Social policy: commentary and updates
Paul Spicker
This occasional blog discusses issues in Social Policy.
My polemical paper on leadership (and why we shouldn’t be using the idea) has been selected as winner of last year’s ‘Outstanding Paper Award‘ in the International Journal of Public Sector Management. The article is on-line here and the publishers have told me that itis going to be available free for a year.
A typsescript of the paper is also available on the Robert Gordon University‘s open access repository.
The Centre for Social Justice has announced the publication of a new report, Signed on – written off, with a press release that says:
I can’t comment on the report itself, because it’s not been released yet, but I can comment on the press release. The first point, which I can’t disagree with, is that some wards in some cities have more than half the households where people are out of work. That’s what happens during a slump in the economy. Nor is it in dispute that “Across the country, 6.8 million people are living in a home where no one has a job.” What I can dispute is the assumption that the first statement is a reason for the second. It’s the other way round. If lots of people are out of work, and the distribution varies between areas in any way, then there must be some areas where even more people are out of work.
The report’s other main contention is that the concentration of workless people is somehow the reason for the rise in the benefits bill. Benefits will indeed cost £1 trillion over five years, if we include HMRC benefits and benefits for working families in the figures; but even with that inclusion, more than half of the cost is down to pensioners. That raises the horrifying spectre of the ‘benefit ghetto’, a sea of grey heads trapped in a cycle of tea dances and complaining about the younger generation. The Royal Geographical Society’s resources for schools, Where is Granny Going?, reveals the truth: some places have becomer ‘retirement towns’ and pensioners are increasingly blowing their idle savings on beauty, fashion and electrical goods. Watch out, Worthing: the CSJ is coming for you.
In the Scottish Parliament, Labour leader Johann Lamont has raised the case of a cancer patient who is “considering moving to England to get free access to drugs she cannot be prescribed on the NHS in Scotland.” Lamont is critical of money being used to pay for paracetamol while this drug is not prescribed.
Cetuximab is a drug prescribed in certain cases of advanced cancer, principally colo-rectal or head and neck cancer; in both circumstances it’s used for a relatively short period in combination with other therapies. It’s approved for use in Scotland and England and Wales on similar terms, but the terms are highly specific. Three issues are worth noting. One is that while the treatment does lead to an improvement in life expectancy, the improvement is very small – two to four months, assuming best supportive care. The second is that the drug is dangerous: “Cetuximab has a non-trivial safety profile and data are compatible with an increased risk of death in patients administered cetuximab as add-on to chemotherapy.” (Scottish Medicines Consortium) The third issue, as often happens, is that the drug is also very costly – the Health Technology Assessment suggests that the manufacturers have underestimated both the duration of treatment and the cost of supportive care.
It’s not possible to tell what the basis is for the decision about the particular patient identified in the Scotsman, and I’m not going to try. It’s not difficult to understand, however, that decisions about prescription have to be made in a specific context, for a specific person, and that different decision-making bodies may reasonably arrive at different conclusions.
Paracetamol, by contrast, is a largely beneficial drug, prescribed in well over two million cases in Scotland every year. The idea that Scotland should stop prescribing it in order to facilitate paying for expensive drugs with very limited benefits doesn’t look like sound policy.
The Joseph Rowntree Foundation claims that attitudes towards the poor are hardening. They report:
Fifteen per cent of the public in 1994 thought people lived in need because of laziness or lack of willpower, compared to 23% in 2010. Support for the view that people live in poverty because of injustice in society fell from 29% to 21% over the same time period.
The evidence they’ve cited isn’t persuasive. 1994 was the point when fewest people agreed with this statement in over thirty years. In 2003, 28% agreed with the statement; in 1976, it was 43%. See e.g. P Dorey, A Poverty of Imagination, Political Quarterly 81(3) 2010. So 23% in 2010 is at the lower end.
There are reports today that an independent Scotland would face a ‘timebomb’ from increasing numbers of older people. Scotland on Sunday mangled the figures when it reported that “an independent Scotland would have to increase the proportion of GDP spent on welfare from the current level of 14.4 per cent to around half.” That would be three-and-half times current spending. This is obviously wrong, but I’m not going to criticise – one of the hard lessons I’ve learned from writing this blog is that it’s all too easy to jumble figures from different calculations before hitting the ‘send’ button. (And yes, I confess, I just did that again on the first version of this very post.)
The actual increase that’s being reported is that the ratio of pensioners to workers will double, going from 25.8 pensioners per 100 workers to 51.7 by the year 2060. (The figure for the rest of the UK is 45.9). If that is translated into public expenditure at current rates – which probably won’t happen – it implies that two workers will need to pay for pensions what four workers pay now. As pensions currently cost half the ‘welfare’ budget, that implies a 50% increase in that budget, not a 250% increase. There’ll be increased calls on health and social care, too. These are contingencies that need to be planned for, but none of them is catastrophic.
I’ve previously considered the general principles of managing the costs of an ageing population in this blog.
The announcement that the pilots of Universal Credit have been delayed has to be welcome. The scheme was due to run in four pilot areas; three of those four will now start in July instead of April. The delay has been described as an ’embarrassing setback’, but there are worse forms of embarrassment. The scheme was supposed to start for new claimants in October, and over the next four years it is still scheduled to run for well over eight million people. The more that can be done to reduce the possibility of things going wrong, the better it will be for those people. This is not a race.
My latest book, Reclaiming Individualism, has just shipped. At present it’s available only in hardback.
Individualism used to be a radical idea; it was a way of asserting the rights, dignity and value of each and every person. That was before it was dragged into a back alley and stripped of its valuables. For many people nowadays, individualism has become a defence of privilege – a cornerstone of arguments for unrestricted markets, privatisation and the commodification of everything. In Reclaiming Individualism, I make a case for a different balance, trying to show how individualism can be taken to argue for welfare, empowerment and government for the people.
It’s reported today that the government will introduce a residency test for ‘council housing’ , requiring people to have lived locally for up to five years before they can even be admitted to the housing list. (Despite what the linked article says, the rule will almost certainly relate to local residency rather than migration to Britain – the second would be counter to EU rules.)
This is a long-running issue. Some local authorities have long had residential rules, but the continuing use of residential qualifications was condemned in the reports of the Central Housing Advisory Committee in 1945, 1949 and 1969 (no, I haven’t mis-typed those dates). In the 1970s, the London Borough of Hammersmith removed its residential qualifications and demonstrated, the process, that they served no useful purpose – they didn’t alter the pattern of demand, even in an area where pressure was high and people could easily be coming from immediately adjoining local authorities. The critical arguments – reviewed e.g. by Derek Fox, a former Director of Hammersmith, in the 1970s – were that
The main problem that local authorities are facing now is different: much of the demand comes from single people, for smaller accommodation which doesn’t exist. And no alteration to the law governing allocation policies is going to make any difference to that.
Gareth Morgan has fired off a broadside against Universal Credit, arguing that the system is not simple, that some people will clearly not be better off in work, and that pensioners have not been protected. Find his arguments here.
At the same time as a stream of reassurances has been issuing from Ministers, the DWP and the project team, The Guardian is reporting that the project to implement Universal Credit has stalled, and that staff have been stood down. They cannot all be right. Although personally I lean towards a glum outlook, the government could still save its face without too much effort. Universal Credit has not really been designed as a unified system – it sticks together a number of existing benefits, most of which already have common rules and structures. So it has always been open to the Government to say, here is Universal Credit (Jobseekers Allowance), Universal Credit (Employment and Support Allowance) and so on, claiming to have introduced an integrated system when all they have really done is to rename the benefits. True, that would not give us an integrated system, responding to millions of people individually in real time – but the idea it could was always a fantasy.