Reform Scotland has published a pamphlet arguing that since GP practices are insufficiently sensitive to patients’ needs, the answer must be to promote competition between providers. That doesn’t follow. When markets are based on ‘choice’, the choices that are made are not just the choices of consumers; they are also the choices of providers. Competition works because providers refine and select what they do. They choose who their customers are. They choose their location. Making the right choices cut costs; that is why competitive markets tend to be efficient (and why public services aims for ‘cost-effectiveness’ instead of efficiency – the aims are very different). The selective decisions of providers, within the current system, are precisely the reasons why patients do not get what they need. Which practices are going to cover people in isolated rural locations? Who is going to provide services to drug users, who use GP services at ten times the rate of other people? Who is going to provide services to very elderly people, who cost practices seven times the resource of other patients? Competition is not the way to a universal service; it is the opposite of what is called for.
Category: Social Policy
This occasional blog discusses issues in Social Policy.
London Metropolitan University
I have signed a petition to the UK Border Agency at http://www.gopetition.com/petitions/amnesty-for-international-students-at-london-metropolit.html. It reads as follows:
We believe that it is completely contrary to natural justice that students should be punished for problems emanating from their University.
We therefore demand that the UK Border Agency agree to an immediate amnesty for the international students at London Metropolitan University affected by the Agency’s decision to revoke the University’s ‘Highly Trusted Status’. This would enable them to continue their studies while the problems at London Met were addressed.
We believe that the UKBA’s decision is a disproportionate reaction to a situation that could be addressed without the recourse to such drastic action. The UKBA’s decision punishes thousands of students who are entirely innocent of any alleged immigration breaches and sends a disastrous message to the rest of the world that UK higher education is not accessible to international students. Its actions threaten the immediate futures of thousands of London Metropolitan students, as well as the future of the University, and casts a huge shadow over the very valuable contribution that international students make to the culture and sustainability of UK higher education.
Tuition fees
Joan McAlpine writes in today’s Daily Record that the Scottish Government’s actions to remove fees from Scottish students has been “well and truly vindicated” by improved recruitment. However, the story is not yet complete. Undergraduate fees have not been abolished; they are charged and reimbursed by the Students Awards Agency to Scotland, which makes a payment direct to the university. The fees which are being charged and reimbursed to Scottish students by this process are different from, and signficantly lower than, the fees charged to students from the rest of the UK. Expect the court cases to blossom. There is probably a very simple solution, which is to charge all students the same nominal fee and then reimburse it to Scottish-based students. It’s been done in Further Education for years.
The base of the pyramid
There is more than one road to excellence. Six weeks ago, I went to an open-air concert performed by the Simon Bolivar Orchestra, the product of Venezuela’s El Sistema (try this clip on Youtube.) This is one of the world’s greatest orchestras, but they didn’t get there by selecting elite musicians. El Sistema is also a major project for social inclusion. It has achieved a small miracle through a mass programme of musical education, drawing in hundreds of thousands of children. The orchestra is only the apex of a large pyramid. That, as much as the performance, is what makes it special.
This week, in Britain, we are having success in sport at the Olympics. The media are buzzing with claims that the success of elite sportsmen and women will trickle down; they will be role models; they will encourage children to participate in physical exercise; they will “inspire a generation”. I see no evidence to support any of these claims. Success has been achieved – as it was formerly achieved in East Germany – by selecting elite athletes and giving them elite resources (such as the individually engineered bicycles that have helped the British to dominate in the velodrome). Britain’s tally of medals is approaching that of the USA – another country which, like us, suffers from social exclusion and an obesity epidemic. If we built a pyramid from the base, it will be possible to identify people at the heights. If we start at the top instead, that is all we will ever see.
The consultation on same sex marriage
I read the report on the consultation on same-sex marriage with a certain professional interest: my team processed the previous consultation on civil partnerships in 2004. Nicola Sturgeon was subject to some hostile questioning on Newsnight Scotland about the treatment of the consultation, on the basis that a majority of respondents were clearly opposed in principle. But a consultation is not a sort of referendum; the purpose is not to count heads, but to make sure that a full range of views is taken into account.
Part of the problem is that consultations are presented as if the proportion of respondents mattered. We wrote in our report:
The consultation was not in any sense numerically representative, and caution should be exercised in interpreting the pattern of responses on the basis of majorities or minorities. The validity of a consultation depends, not on numerical representation, but on the extent to which it succeeds in representing and giving voice to diverse groups and shades of opinion. … A quantitative analysis does not really do justice to the range and diversity of responses. Many responses did not follow the pro-forma. Some responses respond to one question with the answer to another; others try to shoehorn issues under ill-fitting headings. … Where issues are raised by several respondents, this has the effect of cross-validation and reinforcement. This is the primary basis of analysis. However, it is also true that isolated responses may raise issues of importance: … where there are complex legal issues to unravel, particular responses also pose specific problems, cite examples and identify conflicts. In these circumstances we have recorded these concerns and sought to report on issues which require resolution.
This was reported in the press as saying that “Most Scots back plans to recognise gay marriages as legal, according to a study by the Robert Gordon University.” (Aberdeen Press and Journal 6.2.04) The Daily Mail headline (17.2.04) complained that “Same-sex marriage survey was hijacked by gay rights lobby” and that the consultation was “flawed” because several similar responses had come in from Stonewall.
From which I take it that either the press don’t understand what a consultation is about; or that they don’t bother reading the reports; or that the whole issue is so emotive that they will only read what they want to read. Possibly all three.
"Troubled" families
Louise Casey’s report, Listening to Troubled Families, does what it says in the title: it reports the concerns of issues of a number of families with problems. She’s convinced that intensive social work can make a difference, and as far as that goes I have no disagreement. But there are serious problems in the language that she is using, and in particular in her persistent references to inter-generational problems. She’s talked about “welfare dependency and sexual abuse going back generations.” She refers to “entrenched cycles of suffering problems and causing problems”. She claimed that “problems such as sexual abuse, teenage pregnancies, domestic violence, juvenile delinquency and educational failure were often repeated by different generations.”
This argument has a long history. “Troubled families” have been called degenerates, moral defectives, the abyss, problem families, multi-problem families, the ‘hard to reach’ and the underclass. The claim that they passed problems from one generation to another features in arguments on degeneracy, the culture of poverty, the cycle of deprivation, transmitted deprivation and the dependency culture. And what we can say about all of these arguments, because there are decades of evidence to draw on, is that they are not true. The population of people who have problems now is not substantially the same as those who will have problems in ten years’ time. Most adults have varying experiences through their lifetimes. Most children from deprived backgrounds are not deprived as adults. Keith Joseph, who coined the phrase “the cycle of deprivation”, set up a major social science project to investigate it. From that project, we know that if, over a long period of time, we begin with a cohort of the most deprived children and follow them through the generations, their great-grandchildren will have much the same profile as the rest of the population. For example, as part of the work, a thousand deprived families in Newcastle were followed through the generations. They did not pass down problems from parent to child. (The main source is I Kolvin and others, Continuities of deprivation, Avebury 1990.)
Why refer to poverty as a proportion of median income?
This is the abstract of a paper I’ve just had published in the Journal of Poverty and Social Justice, vol 20(2) pp 163-176 – the paper is not online yet but I have received a paper copy, so it will appear shortly.
“The most widely used indicator of poverty refers to a threshold set at 60% of median income. This paper reviews the implications of this approach and the conceptual problems it raises. The threshold relates to inequality and ‘economic distance’ rather than need. Though it was initially intended to be simple and comprehensible, the indicator causes considerable confusion, and successive refinements, including adjustments for disposable income, housing costs and equivalence, have limited the accessibility and use of the figures. Referring to median earnings would be a simpler, more practical approach.”
From the Department of Circumlocution
Following the publication of the draft Universal Credit Regulations, I have been looking at the rules defining couples. Under the new rules, couples are being required to claim jointly, and neither has any secrets from the other. Couples are defined in the Welfare Reform Act 2012, s.39, as follows:
- “(1) In this Part “couple” means—
- (a) a man and woman who are married to each other and are members of the same household;
- (b) a man and woman who are not married to each other but are living together as husband and wife;
- (c) two people of the same sex who are civil partners of each other and are members of the same household;
- (d) two people of the same sex who are not civil partners of each other but are living together as civil partners.
(2) For the purposes of this section, two people of the same sex are to be treated as living together as if they were civil partners if, and only if, they would be treated as living together as husband and wife were they of opposite sexes.”
I was intrigued by the description of people in same sex relationships as “living together as civil partners” when they are not civil partners. When the legislation governing civil partnership was introduced, the government went out of its way to emphasise that it was not a form of marriage. Civil partnership was deliberately defined in terms of public commitment, and strongly distinguished from marriage. Now we find it treated in the same terms as “living together as husband and wife”. Neither definition, of course, explains directly what this means.
Poverty, democratic governance and poverty reduction strategies
I have given a presentation today at an International Symposium in Istanbul, Turkey, organised by Fatih Sultan Mehmet Vakif University and Sosyal Politikalar Dernegi. The argument was this:
The Poverty Reduction Strategy Papers have become a significant experiment in world governance. Poverty is a complex, multidimensional phenomenon, and responses to poverty need to be adapt to a wide range of circumstances. In the belief that deliberative democracy is the route to prosperity, international organisations have directed governments around the world to undertake a process of strategic planning, based on participative development and negotiation of policy with stakeholders. However, the emphasis in the PRSPs seems to have fallen more on the methods they use than the substance of the strategies. Democracy is not valued only for its process; it matters what it achieves. If PRSPs are to help the poor, they need to extend their focus, moving beyond procedural issues towards substantive policies that stand to benefit the poor.
Here is a copy of the slides and a copy of the paper.
The scope of the welfare state
Policy Press asked me recently to lead off a discussion on the Welfare State with a short 300 words. My contribution is here.
The issue I’ve raised is about the scope of government, and that will be part of my next book, Reclaiming Individualism. The typescript will go to the publisher in August for publication next April.