Category: Social Policy

This occasional blog discusses issues in Social Policy.

Coronavirus: another week of mismanagement, misleading statements and mixed messages.

There are good things to say about the response to the pandemic.  The response of health service staff is beyond reproach.  Many people in hazardous occupations – cleaners, refuse workers and police – have carried on despite an almost complete absence of appropriate protections.  The public have behaved wonderfully.  The central response to a plague  is not to ensure 100% compliance from every individual: it’s for enough people to change their behaviour to make an impact, and that’s certainly been happening.

Unfortunately, the same cannot be said for government or for the public authorities.   The most obvious problems have been about preparedness – it’s not as if there were no warnings – and procurement.  This comes from The Lancet:

February should have been used to expand coronavirus testing capacity, ensure the distribution of WHO-approved PPE, and establish training programmes and guidelines to protect NHS staff. They didn’t take any of those actions. The result has been chaos and panic across the NHS. Patients will die unnecessarily. NHS staff will die unnecessarily. It is, indeed, as one health worker wrote last week, “a national scandal”. The gravity of that scandal has yet to be understood.

Then we have a series of misleading statements from the government about what is happening.  Some are prevarications – that discussion of strategy is impossible at this stage, that there is consolation to be drawn from the horrifying figures, and so on.  But some have been downright lies: that the Prime Minister was in good spirits and actively engaged at the point where he was about to go into hospital, that 19 members of NHS staff had died when the government already knew there were 36, or that there is a full supply of personal protective equipment when the ministry has deliberately degraded the acceptable standard of that equipment.  The government is behaving as if it had a monopoly of information, which it doesn’t, and that it is not open to scrutiny or discussion, which it must be.

And then there are the mixed messages, usually preceded by the fatuous claim that ‘we have been perfectly clear’.  Confusion is easy: two prominent public figures have been pilloried for taking steps that were within some guidelines and not within others.  For the avoidance of doubt, social distancing (or physical distancing) is not the same as staying at home, and staying at home is not the same as isolation or quarantine.  Having a ‘reasonable excuse’ for travelling is not the same as ‘travelling only for expressly permitted tasks’.  The government seems to favour ‘stay at home’ as a message, thinking (disputably)  that it is straightforward, but it is a message with exceptions; it’s really not clear why they think this is more likely to be effective than ‘keep your distance’.

There’s a bitter lesson to be drawn from France, where the rules have been much stricter but the spread of the disease has been at least as bad and arguably worse.  What matters is breaking connections that lead to cross-infections.  The current strategy may be having an effect, but what we can’t tell in the absence of decent information is how large that effect is, or whether it’s enough.

That leads us back, in a circle, to the mismanagement of the problem – the failure from the earliest days to test and trace.  We have few usable indicators: verified hospital admissions and deaths (the ONS is adding in deaths not in hospital).  I very much doubt that the government does not have stats for notifications of COVID-type illness made to NHS 111 – it is, after all, a notifiable disease – and they should be pressed to release them.   There may, too, be another indicator that we have the capacity to obtain: the presence of COVID-19 in sewage. The purpose of indicators is not to obtain a precise and accurate individual count: it’s to see the general direction of movement when taken along with other indicators.  Indicators travel best in convoys.  Given the lack of general community testing, it’s the best we can do.

Towards an exit strategy

The government and its advisers have fobbed off repeated queries about an exit strategy.  There was not enough information about the progress of the pandemic; it was too early to say; they didn’t want to distract from the message of social distancing.

I don’t know what our exit strategy should be, but I know what a strategy looks like, and none of those answers is relevant. A strategy, in this context, is a review of information, priorities, options and possible choices.  It’s not an action plan – that’s what you come up with after the approach has been agreed.  And if there’s only one option, and the choice has been made, it’s not a strategy –  it’s a policy.  Claiming that this is no time to consider an exit strategy is basically announcing that the government hasn’t thought about  what the priorities, options and choices might be.

I doubt that this is true.  The government almost certainly has a strategy; it just doesn’t want to tell us what its priorities, options and choices are, in case we, the public, should happen to disagree.  Their way is the only way.   It’s a fortress mentality – the same approach that they have taken to social protection, to Brexit, and to recent measures to help business.  And invariably it leads to worse decisions than there would be if the matter was opened to informed discussion.

One of the defining characteristics of a democracy, Joshua Cohen argues, is that it is ‘deliberative’: people are able to engage, to discuss and to disagree.  For any strategy to work in the current crisis, the government has to bring people along with it.  If they don’t consult about their options and choices, it puts compliance in jeopardy.  Imposing a single, authoritative policy is not ‘leadership’; it’s arrogance.

Additional note, 8th April.  I am feeling the same sense of irritation at statements that the government cannot ‘review’ its policy, as the Prime Minister promised.  It is too early to end the lock-down, they say.  ‘Review’ does not mean ‘bring to a close’; it means that one looks at a policy to see how it is working.  And it’s pretty clear that while some parts of the policy are working very well, others aren’t. 

The bits that are working:

  • there has been excellent compliance from the bulk of the population, slowing the spread.  We don’t need full compliance; we just need there to be enough.
  • time has been bought for the NHS to cope – we have reasonable hopes that what happened in Italy will not happen here.
  • food distribution – the supermarkets have done brilliantly.

The bits that aren’t:

  • social care provision – the model that depends on multiple visits by peripatetic staff doesn’t work
  • the protection of front line workers
  • the protection of people’s incomes 
  • management of access to public spaces, such as parks – closing them is bad practice
  • restrictions which have nothing to do with the spread of the disease – the ending of legal transactions, stopping people going to allotments, visits to second homes (the test is social distancing, not travel) and over-zealous policing.  Whatever happened to ‘reasonable’ grounds  for going out?
  • policing of abuses.  Where is the heavy equipment that was supposed to be used for major construction projects today?   (I ask because I already know it’s not where it’s supposed to be.)

The UK’s response to coronavirus has been marked by incompetence.

It’s a difficult situation for any government to manage, but the problems  produced by coronavirus have been marked by muddle and incompetence in the response from the government.  I think we can exonerate them of three serious charges.  It was not inappropriate to delay the initial response: they judged, that people would not comply with instructions until they were convinced of the seriousness of the situation, and so it proved.  It was not obviously wrong, before the numbers became apparent, to ask whether the disease could be allowed to run its course with with only moderate social distancing.  (An illuminating set of simulations, published online by the Washington Post,  suggests that this strategy would still have been more effective than quarantines.)  And it is not wrong to impose restrictions that cannot be adequately enforced.  The nature of the disease’s spread is that every reduction in social activity limits the potential of the disease to spread.  It cannot be stopped, but it can be delayed, and delay makes it more possible for services to cope and ultimately to the availability of a vaccine.

Having said that, there have been several marked problems in the government’s response to the situation. The problems include:

    • Preparation
      • The lack of testing means that the government has not been able to keep track of what is happening, let alone manage public health issues such as contact tracing.
      • The failure to provide personal protective equipment for medical staff is utterly disgraceful.  Hospitals have become a danger zone.
    • Protection
      • The government’s first response was to protect business; its second response was to protect employees.  There are still major problems evident in the protection of people in precarious employment and those on benefits.  I have covered those issues separately.
    • Process
      • Contradictory and inconsistent advice.  There have been frequent, repeated, muddled statements from different government ministers and advisers about what is required, what the rules are, and who is affected.  Instructions are imprecise.  For example, there is still prevarication about what is essential work, such as whether or not construction can proceed.  And if the aim is self-contained households with minimal interaction, what is wrong with individuals working alone on an allotment?
      • Announcements have been sudden and immediate, making it difficult for people to close business or even to move physically to the right location for isolation.
      • Over-reaction.  The police have criticised the public for going to isolated places to walk and exercise.  I am in the middle of a house move – my furniture left on the van on Friday – but the registration of  property transactions has stopped,  and the Law Society has advised solicitors not to conclude business.  I don’t claim any medical expertise, but I think I can say with confidence that coronavirus cannot leap down the circuitry of internet communications to emerge at the other end and eat you.

Covid-19: a few questions about the government advice

I was asked once to examine a sick sheep.  What I know about the diseases of sheep and other animals wouldn’t cover the head of a pin, but I manfully walked up to the sheep in question.  It promptly got up and ran away.  I was able at least to call back, “It’s alive”.  It’s always nice to find oneself in a position to make definitive pronouncements, and it seems to me that many of the statements coming from government have at least as much authority as I did with the sheep.

The strategy of the UK government is to normalise the illness, as we have done with other killers such as influenza: allow for large numbers of healthy adults to be infected, reserve special defences for people who are particularly vulnerable, and accept that some people will die.

This position is out of step with the WHO advice, which is to contain the illness.  It is not indefensible, but there are a few holes to fill in the policy.

Question 1:  How will we know if the government’s strategy is working?  If there is no routine testing, we cannot say much if anything about numbers – and so, we will find it difficult to say whether or not the policy is working.

Question 2: What is the cost of telling people not to seek help?  The recommendation to self-isolate and soldier on through the course of the disease depends heavily on people contacting services in due course when problems become serious.  That involves more than self-isolation: it depends on self-assessment.  How many people will this kill?

Question 3:  What happens to people who can’t self-isolate?  The advice that is being given asks people to isolate themselves within their home, to keep a distance and not to make contact with others.  That is feasible for about two-thirds of the UK population.   The others don’t necessarily have a space they can isolate themselves in.  Some have no home; some share their bedrooms with others.  And we might point out that the UK government has issued various edicts requiring poorer people to share rooms.  It is the policy of the UK government not to permit people on benefit to be supported if they have spare rooms, and to penalise them financially  if they do.

Question 4: What happens to people on benefits?  As things currently stand,  there are severe penalties for non-compliance with benefit regulations, including the requirement to seek work, to attend meetings and appointments, and to be available.  Benefit claimants have limited room for manoeuvre – there are limits on how many periods of sickness and how long a person can be excused.

Question 5.  Where, in a society in lockdown, will people’s income come from?  In the short term, the problems identified in questions 3 and 4 could be dealt with in part by two immediate measures:  stop the bedroom tax, and stop all sanctions.  There is a more severe underlying problem, however: our economy and our labour market do not deliver regular, stable incomes for many people.   Under the old system of Unemployment Benefit, people reduced to short-term working or interruption of earnings would receive direct help, based not on a personalised means test but a simple question, about whether or not they had worked on that day (any day where someone had earned £2 was deemed to be a day at work).  We no longer have that system.  Successive governments have undermined the principle of social protection.  We need it more than ever.

More bad science: race and IQ again

Just when we think the arguments can’t sink much lower, some kids have a party in the crypt and the dead walk again.  Dominic Cummings wants to select designer babies with higher IQs.  Andrew Sabisky repeats the canard that African Americans have lower IQs than whites.  There’s been no direct comment from Boris Johnson, but he’s on the record as believing stuff about IQ: “it is surely relevant to a conversation about equality that as many as 16% of our species have an IQ below 85 … while 2% have an IQ above 130 … And the harder you shake the pack, the easier it will be for some cornflakes to get to the top”.

IQ tests are supposed to be a proxy for Spearman’s ‘g‘, an underlying factor denoting general intelligence and intellectual potential.  There are two common complaints about that.  The first is that it’s not obvious that anything called general intelligence actually exists.  The second is that even if it does, it’s not clear that g is the underlying factor that IQ tests measure.  It’s much more plausible to suggest that IQ tests  reflect the skills that people gain through education.  The suggestion that people in some racial groups have lower IQ looks very different if we understand it to mean that some groups are disadvantaged in education, educational testing and educational attainment.  We wouldn’t expect a different result.

The other side of the IQ debate is, of course, the assertion that g, and IQ, both reflect people’s genetic endowment.  To establish genetic influence, the believers have relied extensively on twin studies.  There are three big problems with that.  First, twins are generally reared together; they have a common background as well as a common genetic inheritance.  Second, the data are rigged: twins are often accepted as monozygotic on the say-so of their parents rather than a genetic test, and twins where one is disabled (although such twins still have common genetic factors) are routinely discounted from the studies.  And that rigging points to the third problem: the cultists are determined to prove their case, regardless of what the evidence actually shows.  Of course, they say, social factors must be inherited.  Of course that will be manifest in twin studies.  Of course, if genetic evidence isn’t there, it must be lurking in there somewhere. This is very bad science; a scientist is supposed to set out to disprove a proposition, not to prove it.  Twin studies could prove something; they could show, if there are differences in monozygotic twins (such as the known differences in sexuality), that the difference cannot be genetically determined.   But that is not what the scientists are looking for.

From twin studies we have estimates of ‘heritability’.   Many believers claim that this is a measure of genetic influence; it isn’t.  Technically, heritability refers not to genes, but to a combination of genotype and phenotype.  In practice, that combines genetic and environmental influences; it is supposed to disregard familial influences such as culture and language, but in practice that can only be done by weeding those out of a study.  In human terms, heritability means only that something runs in the family.  And that, despite repeated assertions to the contrary, is not the same thing as genetic influence.

Scientists have not been able to link genes, either individually or in combination,  with intelligence – or indeed, with any other social trait.  The problem has been discussed in Nature under the heading of ‘missing heritability’. Differences in physical traits such as height are hardly explained by genetic endowments.  That shouldn’t be surprising, because the progressive gain in height over the past few generations has clearly been environmental, and the environmental difference is so large that it far outweighs the limited, if more extreme, genetic influences.  There is a more recent summary of the state of play here. Like many people in the field, the writer still seems to be convinced that there is something there to be found.  If there is, it’s well hidden.  The fact remains that after 150 years of trying, no-one has been able to prove that factors like intelligence are inherited.  Indeed, one of the assertions made by specialists in this field  is that there is a ‘regression to the mean’.  So their case is held to be proved if children are cleverer than their parents (that’s ‘breeding’), proved if one generation is like another, and proved if children are not as clever.  This is pseudo-science.

The problem that people like me have in engaging with this kind of topic is that believers in genetic influences often assert that their expertise exempts them from critical scrutiny by non-specialists.  Eysenck, whenever he was faced with criticism for the rubbish he published about IQ and inheritance, would deride the critic for not devoting his or her self to the study of the psychology of intelligence. Of course none of the critics would have done that, because no-one wants to waste their life refining the measurement of meaningless claptrap.  You might as well devote your attention to astrology, or ley lines, or the mystic significance of the great pyramid. And you don’t, as Dr Johnson said, need to be a carpenter to know that a table wobbles.  It takes more than scientific method to make a study scientific.

 

Bad science: eugenics hasn’t gone away

Over the course of last couple of days, it’s emerged not only that number 10 appointed a believer in eugenics to the Cabinet Office, and that Dominic Cummings believes the same sort of drivel, but that a clutch of other people think this is all a perfectly respectable argument.  Richard Dawkins tweeted:

And ideology, it seems, obliterates evidence about eugenics, which we have in abundance.  The ‘why’ is easy to answer.  First, there is no evidence that the characteristics people like this would wish to foster can be arrived at by selective breeding.  In the late 19th century, it was widely believed that poverty was the result of ‘degeneracy’, and that a series of social problems – crime, poverty, madness and disability – were inherited.  This was all rubbish.  The ‘scientific’ studies that were published were, by modern standards, fraudulent; the writers were so convinced it must be true that they didn’t mind a bit of embroidery.

Second, the characteristics that eugenicists want to stop are mainly socially determined.  Andrew Sabisky, the Downing Street adviser at the centre of the storm, was arguing that

“One way to get around problems of unplanned pregnancies creating a permanent underclass would be to legally enforce universal uptake of long-term contraception at the onset of puberty.”

Teenage pregnancy occurs across the social classes, but poorer girls are more likely to choose to keep the baby – it’s a positive choice.  Most girls in this position find a partner later, and partnering plays a major role in breaking any trend to long-term dependency.  There is no permanent underclass.

Third, the methods of eugenic policies are repugnant – I’d recommend Carlson’s excellent history, The Unfit: history of a bad idea.  Forced sterilisations and selective euthanasia  were tried, notably in Virginia and later in Nazi Germany. There’s no defence for this.  And there is no evidence to suppose that in Dawkin’s sense, any of this ‘worked’. I admit freely that selective breeding of animals has led to more productive yields for those eating meat.  When I next want to eat a better tasting baby, I’ll know who to call.  I see no reason, however, to suppose that any amount of selective breeding will lead to more perceptive, morally considerate scientists – much as we need them.

The techniques might be new, but the urge to watch and control poor people isn’t.

A Dutch court has ruled that mass surveillance of welfare recipients is a breach of their human rights.  This process has attracted attention because of its concern with technology and surveillance society, but the truth is that poor people have always been subject to surveillance.   In the US, where the Constitution protects people from unlawful searches and seizures, people in receipt of benefits were told in the 1960s that of course they have the right to refuse entry, but that the authorities then have the right not to pay them any benefit.  (The case is in Piven and Cloward’s Regulating the poor.)  In the UK, the obsession with sex in the lower orders has all too often been manifest in the surveillance of couples to see who was sleeping with whom.  I lost one tribunal because the department had a diary of early morning surveillance on the house.  I won another where they were elderly and of mixed race, and the tribunal were content to accept that it was a commercial relationship.   I’ve referred before to circumstances  where HMRC had commissioned the sort of examination of financial records – and jumping to conclusions – that wouldn’t be tolerated for the respectable middle classes.

There are lots of people in sociology who will immediately link this to Foucauldian ideas of ‘discipline’ and surveillance, but I think it’s got more to do with attitudes to the poor: They are not like Us, and They have to be Watched.  At the same time as we’re talking about high-tech surveillance, Australia has been rolling out electronic benefit and transfer cards as a way of controlling the way that poor people spend the little money they’re allowed.  The purpose is to make sure that people don’t fritter their benefits on drink and gambling (not that there’s much reason to think they do). The restraints are  inconsistent with the basic idea of social security or pensions – and,  for that matter, with the kind of free-market ideology which holds that people should be given the money to pay for things like education or health care.  The whole point of cash benefits is that people get to decide how they use them.   The basic case for limiting spending is the assumption that poor people can’t be trusted.

I thought of calling this the ‘new paternalism’, but the truth is that it’s never really gone away.  Five hundred years ago, Juan-Luis Vives was arguing that  the ‘censors’ (or overseers)

 should inform themselves of the life and customs of poor people, whether they be children, young men or elderly. They should know what the children do, how they are progressing, what are their habits and character, what they might become, and, if some of them sin, whose fault it is.  All this has to be corrected. The censors should take care to know if young and old people are living according to the laws they have been made aware of. … They should know whether everyone conducts themselves with economy and temperance. They should reprimand those who spend time at games of chance or who frequent wine or beer taverns.  If one or two warnings are not enough, they should be punished. Penalties will be imposed according to the judgment of those who, in each town, are most prudent … Special care must be taken to protect against frauds by idle people and malingerers, so that they do not have the chance to cheat.

The urge to control the poor was there before social security  came into existence, and it will be there when we are all gone.

Harry Burns on mortality figures

I’ve recently joined the board of Barony Housing Association, which is part of the Wheatley Group, and consequently was invited to a institutional lecture by Prof Sir Harry Burns, who was considering mortality statistics in Scotland and the UK.  He made the case that, despite the emphasis on nutrition in much of what’s written about public health, nutrition is not at the core of the problems.  Scotland’s nutrition-related mortality follows a pattern, astonishingly, which is not much different from Finland’s.  Finland has an exemplary nutritional policy and lots of virtuous practices, and Scotland (notoriously) doesn’t.

The real difference in mortality, he argued, occurs in younger age groups; and the primary issues for the mortality of younger adults are drugs, alcohol, violence and suicide.  All of which are social.

The last of the main manifestos, from the SNP

The Scottish National Party’s manifesto is the last of the main manifestos to appear.  It’s a reflective document, explaining the SNP’s work in opposition, their role in Westminster and some of the things they hope to lobby for.  In the field of social security, that includes ‘halting’ Universal Credit – presumably that means halting the roll-out, scrapping the two-child limit, ending the freeze on uprating and protecting the WASPI women.   That platform brings them quite close to Labour, who are similarly trying to reverse some of the negative policies of recent years.

I have to accept, reviewing the clutch of election manifestos, that I’d been looking for something that none of the parties is really ready to consider: some thinking about what government should be trying to do for its citizens, what might be done with benefits, what principles we would want to uphold.  I had imagined, after the great splash on social care in 2017, or the continuing problems in health care marked by the troubles of A and E, that some party would have run with something more innovative – for example, what should be done by contributions (the German approach to social care), what by different social arrangements (such as the Kerr reforms of urgent health care) or what by redistribution.  However, these are not the sort of things that our political system is engaging with.  It’s easy to blame Brexit for monopolising everyone’s attention, but I think it goes deeper than that.  After decades years of neoliberalism, marketisation and ‘austerity’, there’s little appetite for solidarity, redistribution  or the expansion of public service.

 

Suffering for my art

I’ve been trying to catch up on reading for social policy, and it’s not been a rewarding experience. I’ve just read two books on inequality that couldn’t tell me was inequality was; three books on austerity, two of which could have been written at any time since 1980; several papers that have gratuitous numbers and more references than text; and two and a half books on social work which have told me useless things like saying that capitalism is bad or that people have problems, without giving any hint or clue about what social workers might actually do about it. I’m not going to name those books, because throwing around insults isn’t going to win any friends, but I will mention the one glimmer of light, which was Frances Ryan’s book Crippled: austerity and the demonisation of disabled people. It’s about people’s lives, and everything rings true. If only there were more like it.