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BMJ 2012; 345 doi: (Published 19 September 2012) Cite this as: BMJ 2012;345:e6318
  1. Tony Delamothe, deputy editor, BMJ
  1. tdelamothe{at}

“Economically, socially and politically, the north is becoming another country,“ said the Economist last week of England (15 Sept 2012; p 27). Accelerating this division are the latest cuts in UK government spending, which will disproportionately affect the north.

However, sympathy is in short supply, as the latest British Social Attitudes survey makes clear. “If you look back at the previous recession, you find that people became more sympathetic . . . that hasn’t happened this time,” said the head of the survey group. As reported in the Financial Times (17 Sept 2012, p 2) the proportion of people wanting to see more spending on welfare benefits has fallen from almost 60% during the 1991 downturn to about 35% at the start of the 2008 recession, and to about 30% now.

Attention turned briefly to the north of England last week—specifically to Liverpool, and the 96 Liverpool fans who were crushed to death at Hillsborough football ground in 1989. Published on 12 September, a report by an independent panel chaired by the Bishop of Liverpool contradicted some of the prevalent beliefs about the disaster that had been fostered by the police and other emergency services. “The panel’s careful catalogue suggests that the worst sporting disaster in British history may also be the worst police cover up of all time,” summed up the Economist (15 September 2012).

In his blog column this week, John Ashton describes the immediate aftermath of the disaster, and a disturbing change of mood a few hours later ( “Police were rounded up, and everybody else was evicted; doors were barred; and the first police debrief took place. I think that this was when the systematic conspiracy began,” he says. “When I gave evidence at the [earlier, official] Taylor inquiry, the most expensive barristers in the country sought to traduce my account and throw doubt on my competencies. We now know that police officers’ accounts, which made exactly the same points as mine, were redacted, that points criticising the police and emergency services were removed on 116 occasions, and that anything relating to supporters was left in or accentuated.”

New inquests into the deaths and prosecutions may follow, but past performance suggests it’s unlikely that any of the culprits will go to prison. In the first article in his series on prison healthcare, Stephen Ginn sketches out the sort of person who does: poor, disadvantaged, vulnerable; considerably more likely to have been homeless, unemployed, and in social care as a child; and of very low educational attainment (doi:10.1136/bmj.e5921).

As Ginn points out, prison presents unique challenges to the delivery of good healthcare. Additionally, “any successful health initiative runs the risk of being seen as too good for prisoners, who are portrayed as undeserving.” England and Wales now lock up nearly twice as many people as they did 20 years ago. It can’t be because prison “works”—reoffending rates remain stubbornly high—unless prison’s main function is to keep the most disadvantaged members of the population out of sight and out of mind.

If a measure of society is how well it treats its weakest members, or its poorest or its neediest, Britain’s current record is appalling.


Cite this as: BMJ 2012;345:e6318


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