more valiantly, than Will Hutton.  

  

 

Article
Change
6 min read

Are we forgetting how to care?

The profound act at the heart of nursing.

Helen is a registered nurse and freelance writer, writing for audiences ranging from the general public to practitioners and scientists.

A nurse bends beside a bed and talks to a patient
Marie Curie.

Recently, at a nursing leadership programme in Oxford, attendees focused on the fundamentals of care.   Have we forgotten how to care? What can we re-learn from those who pioneered an ordinary yet profound act that affects millions? 

Anam Cara is an old Gaelic term for ‘soul friend’, a person with whom you can share your innermost self, your mind and your heart. It is a term that Tom Hill, former chief executive at Helen House Hospice in Oxford, used to describe the relationship between his staff and the thousands of children and their families who passed through their ‘big red door’ in its first twenty-five years. The hospice (or ‘loving respice’ as it became known) had been founded by Sister Frances Dominica in 1982.  

Other care in this country can also trace its religious roots. Between 1048 and 1070 in Jerusalem, the Order of St. John was founded for the purpose of helping pilgrims (“our Lords, The Sick”) who had become lost, weary, or beset by other difficulties while on their way to the Holy Land. Today, in the United Kingdom, the British Association of the Order has extended care to older people first in almshouses and later in care homes. A trustee for ten years was John Monckton, a man of ‘considerable talent, enormous integrity and deep religious conviction’; his tragic murder in 2004 led to the creation of the John Monckton Memorial Prize, which recognised and rightly celebrated commitment to care by care workers. 

Today, across the world, seen and unseen, nurses, carers and families continue to provide compassionate care. “Assisting individuals, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge” is the very essence of nursing, captured by ‘architect of nursing’, researcher and author Virginia Henderson in 1966. Meeting more than basic needs such as breathing, eating, drinking and eliminating bodily waste (which are of essential importance), Henderson recognised the role of the nurse in enabling humans to communicate with others, worship according to their faith, satisfy curiosity and sense accomplishment.  

In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care?

An uncomfortable truth brought out in healthcare reports such as the Final Report of the Special Commission of Inquiry (The Garling Report) 2008, and the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (The Francis Report) 2013 is though that this type of nursing is too often done badly or even missed, leading to pressure injury, medication errors, hospital-acquired  infection, falls, unplanned readmission, critical incidents and mortality. According to nurse scientist and scholar Professor Debra Jackson, “missed care occurs much more frequently than we might think”. She cites a systematic review in which ‘care left undone’ on the last shift ranged from 75 per cent in England, to 93 per cent in Germany, with an overall estimate of 88 per cent across 12 European countries’. 

In one offensively-titled paper, “Shitty nursing - the new normal?” (in which the authors apologise for the title but not the questions raised), real-life pen portraits are drawn of patients lying for hours on hospital trolleys, immobile through infection or injury, ignored by staff. Whilst acknowledging contextual factors for poor care, such as a shortage of nurses and resources, the authors argue that circumstances cannot be the sole cause of missed nursing care. 

A report published by the University of Adelaide, School of Nursing, has called for nurses to ‘reclaim and redefine’ the fundamentals of care. It asks whether the cause of the problem (of missed nursing care) lies “deep in the psyche of the nursing profession itself?” “Has something happened to the way modern nursing views and values caring?” it continues. “Indeed, is nursing in danger of losing its claim to care? In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care? Or is this a broader social pattern where individuals are less inclined to show kindness, compassion, and care for others even if it is a necessary requirement of the job?” 

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness. 

Writing in the British Medical Journal, Professor of critical care medicine Peter Brindley and Consultant in intensive care Matt Morgan wonder whether doctors also “too often default to high-tech and low-touch” when patients are dying – a time “when community and connection matter most”. They powerfully begin with a mother’s comment: “Humans are gardens to tend – not machines to fix.” 

Professor Sir Al Aynsley-Green, the first National Clinical Director for Children in Government and former Children’s Commissioner for England, and past president of the British Medical Association, suggests that we as a society need a “momentum for compassion”. Struck by the extremes of compassion witnessed during his wife’s treatment in the last years of her life, Sir Al wants to see a cultural transformation in healthcare: for compassion to be a key operating principle in NHS and care settings, led by the Chief Nurse’s Office; for every organisation to promote the importance of compassion at the professional level; for the views of patients and families to be sought regularly; for much earlier and better focus on compassion in undergraduate and postgraduate teaching programmes for all staff; for compassion to be inspected against by the Care Quality Commission; and for a willingness to encourage staff at all levels to expose poor practice as well as celebrating excellent care.  

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness. “It’s putting yourself into somebody else’s shoes – and doing something about it.” Recently appointed the UK’s first Visiting Professor in Compassionate Care at Northampton University, at the age of 80, Sir Al certainly is doing something about it. He has made it his new purpose in life to “embed compassion into every aspect of care”.  

Like Sir Al, Queen Elizabeth II, the UK’s longest serving monarch, espoused compassion, in word and deed. Living a life of compassionate service, the Queen made clear that her Christian faith was her guiding principle. She speaks of Jesus Christ as ‘an inspiration,’ a ‘role model’ and ‘an anchor’. “Many will have been inspired by Jesus’ simple but powerful teaching,” she said in her Christmas Broadcast, 2000. “Love God and love thy neighbour as thyself – in other words, treat others as you would like them to treat you. His great emphasis was to give spirituality a practical purpose.”    

When nurses do unto others as they would have done unto themselves, and act as role model to colleagues, not only do patient experiences of care and their outcomes improve – but so does job satisfaction for nurses: a critical factor in nurse recruitment and retention – the biggest workforce challenge faced by healthcare organisations. Across the UK, there are currently more than 40,000 nursing vacancies, and thousands of burnt-out nurses are leaving the profession early. Whether nurses decide to stay or go is driven in part by their daily experience at work. The late Kate Granger, Consultant in medicine for older people, inspired Compassionate Care Awards in her name, envisioning that such a legacy would drive up standards in care - and surely also help retain nurses, through restoring a sense of pride, achievement and fulfilment to the nursing workforce.