Public Policy Conjectures

Background

This essay was submitted in February this year as evidence to an enquiry group set up in December 2025 by Wes Streeting Secretary of State for Health to report in the summer of 2026. There was concern that mental health demand in the NHS was rising alarmingly and that the causes needed understanding and the issues addressed. Inter alia, there was concern that mental illness was being over-diagnosed. With two changes of secretary of state, and despite a policy announcement, the outcome of the enquiry is still under some Westminster carpet. And that no doubt is where this essay is, along with the much sounder and scurrilousless contributions of the eminent scientists. So resteth most expert advice. Selah.

Introduction

Over the last 40 years, there has been an almost continuous policy, even under New Labour, of neoliberal economics and its associated idea of each individual and family, having the power to “do their own thing” .  The nation is happiest when individuals and families are free to take full control of their own lives, and so far as possible, without the interference of the state. Individuals and families know what’s best for themselves and do not need a Nanny state. 

So laws and rules have been eased or abolished by deregulation.  Joint action through unions has been discouraged.  Self-employment, individual saving, individual pension plans, home ownership, have been encouraged.  Health insurance, independent of a national health service, has also been encouraged. Indeed, most people now use a private sector dentist, not the NHS. 

Neoliberal economics with its focus on money, drives cost cutting, both in the private and public sectors. Its aim is to increase efficiency, providing goods and services at less cost. The nation becomes more productive, the economy grows and we all enjoy a rise in living standards.

Part of cost saving has been a reduction in public spending.  Since 2010, this has been of the order of 30% in local government.  Over 40 years, this reduction must be much higher.   Similar efforts have been made in central government services, presumably with similar results. 

But to cut costs, there has been huge pressure on wages and working conditions, not only in the public sector but In the private sector also.  Clear evidence of this is to be found in the efforts made by governments in the last 20 years or more to raise the minimum wage, and also at government alarm at the rising benefits bill.

Quite separately, there has been a rise in corruption including corruption involving IT —computer fraud —which has reached frightening proportions. 

There have been other factors at work over this period on which I will only touch in this paper. 

So how have these developments affected the mental health and well-being of us all?  How have Neo-liberalism, corruption and certain aspects of IT affected our well-being, and perhaps, (we cannot be sure), our mental health?

Is everybody happy? You bet your life we are!

Individualism or selfishness

With neoliberal economics has come a focus on individualism—the American dream turned Anglo-Saxon. Some have also proclaimed there is nothing wrong with greed. 

Great emphasis is placed on our rights: to free speech, to health care, to nothing ever going wrong  (it won’t happen again), to park where we like, drop litter where we like, make noise where we like. Whilst giving to charity has been promoted, practical caring for our neighbour has not.  So we don’t open doors for others, or close doors behind us, or we drive cars too big for the car-parking spaces, or for the climate. The care of suppliers to customers has disappeared and the loyalty of customers has now to be bought by nectar points.   

Queen Elizabeth’s publicly stated commitment to service, to others, and her obvious faithfulness and commitment to her promise, is not a common talking point. Service to others is how I was trained at home, at church, in education and as an accountant in local government. Then the new hard-nosed business culture took over the public sector.  The focus was the business and the object efficiency and eventually saving money. The bottom line moved from the imprecision of the citizen to the precision of the customer, with a £ sign nearby.  We citizens are still called “customers’ to this day. We citizens are no longer served, but have customer services delivered to us. 

Behaviours like road rage, parking disputes, maybe neighbour disputes, demonstrations and protests have become more angry, though fortunately not too violent, but certainly less peaceful.  

Is there more intolerance or less tolerance?  Are we kinder or less kind to each other?  

There seems to be a feeling about that we have become a more selfish people. Are more of us, more of the time, looking after number one?  Does even the phrase ,“number one”, now in common parlance, indicate a change of culture? 

And is anyone more stressed or even anxious as a result?   And does it have any significant effect on mental health?  Or have we become quite used to it and take it all in our stride?

Enhancing or demolishing workers’ rights, conditions, salaries, security of employment

Workers today are expected to give their life and soul to their employer.  Some are paid handsomely for it. Others are expected to work to order for a pittance. In many cases they are treated as self-employed—when they are not—off-loading costs and risks from the business to the worker.

All workers’ hard-won rights over hours worked, sick pay, holidays, pensions, etc have been attacked, reduced, amended, and new contracts of employment enforced or forced upon workers. 

Most workers now have no security of tenure even in the most stable of government bodies such as the NHS. This applies from top to bottom of the organisation. 

Some employees in labour only contracts, part-time contracts, allegedly self-employed etc do not even know from week to week how many hours they will work and therefore what their weekly income is.  But they still, apparently, need to eat every week—even eating every day is recommended. 

Some are in such poverty that they have to switch off the heating, cannot pay the rent, have to have resort to loan-sharks to feed the family.

Most workers now have inadequate pensions. With inflation sensitive cash based pensions, no-one knows whether or not the pension will be adequate on retirement. No-one knows if they can even live in the same house or in the same locality.  Everyone needs a final salary pension, which is just as obtainable now as ever, provided we save enough and work a bit longer, as we all live to such a ripe old age. 

The poor in rented housing are worse off still—they can’t afford to save for a pension and have to pay rent in retirement. 

But we seem to prefer today’s pleasures to tomorrow’s security—and when tomorrow comes we we will be short and complain. And tragically, the economy suffers from the frugality of poor pensioners. 

Is everybody happy? You bet your life we are! 

Cost cutting and efficiency savings 

This puts huge pressure on workers, including bosses.  It is hassle and stress in its implementation.  It is also a threat to pay and livelihoods (redundancy).  

The nation is obsessed by cost cutting, cheap goods and services, nectar points, multiple credit cards, bargains, discounts , three for the price of two, black and white Fridays, and get rich quick with gambling and competitions. No-one wants to pay the full price (the average price) for anything. 

So the pressures on workers are intense. 

Does it cause anxiety and stress? 

Motivation of workers 

Are workers motivated or demotivated by these changes?

Efficiency savings in the public sector are largely or overwhelmingly the cutting of services or of service quality. The consequential failures of every government service are a complaint of the entire nation.

Bullying of workers seems to be rampant.  I was one of Blair’s “wreckers”.  Cameron and even Starmer,  and Hodge, Balls, Rees-Mogg, and many others have cast outrageous slurs on public sector workers.  It is extremely stressful and totally demotivating and depressing.   “Yes Minister” must take a lot of blame for this. 

In the private sector we have Mike Ashley. There was also the American who ran the Sky Blues at Coventry and whom I watched for 10 years bullying club, fans, probably the stadium, the city council and the entire population of Coventry.  The other day, I watched my coach driver falling a asleep at the wheel coming from Guilford station to  Basingstoke in the pouring rain.  I kindly told him he should go off duty and found he had worked too long.  When I reported it to SW Trains and blamed the driver’s employer, he replied, “You can say that again”.  

At the Post Office, they lock you up in prison if you get it wrong.

Trump’s and Sugar’s “Apprentice” is all about promoting this kind of macho, bullying management. Watch it on the TV tonight!  And practice it at work tomorrow! 

Burnout and constant measurement of performance, targets, have also been instanced.

But no-one’s upset or anxious or stressed by all this, now, are they?

Privatisation

All sorts of public services have been privatised. This has not only worsened workers’ conditions 

as explained above, but it has also worsened the services the citizen receives. Cost rather than quality has been the aim of privatisation. Cutting taxes rather than delivering services has been the aim.

The grass verges outside our house are no longer maintained; they are cut occasionally and cut-up by machine-driven operatives.  The scandal of the totally miss-named child-care services  has surfaced yet again.  The probation service was privatised and then nationalised again because it didn’t work. Homes—or so called homes—for the elderly are owned by equity firms who have no care for Britain, but are based in the Bahamas so they pay no UK tax. Housing management and maintenance, estate roads are being privatised every year; the new development across our road will be another.  That will bring future hassle. Privatised school buildings under PFI involve extra management problems for school staff.  The railways are gradually being nationalised again. River pollution is a gift of privatisation .

Has the re-organisation hassle it has involved been worthwhile?  Is it stressful maintaining your school through a privatised business with the aim of profit? And have the cost reductions been at the expense of workers’ wages or conditions? 

Has any of this caused worry and stress? If so, how much future stress is still in store for all of us? 

Deregulation 

Deregulation is a popular idea and a primary aim of much government change and legislation. Individuals and businesses should be freed of the shackles of the state. There should only be light-touch regulation—whatever that means. Competition, the market and self-regulation will maintain standards.

However, deregulation is compounded by cost cutting of staff in every regulatory body such that the remaining regulation is not properly enforced. Ofcoms etc fill the headlines with their failures. Scandals abound.

The most awful of course, is Grenfell Tower in 2017, where unsafe cladding caught alight and killed 70 people and destroyed lives.  Immediately, all such ,buildings were at risk, and 2 or 3 millions lives were and still are blighted.  Nearly 10 years later, only half the work has been done. And where it has, lives are still blighted as occupiers can’t move because no-one will buy their apartment, or can get a mortgage on it. Some couples cannot start families because they have no room and cannot move.  

And all aspects of building safety and building standards have now been compromised. No-one in a house or flat built after say 1990 can have confidence in its structure and finishes. Worse still, I have got the impression that any house built in the last twenty years is of questionable quality. 

Light touch regulation in the City has produced an epidemic of financial scandals.  They are covered next under Corruption.

Our rivers are polluted; and rubbish in 20,000 ton lots is dumped where criminals like, and no-one takes any action—even it seems, when it’s too late!  

And is everybody happy?  You bet your life we are! 

Renting houses 

There has been a decline in houses to rent from the public sector and a huge increase in renting from the private sector.  This is firstly to replace public housing, then to off-set the big reduction in home ownership, and also to fulfil the increased demand for housing from increasing population and household formation. 

However, the temporary nature of private sector renting, the increased power of landlords to end tenure, and the high inflation in the costs of housing, have all increased the pressures on tenants. There are also many cases of failure of private and public landlords to properly maintain houses, and to even respond to problems.  

The high rents often mean that they are higher than the costs of a mortgage, which the tenants allegedly cannot afford. This is an iniquitous distortion of how the private housing market used to work and how it still works abroad. 

The whole housing rental market seems to be an extortionate abuse of those who are deemed by the market, society, and the government to be too poor to own their own homes.

Is everybody happy?  You bet your life we are.

Corruption

Corruption has grown greatly this century. And it has reached astronomic proportions—even though it is well below that of Trump’s nascent kingdom and far below Czar Putin’s.

The first inkling of its scale was the Anglo-American financial failure in 2007-8 when the whole banking system nearly collapsed and had to be saved by the state—bizarrely by a Labour Government!  By the Blessed Margaret’s despised Socialist Opposition!  Would you Adam and Eve it!  No-one knows the personal losses borne by individuals, despite monumental amounts of government intervention and taxpayers’ money.  But all sorts of incompetences and dubious or corrupt financial practices were suspected and nearly came to light. 

Prior to this, corruption and financial crisis on this scale dates back to the crash of 1929.  The scandals of Maxwell, T Dan Smith and big 19th century scandals such as Hudson, the railway king, were not on this scale.  Moreover, as instanced later, the scale of IT fraud is regarded as immense: 40+% of UK crime, and the single largest crime. 

The next big scandal was an insurance swindle (PPI) run by the big banks: they have now spent £50 billion on paying compensation. (This figure is correct: it is the total of amounts over many years provided in their published accounts.)  The next big bank swindle is on car finance. It is worth £30 billion, though they’re trying hard to reduce the compensation to victims, so that the banks don’t suffer.

Some small or medium-size businesses have been destroyed by the banks: by withdrawing loans.

Many people have been miss-sold pensions. 

A former member of the Bank of England Financial Policy Committee listed 144 such scandals.  But that was 10 years or so ago. I am not aware of its being up-dated.  But the car finance scandal above was not amongst them.  To my surprise, The Telegraph and Times give weekly updates on financial scandals!

A new industry has sprung up selling services to help people recover money that has been stolen from them.  But some of these businesses seem to be taking excess shares of victims’ compensation, or even defrauding the victims for a second time.  

Has any of this caused any anxiety or stress?  As for me, I no longer trust any financial institution: my own bank, Barclays, is a multi-billion offender—crook is a better word for crooked dealing! 

IT, business efficiency and leisure-time 

IT works on an individual  basis.  Email addresses, accounts , even contact with big business is always individual to individual. You discover quite quickly that even an email address “info@cornflakes.com” is Barbara or Jack.  So IT is very neoliberal in its outlook. 

It also requires each individual to manage his IT use: his email, social media account  etc to keep it working, all his apps, passwords, and master the kit as well. This is not much of a chore when it works—but it does take time—but it is an absolute nightmare when it doesn’t work,.  This is because it is a highly technical task on a highly complex machine on which you cannot be expected to have any expertise. It’s like maintaining your car without expertise or tools. 

We also have a much higher tolerance of mishaps and even failures with our computers than we would even contemplate with our car.  The University of Copenhagen estimates its daily rate as high as 10 or 15%.  That sounds too high to me. But 5% is too high. We would never tolerate a situation where 1 in 20 times we used our car we had some minor technical glitch —with a major one thrown in every 6 months or so.  Why do we tolerate such different reliability with IT?  

Business efficiency works hand in hand with IT in two ways. 

Firstly, it now expects everybody to frequently switch providers on every possible service they use to get the best quality and price.  Just to make that easy for us, they will only agree to supply their service for 2 years. So things like gas or electricity or mortgage, which I only ever set up once in my life, now have to be done every 2 years. You also have to do the same with all those things like a pension that you now manage yourself, instead of getting them sorted by your employer. If you’re self-employed you have to do a tax return. Lots of things including organising a holiday are DIY today. In addition, all sorts of extra tasks such as managing nectar points, seeking out discounts, and online gambling all eat into other leisure time.  

Secondly IT enables staff reduction, because office work is computerised and some work is off-loaded to the customer.  So call centres , automated telephone switchboards, hiding staff behind computing , flexible working, working from home, having to leave messages, change of business representative—all of these give rise to common complaints.  It’s nearly impossible to get a response. That is stressful!

Everyone I have ever met, or spoken to, or read in the media or even heard do a quick poll on air in the BBC radio studio, has a rich anthology of these challenges—yes, we have no “problems” these days.  

Off-loading many tasks to customers and increasing customer activity also eats into customer time—into our leisure time: yours and mine. 

Extra stress in dealing with problems and reduced leisure time are not good news.

IT Crime

IT crime is in your face and in your ear most weeks in our house.  We get a few phone calls from recorded crooks or sometimes live crooks.  We get neighbourhood watch emails telling us of all the crimes committed around us, of one up the road, how we should be fearful; and also of how we can hear a local policeman tell us how to keep safe, or how we should avoid scams.  Whenever I pay someone new on Barclays Bank internet banking I am told it could be a scam.  It doesn’t matter how I answer their half dozen questions—it always ends up saying it could be a scam. My B&B booking payment could be a romance scam, Barclays said. So I contacted Susan and she said, “No such luck!”. 

Barclays are supposed to be after the mafia and money-laundering.  Instead they’re after me. I paid £35 to a hobby organisation in France.  Barclays phoned me up to see if it was money laundering: was I paying money to an outfit that would split it and send it on to 3 or 4 different outfits? As much as 10 euros each. 

And of course the money pages of the newspapers and the BBC Scam-watch etc are always telling you to be on your guard.    

I and my wife spent 60 years or more of our lives not even thinking about crime and criminals being just around the corner all the time. We never even spoke to a criminal, even with two minor burglaries.  But now we get crooks and criminals frequently phoning us up—in our homes.

Do we feel threatened?  Do we feel more anxious? Do we want 2 or 3 reminders each week from friend and foe telling us what a wicked world we live in and that we could easily be prey to evil? 

IT social media abuse

There is no need for me to go to town on this. 

However wonderful the internet, and the fact that I couldn’t even write this evidence without such wonderful technology, there is no doubt it is full to brimming of evil.

It is worrying. It is threatening.  It does give rise to immense anxiety, especially to the vulnerable and their friends and relatives. 

Other factors

There are a range of worries arising from climate change.  Amongst them drought, flooding and coastal erosion.  But storms, new power lines, other disruption including installing solar panels, heat pumps and constant phone calls from roof insulators don’t help the cup of joy to overflow. 

But it could be argued that these are today’s examples of the normal vicissitudes of life.  We cannot take policy decisions to avoid them.

The Nation as a whole

There is a general feeling of malaise which is quite widely expressed. There is common talk of “broken Britain”. 

Part of this is a failure of government to intervene or to resource services adequately.  Here are some examples: 

Train service punctuality and reliability 

Pot holes 

House building 

Regulation enforcement

Prosecution of offenders e.g. financial fraud

NHS maternity care —baby deaths and unpleasant mother experiences. 

Getting driving tests

Another part is cynicism about government, public servants, and politicians. Fear and joy over Brexit has been replaced by disappointment  and disillusion. There is a widespread view that politicians squabble amongst themselves and seek personal advantage. (As a public servant I strongly disagree—most politicians are committed to serving us all.) 

Everyone has their story of problems, hassle, inability to contact anyone in any organisation on any matter when there is a problem a complaint or even anything that is not run of the mill. We all know that this is stressful, wastes time, which is a further stress, and reduces our leisure time—the impact of which cannot be good. 

Is everybody happy? You bet your life we are! 

Mental health

The nation, including politicians, seems agreed that there is a serious lack of resources to deal with mental illness.  The general view I believe, is that together with mental disability, it really accounts for something like 50% of ill-health, but receives only 30% of NHS funding.

So we’ve been mis-diagnosing and over-diagnosing mental illness have we?

There’s no proof that any of the issues I have identified has had the effects I am suggesting or claiming.  Nor can I claim these things have had or ever will have any deleterious effect on mental health. Nor can anyone else—at least, not in any comprehensive way over time.

Likewise, no-one can prove that a diet of violent entertainment or violent family life, or being addicted to Eastenders rather than Mrs Dale’s Diary, or to social media or advertising will in any way affect a person or a person’s Iife, for good or ill. Watching public executions in Iran or in Merrie England, likewise, may have good or bad effects on anyone. 

But £ trillions spent on advertising and publicity is spent on the basis that social pressure and pressure on individuals does work. It does have an impact that changes behaviour. 

So we have to make value judgements about these things, even when we need to take action. 

We have to rely on what uncertain evidence we have; on the evidence of our own eyes; on circumstantial evidence (as here;); our own moral fibre, or lack of it; the practicality of taking action; liberty; the costs and other factors. 

Here, I think the circumstantial evidence is extremely worrying.  Otherwise indeed, politicians would not be calling for evidence and advice on the matter—though not from me, an ordinary citizen!  (No public sounding or consultation has been organised.) 

I suggest that 40 years of neoliberal economics and its associated individualism, and individualised IT, (despite their benefits), together with increased corruption, have increased anxiety and stress.  And, ceteris paribus, that can increase mental illness. 

We are reaping what we have sown.  And this “model of cultivation” is still strongly practised and promoted by all the political parties. 

Is everybody happy?  Not as happy as they could be. 

© Philip Morgan   February 2026  Public Policy Conjectures All rights reserved