Designing the National Care Service

Common Weal has offered a blistering critique of the process for designing the new National Care Service in Scotland.  They argue that it’s been designed for top-down governance, rather than service delivery, and that pledges to ‘co-design’ the service with users and carers have proved empty.  Their criticism seems to me justified. The design, and the patterns of governance which are being proposed, are both centralised and corporatist.

I don’t know, to be honest, whether a service that is ‘co-designed’ is likely to be better than one that isn’t.  People who have experience of the system are often conditioned by that experience to look for tweaks and minor improvements, rather than thinking how things might be done differently. The needs of older people with limited mobility, adults with mental health problems or people with developmental disabilities are rarely the same, the interests of ‘carers’ and ‘service users’ vary hugely, and we cannot imagine that one set of service users can speak for others.

I have written recently about some of the long-standing problems in social care: fragmentary, insecure and expensive services, the misplaced attempt to create ‘markets’ in disparate fields and the treatment of ‘personalisation’ as if it meant a selection of services from a shopping list.  I argued there that people need flexible forms of provision based on personal relationships, rather than a commoditised response. If a National Care Service is going to work, it needs to be conceived in terms very different from the old models.

The Scottish Census of Health and Wellbeing: inept and possibly unethical

There’s some controversy in Scotland about a census of ‘health and well-being’ that’s being asked of schoolchildren of different ages.   This questionnaire seems to have been put together by a committee, all of whom wanted their particular issues to be included and addressed.  It’s  one of the worst designed questionnaires I’ve seen in years.

The area that’s attracted most concern relates to questions about children’s experience of sex. I found a copy of the census questionnaire from a local authority website, and was taken aback not just by the most controversial questions, but by the whole exercise.  I have no particular expertise relating to children’s health, but I taught research methods for more than 25 years, and this is not the way to do things.

First question: why is this a census?  Censuses are intended to give a comprehensive, precise count of issues.  There are well-known problems in doing this, because systematic non-response leads to systematic biases in the results.  Several local authorities have opted out, and many pupils will. The count will be meaningless.  What matters – the same as any other quantitative questionnaire – will be the relationship between answers: for example, whether there is a relationship between educational experience and negative body images.  We do not need a census to do this. It can be done at least as well, and probably better, by a series of smaller-scale social surveys.

Second question: in what circumstances does it make sense  to put together a questionnaire that is this long?   There are 61 questions, but because there are sub-questions,  pupils are actually being asked to answer, by my count,  126 distinct questions.  The rubric claims that the questionnaire should be completed in 20 to 40 minutes. To do this in 40 minutes a pupil could have to answer one question every 20 seconds.  Even if the questions weren’t sometimes difficult, this is wildly unrealistic, and it raises questions as to how valid the exercise can be: the exhausted respondents will skip, fabricate answers to finish or simply give up.

Third question: has the questionnaire been piloted and validated? There are indications it might not have been: the length of the questionnaire, the complexity of the language used, and the validity of responses to deeply personal questions.  Pupils are supposed to know what ‘intimate touching’ means (q 49) and whether an experience amounts to ‘penetrative vaginal sex’ (qs 50 and 51).

Fourth question: what measures have been taken to protect vulnerable respondents?   Some children will be distressed by the questions.  Some of that distress is predictable – for example, from those who have been subjected to sexual abuse.  Every school administering a questionnaire should have someone with specialised competence standing by to offer support in the event of distress – and that cannot be the teacher tasked with supervising children using computers, because it would not be possible for that teacher to break off for a distressed pupil before the questionnaire is complete. The FAQs issued by the Scottish Government say this:

What happens if a child or young person needs help, or wants to discuss something, after taking part in the Census?  At the beginning and end of the questionnaire, children and young people will be informed that if any of the Census questions have made them think of any problems, or has raised any issues they are having, then they are advised to speak to someone in relation to the information they have provided in the Census.  For example, if pupils are having problems with other pupils (e.g. feeling that they are being bullied), they are advised to talk about this with their parents / carers / teacher / support worker, etc.

That is not good enough.  This project should not have passed ethical review.

So, you may reasonably ask, what should the government have done instead?  That’s easy enough to answer:  a series of much smaller questionnaires, based on proper samples, administered by people with a competence in the field, and supported by people capable of responding to any distress.  It should include a proportion of open, qualitative questions. Good social research starts with listening.

Poverty in Scotland 2021: a report from the JRF

I was listening today to a seminar for Challenge Poverty Week, covering the latest report from the Joseph Rowntree Foundation on Poverty in Scotland . The report identifies six main ‘priority groups’ which put children at a greater risk of poverty.  The groups are

  • families with children under 1
  • larger households
  • single parents
  • people in minority ethnic groups
  • families with a disabled person, and
  • workless families.

There are no great surprises in that.  I think, from memory, that this pretty much reflects the findings of the Royal Commission on the Distribution of Income and Wealth in the 1970s, with a substitution: pensioners don’t feature, leargely because this is about child poverty, but the position of minority ethnic groups has been recognised.

The next question, however, is what to make of the information. Shona Robison, for the Scottish Government, clearly thought that a focus on these priority groups was the way to break the ‘cycle’ of poverty.  She suggested that the government would be offering ‘bespoke’ responses to families in this position and recommended better paid work as the way out.

There are problems with that.  The place to start, perhaps, is with the statement that these people are at greater risk.  Yes, the risk is higher, but that doesn’t mean either that all these people are poor (the highest proportions are those in minority groups, and people who are disabled) or that people are trapped in poverty.  Low-income poverty is a position that many people pass through.  Very young children are important, because women’s capacity to earn is impaired.  Worklessness is important, but work is no guarantee of coming out of low income.  Precarious work is widespread, and part of the problem.

The other main problem relates to the assumption that people and families can be targeted on an individual basis.  Poverty is a moving target, and most attempts to deal with it by targeting are doomed to failure: people’s incomes fluctuate, their household status changes, they do whatever they can to improve their situation.  What we need is not a set of individualised responses, but a reliable, predictable foundation of the benefits and services that make it possible for people to secure their position.

If not now, when?: a report on social renewal

The title of the new report from Scotland’s Social Renewal Advisory Board is, ‘If not now, when?’  It’s a great title, but not a great report.  There are some areas about which I’d have minor reservations, and others where I’d have major ones.  The minor reservations are, for example, the recommendations that:

      • “It is time to trust (third sector and community) organisations to do good work without onerous requirements.”  Have we forgotten the abuse of charitable status that led to the reform of charity regulation?  Look up ‘Moonbeams‘ on Wikipedia.
      • “There are several themes that run throughout the report, again with links to Christie.  We need to make sure we embed the best partnership and practice.”  Partnership is already embedded.  On the positive side, it can focus attention on issues that get overlooked, such as poverty or learning disability, and it puts agencies into contact (such as the NHS and the police) where there didn’t used to be much.  On the negative side, it eats time and resources, and it can be as much an obstacle to delivery as a help.  The Christie Commission took the misconceived  position that every organisation should have a ‘common set of duties and powers’, including  a general power to ‘advance well-being’ (pp 46-7).  That would make every agency responsible for the work of every other agency.   Do we really want the health service to share the responsibility for developing railways?  If we want agencies to work together, we need an appropriate functional division of responsibilities, effective liaison at the sharp end, and budgeting practices that don’t set up walls between agencies.
      • “Hate crime must be addressed for all affected groups. We want to see significant investment in preventative approaches to hate crime, based on evidence of what works. … we want to see a significant improvement in the accessibility of reporting a hate crime or hate incident over the next five years so that hate crime reporting is more closely aligning with actual incidents. We also want to see an increase in people reporting street harassment to Police Scotland whenever they experience it.” This is saying nothing that isn’t already happening.  Yes, as someone who’s been responsible for maintaining a synagogue, I’ve been on the receiving end of hate crime; no, sharpening the criminal law is not going to stop it.

All right, these points are not really that ‘minor’.  But the ones that got my goat are in a different class.  On universal basic services, the Board has this to say:

“calls on the next Scottish Government to adopt the principles of ‘Universal Basic Services’  … In particular, the Scottish Government should undertake pilots into specific actions that could deliver reductions in energy, travel, housing, childcare and digital costs … These could include: … Social tariffs for broadband and other essential digital services – providing free and discounted digital access to low-income families across Scotland. …”

This misses the point of universal basic services completely.  They’re not meant to be targeted on people on low incomes; they’re supposed to be there for everyone.  I carried on to specific example of broadband, because it shows the point clearly – they’re talking about means-tested or passported services, not universal ones.   We should be looking at open-access, community-based broadband.

And then there is anti-poverty policy, where they recommend that the Scottish Government should “develop an approach to anti-poverty work,
including personal debt, that is designed around the needs of the individual”.  Of course I want to see well-funded advice and support for individuals, but it’s not an anti-poverty strategy.  It’s not even an anti-debt strategy.  People are in debt because (a) their incomes are inadequate and (b) the legal terms on which debt is enforced are pernicious.  The Scottish Parliament has the power to do something about both of those.

Scotland is not ready for an independence referendum

The First Minister of Scotland has been pressing for a further independence referendum, and the UK government seems determined to refuse the request.  I am not sure that either party means what it says.   If the polls are to be believed, there is a narrow majority against independence; and in a time of great insecurity, with the difficulties of leaving another union all too apparent, many voters will be apprehensive about what a vote for independence might mean in practice.  The longer the process, the more likely the movement for independence is to gain in credibility and support.  If the UK government genuinely wishes to maintain the Union – which is uncertain – a proposal for independence is far more likely to be defeated if it takes place very soon.

On the other side, one has to ask whether the Scottish Government really is prepared for a referendum campaign that will avoid the traps that the last one fell into.  During the long campaign before the 2014 referendum, the Scottish Government presented a ‘White Paper‘ with specific plans for action.  Alex Salmond told the electorate that this is what they would be voting for.  That was a miscalculation: it meant that every detail that people disagreed with became a reason to vote against the deal.  The debate about currency was an illustration: units of exchange are not decided exclusively by governments, there was no need to commit to any specific plan, Scotland could use multiple currencies (it already trades oil in dollars)  and in practice no-one can stop people accepting trades in foreign currency.  Committing the country to a specific single policy outcome was unnecessary and destructive.

Similarly, the draft Independence Bill went off-track when it started to legislate for future policies, such as sustainability or the possession of nuclear weapons, which serve no useful purpose in a constitutional document.  None of the constitutional issues that have to be nailed down was clearly settled.  The draft Bill left gaps in terms of rules of recognition (such as delegation of authority to ministers or to local government), change (such as how to amend the constitution) and  adjudication (such as the power of the courts).  It assumed that there would be only one legislative chamber, which could not possibly have the capacity to deal with national legislation; it proposed no constitutional limitations on the power of government.  I argued at the time that Scotland’s great strength was in participative public engagement, and that what Scotland needed to have was an extended period of discussion about constitutional arrangements.   That discussion has not happened yet.

An early referendum would require the Scottish Government to go into the campaign either with another White Paper – a settled prospectus – or with a promise to have a discussion in time to come, something that would depend largely on on trust.  Neither or those is a winning proposition.

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.

Evidence on benefit takeup

The Social Security Committee of the Scottish Parliament is reviewing the issue of take-up, with a particular focus on the introduction next year of the disability benefits they’ll be taking over from the DWP.  I gave evidence to a witness session last week, alongside David Bell and Mark Shucksmith.  The video is here.   My written evidence is in the agenda papers; the verbal evidence is now out in the  Official Report of proceedings.

I’m sceptical that much can be done about takeup.  I’ve long argued that the problems of ignorance, complexity and stigma played as much of a role in relation to non-means tested benefits as they do for means-tested ones.  Putting a kinder face on benefits will not go to the root of the problems.  Disappointingly, the Scottish Government has opted largely to replicate the existing system, with all its muddles, anomalies and confusion.

Some snippets on the Scottish variations in benefit rules

I have spent a little time this week preparing for an evidence session of the Commons Scottish Affairs Committee, which was reviewing the development of social security in Scotland.  The hearing, scheduled for next Tuesday, has now been cancelled, because everyone is currently more concerned with High Politics; the process may resume in due course, or it may not.

I’d been focusing on the back half of the committee’s remit, which was concerned with the relationship between the Scottish system and the UK system.  In the process, I’ve spoken with people from a range of organisations, including the Scottish Federation of Housing Associations, Glasgow Welfare Rights, Citizens Advice Scotland, Clydebank Independent Resource Centre, Child Poverty Action Group and One Parent Families Scotland.  I’ve also seen the written submissions from Inclusion Scotland, Poverty Alliance and the Scottish Campaign on Rights to Social Security: the written submissions should be published more generally  shortly, but publication has to be approved by the Committee first.  Thanks to you all.  I also found a SPICE paper, on administrative costs and relationships with the DWP, particularly helpful.

There have been very positive things said about a couple of the new benefits that rely heavily on the cooperation of the DWP, particularly the Carers Allowance Supplement and the Best Start Grant.  There are more reservations about the operation of variations in Universal Credit, partly because the system from direct payment of rent to landlords isn’t adequately integrated,  and because there seems to be some hesitation about applications.  That may reflect advice from housing associations, and there have been some problems with some rent being paid monthly while income is bi-monthly; but I’d guess that it may also be because bi-monthly payments don’t get over the outstanding problems of an unpredictable, fluctuating level of benefit.

Additional note, 30th October: I have just received notice that, following the announcement of a General Election, the Committee’s review of the Scottish social security system will not now take place.

Functional illiteracy in Scotland: Andrew Neil’s figures were out of date, but they weren’t made up

Andrew Neil has been censured by Ofcom for saying in an interview in 2017 that one in five pupils who left primary school in Scotland were “functionally illiterate”.   According to the BBC report of the judgment, the BBC submitted that

“the figure had come from a 2009 report, but that “it was not accurate to say that this allowed the conclusion quoted in the programme  … It should have been made clear that the phrase ‘functionally illiterate’ was not used in that report and that its source was the education spokeswoman of the Scottish Conservatives.” When it published its findings in November 2017, the ECU said that the 2009 survey “contained no reference to ‘functional illiteracy’, and no data which would have justified the claim in question”.

That surprised me, because I’d come across the 20% figure before.

The main source of the figure is arguably a report written by Professor J Lo Bianco, Language and Literacy Policy in Scotland, published in 2001 by SCILT at the University of Strathclyde.  Lo Bianco’s report was a wake up call for Scottish education – it had a major impact on the treatment of Gaelic and BSL.  He wrote that “More than one adult in five is not functionally literate in English and even more people have problems with numeracy.”  He wrote:

The UK-wide Report Improving Literacy and Numeracy, A Fresh Start (Moser Report 1999) notes in its opening paragraph that ‘something like one adult in five in this country is not functionally literate and far more people have problems with numeracy. This is a shocking situation and a sad reflection on past decades of schooling. It is one of the reasons for relatively low productivity in our economy, and it cramps the lives of millions of people.’ Whilst the situation that is reported is indeed shocking it is far from clear that it is valid to make a direct and causal connection between the levels of assessed adult literacy and ‘past decades of schooling’. The International Adult Literacy Study of 1997 suggests that 23% of adult Scots have low literacy skills.

Subsequently, England developed the “Skills for Life” survey, which by 2011 recorded marked improvements in functional literacy.  A Scottish report in 2008, “New Light on Adult Literacy and Numeracy in Scotland”  avoided the question of functional literacy.  Based on a study of adults aged 34, it commented that ” literacy levels in England and Scotland were nearly identical”(p 8)   but commented that ” 39% of men and 36% of women in the survey had literacy abilities at a level likely to impact on their employment opportunities and life chances.”

What’s been happening since is important.  The Scottish Survey of Literacy and Numeracy shows a marked improvement in standards in primary schools, where the foundations of literacy are laid, and now 88% of pupils in P7 are considered to be performing ‘well’ or ‘very well’.  That improvement probably wouldn’t have happened without those earlier reports.

I don’t much like Andrew Neil’s politics, but he’s a terrific journalist.  Even if on occasion he gets things wrong, he doesn’t make things up.  The main charge against him is not that he was wrong, or that his use of the term ‘functional literacy’ was inappropriate, but that he was outdated.  That’s a mistake that any of us who are trying to distill information drawn from a wide field might have made.

Scotland doesn’t have to have one currency. It could use four.

I was puzzled when Alex Salmond, during the referendum on Scottish independence, opted to push a particular model for currency in an independent Scotland; it simply wasn’t necessary.  As Iain McWhirter recently argued in the Herald, it’s the sort of decision that can be put off till later, and it’s perfectly possible to change the model if something isn’t working.    In the current debates, I think we’re seeing a reiteration of many of the same arguments.  All of them seem to me to be based on a false premise: that Scotland must choose its currency.  Why?

The Growth Commission, which fell victim to the same elephant trap, starts off its discussion by identifying  three purposes of money:  as a medium of exchange, as a unit of account, and as a store of value.  They could quite reasonably have added a fourth, because it’s most of what their discussion is about: money as an instrument of economic policy.  The histrionic criticisms made by some of the pro-independence commentators have suggested that it is not possible to be independent without an independent currency.  This quotation from Wynne Godley, objecting to the Euro, is going the rounds on Twitter:

the power to issue its own money, to make drafts on its own central bank, is the main thing which defines national independence. If a country gives up or loses this power, it acquires the status of a local authority or colony.

Have at you, France!  Italy, you are a local authority!  I blow my nose in your direction!

Let’s take some of the heat out of this. Money of all kinds can be used as a unit of exchange.  There are lots of places where currencies of different sorts will be accepted, regardless of what the official currency might be.  I’ve been places where they wouldn’t accept local currency, but asked to be paid in dollars.  As someone told me in Croatia, asking for payment in  pounds:  “Money is money.”  And money can be a unit of account in one currency while it is being exchanged in another.  When I was in Poland, my formal contract was paid in zloty, as the government requires, and tax was deducted in zloty, but the job offer and the pay were in Euros.

Scotland could survive while using the British pound.  Despite some of the nonsense that people come out with – such as George Osborne’s preposterous claim that Britain would “stop” Scotland using the pound  and that there’d have to be trucks crossing the border carrying notes and coins – whether or not Scottish people use the pound, or any other currency, is down to them.  But things don’t have to stop with the pound.  The Scottish economy, for those who haven’t noticed, already uses two currencies.  Most people use the pound sterling in ordinary life, but the oil industry conducts its transactions in US dollars.

In the past, it’s been difficult for buyers and traders working in multiple currencies.  The main issue has been the practice of the banks.  A combination of technology and competitive innovation has already largely overcome that.  Most retail payments in the UK are now made by card, not cash.  I use a bank which offers me parallel currency accounts and transfers without holding or transaction fees.  As transactions are cashless, there’s absolutely no reason why people shouldn’t hold accounts in Euros, pounds, dollars and other currencies at the same time; traders could make their own choices.  Scotland could reasonably have four currencies: a Scottish currency, the dollar, the pound and the Euro.  The main reason for having a separate Scottish currency would be as a unit of account and a tool of economic policy.  Whatever the choice is, we don’t need to get hung up about it.