The reform of social care will take more than money

The House of Lords Economic Affairs committee has called for free personal care in England, on lines similar to the system in Scotland.  “Under free personal care individuals would therefore only receive funding for support with these basic activities of daily living, based on the minimum threshold of eligible needs as defined by the Care Act.” They are recommending a major increase in the funding for social care, so that care can be delivered on much the same terms as health care.  However, they accept that people should pay accommodation costs themselves, with means-tested support, and they recognise that this might entail “catastrophic accommodation costs” which might have to be subject to a cap.

This has been welcomed as a radical proposal, but it doesn’t touch on most of the problems that go with social care.  We’re still thinking of social care as a set of needs which can be satisfied by specific cash payments.  The Lords report explains:

“Personal care means essential help with basic activities of daily living, such as washing and bathing, dressing, continence, mobility and help with eating and drinking. It does not include other areas where support might be needed, such as assistance with housework, laundry or shopping.”

I don’t believe that a system based on this approach can ever deliver what people want to see.  I don’t believe people want, or are comfortable with, successive 15 minute visits from a team of people who bathe them, or dress them, or help them to bed.  I don’t believe that what most people really want in life is to manage a rota.  I think that providing for a series of events, sold as if they were commodities, meets people’s human needs.  What we should be allocating is time with a person, and that calls for a different approach to assessing needs from one that focuses on whether or not someone needs help with brushing their teeth.

Social policy and interpersonal relations

Screwing my courage to the sticking place,  I have added a new page to An Introduction to Social Policy.  It’s about Social Policy and Interpersonal Relations, and it includes coverage of topics including the body, terminating pregnancy, sexuality, suicide and domestic violence, amongst other issues.

The website is used around the world, but few people have noticed the new page yet – there were 21 visitors last week out of 2,730 for the whole site.  The new page covers  potentially sensitive material, and  I’ve been acutely aware that what I write has to be useful for people in a variety of cultural settings.  I’d appreciate feedback.

What’s wrong with the idea of opening the NHS to US traders? Plenty.

There’s been a lot of discussion about the potential for a trade agreement with the USA and its possible impact on the NHS.  “I think everything with a trade deal is on the table,” Donald Trump has said.  “When you’re dealing in trade everything is on the tabl,e so NHS or anything else, a lot more than that, but everything will be on the table, absolutely.” The response of those who want there to be such an agreement has been to say that it won’t matter – a “storm in a teacup”, one IEA spokesperson commented. US firms are already providing services in UK health care.  Services can be provided by a range of providers; what matters for the consumer is that the NHS continues to offer services that are free at the point of delivery.

This view may be disingenuous, because there is a strong financial incentive not to see the problems.  It is certainly mistaken.  The usual complaints from the left are that profit-making firms are extractive, and that competition consumes resources.  Either might be true, but the problems run much deeper than that.  There is now abundant evidence of what happens to public services when ‘competition’ or part-privatisation is introduced.  I have just had a paper rejected which makes the arguments in some detail – admittedly it’s too tendentious for an academic journal – but I can sketch out a couple of points here.

There is no system, anywhere, that is wholly public, any more than there is a system that is wholly private.  The NHS has had an uncomfortable relationship with the private sector, but its successful functioning relies mainly on two pillars: that the private sector is small and select, and that the services are sufficiently integrated to ensure that really serious cases can be taken over by the national service.  Both of those are at risk from creeping commercialisation.

The fundamental problem in any mixed system is that commercial providers get to choose what they cover; public providers, committed to meeting the needs of a population, do not.  Commercial providers select those areas of operation which they are undertaking to provide – that is how markets work.  That means that in general they will select those activities which deliver the best return per unit.   It follows that some things will be left out; when they are, the public services will have to deal with them as provider of last resort.  (Take a simple illustration, delivering post and parcels.  If private firms can subcontract for the profitable bits, they choose the easy runs – between major cities, or within busy areas.  In the case of private health care, that has generally meant a preference for relatively low-risk elective surgery, while long term psychiatric or geriatric care don’t attract the insurers or the services.)

Taking those points together, that must also mean that public services have a higher cost per unit than the private services – the difference is built into the process.    Politically, there are constant complaints that public services don’t work as well as private ones.  Of course they don’t; they have to take on the bits that private providers leave behind.

That’s the unavoidable part of the problem.  Some other things follow in the wake of that structure.  They may be avoidable, but they are still difficult.

  • There is a continuing incentive for private providers to cut corners – skimping on service, paying less, holding to the letter of complex contracts.
  • The public sector has to develop processes for sub-contracting and compliance, which are expensive and uncertainly effective.
  • When private providers get it wrong, and services collapse, the public services have to pick up the pieces.

There’s obviously a lot more to be said about competitive structures, but that’s why I started out trying to write a paper on it rather than a blog entry.

Thinking Collectively

I’ve just received the first print copies of my new book, Thinking Collectively: social policy, collective action and the common good. In Reclaiming Individualism, I made a case for social and government action in order to protect and enhance the conditions of individuals. Thinking collectively complements those arguments by considering collective approaches to social policy.

These comments are from the reviews obtained by the publisher:

“Paul Spicker asks how to think-with, live-with, and be-with collectives in this important new book which sees afresh the possibilities of collective life. Crucially, it also reinstates the significance of the common good and value of the common weal for social scientists and activists.”   Stephen A. Webb, Glasgow Caledonian University

“This concise and well-written book is a compelling and timely reminder of the importance of collective action and political community.”   Daniel Béland, McGill University

It’s my nineteenth book, my third since leaving Robert Gordon University.

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.

Intergenerational fairness shouldn’t mean that we cut pensioner benefits

The House of Lords report, Tackling Intergenerational Fairness, is a strange document. Most of it – six chapters out of seven – is a sober, well-documented account of demographic shifts in the pattern of disadvantage.  When it comes to policy, however, there is a serious disconnect.  There’s precious little about policies to remedy disadvantage within the older population – Pension Credit hardly gets a look-in, Housing Benefit (due to be shifted into PC) disappears, social care is punted into the long grass while waiting for a different report.

What there is an attack on policies that benefit old people: the report tilts at National Insurance, benefits for pensioners and universal provision, suggesting cuts for all of them.  Winter Fuel Payment is attacked, foolishly, because it doesn’t do much about fuel (a category mistake: as I’ve previously argued in this blog, we mustn’t get confused between the title of a benefit and the purpose it serves).  The welfare state, Alan Walker once commented, is largely a welfare state for older people, and the apparent premise behind the recommendations of this report is that the answer to that imbalance is to have a go at the welfare state.  It might be more constructive to think about how the benefits of secure, solidaristic benefits might be extended to younger people and people of working age.

The ‘will of the majority’ is not a democratic principle

I can’t believe I’m having to say this, but the storm of protest when I posted on Twitter a couple of days ago tells me that some people really can’t tell the difference between democracy and dictatorship.  Twitter doesn’t lend itself to extended arguments, and it’s difficult even to reply sensibly; once a tweet has cropped up in four or five postings, there are too many threads to take account of.  The (admittedly truncated) comment that sparked people off was this:

Democracy is not a system that “implements the majority’s will”. It’s a system that respects and protects the rights of minorities. 

This attracted withering scorn.  One critic – a politics lecturer! – wrote:

Some confusion here about the meaning of democracy, from an emeritus professor of politics.

I tried to explain in these terms. 

The main models of democracy are institutional (eg elections, protected opposition), prescriptive (eg rule of law, deliberation) and normative (eg participation, rights). Majorities are only a device for resolving disagreements. The reason why we have oppositions is that majority views are never enough. Madisonian democracy treats majorities as a coalition of minority interests. In no democratic country does the winner take all.

Majority rule is a convention – a method for arriving at decisions, rather than a principle in itself.  It’s been used (like some other methods) in a variety of circumstances, and in many cases those circumstances are not democratic. I tried to explain that ” majority rule is not intrinsically democratic – it’s also used in dictatorships. Without contest, respect for rights or the ability to vote again, it’s undemocratic.”

It is absurd to suggest that “majority rule is used in dictatorships”. Elections in dictatorships are never used to express the majority will; if they were, they would not be dictatorships.

That’s an astonishing reply. Most of the dictators in the world have been elected.  What makes them dictators is the suppression of opposition and civil rights.

Bizarre. You actually think elections in dictatorships are free and fair, such that they actually represent the majority’s will?

You think that a majority can’t ever truly be oppressive, racist or fascist? Dictators often seek majority votes: eg Mussolini 1934, Hitler 1936, Franco 1947, Marcos 1973. “Autocratic regimes consult voters even if the outcome is a foregone conclusion.” (from https://doi.org/10.1017/gov.2018.16)

That is exactly my point. Majority voting is only democratic when elections are free and fair. Therefore, you cannot delegitimise majority voting by pointing to the existence of elections in authoritarian regimes, where elections are not free and fair.

An election where winner takes all on a majority vote cannot be democratic, regardless of whether the process is fair. That’s what gives you Mussolini or Mugabe. Democracy must protect the rights of minorities and of opposition, or it isn’t democracy.

And here we circle back again to your smuggling-in of liberal principles of minority protection into the definition of democracy. Opposition is essential for democracy but winner-takes-all is entirely compatible with it as well. Stop conflating important concepts.

The key point here is that majority rule is never, in itself, sufficient to guarantee democracy.  Beyond that, the translation of the conventions of majority rule into claims about ‘the will of the people’  is itself questionable – a device of demagogues and dictators.

The problems of people who beg

Shelter Scotland has published a noteworthy report profiling people begging in Edinburgh.  The report asked questions of 420 people; that’s unlikely to be everyone, but it’s a lot.

Addiction plays a large part, with nearly 90% misusing drugs or alcohol; more than 80% had mental health problems, mainly depression and anxiety, and more than 60% also had physical health problems.  It’s a population that overlaps with street homelessness – 43% said they slept rough – but the two things are not equivalent, and I was struck as much by the differences as by the similarities.  When I worked on the census of homeless people in Aberdeen, it was the support staff who tended to say that the problems were problems of life-style and personal issues; homeless people said that the main problems were that they were cold and they were hungry.  People begging in Edinburgh seem far more likely to say that it’s down to their personal issues.

I did wonder if people might have been steered in some directions by the shape of the questions asked.  One of the messages from the qualitative studies I’ve done with psychiatric patients in the past is that family matters; the people left without support to become homeless are mainly those whose relationships with the family have broken down.  This is hinted at, but overall it’s not a major factor here.  In fairness, though, it’s difficult to set up exploratory, discursive interviews with homeless people (been there, done that); the remarkable thing about the Shelter study is how much information they’ve been able to bring together.

Some thoughts on nationalism and social policy

Over the last few days, I’ve hopped round a series of apparently unconnected sources which seem, nevertheless, to have a common theme.  I’ve been looking, for example, at material about the experience of poverty in low income countries; at political arguments concerning Zionism and anti-Zionism; at arguments for a distinct Scottish currency; and a constitutional arrangements concerning the rights of European citizens.  The issue that they have in common is a sense of the nation as a body which defines the scope of public policy.

Some years ago, Daniel Béland and André Lecours wrote a fascinating book on the relationship between nationalism and social policy.  The key question they are concerned with is how far our communities, and our responsibilities, extend. The case examples they looked at, such as Belgium and Canada, are effectively multi-national states, but so are others which see themselves as having a unifying culture – look, for example, at the constitutions of Ireland or Poland.   (Those constitutions, for what it’s worth, show that there is nothing exceptional about Zionist nationalism.)  The link between nationalism and social policy isn’t just that nationalist movements tend to emphasis the importance of mutual welfare, though it makes sense that they should do so.  It’s that social policy itself depends on the construction of a political community – an identifiable group which defines the scope and limits of mutual responsibility and support. However, solidarity in a political community commonly extends across nations and ethnicities – and some political communities extend beyond territory, too, which is how a few hundred thousand people have recently been able to claim Irish citizenship.  To be legitimate, solidarity and citizenship have  to be reasonably inclusive: any such community needs to accept that there will be people from more than one nation within it. Scottish nationalism meets that test; I’m not sure that all the other contenders do.

 

A protest about women-only events: can’t there be safe spaces for women?

A stushie in Edinburgh, with accompanying Twitter storm, has exercised my nearest and dearest.  The Audacious Women Festival, as the name implies, might be assumed to have something to do with women: find their tweets at @awfest.  Some of the events are open to all, and some are single-sex events intended for women.  But the idea of a single-sex event has exercised a particular lobby, claiming to represent trans and non-binary people, who have called for a boycott.  Yesterday, Glasgow Women’s Library (@womenslibrary) pulled out of two single-sex workshops they were due to conduct, leaving sixty people without an event at 30 minutes’ notice. Edinburgh Rape Crisis (@EdinRapeCrisis) has pulled a book launch planned for Monday.  Reactions on Twitter have been mixed; it seems to me that more people have condemned the organisations than have supported them.

The offence that the Festival has caused is that the organisers have stuck to the policy on gender recognition advised by the Equality and Human Rights Commission: more or less, that they treat people as women when they present as women (the statement has been misread by the Twitterati who don’t understand the purpose of the word ‘or’ in a sentence).   The call for a boycott was circulated by @ClassicsQueer, who holds that that policy excludes “our trans and nb sisters”. [“NB”, for those lost in acronyms, stands for non-binary.]   She attached a document saying this:

I would urge you particularly if you are a cis woman to boycott … A few weeks ago I reached out to them as I was concerned by the ‘women only’ rhetoric and was disappointed to find their response laden with transphobia.  I was told that the events were for people who are ‘publicly accepted as women’ and that they urge me and my friends to consider if other audience members will feel ‘comfortable with your personal identity’ before attending any events.”

Sisters Uncut Edin (I think the word ‘uncut’ is meant to be taken literally)  posted:  “We stand in solidarity with the trans, nb, gender non-conforming and cis allies who have called for a boycott of the festival.”  (Cis, for practical purposes, refers people who still have the gender assigned to them at birth.)  So, on the face of the matter, it’s not good enough to accept trans women as women, which is what the Festival does; there also has to be space for non-conforming, non-binary, non-females, or it becomes the act of a “#terf” (trans-exclusionary radical feminist).

The first question to consider is whether it is legitimate to ask for distinct spaces for people of different genders.  The need for women-only spaces is recognised in equality law.  As a man, I accept that women need safe spaces; for example, as a social work supervisor with a student working in Women’s Aid, I wasn’t permitted to set foot on the premises.  Women’s discussion groups have long established the principle that the presence of men changes the dynamics of group conversation. Men, and people raised as men, are socialised to engage in discussion in different ways (and often try to dominate).  The rationale for making a distinction in supportive groups is that people from different genders have different life experiences, and behave differently as a result.  Trans, non-binary and non-conforming people have different experiences again – and have just as good a case for a distinct safe space in their own right; but that experience will not be reflected either in a men’s group or a women’s group.

The second question concerns the criteria used for inclusion and exclusion.  It seems to me that if trans, non-binary and non-conforming can be treated as a unifying category (and that, rather than trans inclusion, is the substance of the protest) we are not talking about conventional distinctions between women and men at all.  Some people extend that to include LGBTIQ+ – but that lumps gender together with sexuality, and in any case we are running out of alphabet. The issue is surely, if I can borrow a phrase from Jonathan Sacks, about recognising and valuing “the dignity of difference” – a principle which applies much more widely than the issues of gender.  But you cannot hope to rely on that principle for yourself if you deny it for others; and that, regrettably, is what the critics of the Festival are doing.

The third question concerns the boycott.  I’m baffled that the people demanding to be included can imagine that this is the way to pursue an argument.  Boycotts are exclusive; they stand at the opposite end from tactics of discourse, argument and persuasion. They are beloved by trolls and bullies.  The trans-activists who made this call are behaving like Men.  This is not what feminism looks like.