Universal Credits, Care in the Community and Enoch Powell. A short history of crap policy

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I visited Cardiff earlier this year to see the Dr Who exhibition before it closed.  On the Sunday morning we walked around the City to see some of the filming locations.

It was like a horror movie.   We came across people collapsed in the streets, comatose, or overdosed.  Those who were moving were staggering semi-concious.   

This apparently is Spice, the synthetic cannabinoid, recently made illegal, which has moved from head shops to street dealers with devastating consequences.  Seeing such a desperate situation was very disturbing.  What was worse is that we have been here before, and haven’t learnt any lessons.

Back in the 1980s I lived in Liverpool, and like most students, lived in a fairly poor and run down area.   At this time the Government was implementing the Care in the Community programme, and neighbourhoods like Toxteth were filling up with people recently released from long stay Mental Health services.   I have no doubt that Care in the Community is one of the greatest Social  Policy failures of my lifetime.

Care in the Community was driven by 2 forces.  The Libertarian Right had long

argued that mental hospitals were effectively prisons, preventing a return to normal life.  Enoch Powell, a former Health Minister had argued as early as 1961 for the closure of the “isolated, majestic, imperious, ……  asylums which our forefathers built with such immense solidity to express the notions of their day”.  Alongside this was a second force – a desire to move to a cheaper model of service delivery without the costs of inpatient Mental Health services. 

The Griffiths report in the mid 80s had recommended changes to the model of Mental Health care, inspired by the belief that State provision was bureaucratic and inefficient. The Thatcher Government enthusiastically embraced this philosophy but ignored his recommendation to support the shift of Mental Health services in the community with a ring fenced budget for Social Care support. 

Predictably Local Authorities, already strapped for cash, reacted badly to being transferred large numbers of NHS patients to look after, with no budget to do so.  Rows between the NHS and Local Authorities about who paid for which service were widespread, and larger and larger numbers of former patients became non-compliant with treatment, homeless or both.   Gaps in service became larger and larger, and because the individuals affected were not the most eloquent the gaps were easy to forget about.

The problems were exacerbated by policy changes elsewhere.  Homeless services, for example, had long dealt with people with Mental Health problems on an informal basis.  As they were closed down the range of options available to people shrank.

Not all former patients became homeless, many struggled on in poor quality rented accommodation in neighbourhoods like Toxteth.   There was however a massive increase in homelessness – Shelter estimates that during this period homelessness doubled to over 400,000.   

As more and more former patients became non-compliant with treatment self medication with drink and drugs became widespread, and groups of outdoor drinkers and drug users became a common feature in large cities.   Often people who hadn’t been in long stay accommodation gravitated to these groups.   

It is hard to write about violence by people with Mental Health problems without slipping into cliche, and it is important to stress that Mental Health patients are massively more likely to be victims of violence than perpetrators.  However, within these groups of people , self medicating with drugs and drug, and with chaotic lifestyles, there were a number of people who were very dangerous and very violent.   They found cover among the homeless and the Mentally Ill and largely preyed on them.   From time to time they would attack members of the wider population.

By the early 90s we had come to accept groups of homeless people on our streets, many with visible signs of Mental Health problems, some drunk or high on drugs, as part of living in big Cities. 

The turning point was the 1999 Mental Health National Service Framework, the first time the NHS had produced a detailed service specification for Mental Health services.

Mental health wasn’t the top priority in the early years of New Labour, but the NSF meant that local areas were audited on their provision.   Gaps were identified, and many, but not all were closed.  Services were expanded, and new services introduced. 

The National Service Framework benefitted by being introduced at a time when the new New Labour Government was increasing spending on the NHS.   In 1997/98 the NHS Budget was £33.5bn.   But 2005/6 it had grown to £76.4bn, and by 2008 had hit £96.4bn.   

To put this into context Boris Johnson claimed that leaving the EU would provide a one off  increase to NHS funds worth £350m per week.    In the early years of C21st the NHS budget got an extra £150m every week. 

One of the new services that was established in the National Service Framework was Assertive Outreach.  These were specialist Mental Health professionals, normally Community Psychiatric Nurses, who went out and tracked down people who weren’t engaging in treatment.  This was an expensive solution but bit by bit individuals were found.

Some re-engaged with treatment, but for many years of neglect had left them damaged.   The best which could be hoped for was to limit the harm.  For many this meant being helped to access benefits that they were entitled to, and live less chaotic lives.   We funded a worker based within our local branch of Mind who advised people with Mental Health problems to access benefits and housing. 

More controversially from 2001 onwards a new initiative called the Dangerous Severe Personality Disorder (DSPD) Programme was established, which targeted individuals with a very high Psychopathy Checklist – Revised (PCL–R) risk score in the community.

Not all of these developments were welcomed by the Professions.  The DSPD programme was incredibly unpopular with Psychiatrists.  In many parts of the Country the new resources the Government provided were hoovered up by Acute Hospital Care and waiting list reductions, and Mental Health services struggled to meet the National Service Framework requirements.

What is true is that people did re-engage with treatment, and British cities no longer had large groups of outdoor drinkers and drug takers.  Homelessness peaked in 2003 and then fell sharply through to 2010.  We need to be careful not to conflate homelessness and Mental Health, but it is clear that vulnerable people with Mental Health problems are more likely to become homeless if they aren’t receiving the right treatment.

By this point I had left the NHS and I was working for a Crown Non-Departmental Public Body sponsored by Department of Work and Pensions when the Coalition government came in.  I was in the unusual position of having worked at Department of Health, which gave me a different perspective on the incoming governments policy mix. 

The policy agenda they were persuing was a jumble, just as it had been in the 1980s.   There was a movement within the Conservative party led by Ian Duncan Smith and the Centre for Social Justice which wanted to emphasise personal responsibility, similar to the beliefs of Enoch Powell in the 1960s.   IDS wrote the foreword to a collection of essays in praise of Enoch Powell in 2014:

https://www.amazon.co.uk/Enoch-100-re-evaluation-politics-philosophy/dp/1849547424

But this was secondary to the overwhelming policy commitment of the Cameron Government – Austerity.   Whatever happened had to be cheaper.   A lot cheaper. 

I am forbidden from being too mean about IDS by a compromise agreement signed when I left the Civil Service.  I am however able to criticise the Centre for Social Justice.   In 2010 after 6 years of well funded policy formulation the Coalition government came into power with little or no actual policy ideas.  Normally the problem with think tanks is they produce too much, with not enough thinking through.  The Centre for Social Justice produced nothing of any value.

Despite the emptiness of the policy cupboard Cameron and Osbourne had a desire to appear reforming and meaningful, and not just cost cutters, but with little concept of how to achieve this.    IDS offered them Universal Credits as a solution and they embraced it without really considering what it meant.

Universal Credits was originally designed as a Labour Party policy, and was proposed by James Purnell during his brief tenure as Secretary of State.   Gordon Brown squashed it as too expensive and complex.   Given Gordon’s willingness to sign off on expensive public sector change projects this decision should have sounded alarm bells for David, George and Ian.

Instead it was seized upon by the Coalition as a way to give them a focus for Welfare Reform while they cut benefits.   

I’ve written previously about some of the existential design problems that have beset UC:

Deep House Victims Mini Bus Appeal

In truth I could write about Universal Credit design flaws and programme management mistakes every fortnight for the rest of the year and still not communicate exactly how bad it is.   Gordon Brown might have made some mistakes with Public Spending over the years but scrapping UC was one of his best decisions.

At the same time the Coalition was filling up friendly newspapers with horror stories about people claiming benefits, doing nothing to find work, and sitting around all day drinking cheap lager.   Mostly stories like this were made up, but in truth there were people, claiming benefits doing exactly that, although they weren’t representative.

The Government ordered a massive clamp down shiftless benefits claimants both imaginary and real, and Job Centres were set targets for sanctioning the benefits of anyone who was deemed to be insufficiently diligent in seeking work.    I signed on to Job Seekers Allowance while I was setting up my current business in order to access DWP’s small business start up service, and I had my benefits sanction on a couple of occasions, for trivial reasons. 

Before leaving the Civil Service I tried to explain to some of my DWP colleagues the work that the NHS had done in Assertive Outreach, and that for some people, particularly those who had suffered under Care in the Community it was better to leave them securely housed and claiming benefits, even if their attempts at finding work were negligible.   I even tried to describe the DSPD cohort who lived in the Community and how important it was that they stayed where they were, in contact with Community Mental Health services. 

Predictably I was ignored, and Job Centres targeted the most vulnerable for sanctions in order to hit local targets.    Targeting poor people in this way has become so politically acceptable that the last Labour Manifesto banked £7.5bn of savings from benefit cuts and freezes to fund it’s spending plans, while promising a rather timid “review”.

Homelessness has risen every year since then, as this graph for Rough Sleepers shows:

 

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UC is years behind schedule and only has 500,000 people on it  – the original target was 8.5m by 2015.  It is clear that it is making things much worse.   Applicants have to wait up to 12 weeks before receiving any money, which is then paid monthly in arrears.  When they do receive money cuts and freezes to the value of benefits have left too many people unable to afford housing.  And then there is the Bedroom Tax.

This has left us with exactly the same problems we had in the 80s and 90s, and it is exactly the same groups of people being hit the hardest.   I have no doubt that there are people who suffered under Care in the Community, who got their lives back together thanks to Assertive Outreach, who are being targeted again by Government Benefit cuts and Universal Credits.   The only thing that has changed is rather than alcohol and heroin the drug of choice is now Spice.   People living in Cardiff or Manchester will already know how bad things are. 

The rest of us are about to find out.

While the Labour Party were recently asking for a pause in the roll out of UC with typical timidity the Centre for Social Justice were publishing a report recommending placing homeless people with problems like alcohol and drug abuse in permanent accommodation and giving them access to care and training. The approach, known as Housing First, had been trialled in the US and adopted by Finland with positive results. Conservative communities secretary Sajid Javid said he was “keen to examine the scheme”

No shit Sherlock. 

References:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/198051/National_Service_Framework_for_Mental_Health.pdf

https://www.ifs.org.uk/bns/bn92.pdf

https://www.kingsfund.org.uk/projects/general-election-2010/money-spent-nhs

https://www.cps.org.uk/files/reports/original/111028104921-TheNHSSince1997.pdf

http://sticerd.lse.ac.uk/dps/case/spcc/wp02.pdf

http://www.lse.ac.uk/website-archive/newsAndMedia/newsArchives/2011/03/NHSreport.aspx

http://www.newstatesman.com/blogs/the-staggers/2010/11/universal-credit-purnell-brown

Modi, Thatcher, Reagan, Morrissey

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Nahendra Modi is the first world leader to have been a chai wallah.  He is also a tea-total vegetarian, unmarried (although he was briefly married when he was younger), and by repute, celibate, possibly a virgin.

Add to that some conservative social attitudes and you have the political equivalent of Morrissey. 

I had read a fair bit about Modi before I left the UK. Mostly the left leaning press give him a very hard time – he is portrayed as a hard right Hindu nationalist.  The right wing press tend give him a hard time for a different reason – for not delivering fast enough on a predictable neo-Liberal economic agenda.

I started to write about Modi as if he were an Indian Thatcher, or Reagan. Modi is normally portrayed in the West as a Conservative hardliner, pursuing an agenda of economic reform comparable to the changes the UK and the US went through in the 80s.  This isn’t entirely inaccurate.  Modi recently removed large numbers of high denomination notes from circulation.  This was pitched to the Indian public as an attempt to control corruption, however it looked more like a classic attempt to reduce the money supply in a country which is still very cash based.   I fully expected to see further announcements making it difficult to do business without a financial intermediary like a Bank, followed by de-regulation of financial services.  Exactly the same formula the US and UK applied, which led to widespread corruption, mis-selling and eventually the Credit Crunch.  Modi has also staked a lot of political capital on a new Tax code that is meant to simplify the taxation system and cut red tape.   

There is still time for Modi to become a new Maggie or Ronnie, but in all honestly the country that I visited didn’t look like it was heading in a Thatcherite or Reaganite direction.   India is very different today to the country I first visited 20 years ago.  It is visibly cleaner, wealthier, and everyone apparently has a mobile phone.  The participation of women in the workplace looks like it has increased significantly too, particularly in urban areas.  Fast expanding business sectors like financial services with good working conditions have attracted large numbers of high quality female employees.   More than half of all Indian Companies with female CEOs are in these sectors.   Women head the largest public and private banks in India, and India has more female Airline Pilots than the UK or the US.   

It is hard to tell how much of the change in female labour market participation is driven by indigenous changes to the Indian economy and how many of have been imported from the West as companies from the UK and US have built their presence in India.   The first time I visited Gurgoan it was still a small town, with more farms than offices, and when I was told that this was going to be a massive commercial area in a few years I was very skeptical.    Now I wish I had bought a couple of acres.   When big Western companies arrived at Gurgoan or Pune and started to recruit they didn’t really care wether India had traditional gender roles, or a family structure that demanded that a woman’s place was her mother-in-laws home.  Nor did they care about which religion their employees came from.  They looked for the cheapest, most productive employees, the ones who would earn them the most money.  This meant recruiting woman as well as men, sometimes recruiting women rather than men.

The change in woman’s participation in the workforce was so striking that I was pretty shocked when I checked the statistics and discovered that India is one of the few countries in which female participation in the workforce is declining sharply.  When I first visited India 20 years ago roughly 40% of women worked, now it is 28% and falling.    Female economic participation rates in urban areas are rising, but falling in rural areas, and the fall is so dramatic that it is over writing the increase in urban employment.  In an economy growing by 7% a year this is baffling.

The driver of this change is rural employment.  Of the 40% of woman who were working 20 years ago the majority were employed as subsidiary workers in farming, supporting a main, male, wage earner.   In rural areas the number of women working has fallen sharply as wages have risen. Families in rural areas are sharing India’s fast economic growth, but are using the extra money to reduce female participation in the workplace.  More women are staying on a school, in both rural and urban areas, which reduces the female workforce further.   

This highlights the central dilemma of Modisim.  India has a young, fast growing population, and it needs high levels of economic growth to keep GPD per capita increasing.   It is hard to achieve this with a substantial proportion of it’s human talent out of the formal workforce. But the economic regime of production determines the values and social structures of a society, and if you change the economic regime the values and social structures change with it.

Modi’s constituency are Conservative Hindus, exactly the people who are determined to maintain traditional gender roles, who demand that woman stay at home, and who want to use additional income to turn the clock back not forward.  Hindu religious Conservatives are similar to their contemporaries across the Muslim world who complain loudly about the impact of Liberal Western values on their societies.  They share their concerns with changing traditional patriarchal societies, and with concepts of equality on behalf of groups for whom equality is not a feature of traditional societies, such as LGBT rights.

This is the central tension of the Modi government.  It has come to power with support from traditional Hindu voters, many of whom are concerned about the pace of change, and who want to keep their privileges.  This same group, however, also want the economy to grow, which means economic change, which in turn produces social and cultural changes.  This conflict between urban and rural values, men and women, played out in the surprise Bollywood hit of the summer; “Toilet: A Love Story”

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It is this tension between the economic and social pressures which lies behind the criticisms of Modi which have come from the political and economic right.  The Economist was recently scathing about Modi’s record of economic reform, showing him riding a paper tiger.   When Thatcher and her successor John Major were in power they forced through economic reforms such as Sunday Trading in the face of opposition from the Church.  Righties will be very disappointed if they think that Modi will take on organised Hindu groups in the same way.

So far Modi has done well in resolving these tensions, partly because he is an astute political mover, but also because he isn’t afraid to use a loud crowd of right wing Hindu political activists to drown out any opposition.  To this extent he resembles Trump or Corbyn in harnessing the social media power of partisan activists to stifle dissent.   The continuation of the 1870 Raj era Sedition laws give politicians a lot of power to suppress views they don’t like.   Britain of course being much more Liberal than India abolished these laws years ago.   In 2009.   And India isn’t the only country to retain repressive British legislation.  The British tried the writer Saadat Hasan Manto for sedition 3 times in the 1930s.  After Independence the Pakistani government used the exact same laws to try him a further 3 times. 

Despite the popularity of socially Conservative politics there has been a massive shift in Women’s Rights and LGBT Rights around the world over the last 20 years.  Partly this is due to work by NGOs, local activists, and brave role models.   But to a great extent it is driven by economic changes which have provide a wider range of employment opportunities with employers who are more concerned with the bottom line, than with protecting traditional social structures.  This has increased the economic power of women and the LGBT community, which in turn has been a key factor in successful Rights campaigns.  The great irony of this is that it is exactly the kind of Neo-liberal economics which left wing activists loathe which has provided this favourable economic context. 

Of course this approach to equality has some clear draw backs – it is very good at empowering well educated women with in demand skills in urban areas.  Less good at tackling poverty and Conservative social structures in distant villages. 

This doesn’t mean that this is a purely rural problem.  I have no doubt that the Conservative social attitudes which keep women out of the workforce in rural areas are the same Conservative social attitudes which drive harassment and violence towards woman in urban and rural contexts – the use of power to keep women in their place.    

But there is more to Modi and the BJP Government than the tension between economic reform and social Conservatism.  Travelling across India it was hard to miss adverts praising the Prime Minister for giving 2 Crore Indians access to subsidised LPG.   20 years ago you would see cow dung cakes drying on walls for uses as fuel, and I was glad that I didn’t see a single wall covered in animal poo on my most recent visit.   This campaign was explicitly promoted as giving dignity to women.

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It was also startling to see Government adverts on the backs of buses promoting HIV/AIDS testing and treatment with Modi’s face on.  Hard to imagine Donald Trump lending his support to such a campaign.  There were equally large posters promoting condoms in a way that would cause US Conservatives to wet their pants.   

Modi’s economic policies go way beyond Thatcher style demoniterisation.  His Government isn’t scared to intervene directly in the economy, and has huge infrastructure plans; large scale rail and tube building, plus anti-car measures like increasing car parking.  These measures look a lot closer to Roosevelt or Attlee, and would place him on the left of the political spectrum in the UK.

And just because opposition to Modi is muted doesn’t mean he is in complete control.   While we were in India the Supreme Court made 2 huge judgements.

The first made the Muslim practice of Triple Talaq divorces illegal as the result of a campaign by Women’s Rights Groups.    

In the Second Judges ruled against the Modi Government ID card scheme, in direct opposition to the Modi governments use of “offence to the sensibilities of the majority” as a reason to curb personal choices.  Not only does the rolling have massive implications for the Government, it also has massive implications for LGBT rights:

“It is an individual’s choice as to who enters his house, how he lives and in what relationship. The privacy of the home must protect the family, marriage, procreation and sexual orientation which are all important aspects of dignity.”

LGBT rights in India have had a complex recent past, with the Delhi Court over turning the 1860 Raj era laws banning same sex relationships in 2009, only for the Supreme Court to re-instate the ban in 2013.   The privacy ruling strengthens the case for reinstating the 2009 ruling, and makes it hard for those opposing the repeal of the 1860 Act to continue with their arguments. 

The Modi Government wouldn’t have shed any tears over the Triple Talaq judgement, however the defeat on ID cards, and the way the Supreme Court framed their judgement most definitely ran against Modi’s wishes.

These judgements show that even with a Prime Minister sympathetic to Conservative values an independent judiciary can be swayed by liberal campaigns.  History has plenty of examples of politicians driven in the opposite direction to the one they set out on. Gladstone was an anti-Imperialist who ended up annexing chunks of Africa.  Modi is a social Conservative whose time as Prime Minister might end up advancing LGBT and Women’s rights further than his more Liberal predecessors.    Modi is certainly serious about unpicking the caste system and supported the appointment of an Untouchable as President.

The interaction of economic and social changes have similarities to those I wrote about a few months back in Wath on Dearne.   The difference is the timescale – these changes are moving much faster in countries which started off decades behind, and which are catching up rapidly.

There is however one aspect of Nahendra Modi that the British press don’t really get.  Modi is the first Indian Prime Minister born after Independence.  He doesn’t remember British rule for good or for bad, and he isn’t shaped by it.   India under Modi is a geo-political rival to Britain, a much larger and more powerful rival, particularly once we leave the EU. He is someone not really interested in making an arrangement with Britain on British terms.   The trade deals that Brexiters talk about are all based on the idea that we can get a better deal than the EU because these deals will be on British terms.   The world frankly isn’t really interested in doing deals on British terms, and this is only going to get worse as Britain tries to force it’s economic will on larger economic players with their own agenda.   India’s big geo-political priority is China, who is building alliances with Pakistan and Bangladesh supported by huge infrastructure investments.  Britain within the EU was willing to stop or stall progress on EU policies and projects in a way that no other country would.  This made Britain a valuable ally for countries such as the US, China and India who frequently wanted to stall or divert EU decisions.  Outside of the EU Britain is a much less influential player to

What I saw in urban India was an economic system which supports individuality and a plural culture, protected by the Supreme Court, triumphing over a government which favours the views of Social Conservative Hindus who are uncomfortable with individuality and religious and personal diversity.   I suspect in India, as in other countries where this conflict is playing out, it is the economy which will win out in the long run.