Category: Social Policy

This occasional blog discusses issues in Social Policy.

Review: B Greve (ed) Handbook of Social Policy Evaluation, Elgar 2017

This is a review of a book I’ve been sent by the publisher, Edward Elgar. I’ve explained the terms on which I review books here.

Bent Greve, the editor, explains that this book is intended to cover “methodologies, cases and how and when to make evaluation in social policy, and its possible impacts”.  Part 1 offers six chapters on the techniques, most of the chapters in part 2 discuss issues in evidence based policy making, mainly offer discussions of evidence on sixteen policy areas (though two of the seven chapters are really case studies rather than discussions of that sort), and part 3 has ten further chapters of case studies.  That really means that half this book is about evaluation and evidence, and half is discussion of specific policies.  The more interesting case studies, to my mind,  were on medicines, long term care and interventions for children, but none is exceptional.  A couple of the other case studies are discussions of policy, not centrally about evidence or evaluation at all.  This does not add up to either a book on evaluation, or a handbook for people who want to do one.

The real place to start, unfortunately, is the price.  This book, 520 pages plus index, costs £195 – that’s not a misprint.  (NB: Since I posted this review, the publishers have told me there is a cheaper e-version at £36 on Google Play.)   The price might be defended for a library purchase if this was an irreplaceable, essential read, but it’s hard for any collection of papers to meet that standard.  Like most collections, it has a mix of good and not so good, and there’s a lot of competition out there.  On evaluation, Parsons’s short book on Demystifying Evaluation (Policy Press, 2017) is a relatively  accessible and practical guide.  I still like Michael Scrivens’ Evaluation Thesaurus, even if it was published in 1991; his evaluation checklist is available free on line.  On evidence and policy, there have been several recent books; I’d recommend Justin Parkhurst’s The politics of evidence (Routledge, 2016) an insightful and well-written book that explains a lot of what’s wrong with the main approach in this one.  Parkhurst’s book is available in a free Open Access version.

There’s other stuff out there for free, too.  The World Bank offers a virtual library of methods and case studies in evaluation, along with guides such as P Gertler et al,  Impact evaluation in practice (World Bank, 2011).  There are problems with the  World Bank’s approach; it’s technocratic and liable to be uncritical.  The objections are

  • theoretical – evaluations, especially RCTs,  often look at the wrong things in the wrong way;
  • political: aims, methods and outcomes cannot be understood in a political vacuum;
  • statistical: the variables are interdependent, the methods heavily sensitive to the statistical assumptions  and results are unlikely to be replicable; and
  • evidential: the available data don’t support the main methods.  Garbage in, Garbage out.

Some of the writers for the Handbook refer to some of these points, but neither the criticisms nor the practicalities are dealt with thoroughly.   A reader has to dig for the objections, because they are referred to in the context of the paper where they occur, not systematically – you have to get through a hundred pages, well into the chapter on systematic reviews, before you even catch the sense that the “evidence hierarchy” introduced on page 6 is contentious.  There may be room for a state-of- the-art review of evaluation and policy, but this isn’t it.

Arguments for welfare

Arguments for welfareI’ve received today the copies of my new book, Arguments for Welfare.  It’s a short book at 117 pages, published by Rowman and Littlefield at the hefty price of £19.95.  From the cover:

This book makes the case for the welfare state. Nearly every government in the developed world offers some form of social protection, and measures to improve the social and economic well-being of its citizens. However, the provision of welfare is under attack. The critics argue that welfare states are illegitimate, that things are best left to the market, and that welfare has bad effects on the people who receive it. If we need to be reminded why we ought to have welfare, it is because so many people have come think that we should not. Arguments for Welfare is a short, accessible guide to the arguments. Looking at the common ideas and reoccurring traits of welfare policy across the world it discusses: the meaning of the ‘Welfare State’, the moral basis of social policy, the limits of markets, public service provision and the role of government.   With examples from around the world, the book explains why social welfare services should be provided and explores how the principles are applied. Most importantly, it argues for the welfare state’s continued value to society.

 

Why the Bible disapproves of Obamacare and suchlike

I’m always slightly nonplussed by the postures of the American right, and one of the items flagged on on my regular alerts took me into a different world: an article in Conservative Review entitled, Is God in favor of a welfare state?  First, I should say something about Conservative Review.  The positions  they adopt are not what you’d get from an academic book on Conservatism; they advocate a confection of Tea Party, Republicanism and neoliberal ideas, such as

  • “Americans should be free to conduct business free from government intervention or control.”
  • “Congress should work to devolve federal spending and control of education to the state level.”
  • “the right of the people to keep and bear arms shall not be infringed.”
  • “Americans must be allowed to purchase health insurance on a free and open market.”

The article on God’s view of the welfare state talks a fair bit about the Bible.  It argues:

you cannot make a valid argument that God supports a welfare state, redistribution scheme imposed by a secular government without either distorting, or outright ignoring, His Word.

I’m grateful for the correction.  I might otherwise have been confused, for example, by the suggestion that the Bible told us to protect the needy.

For the poor shall never cease out of the land: therefore I command thee, saying, Thou shalt open thine hand wide to thy brother, to thy poor, and to thy needy, in the land. (Deut 15:11)

I’m not a Christian myself, but Christians seem to be pretty hot on redistribution. The early Christians went so far as to hold property in common:

And the multitude of believers had but one heart and one soul. Neither did any one say that ought of the things which he possessed was his own: but all things were common unto them. (Acts 4:32)

Admittedly, on the strict construction of the words, the Bible doesn’t say anything about the welfare state.  It doesn’t say much about modern statecraft, sewers or telecommunications either. But it does say quite a lot about moral responsibility and social organisation – rather more, as it happens, than it has to say about the Creation, which should tell you something about God’s priorities.

Many religions have developed strong communal institutions founded on that.   Jews have formal mechanisms for the management and distribution of charity; Lutherans support the principle of a common chest; Catholics teach the central value of solidarity; Islam has zakat.  Apparently they’re all wrong.

There is absolutely no wealth redistribution, coerced and implemented by the state, either advocated or modeled anywhere in the Bible.

That contention is backed up by the claim that the organisation of biblical Israel was entirely theocratic and ordained by God, so that it doesn’t count as advocating or modelling a system.   I’m not sure I follow the reasoning there.  Besides, it wasn’t either exclusively theocratic, or ordained by God: God expressed his dislike of the people’s request to install a king,  but decided that the issue was up to them (1 Samuel 8).  Absolutely no wealth redistribution?  Try the Jubilee (Leviticus 25), when debts and claims were cancelled and people in servitude were freed.  Nothing in a premodern society compromised liberty as fundamentally as debt.  That’s coupled with the injunction not to oppress each other in trade (Lev 25:14)   No coercion of resources by the state?  The Jewish tradition was that every nation had a duty, commanded of Noah, to establish a system of laws, and understood that people would have to comply with it – an important doctrine for a people with the experience of subjection or exile.  Jesus, who would have known that tradition, was more direct about it:

[They asked] Is it lawful to give tribute to Caesar, or not?  … And Jesus, answering, said ‘Render to Caesar the things that are Caesar’s …’  (Mark 12:14,17)

But perhaps I’m reading the wrong sort of Bible.

Resilience and welfare reform

Thursday was a conference on Resilience and Welfare Reform, with Citizens Advice Scotland.  The idea of resilience is often misunderstood in Scotland, where it’s seen as a characteristic of someone’s personality; it’s up to individuals and poor communities to pull themselves up by their bootstraps, and the emphasis is duly put on removing barriers rather than providing the services they need.   However, in the literature on development, as put e.g. by Robert Chambers, resilience has a more more relevant meaning.  People are at risk when bad things might happen; they are vulnerable if, when bad things happen, they are likely to be harmed by them.  Resilience is the opposite of vulnerability.  People are resilient if they are not likely to be harmed by adverse risks.  Their capacity to recover depends their resources,  on other people around them and on the framework of services.    One of the most effective ways of making people resilient has been to develop social protection, and many of the problems we currently have are because that protection has been removed.

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.