One of the features of our age is that ‘improvements’ are rarely good news. A promised improvement means that those with power are going to change something, and those with power would not be where they are if they were going to change anything for the better. In the public realm, an ‘improvement’ generally involves the transfer of large sums of money to private contractors to make something worse than it was before. The ways in which they ‘improve’ things are strikingly homogenous. In my hometown, as in others across Britain, wooden benches are replaced with concrete coffins, far less comfortable but supposedly more chic. Pavements are ripped up and replaced with newer, shinier ones that transform into ice-rinks at the first sight of frost. In the weeks after my town’s market square was revamped – in the teeth of strong opposition from locals and stall-holders – several people slipped and fell on the new steps, and one man died. But then, the main justification for such projects is not normally utility, but a vague promise that they will ‘attract investment to the area’.

So when I saw an article in my university’s newsletter entitled ‘Enhancing our wellbeing provision to staff’, I was not filled with optimism. This is not the first time the University of Essex has made an announcement of this kind. In 2018, I wrote about the outsourcing of student counselling to the company already used for university staff, Validium (now HealthHero), a move pitched as – you guessed it – an improvement. Clearly, the provision has since been so good that it has had to be improved again. Out with Validium/HealthHero, in with Health Assured, a ‘confidential and independent counselling service’ whose promise to organisations, from universities to police forces and NHS trusts, is to ‘maximise your ROI’ (‘return on investment’), protecting the mental health of ‘your people’ from just one pound, per person, per month.

A quick internet search cast doubt on Health Assured’s claims to be confidential, independent or a counselling service. In 2024, the company was investigated and subsequently had its accreditation suspended by the British Association for Counselling and Psychotherapy (BACP) after a BBC investigation revealed that Health Assured had allowed corporate clients to eavesdrop on confidential calls without the knowledge or consent of those using the service. Nor, of course, can a profit-making company like Health Assured be described as ‘independent’ when it comes to the bottom line, whether its own or that of its clients (its website boasts of its ‘ability to deliver 10:1 returns on every pound you invest’). That might help explain why the same investigation also found that the company had put pressure on its employees to keep the actual counselling to a minimum, imposing targets on length of calls (20 minutes max) and on the percentage of callers referred for therapy (20%). But hey, that was last year. Maybe things have improved.

The story here is a bigger one, not confined to Health Assured or the University of Essex. The provision of ‘Employee Assistance Programmes’ (EAPs), schemes offered by employers to help staff deal with personal problems that might affect their performance at work, is dominated by large ‘digital health companies’ (Health Assured alone provides EAP services to 13 million workers) whose business model depends on the sorts of ethically dubious practices uncovered by the BBC’s investigation. How do you provide for the mental health of the employees of large and often dysfunctional organisations for the bargain price of one pound, per person, per month? Simple. By banking on having to provide in practice only for a small minority of the minority who pick up the phone in the first place. The rest are, in the words of one former Health Assured employee, ‘fobbed off’: steered away from costlier options like therapy in favour of remedies such as the Wisdom app (also owned by Health Assured), which, in addition to offering an ‘interactive mood tracker’ and ‘1,000s of perks and discounts’, concurs with just about all the other ‘wellbeing apps’ on the market in advising users to sleep, breathe and drink water. Wise indeed.

It’s an eerily similar picture with HealthHero, which has gobbled up rivals like MyClinic, Doctorlink and Medvivo, and its provision of out-of-hours GP services for the NHS. GPs employed by HealthHero report that the company made allocation of shifts conditional on meeting ‘performance targets’ which included ensuring that 80% of telephone consultations were closed ‘with no onward referral’ for treatment. The service offered by outfits like Health Assured and HealthHero is thus the precise opposite of what it claims to be. Rather than providing easy access to help for those who need it, their role is to stand between the help available and those seeking it in order to make access more difficult.

Nobody should be surprised by the discovery that politicians and corporations do not do what they say they do. But while political euphemism is nothing new, recent times have arguably seen a shift toward a purer double-speak in which meanings are ever more perfectly and unblushingly reversed. Whereas terms like ‘austerity’, ‘downsizing’ or ‘streamlining’ at least preserve an implicit acknowledgement of the basic character of the changes on which they are attempting to put a positive spin (or presenting as unfortunate necessities), the wielders of today’s ‘improving’ knives are reluctant to call a cut a cut. The interchangeable, faceless gimmicks that increasingly take the place of human support are pitched to us as technologically enabled abundance (the ‘Wisdom’ app, for example, gushes that its helpline and ‘live chat’ are open ‘24/7, 365 days a year’). In the radically vacuous parlance shared by political and institutional leaders alike, less is always more. Lumping it is not enough: you are required to like it, too. Under these conditions, often the best we can hope for is that things won’t ‘improve’ too much.

Read on: Lorna Finlayson, ‘On Lesser Evilism’, NLR 145.