Learning about disability provision in France

I spent the back half of last week in Lyon for a forum on the ‘disability sector’.   It was an international conference.  I was there to explain alien aspects of the British system, such as care packages, personalisation and welfare reform; others were there from Norway, Germany and Italy.   I’ve had to learn some new vocabulary – for example, that people with disabilities are no longer personnes handicapées but personnes en situation de handicap, and learning disability is sometimes (but not always) rendered by handicap intellectuel, sometimes by les personnes ayant des difficultés d’apprentissage.    Beyond that, there’s always the problem that professionals in France routinely talk in acronyms, such as the ESMS (établissements et services médico-sociaux) or the CPOM (contrat pluriannuel d’objectifs et de moyens) – I’ve only deciphered that one after coming home and looking it up, and I still don’t know what it really means.  There were interpreters at hand, so I chickened out and spoke in English.

It’s more of a culture shock to understand some of the differences in provision.  None of the agencies represented, in a conference with more than 300 managers attending, dealt with older people.  France still makes heavy use of residential care for younger disabled people.  There was also a moment of incomprehension when the German speaker asked about the  representation of people with disabilities in monitoring groups and got an answer about institutional accountability instead.  However, there’s a level of funding that many people in the UK would find enviable.

Remaining in the EEA was held up as a prospect in the referendum.

It’s being widely reported that Theresa May is going for the “hard’ Brexit, arguing that in the referendum people made a clear decision to  leave the EU behind altogether.  That’s not how I remember the debates. While the EU referendum was going on, we were constantly being told that leaving the institutions of the EU would not mean that the UK didn’t have access to the European single market.   For example, the pro-leave Bruges Group put out a video, fronted by Norman Tebbit, arguing for Britain to work through the European Economic Area.  A spokesman for the Bruges Group argued on that video:

“Britain could still remain a member of the single market, which is the European Economic Area, or EEA, which allows for free movement of goods, services, capital and people.  And that means that as far as business is concerned, businesses will trade as they have before.  But the difference will be that regulations will no longer apply to 100% of the UK, but only, if you want, the 9% that are directly involved with export.”

Michael Gove – remember him? – argued, in The Telegraph on 22nd June:

There is no trade-off between any of this and greater prosperity; in fact, the very opposite is true. The premises of Project Fear – that Brexit would trigger economic dislocation, a trade war and a recession – are utterly bogus. We would join the European Economic Area in the short-term, like Norway, retaining access to the single market, before negotiating our own, à la carte deal with the EU …

A YouGov poll, shortly before the vote, claimed that most people in Britain favoured the Norway option.   Now, of course, none of this is equivalent to an election manifesto, and there is nothing here that today’s politicians should need to feel bound by.  But it does reflect on the mantra that we’re hearing that people voted to get out and so the route is all very clear.

Oxfam is critical of extreme inequality but it’s not clear about what the problems are.

Oxfam’s briefing paper on inequality, An economy for the 99%, has attracted some plaudits, but I was disappointed.  Its main theme is the startling disparity between the super-rich and the rest of the world.   While it’s well researched, it suffers from two key vices.  The first is that it doesn’t do enough to explain why this inequality is a bad thing.  The second that it gets distracted by other issues – climate change and violence against women.  That’s not to say that they’re not important, but so are lots of other things – war, corruption, sanitation, communications –  and they’re all irrelevant to this case, too.

What, then, is wrong with extreme inequality?  The problem with  inequality is not that very rich people don’t pay their taxes, though it would help if they did.  It’s that their wealth limits the rights and security of the poor, most obviously in access to land and resources.  At the same time,  that the maldistribution of resources going to lower paid workers holds back the world economy, ultimately costing everyone.  We need to be wary, too, of the assumption that the Rich are exclusively made up of people richer than us.  From the point of view of much of the world, those of us living comfortably in Europe are the Rich, and we’re just as much of a problem as Bill Gates and Warren Buffet.

The crisis in the NHS

Leaving aside the question of whether the NHS has a ‘humanitarian crisis‘, which sounds apocalyptic, there’s much about the current state of the NHS which is based in long-standing problems.  The first problem is the lack of spare capacity in the hospitals. The effect of insisting that beds have to be fully occupied is to create inflexibility and bottlenecks.

However, the problems which show themselves in the hospitals are not necessarily problems which can be addressed through the hospitals.  The second key issue has been the retrenchment of social care.  Social Services Departments, or Adult Care Departments, have radically reduced the scope of their involvement with the public: figures are difficult to find, but between 2008 and 2013 the numbers of people being served fell by a quarter.

The third problem has been an apparent failure of GP coverage.  This is puzzling because the figures seem to imply the opposite.  Currently there are 5.8 GPs per 1000 patients per practice.  That   averages out to just over 1700 people per GP, in the worst cases rising above 2300.  When I started in this game the ratio of GPs to patients used to be 2200, in some areas going up to 3500, and that was in the days when GPs also had to come out at night.  However, there appear to be more people on GP lists overall than there are in the population – suggesting that general practices and CCGs are not very good at keeping their records up to date, possibly because it’s not in their interests to do so.  I’ve also not been able to find respectable figures for how many people are not registered with any local GP, which may be marginal (the same people are less likely to get access to any health care) but is potentially important in the demand for direct access to A and E.

It’s understandable that the government is focusing on GPs, because it’s the most immediate response that could affect the numbers of people coming into A and E without directly requiring new capital investment to do it.   Demanding that GPs change their office hours, however, is not likely to make much difference; this redistributes the times when people get seen, but it’s no guarantee that more will be seen and where, for example, a GP is taken off a Monday rota to go on a Sunday rota, it may mean (depending on the practice setting) that fewer are.  There may be other implications.  GPs do much more than talk to patients; they also coordinate continuing care and the multidisciplinary team.  (I understand this may be different in England, where GPs have been complaining that they’re more remote from community nursing.)  If at least one GP has always to be seeing patients, when can the practice ever have team meetings to discuss care management?

The fourth problem concerns how we respond to the population in need.  We should dismiss one of the common explanations: that the ageing population itself implies a greater burden.  There are theories about the ‘expansion of morbidity’, suggesting that people are ill for longer; there’s a contradictory view, the ‘compression of morbidity’, which says that people are healthier for longer – but frankly the evidence isn’t convincing for either of them. (The issues are discussed in a WHO report, Global health and ageing.)  However, it is true that local population movement does increase local demands in some places – the South East of England is overcrowded while some areas of Scotland are depopulated.  That’s  a different kind of issue.  We need to give more thought to the kind of services that are available for a mobile and often transient population.

The DWP misleads tenants about benefit changes

I know that Scottish Housing News may not be everyone’s constant study,  but they’ve been covering an interesting dispute about housing support.  The Director of Angus Housing Association, Bruce Forbes, had talked to the Dundee Evening Telegraph, expressing some criticism of the coming introduction of Local Housing Allowances in social housing, and particularly the ‘horrendous’ effect on younger single people.  The DWP replied with a general justification of the policy:

These changes are about restoring fairness to the system and ensuring that those on benefits face the same choices as everyone else. The reality is, nothing will change until April 2019, and existing tenancies signed before April 1 2016 will be unaffected.

That prompted a furious public response from Mr Forbes.  The DWP statement was irresponsible, “blatantly untrue” and “totally false”. The DWP were “peddling lies and misleading the public”.   Since then, the Scottish Federation of Housing Associations has expressed concern about the inaccurate information.   (I should declare an interest here; I have previously been a consultant with SFHA  and have worked with them on issues about benefits.)

There’s a point at which propaganda tips over into misinformation, and the DWP statement has done that – claiming that existing tenants won’t be affected.  This is not right – everyone coming onto Universal Credit will be subject to the new rules, and in due course that should be everyone of working age.  The main problem here is, of course, that people with very limited resources are suffering further cuts.  The same cuts also threaten the financial security of social landlords, which is another reason that the housing associations are worried about it.  Having said that, it is also worth remarking on the secondary issue.  The DWP has to make sure that the information it gives out to claimants is reliable, and that has to be more important than scoring political points in the local papers.

The IEA fails to understand some basic facts about disability

The Institute of Economic Affairs has published a briefing on Disability Benefits.   They claim that the cost of disability benefits could be reduced by making sure that more people with disabilities went into work.  The approach has been sympathetically reported in the Mail and the Independent.  Unfortunately, the briefing is written with a cavalier disregard for the most basic facts about disability benefits, which rather tends to undermine any arguments they wish to make about what should be done.

There are three quite simple reasons why a greater emphasis on work will not do very much.

First, disability benefits are mainly provided for people who are not part of the labour market.  Half the population with disabilities consists of elderly people (the figures used to show more than half; the 2011 census puts it at 48%).   Claims for Attendance Allowance, and a third of the claims for Disability Living Allowance, are made by older people.

Second, disability benefits are provided for many reasons which have nothing to do with work – among them meeting special needs like mobility, supporting care,  compensation for injury and even (in War Pensions)  reward for merit.  The main justification for DLA is not really to cover extra costs, as many suppose, but to compensate for long-term low incomes of people with disabilities.   None of these reasons disappears if people are in work.

Third, and following from that, many disability benefits (such as DLA and PIP) are provided regardless of people’s income or employment status.  The main benefit supporting disabilities for people of working age who are not in work is Employment and Support Allowance – and while it is true that ESA has been used to cover a hotchpotch of different circumstances, sometimes including disability, it is a sickness benefit, not a disability benefit.  Disability is neither a necessary or sufficient reason for getting it.

It’s true that the numbers of ESA claimants have persistently failed to go down, unless it is by the rather brutal approach of using disentitlement and sanctions to throw people off benefits with no income.  The main reasons why so little has been achieved for ESA claimants  are

  • the failure of psychiatric services to achieve valuable outcomes for people with long-term mental illness
  • the use of ESA as the low-income equivalent of schemes for early retirement
  • the preference of employers for employees who do not have long-term limiting health conditions
  • the penal treatment in the benefit system of part-time and therapeutic work, and
  • the perverse emphasis on individual effort to find a job, mainly focused on people who are too ill to work.

If what the IEA is saying is that more people on ESA need to work, they have about 25 years of policy failures to show that policies which try to do this are ineffective.

 

California gets rid of a nasty rule

It appears that the rule in California, which stopped families claiming extra benefits for any child born while they were receiving welfare payments, has been abolished.  The ‘maximum family grant’, introduced in 1994, is the model for the scheme in the UK, about to be introduced in April, to limit benefits to the first two children; both are based in the idea that people who receive benefits shouldn’t have babies.  Unusually the measure was opposed simultaneously by both the Catholic Church and Planned Parenthood.  Because having children is not always a choice, it included exemptions for mothers who had tried to be sterilized and those who had been raped. There is no way of administering a scheme of this type without intrusive inquiries, injustice and distress.

Stopping in-work benefits for EU workers

It’s been widely reported (for example, in the Times, the Mail and the Sun) that Theresa May has plans to restrict in-work benefits to EU workers, putting them on the same footing as non-EU claimants.  I’ve been puzzling about what this means.  The only benefits specifically mentioned in the reported briefings are Tax Credits, which in any case are supposed to be being replaced by Universal Credit.  In most cases non-EU migrants are entitled to benefits as long as they meet the various tests – residence, presence or habitual residence,  depending on which benefit we’re talking about.  So, for example, to be entitled to Child Tax Credit, Working Tax Credit or Child Benefit a non-EEA migrant is expected to have lived in the UK for three months.  Refugees and family members don’t have the three month test; but both EU and UK citizens returning from abroad, who are not working, are subject to the  test.  If Ms May was saying only that there’s to be a three-month residence requirement for everyone, she wouldn’t need to wait for Brexit; it would be compatible with EU law now.

The main restriction that actively affects non-EU migrants is something quite different:  the restriction of the terms of entry on their visa, where they undertake not to be dependent on public funds and are threatened with deportation if they do.    Treating EU migrants in the same way could only happen after Brexit.  It would mean that the issue is not mainly about benefit law at all, but about the way that Britain deals with foreign citizens.  It’s only workable if we have a straightforward way of identifying who is, and who is not, a migrant, and a clear record of the terms of entry.  That could affect millions of people.

Review: Beland and Mahon, Advanced Introduction to Social Policy

This is a review of a book I’ve been sent by the publisher, Edward Elgar. I’ve discussed the issues around reviewing before.

Calling something an ‘Advanced Introduction’ obviously invites questions about what could be in it.  This is a very short and rather expensive book (currently £14.36 for 126 pages, not 160 as advertised), mainly concerned to sketch out some key issues in comparative social policy.  The authors explain, right at the end, that “Rather than reviewing all theories and concepts available, we decided to focus on those we find the most analytically and empirically fruitful.”  So, despite what it says on the cover, this isn’t either ‘comprehensive’ or based on ‘compelling empirical materials’.  It’s about some of the ideas that inform comparative social policy: mainly, after an overview of comparative approaches to policy development, about exclusion, gender, the role of nations and globalisation.

Students are in safe hands with Béland and Mahon, but comparative social policy is a difficult subject to cover at a basic level.  Before they start, students need either to have some tools for comparison, or some basic knowledge of social policy.  If they have neither, it’s hugely difficult for them to approach the subject critically, because so much has to be taken on trust.   While several approaches to comparison are discussed – power resource theory, historical institutionalism and welfare regimes – I’m not sure readers would know what to make of the social division of welfare, path dependency, or the oblique references to issues like identity politics or functionalism.  The discussions of gender and diversity are interesting, and spreading the focus beyond wealthy countries is absolutely the right thing to do,  but I’m sceptical that someone who went into this book without knowing about social policy would come out knowing anything more about the kind of provision that has been made.  For the most part, the treatment in this book is discursive rather than explanatory, and that means it has to be read as an adjunct to other material, not as an introduction that stands in its own right.

Whatever happened to Social Policy?

It’s the shortest day, the bleak midwinter, and a note from WordPress tells me that I’ve now been writing this blog for five years. It’s also just over a year since I left my university post; I’ve managed in that time to complete a couple of books and I’ve attended about 25 sessions relating mainly to the development of social security issues.

While I was sorting through papers, I came across a copy of a rhyme I wrote for the Social Policy Association.  When I gave one of the talks in the plenary session of the SPA conference in 2004, I argued that  University departments in Social Policy had gone astray by abandoning its commitment to practice and the study of social administration, where so many exciting things were and are happening.  A short version of the paper appeared in Policy World.  I knew this message wouldn’t be popular (and it wasn’t), so I wrote it in verse to make the message more palatable.  Here it is.

I have a cautionary tale,
Which some may think beyond the pale:
It starts out as a fairy story
But ends up nasty, grim and gory.
A group of children lost their way
And, dreadful as it is to say
While they were out and having fun
Were slowly eaten one by one.
When first they set off through the wood
All were intent on Doing Good,
But those who strayed from off the track
Disappeared, and ne’er came back.
Sadly these kids met their fate
Where Funding Councils lay in wait.
Some strayed into a sorry fix
With Departments of Politics.
Hidden in the distant mists
were bears and Sociologists.
Blithely tripping, these young fools
Were unaware of Business Schools.
Some ran away, and some got lost;
Some compromised, at quite a cost.
Their numbers gradually diminished
Until the little band was finished.
(I don’t know if they tasted good
But they shouldn’t have run off into the wood.)
The moral of this sorry tale
Is, if we don’t want this group to fail,
We have to choose the path that’s best
Or we’ll be swallowed, like the rest.