- IoI Forum
- Social Policy Forum
- Date: Ongoing
Social policy is apparently everywhere these days, embedded in everything from soap opera storylines to arts funding criteria. Yet, for all its pervasiveness in our culture, it is rarely discussed in its own terms. This is a problem because instead of policy makers trying to find ways to better meet people’s needs, they are more likely to be found promoting behavioural change or advocating intrusive interventions into people’s lives. The Social Policy Forum aims to challenge social policy by stealth, while taking a closer look at some key policy debates on everything from housing, social care and welfare, to the reforms of local government and public services.
Contact Dave Clements for more information.
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Big society, broken society, sick society, stuck society? Who gets to say how we should behave when it comes to what we smoke, drink and eat? Politicians, nudgers, doctors? Should volunteering for the greater good be compulsory? Is living life dependent on welfare actually making people morally and physically sick? Should our schools become ‘engines of social mobility’ or are they ill-equipped to tackle ingrained social inequalities?
Following the Society Wars strand at the Battle of Ideas 2011, the Social Policy forum has put together a taster of what the debaters had to say.
Download Society Wars pdf here
Earlier series of the Social Policy Forum are archived here.
Thursday 30 May, 7pm
Policy over a Pint
At the Social Policy Forum we will be having one of our 'Policy over a Pint' meet-ups shortly. We will be discussing a recent Demos report called Control Shift. It argues for a 'nudge-plus' approach to helping individuals, families and communities make 'better choices' and behave more responsibly.
Martyn Perks, a consultant, writer and speaker on design, innovation and business change, will kick things off.
If you would like to attend, please contact Dave Clements
- Control Shift, Demos
Tuesday 29 May, 7pm
A crisis of caring?
Alka Sehgal Cuthbert asks whether there is a crisis of compassion and caring in health and social care. She welcomes some of the recommendations in the interim report from the Commission on Improving Dignity in Care for Older People but thinks there is a bigger issue. The managerial response of the inspection regime is part of the problem not the solution. By encouraging a ‘performance’ culture that can say nothing about the intangibles of care it undermines a professional commitment to a caring ethos. To the extent that society has an ‘elder abuse’ problem is it because of a lack of vetting of carers, or is it driven by damaging institutional cultures? Will new improved national quality standards make any difference?
- Why there’s a crisis in compassion
- What’s really behind the crisis in caring?
- Commission on improving dignity in care: draft report and recommendations
- Undercover: Elderly care on panorama
Monday 26 September, 7pm
Hand-out Britain? Has a dependency culture made us sick
The current drive to cut public spending has focused attention on a ‘dependency culture’. The summer’s riots were seen by some as the consequence of a dysfunctional welfare system destroying informal community bonds by institutionalising individual dependence on state hand-outs, thereby fostering a widespread and antisocial sense of individual entitlement. Even some supporters of the welfare state concede there is something wrong when generation after generation in some areas do not expect to work, and that the problem is not as simple as a lack of jobs or opportunities. In particular, many feel there is something dodgy about the high number of people claiming incapacity benefit. But is the problem about a minority of malingerers ‘on the sick’, or is there a broader cultural malaise, whereby people are encouraged to see themselves as ill? Labour MP John Cruddas has said we are not suffering from a crisis of welfare dependence but one of ‘mass chronic ill health caused by worklessness and poverty’. Nowadays those deemed too ill to work seem as likely to be suffering from mental health conditions as the industrial ailments and diseases of old: over a third of successful incapacity claimants have been diagnosed with mental or behavioural disorders. But do these disorders owe more to the welfare system itself than to the economic situation?
It is not just benefit claimants who are accused of being on the sick. Last year, the government replaced sick notes with ‘fit notes’ – asking doctors to suggest types of work the patient may be fit for - in an attempt to claw back the estimated £100 billion per year lost due to employee illness. But can politicians and pundits plausibly complain about a ‘sick-note culture’ when the constant refrain from these same commentators is that contemporary society makes us ill? From the beginning of the economic crisis, experts lined up to tell us impending hardship threatened our mental health, while Cameron’s happiness agenda is underpinned by the notion that modern life makes us depressed.
Is it true, as some allege, that the rise of poor health is genuine, a product of precarious employment and an inequitable society? If sickness is psychological, isn’t it still ‘real’? Or are we simply talking people into being ill? Can the welfare system be reformed in such a way as to encourage resilience and help people regain their independence while still guaranteeing a safety net for those who need it? Is it time to rethink the welfare state more generally?
Duleep Allirajah will be introducing the discussion on Hand-out Britain? Has a dependency culture made us sick?.
- Working for a Healthier Tomorrow, Dame Carol Black, Department of Health, March 2008
- Lax benefit rules not responsible for high disability figures, David Brindle, Guardian, 19th January 2011
- These welfare reforms won’t end our costly sick-note culture, Mary Dejevsky, Independent, 18th February 2011
- From working class to incapacitated class, Patrick Hayes, spiked, 27th July 2011
- PM vows to get addicts on benefits into work, BBC News, 21st April 2011
- Plan to cure “sick-note” UK, Louisa Peacock, Daily Telegraph, 13th February 2011
- Fit note ignored by many doctors, Lord Freud warns, Louisa Peacock, Daily Telegraph, 22nd March 2011
Tuesday 23rd August 2011, 7pm
Radical Surgery for the NHS? What is a GP's role today
Proposals in the recent Health Bill to change the role of GPs have been among the most contested of all the coalition’s policies. David Cameron cited GPs’ frustration with NHS bureaucrats as a core motivation for putting them in the driving seat, responsible for commissioning most healthcare and in charge of huge budgets. Yet while some rejoice at the prospect of the medical experts having a greater say in deciding how best to allocate resources, others worry GPs will see their professional authority undermined if they take on managerial roles on top of their medical responsibilities. Meanwhile, frontline healthcare is increasingly being provided by ‘nurse practitioners’ and call-centre surgeries such as NHS Direct; even pharmacists now provide vaccinations and routine health checks.
Whatever happens to the current Health Bill proposals, there is little doubt the role of doctors has been changing for some time. The increasing focus on public health and preventative medicine means GPs are no longer asked simply to treat sickness, but to help prevent healthy patients getting ill in the first place. Patients’ diet, alcohol intake, smoking habits, weight and level of exercise are now considered to be doctors’ main focus, to the extent that recent NICE proposals could see GPs paid more depending on how many patients they encourage to stop smoking. Some surgeries are now setting up shop in supermarkets to attract doctor-shy shoppers and foster greater public awareness of healthy living. At the same time, the ever-greater scope of the Quality and Outcomes Framework means GPs are required to probe ever deeper into patients’ health and lifestyles beyond their reported illness.
Have these changes really been thought through and debated sufficiently by doctors, or simply nodded through with a shrug? Are the new roles empowering or, as the Kings’ Fund suggested in 2010, has the medical profession has lost confidence in itself? Are GPs undermining the doctor-patient relationship by trespassing into lifestyle areas previously considered private? Why have GPs’ roles become such a political issue? How much does it have to do with current economic uncertainties and public sector cuts? Are doctors being turned into bureaucrats, rather than liberated to get on with their medical responsibilities?
Brid Hehir will be introducing the first discussion on Radical surgery for the NHS? What is a GP's role today. Until recently, Brid has spent a long career in the NHS. She has been a nurse, midwife, heath visitor and senior manager, and remains a regular contributor to the nursing press.
If you would like to attend, please contact Dave Clements
- Improving the quality of care in general practice Kings Fund, March/April 2011
- David Cameron reveals GP frustration inspired Health Bill, Neil Durham, GP, 27 January 2011
- For Liberating the NHS’ read ‘Dismantling the NHS, Clive Peedell, NHSCA, 4 Jan 2011
- Understanding the doctors of tomorrow, Kings Fund, 2010
- What makes a good doctor? The start of a national conversation, GMC, Feb 2011
- Time for NHS to act after pause, says Andrew Lansley, Guardian, 8 July 2011
- It’s unethical for general practitioners to be commissioners, Mark Sheehan, BMJ, 10 March 2011
- NHS reforms could reduce patients' trust in doctors, BMA warns,Rajeev Syal, Guardian, 27 June 2011
- Supermarket surgeries give GPs a new way to reach patients, PULSE, 6 July 2011
- The BMA: modern-day prohibitionists, Max Klinger, spiked, July 2011
- GPs agree ban on operations for smokers and obese patients PULSE, 19 July 2011
- QOF targets must not be outside GP control, Tom Moberly, GP, 24 January 2011
- Doctors can promote fairness and equality in health through education, Bob Davidson, Total Health, June 2010
- Questions to Roy Lilley, OnMedica, 10 May 2011
Thursday 26th May 2011, 7pm
Social Mobility and Education
Sally Millard will be introducing the discussion.
If you would like to attend, please contact Dave Clements
Tuesday 31st May, 7pm
How not to defend public services?
Discussion introduced by Dave Clements.
David Cameron has promised that a much anticipated white paper will mark the ‘decisive end of the old-fashioned, top-down, take-what-you’re-given model of public services’. The government want to end the state monopoly and encourage a diverse market of independent providers. While advocates argue that this outsourcing will stimulate innovation, critics see it as little more than an apology for a massive programme of cuts to local services that are already well underway. The government has pledged to save £95bn over the next five years. And yet for all the people on the TUC’s March for the Alternative ‘the public’ are indifferent.
Still, commentators worry about the impact of cuts on the most vulnerable groups. The latest protestors to take to the streets against the cuts - people with disabilities - described themselves as the Hardest Hit. Critics characterize the cuts as an ideological attack on the public sector, and oppose the reforms and cuts to public services as a threat to ’cherished institutions’. But instead of assuming public support, it is perhaps worth asking why public services are worth defending. While the prospect of public sector workers losing their jobs is nothing to celebrate, is the growth of the public sector something we can afford to ignore? And what about those in local government who claim to oppose the cuts, but are busily implementing them anyway? Unless those who oppose the cuts come up with some better arguments, will there be anything left to defend?
If you would like to attend, please contact Dave Clements.
Readings will be posted here.
Tuesday 29th March 2011, 7pm
Nudging towards a Big Society?
While the Big Society may seem to offer the possibility of an opening up of civic involvement, will this in fact usher in a new dawn of autonomy from the state as promised? Or is the Big Society another way of encouraging a prescribed notion of social responsibility, whether that be recycling, parenting or indeed individual health? And if the aim of the Big Society (like Nudging) is to create new social norms while not (overtly) involving the state, then what is meant by autonomy today? Martyn Perks will be introducing the discussion.
Thursday 17th February 2011, 7pm
Must poor children become poor adults?
The IOI social policy forum will be starting 2011 with a discussion of Frank Field's report The Foundation Years: preventing poor children becoming poor adults, especially the Introduction and chapters 1,3, 5 and 6.
Thursday 2nd September 2010, 7pm
Cutting down the quango state: will it deliver power to the people?
In opposition David Cameron promised to cut back the 'quango state', over 700 autonomous non-departmental bodies blamed for the lack of accountability in politics and much of the waste in state spending. Now with over 80 extra-departmental bodies to be abolished, and more threatened, the much promised bonfire seems at last to be underway. Scrapping these organisations is not just a matter of saving money, it is a core part of th...e government’s strategy to take power away from the centralised state and give it to the front-line. In education the Qualifications and Curriculum Development Agency (QCDA) is to be abolished as schools are given more freedom to devise their own curricula. In the NHS, half of all non-governmental bodies are to be abolished while more responsibility is given to general practitioners.
History would suggest however, that culling the quangocracy is not as straightforward as it sounds. Both Thatcher and Blair came to power promising the tackle the burgeoning growth of non-governmental organisations and both ended up creating new ones. Similarly the new government has already created new quangos such as the Office for Budgetary Responsiblity. What looks like a bonfire is too often a re-structuring of unelected bodies. But might quangos in fact be the best way for the state to carry out its functions? Will G.P.s for example really take on more administrative responsibilities or employ the same sacked managers to do it instead? Similarly if Whitehall takes on the responsibities of abolished quangos, will this improve accountablity when the priorities of these unelected bodies have already been decided by politicians? It is not only HEFCE (the Higher Education Funding Council for England) that demands that University departments prove their 'relevance', for instance, but the political elite as a whole. So it may be the case that politicians are hiding behind quangos not only in setting them up, but also in attacking them.
So will the 'bonfire' at last make the state answerable to the people, or is the problematisation of quangos itself a way for politicians to avoid accountability? Will taking an axe to the acronym forest deliver control to health and educational professionals or impede these vital services from functioning? If quangos are the burden on the state that they are often said to be, then why has getting rid of them historically proven to be so difficult?
We have Toby Marshall of the Education Forum and Brid Hehir, Senior NHS Manager, discussing these issues in relation to education and health policy.
- David Cameron’s opposition speech explaining why quangos need to be reformed, 6th July 2009
- A general summary of the recent cuts by The Independent, 27th July 2010
- A useful House of Commons summary of the figures and some of the history of the quango debate, 24th June 2010
- The coalition's culling of quangos is bad for democracy, 1st August 2010, The Government says that Quangos are bad for democracy, but do they in fact hold ministers to account?
- Careful with that Quangos axe David 16th July 2010, by Ian Magee, co-author of a recent report 'Read before Burning' which is critical of the quango bonfire.
Thursday 29th July 2010, 7pm
Is the Big Society good for society?
The one thing everybody seems to agree about the Big Society is that they don’t really know what it is. Is it about individual liberty and freedom from overweening government, or something to do with rebuilding community and reforming public services? Though it failed to resonate during the General Election, there has been considerable interest since as the new government prepares the way for public spending cuts. For Cameron, the Big Society reflects his ‘profound faith in my fellow human beings and a healthy awareness of the state’s limitations’. Too much government is inhibiting, he says, it can have the effect of ‘undermining social and personal responsibility’, and end up ‘making things worse’ not better. The ‘state will assume a new role as an agitator for social renewal’, he says. Public services will be ‘cheaper to deliver… while bringing communities together. It might even restore people’s trust in the political process’, he says.
But is the Big Society really the new ‘big idea’ that Cameron claims it is, or have we heard it all before? The National Citizen Service, the Big Society Bank, and ‘army of community organisers’, are arguably no more than a reframing of New Labour initiatives around volunteering and ‘community’. In the run up to the election, and after ‘double-devolution’ and the Big Conversation, the Labour government said the ‘moment for mutualism’ had come, and ‘Co-operative Councils’ were handing over assets to the community and people running services for themselves. Nevertheless, the rise of social enterprise, ‘co-production’ and the mutualisation of public services, does seem to speak to the old fashioned notion that people can come up with their own solutions to problems and that government doesn’t need to step in all the time. Whether its parents running their own schools, people paying for social services using personal budgets, nurses starting up their own cooperatives, or concerned locals managing parks and electing police authorities.
Perhaps it has always been little more than a smokescreen for official inertia, and an excuse for the failure to provide decent public services. But it could also be an opportunity, not just for social innovators to inject a bit of life back into the public sector, but for the rest of us to claim the Big Society for ourselves. For all Cameron’s supposed ‘faith’ in individuals to get on with their lives free from state interference, illiberal initiatives persist. Whether it’s policing our parenting abilities, our behaviour online, or our unhealthy lifestyles offline, the state is never far away. If the autonomy of individuals to make decisions for themselves and live their lives as they choose is in doubt, then so it’s the Big Society. On the other hand, shouldn’t we be questioning the eagerness of politicians to ‘hand over the keys’? And should we be turning our backs on post-war achievements like the NHS, social housing or a universal education? Should civil society be expected to fill the gaps as public services are cut, and ‘do-it-yourself’ services put in their place? Perhaps in times like these we need Big Government, and a Big Politics to match?
Introduced by Dave Clements
- Ten Big Questions about the Big Society
- Building the Big Society
- How Social Entrepreneurs can help build a Trust-Based Big Society
Wednesday 9 June 2010, 7pm
On the frontline?
With the national debt now standing at the highest in British history, the Con-Dem coalition are not hiding the fact that they wish these £6 billion to be the first trim in a radical new look for the British economy. The trend is towards austerity. With the debt standing at £741.6 billions the clippers have only just begun to whirr. In Greece, people have taken to the streets as their Government calls in the IMF. In Britain, proposed welfare reforms to force the unemployed to work could end up subsidising the private sector wage bill with welfare payments.
Currently, what passes for debate about cuts in this country consists of echoes from Gordon Browns failed election campaign; there are rumblings about the priority of ‘front line jobs’ and the importance of protecting the education, health and the police budgets. But, at a time when the public sector is in perilous danger, are these the right questions to be asking?
Can the private sector go cold turkey from Government support? Will the coalition make the sorts of cuts it says we need? Will the British Public act ‘in the national interest’ and go along with the cuts? What public services and jobs, if any, are more important than others? Is an outsourced job less important than one directly funded from the public purse?
But perhaps most fundamentally of all: Who or what is the public sector for?
Introduced by Kate Moorcock-Abley.
Monday 26 April 2010
Heartlanders or landlords? Can housing build communities or aspirations?
When Margaret Thatcher introduced the ‘Right to Buy’, it was intended to inculcate an aspirational and more socially responsible population. Today, there is little confidence in the idea of a class of home-owning go-getters. Home-owners stand accused of treating property as a commodity while those still in social housing are pitied as a feckless underclass. Some have said that the decline of the housing market in the past couple of years is an opportunity to create a more cohesive society. The Conservatives, for their part, retain a rhetorical commitment to encouraging social tenants to aspire to own their own home, but this is less about promoting the rugged individualism of the past and more about community engagement.
Whether arguing for a greater role for co-operative and the third sector in providing housing or for the right of tenants to part-own their council houses, the consensus is for a more managed form of housing provision. This will, in theory devolve power to individuals and communities promoting both autonomy and cohesion. But are these exercises in community building as liberating as they seem? While Thatcher’s ‘Right to Buy’ is today criticised for encouraging selfishness, the assumption at the time was that people make the right decisions if given control over their own lives. Are more innovative forms of tenure, with people moving up and down the housing ladder, rather than being either owners or renters, fairer and more desirable than the old system? Is opposition to the ideal of home-ownership motivated by fairness, or the desire to sneer at the suburbs? Should housing policy be aimed at leaving people to get on with their lives, whether aspiring-owners or more permanent social tenants?
- The Conservative Party Green Paper, 'Strong Foundations: Building Homes and Communities', Executive Summary and Chapters 4 and 5.
Social Policy Forum Election Statement
During this year’s General Election Campaign, social policy issues that affect our lives, from education and health to welfare, have been discussed in a technical manner. However, social policy does not depend on how much money is spent on healthcare or whether pensioners get a free bus pass. It depends on how we, as a society, see ourselves and each other, on how we define our needs and wants, and our relationship with the state.
However, today social policy is not seen as the result of the decisions of active, autonomous citizens. Rather, we are encouraged to see ourselves as passive and incapable of running our own lives and our social policy reflects this. Social policy is about changing our behaviour and telling us what we should be doing to promote our 'wellbeing', rather than treating us as autonomous individuals or reflecting our collective desires for new social arrangements.
Read the full statement
Wednesday 24 February 2010
Designing behaviour and healthcare
Listen to the introduction to this forum:
David Cameron has said “I’ll cut the deficit. Not the NHS,” but regardless of what happens at the next election, it seems that the health system will be run on a different basis from the universal system of the past. As Shadow Health Secretary Andrew Lansley says, his proposed Department for Public Health will have “a stronger remit for preventing disease, rather than just its cure. Whenever possible, we will ensure that national public health initiatives funded by public money are focussed wholly on behaviour change and paid for on the basis of the results they achieve.”
The shift towards a provision of healthcare organised around behaviour change will increasingly mean judging access and use of provided services according to whether the individual leads a healthy lifestyle. The motivation for this is not just cutting back public expenditure, even though “unhealthy lives” apparently drain spare resources. Policy makers want to redesign services more closely around peoples’ needs and investigate ways to prevent those same problems occurring in the first place. By focusing on the individual patient, the state can claim that it is acting in our best interest, and even that this approach is more egalitarian as they can understand and connect with vulnerable or disconnected communities in need of support.
Is this behaviour led approach more benevolent than the old universal model, will it result in better healthcare, or is it unacceptably authoritarian?
- Andrew Lansley, A Healthier Nation, Conservative Party Green Paper, 13th January 2010
- Isabel Oakeshott, Hospitals told to make patients happy, The Times, 13th September 2009
- Tim Brown, Participating in healthcare, Design Thinking, 2nd May 2009
- Samir Shah, Active Design Guidelines: A new definition for sustainable cities, Urban Omnibus, 3rd February 2010 (On redesigning cities to facilitate Health)
- Battle in Print, Shaping Social Policy: Designers and Health 20th October 2009
Wednesday 20 January 2010
Database State or Smarter Government?
The stated aims of increased data sharing are improving services to the public by joining them up in more logical ways than given by current organisational boundaries; by reducing the bureaucracy the public experience of repeat contact, and unnecessary and repeat form filling; and by giving better value for money by rationalising systems and processes. In addition, the public protection dimension (e.g. crime and disorder, child protection) is considered critical so that professional’s across service boundaries can serve the public better.
The most controversial aspect of the discussion is around the sharing of personal data. It is argued, for instance, that explicit consent from the public should be gained before any information can be shared. While it is not clear the extent to which the principle of informed consent is shared either within government or more generally by the public; the notion of the need to share data is now deeply embedded in public service delivery.
Do the stated aims of data sharing fully explain what is driving this trend? Or do they reflect the changing relationship between public and state? Is there cause for concern or should we be fairly relaxed that there are enough safeguards in place to protect our personal data from abuse?
Putting the Frontline First, Smarter Government
Database State, Joseph Rowntree Reform Trust report