Category: Social Policy

This occasional blog discusses issues in Social Policy.

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.

The Casey Review

I’ve just been reading the Casey Review, published on the 5th of this month.  It’s supposed to consider “opportunity and integration in our most isolated and deprived communities”.  It seems to be doing something quite different, because the main focus is not about that at all.  The primary focus is the relationship of minority ethnic groups (plus the rather odd addition of sexuality, which is a very different kind of issue) to the ‘British’ mainstream.  Deprivation and disadvantage don’t get much of a mention before chapter 6.

There’s a discontinuity, too, between the issues that the report is discussing and the measures which are proposed to respond to them.  One of the key proposals is to “Build local communities’ resilience”.  The issues being considered – for example, asylum seekers or illegal immigration – aren’t, by virtue of the numbers discussed,  necessarily capable of being linked to specific localities.    A second proposal is to ensure that people adopt “British” values, but that’s done without asking how those values related to issues of identity.  Integration is a matter of relationships, and relationships have at least two sides.

Why we should have some sympathy for Lord Howard

It’s been reported that Lord Howard, once a hardline Home Secretary who became briefly the leader of the Conservative Party, has had a little local difficulty with the law.  When his car was detected speeding, Lord Howard was unable to say whether he or his wife was driving.  It’s a route they drive frequently, the notice of committing an offence comes some time after the offence has been committed, and either of them could have been driving.   Lord Howard has been heavily penalised for not making the declaration, suffering a penal fine and extra points.  The two drivers had the same number of points;  they could have agreed a story between themselves; they could have lied.  They chose not to.  Instead, they gave the honest answer: we don’t know.

Regular readers of this blog will be ahead of me.  I’ve argued for years, sometimes to the bafflement of MPs and MSPs,  that people claiming social security can’t sensibly answer the questions that the authorities want to ask them.  People with disabilities can’t say whether they’re disabled or not (most of them get it wrong).  People who are forming a relatonship with someone else often can’t say when that person becomes a partner.  People who start work in our new, ‘flexible’ labour market may not  know whether they’ve got a job or not, or even if they’re going to be paid.   When they fail to answer the black-and-white question, or when they plump for the wrong answer, they’re penalised for it.  I trust that Lord Howard will now have the insight to champion their cause.

Improving lives? This will do the opposite.

The benefits system has been immeasurably damaged by the obsession with work as an answer to every problem. People who are sick have been forced to declare that they are actively seeking work; others have been put under pressure to find work where there is none, or in situations where their disadvantages rule them out. Some have been sanctioned for non-compliance; more have been disentitled. People who work do not necessarily have the income they need or the rewards or opportunities that work is assumed to bring in its train.

The DWP Green Paper, Improving Lives, is just awful. It complains about the inactivity of the most sick and most vulnerable.  It does not accept that some people need to be excused from the labour market: “1.5 million people now in the Support Group … get little by way of practical support from Jobcentres to help them into work.”   It does not seem to understand that pressure to work will unavoidably be seen as a threat to the security of people’s income while they are ill – because that’s what it is. It proposes to extend to those for whom working is least viable the kind of regime that has so signally failed for people in the ‘work related activity group’. If people who are sick cannot find ways to engage with the labour market, why should we imagine that people who are  sick and vulnerable should fare any better?

Troubled families: a programme without a rationale

The main evaluation report on the Troubled Families programme comes to a clearly negative verdict:  the scheme did not show any produce any significant or systematic improvement in the lives of the ‘troubled families’ it was supposed to help.

The two reports on the programme are difficult to decipher, however; it can be difficult to work out from them what the programme did, how it went about it or how the money was spent.  The basic questions that need to be asked about any programme are about its aims, its methods, implementation and outcomes.

Aims.  What were the aims of the programme?

David Cameron described the initial programme as dealing with ‘neighbours from hell’, but there was never any link established between the programme and the perceived problems.  The initial conceptualisation of ‘troubled’ families was confused, and the target numbers seemed to have been made up.  Claiming to ‘turn people’s lives around’ is pretty vague, and it would be difficult to tell what the effects were without taking a very long-term perspective – certainly longer than the period that this policy has been in operation.  There have been other very long-term studies  and they tend to suggest that the impact even of serious disadvantages tends to dissipate over time.

Methods.  What did the programme do?

The method is described in the evaluation synthesis report.  They were to include

  1.  A dedicated key worker
  2. Practical ‘hands-on’ support
  3.  A persistent, assertive and challenging approach
  4.  Considering the family as a whole;
  5. Common purpose and agreed action.

This is, more or less, a social work process.  It’s not a full professional example of social work with families, because that would have involved assessment, identification of needs and selection of appropriate responses, but it looks a lot like what many social workers would decide to do anyway.

Implementation.  What effect did the process of implementation have?

The report notes that this was happening at a time when resources for social work were being cut, so for the most part it looks as though what was happening for families in the programme was what might have been happening for years before.  If there was more information about specific interventions, I blinked and missed it.

What were the outcomes?

The evaluation focuses on five main factors:

  • benefit receipt
  • employment
  • educational participation
  • child welfare, tested by whether or not children were in care.
  • offending

There are obvious problems in treating benefit receipt as a sign of being ‘troubled’, and being in care is a long-term issue. If there were links to addiction or antisocial behaviour, they were not strong enough to be treated as criteria in their own right: addiction is not referred to and anti-social behaviour is a very minor category within ‘offending’.

There was no good reason in the first place to assume that the families being entered into the programme were ‘troubled’ or anti-social, and while there are good arguments for family social work in its own right, it’s far from clear how the methods were supposed to make a difference to the supposed problems.  Jonathan Portes, one of the report’s authors, has written that this is “the perfect case study of how the manipulation of statistics by politicians and civil servants led directly to bad policy and to the wasting of hundreds of millions of pounds of taxpayers’ money.”