The odd relationship between less and more

Even I have to admit that the burdz mind is a scary place.  There is a constant swirl of questions on policy matters to which I, and no one else, seem to have the answer.

Scottish Labour reckons 13,500 jobs will be lost under this year’s local government settlement.  Is this necessarily by itself, a bad thing?  If the work these people used to do is no longer there, why should they continue to be employed to do nothing?  Of course, the removal of that work is what might well be the bad thing but is that necessarily so?

Take police funding, numbers and crime levels. Generally, police funding has been protected in this round of budgeting, largely due to it being ring-fenced and therefore, allocated separately by the Scottish Government.  Where police forces have identified shortfalls between government grant and their spending need – often, it is claimed, to keep services and police numbers at previous levels – local authorities will top up out of their funding allocations, taking money away from other services in the process.

But why is no one challenging the assumption that the police needs this money more than other areas?  Crime levels are down generally, although there are stubborn and worrying upward trends in violent crime.  Even the fear of crime is decreasing.  The Cabinet Secretary for Justice, Kenny MacAskill, regularly trumpets the Scottish Government’s success in this area.  So why do we continue to need more police, or at least, the same number of police as before?  Or is it – as is asserted – that the high number of police officers has resulted in those crime figures dropping?

There is an unhelpful trend in policy circles, now that the Scottish Government has committed itself to shifting expenditure away from just in time (or after the fact) intervention to acting early and therefore, preventing problems happening further down the line.  This approach clearly has implications for current services and fiefdoms with services and areas of expenditure at the wrong end of the spectrum at risk.  So everyone is now making a claim for what they do as amounting to preventative spending.  The police is no exception.  Investing in high numbers of police officers is preventative because it is resulting in fewer crimes – see?  Look at the figures, there is the evidence.

But in truth, that is spending at the wrong end of the spectrum.  That is waiting for problems to arise, for the circumstances which allow crime to flourish to continue unchecked and unaddressed, sitting back and watching the children who get themselves into “bother” at an early age graduate as full-blown potential adult criminals.  Surely, if we are serious about preventing things, the money currently spent on expensive police officers should be being spent on much cheaper health visitors, family support workers, nursery and classroom assistants, play workers and therapists who can stop the chain of supply, or at least try to.

Yet, these are the kinds of things being cut from many council and health board budgets.  Sarah Boyack was right to point out that women workers, in particular, are most likely to be worst affected by jobs going.  So here’s another question – why is it that women’s work and jobs are expendable when cuts have to be made, when men’s are not?

More questions, this time on health.  Why are health boards overspending despite having their funding protected?  The increasing cost of drugs is not a good enough answer, frankly.  Aren’t there cheaper ones available?  If not, why not?  And why are we continuing to spend so much on drugs in any event?  Significant progress is being made on tackling some of Scotland’s biggest health ills – cancer, heart disease and stroke.  So why then is having fewer nurses and doctors – as Labour is wont to decry – by itself a bad thing?

Surely, if we are all healthier and our wellbeing is improved, we need fewer health professionals to treat us?  Or is it because we have huge numbers of health professionals that we are all getting better?  But, of course, we are not all getting better.  In many deprived areas, the outcomes in terms of wellbeing and life expectancy are woeful.  Are we diverting resources into these areas – in serious amounts – to try and fix these problems, to address the huge inequalities that exist?  Are better off areas getting significantly less to spend as a result?  Of course not.

Yet, some of those areas with better health outcomes are highly rural.  Providing any level of healthcare costs more because of rurality and the lack of economy of scale in provision.  It is much cheaper to provide key services in high population areas than in low ones, where higher numbers of people can be provided for.  Have we managed to resolve this conundrum yet, beyond the time-honoured swing back and forth between centralisation and specialism, and localities and generalism?

This dichotomy exists all over the public sector.  There are fewer children, so why do we need more teachers, unless it is to invest in smaller class sizes, something most councils paid lip service to in the years of plenty and have now largely given up on, now times are lean.  Is the spend per pupil the same in well-off areas as in poorer ones?  Is universalism the right approach anymore if 20% of children are still being left behind, despite record levels of investment in education over the last thirteen years?

Local authority housing has, for many years, provided one of the best/worst examples of illogicality in expenditure.  Look at most housing revenue accounts over the last ten years and you will find a pattern of falling numbers of houses, reduced or at best, largely static maintenance budgets but increased spending on staffing and especially, management activity.  And rising rents to pay for it all.  The result?  Tenants paying more for less.

Admittedly, this was much more heightened when right to buy was at its peak, but the point is the mindset.  It is prevalent and redolent everywhere in the public sector.  Short term decisions are made, largely to preserve vested and self-interest, when what we need is strategic policy-making at all levels of government which applies resources, methodically and evidentially, to where and how they might be needed most and will have the greatest effect.  We’ve been promised shifts in the planning, design and delivery of services for years, yet now the chips are down, we’re getting the same old, panic driven, slash and burn approach to making cuts.  Yet, by and large, there is still “more” right across the public sector, even when it is required to tackle “less”.  Worst of all, is when there is “more” but “less” to show for it.

I told you my mind was a scary place, but one final question.  Isn’t it scarier still that key influencers and policymakers – politicians especially – aren’t asking questions like these and applying themselves to finding or working out the answers?

 

 

 

 

The long slow march to self-directed support

This week, the Scottish Government announced £700,000 of grants for organisations to provide advice and information to disabled and older people and their families, with the aim of enabling more individuals to take charge of their own services and support.

The concept of self-directed support has been around for a long time.  It first appeared in the Social Work (Scotland) Act 1968, which allowed for payments to be made directly to a “person in need”.  The Health and Community Care (Scotland) Act 2002 modernised the provisions with a view to expanding the availability of direct payments to a wider group of people, including children, and this has been developed further in the Self-Directed Support Strategy and forthcoming bill, which effectively aim to create a presumption in favour of self-directed support.

This creates the potential to effect a huge change in how community care is provided.  Largely, social care has been done to people.  Planned, designed and delivered by local authorities and organisations they contract with, disabled children and adults, and older people would be assessed on their level of need, and if it was high enough, they would be matched up with an existing service.  Everyone has acknowledged the need to make services and support more individualised and over the years, social care has shifted from block to individualised purchasing.  Each individual’s needs and preferences are now taken into account and a package of care and services put together to match those needs.

At least, that’s the theory.  The practice has been somewhat different, with needs-led services constrained by fixed budgets and many families left frustrated by the inflexibility of provision.  Local authorities and health boards have devised ever more ingenious methods to ration services – in order to stretch resources as far as possible – and really, only those with the highest needs get.  At the same time, there has been stubborn resistance to the development of direct payments and alternative self-directed support packages, which is why successive Scottish Executives and Governments have found themselves revisiting the issue and expanding and toughening the legislation.

The reasons for the very slow march to self-directed support are complex.  Despite the best efforts of many, the numbers receiving direct payments has increased only incrementally and some of that growth is accounted for an increase in over 65s taking up direct payments, meaning fewer under 65s have received them.  A demographic switch then.

The amount spent overall and on individual packages has increased, which reinforces the view that only those with the highest needs qualify.  Moreover, local authorities allocate a budget to direct payments:  when it is spent out, that’s it, which is never how the policy was intended to operate.

There are also widespread local variations:  some councils are much more enthusiastic about the policy than others.  How else to explain the far lower numbers in Glasgow with direct payments than in Edinburgh?  Or that fewer people in East Ayrshire are on direct payments than in Dumfries and Galloway, despite them being similar sized authorities?

Generally, the improvements in recent years are welcome – there are now more people taking charge of their own care and support, enabling them to live as independent a life as possible.  Thus, some people are supported to work, others to enjoy leisure activities that fall out with traditional social care provision.  Direct payments enable many families to stay together, providing sufficient, additional support and respite to make the burden of care manageable while importantly, giving the person with care needs some level of independence from their family members.   This is a very good thing.

But the numbers – compared to the population of disabled and older people as a whole – are low.  There is anything between 11 and 30+000 disabled children in Scotland with some level of care needs, yet only 584 children under 17 receive direct payments.  There are at least 300,000 people with a physical disability of working age, yet only about 2400 adults receiving direct payments.  This includes over 1000 people who have learning disabilities, yet there are at least 23,000 adults with learning disabilities “known to local authorities”.

Whichever way you look at it, only a tiny fraction of those people who could manage their own budgets and arrange their own support and care are doing so.  Money plays a role: the needs-based rationing of cash-limited budgets clearly limits availability but so too does the types of support on offer.  To date, the only real option has been direct payments which involves a serious amount of commitment and responsibility.  Not everyone wants that, and hopefully the availability of other models through the strategy and forthcoming legislation will expand the take up of self-directed support.

But really, it is about power and control.  The real block has been the attitude and approach of local authorities, professionals and even, trade unions.   The unions, certainly in the early days, viewed self-directed support with suspicion, as a form of privatisation by the back door, and tried to frustrate the extension of the policy and practice whenever possible – without such action being official, of course.

Moreover, local authorities – many, not all – have tried to make it hard for people to take up direct payments.  There is a rigorous, lengthy assessment procedure; individuals with direct payments have to make detailed, overly frequent accounting to the self-styled guardians of the public purse, and they have to account for every penny; some councils limit what direct payments can be spent on or insist that individuals seek approval for their care provider or if they want to change how they spend the money. Worst of all have been the attitudes of some professionals over the years: some people cannot be trusted to spend the money wisely, apparently.

While the ongoing commitment of the Scottish Government is welcome, and this grant funding will make a difference, the solution that will see a wholesale shift away from current forms of support to self-directed support is bound up in the wider issue of public sector reform.  As well as legislation, strategy and funding, we also need cultural and behavioural change to ensure power and control shifts away from agencies and professionals to individuals and families.

Cutting ties will free trade unions to fight real enemy

Reports of the demise of class war on these islands were clearly premature.  The biggest walk-out of public sector workers – since the last one – takes place on 30 June.  And it’s clear that everyone has been rehearsing their roles.

On one side, the trade unions, dusting down their donkey jackets and cliches of battles past to defend the public sector against cuts in services, jobs and pensions.  On t’other, the Tories, indulging in rhetoric Thatcher would have been proud of and brandishing threats to rein in the unions’ worst excesses.  Ah, the old woman taught these boys well.

Somewhere in the middle, Labour, trying not to upset them what pay their wages and provide the only real source of donated income, wringing its hands, calling impotently for everyone to play nicely.

But actually, this time it is serious.  No more crying wolf – we really could be in for the worst episode of industrial unrest and government clampdown since the 1980s.  And that’s because the stakes and the cause are as high as they have ever been.  The Conservative-Liberal Democrat coaltion’s dogged adherence to economic Plan A means that all being in this together actually translates into those at the bottom taking the hardest hits.

Regular Burdzeyeview readers will know that this blogger is no apologist for the public sector.  If Plan A is all that is on offer – and it is, currently, – then there is an awful lot of sucking and seeing to be done.  If pay freezes mean protecting services for the most vulnerable in our society, then so be it.  The issue of pensions is much more complex and needs a blogpost of its own.

But of course, the most vulnerable in our society are not being protected. They too are in the firing line, thanks to the efforts of teflon-coated middle managers deflecting the impact of cuts straight into the frontline.  To date, no political party has come up with more than platitudes on public sector reform.  Bureaucracies once in place are notoriously hard to shift.  Worse – for the low paid in the public sector – is the political unwillingness to take on the worst excesses in the financial sector.  They are absolutely entitled to feel aggrieved at them being expected to play the biggest role in saving our economy.

I’ve said it before but I’ll say it again – the public sector needs reform, it needs to be re-imagined so that it is much more nimble and focused on the needs and interests of those it purports to serve.  There is a better way but it doesn’t involve going back to the 70s – sorry, no donkey jackets required – nor does it mean dismantling the rights of workers to be represented by trade unions. And most importantly of all, denying workers the right to withdraw their labour.

I might not be an apologist for the left but I sure as heck ain’t one for the right.

Apparently, there is concern about the legitimacy of unions’ strike mandate.  With no minimum turnout for strike ballots, turn-outs as low as 20 and 30% can lead to strike action being taken, so long as a majority of those voting say yes.  Conservative sensibilities have been upset, causing some to suggest a floor is required anything from 40% (the CBI position) to an actual majority of members (Boris Johnson’s view).

The hypocrisy is breathtaking.  Such a floor, of course, doesn’t apply to representative politics and in the last twenty years we have seen turn-out in elections slide.  So, if a floor is to be applied, let us at least be consistent.   Shouldn’t our politicians lead by example (though Scotland might be in trouble if the London Mayor’s preferred hurdle was adopted).

Electoral reformers maintain that the way to increase turnouts is to reform voting methods.  One of the reasons the unions cite for low ballot returns is because of a change brought in during the Thatcher years.  All union members have to be sent a postal ballot to their home address and then return it.  It is fraught with difficulty – people move, ballots get put on mantelpieces and forgotten about.  If we want to ensure that strikes are democratically mandated, then we need reform of the method, which is not to suggest a return to the bad old days of collective arm-raising in canteens.  As well as postal ballots, individuals should be able to vote online or in person in their workplace.

But of course, the Tories don’t really want to improve the credibility of trade unions.  All they are interested in is further constraining their rights to represent their members. Which is why they are also suggesting that trade union leaders should not be employed through taxpayer monies. Just like them then huh?

In fact, this idea might have some currency.  Why should the taxpayer pay for central parliamentary offices and the like for parties – shouldn’t they fund this themselves?  And if trade unions are to be denuded of publicly funded support, the same should apply to the likes of Chambers of Commerce and the CBI.  Now we’re talking….

No doubt there will be some who are party-politically motivated that think the trade unions deserve all they get, payback if you like for a century and more of loyalty to the Labour party.  But that would be wrong.  As we enter the maelstrom of unprecedented cuts, pressures on families, job losses and pension squeezes, we have never needed strong unions more.

But it is time for them to cut their ties to the Labour party.  Trade unions should have only one master – their members.  They should be freed from the shackles of political dogma to defend their members’ interests without fear or favour.  Trade unions are rightly proud of their role in founding a political party – and movement – to defend the rights of working people.  But when the leader of that party refuses to back their right to withdraw their members’ labour, then the game is up.   There is nothing to be gained from the political allegiance – and the funding – continuing to flow Labour-wards.  Indeed, political neturality might see their views and experiences being given much greater credence by all parties, Labour included.