Category: Social Policy

This occasional blog discusses issues in Social Policy.

The Maseres scheme for life annuities

I found a copy of Nicholls’ History of the English Poor Laws in a second hand shop, and it’s taken me a few months to get round to it.  My attention was caught by a couple of references to schemes for avoiding the Poor Law, which I hadn’t come across before.  One was Acland’s Universal Benefit Society, effectively a proposal in 1786 for  a scheme of National Insurance.  Another was proposed by Baron Maseres, who attempted in 1772 to create a universal savings plan which would deliver a lifetime annuity of between £5 and £20 a year for men over fifty, and women over 35.

Maseres worked out the costs scrupulously on the basis of actuarial tables of life expectancy.  He argued that

 The design of this bill was to encourage the lower rank of people to industry and frugality, by laying before them a safe and easy method of employing some part of the money they could save out of their wages, or daily earnings, in a manner that would be most strikingly for their benefit. …  if they saw an easy method of employing the money they could spare in such a manner as would procure them a considerable income in return for it in some future period of their lives, without any such hazard of losing it by another man’s folly or misfortune, it was probable they would frequently embrace it: and thus a diminution of the poor’s rate on the estates of the rich, an increase of present industry and sobriety in the poor, and a more independant and comfortable support of them in their old age than they can otherwise expect, would be the happy consequences of such an establishment.

The measure, watered down to allow for reluctant parishes to opt out,  passed the House of Commons,  but it was blocked in the Lords.  It’s not a Citizens Income scheme, but it has some of the characteristics and aspirations of a partial basic income, nearly twenty years before Thom Paine’s more radical and more universal approach.

Additional note:  I’ve appended an extract from Maseres’ text, where he explains the scheme,  in PDF form here.  

Analiza Politike za Praksu

I’ve just received a copy of the Serbian edition of  Policy Analysis for Practice.  It’s been translated into Serbian under the title Analiza Politike za Praksu, and my name is rendered as Pol Spiker.    Followers may prefer Socijalna Politika: teorija i praksa,  which covers most of the ground in this earlier book along with lots of other material.   The choice is yours.

“Fixing our broken housing market”

The Housing White Paper for England, Fixing our broken housing market, has generally been seen as a damp squib.   It’s not immune from ideological claptrap – for example, the assertion that “housing associations belong in the private sector” (p 51).  It must be welcome, though, that this is the first document in many years to recognise the fundamental problem: there are not enough houses.  Most documents on housing policy since the 1970s have been obsessed with the issue of tenure, which is a question of how the housing is distributed after it’s built, or affordable housing, which is about relative costs.  There has not been enough building for more than forty years, and by now Britain needs a couple of million more houses. The crude numbers matter, because wherever there is a shortage, people get left out.  If there are not enough houses, then some people will have nowhere to go, some will be excluded, and others will be forced to live in housing that is unfit.  Because it’s a market system, the people who this is most likely to happen to are those with the lowest command over resources – that is, the poorest.

The policies suggested in the White Paper – it’s more of a Green Paper, with some scope for consultation – are not going to fill the gaping hole in housing supply.  While the proposal to build 275,000 a year will help, there will have to be several years of continuous growth before the benefits are clearly felt. One of the problems is the reluctance of many of the main stakeholders – builders, local communities and banks – to do anything which might jeopardise house prices.  I was intrigued, then, at a suggestion from an unlikely source: the deeply Conservative Michael Portillo, speaking from the couch on the satirical programme This Week.  Portillo suggested that the building had to be done by the public sector, and then went further.  The sale of council housing had shown, he argued, that it was possible to feed council housing back into the private sector as the occasion demanded: so it would be possible to create a bank of public housing now, and slowly to release it for owner-occupation so as not to unsettle the private sector.  I doubt we would ever be able to do this with the fine degree of control that would be needed to manage the market, but the idea has a lot of merit.  In particular, that it could do something for the people who are excluded now.  Let’s build half a million new council houses right away, and then we can talk about what happens next.

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.

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.

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.

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.

 

 

The problems with social care

Social care has been unmanageable for some time, and it’s not simply down to the actions of this government, or the one before it, or the one before that.  The problems run much deeper than any quick fix can address, but many of them can be laid at the door of two very long-standing policies, and I can see no way of resolving issues while those two policies stand.

The first failing policy has been in place for more than fifty years.  Circular 2/62, on Development of Local Authority Health and Welfare Services, declared that “Services for the elderly should be designed to help them remain in their own homes for as long as possible.”   The model sounds plausible, but it is based on the highly questionable gamble that people will never need more intensive support.  This is, quite literally, catastrophic – it generates sudden crises.  It means that we leave people in place until there is a catastrophe, usually a fall or hospital admission.  This leads directly to people being trapped in acute hospitals until they can get an emergency admission into residential care, often settling for a third or fourth choice because that’s all there is.   We need people to be settled in lifetime accommodation long before the crisis happens.

The second failing policy stems from the Griffiths report of 1988, which attempted to provide personalised, individuated social care through the creation of a quasi-market.    Provision based on this model has signally and continually failed to provide people with the level of support they need.    It’s not down, as many supporters of the policy claim, to lack of resources.  Market provision can’t work by providing a flexible response – it implies that support will be fragmented, offered in short bursts of time.   Individuated responses are spectacularly inefficient; they’re also desperately expensive.

The push to personalisation has been based in a futile attempt to implement an impossible dream.  Individuated policies only work for people whose needs are more limited.  The more intensive the support has to be, the more has to be provided in a distinct location.  We spend a great deal of time and money pretending that residential care is really a modified form of domiciliary care, with added accommodation: it isn’t.  A greater commitment to residential care is the only way out of this bind, because residential care brings together trained staff, facilities and resources in the places that allow them to be used for people in need to the greatest effect.