Tag Archives: Big society

Will welfare reform result in a ‘two nation’ society?

As David Cameron makes a U-turn on cigarette packaging and George Osborne finally understands government does sometimes need to intervene in the free market will others follow?

Our ability as an individual to stand against the power of big business is limited to say the least, however, some on the Tory right still expect individuals to form a ‘government of self’ and develop individualised systems of social protection (via ‘big society’). Such personal independence is beyond the reach of many.

However, David Cameron and George Osborne appear to have finally grasped that for ‘big society’ to truly thrive an active state is a necessity.

Commentators are suggesting Osborne is playing social democratic catch up on pay-day loans as the Conservatives have realised Ed Miliband has struck a chord with voters by focusing on the way markets are rigged against consumers.

Yet the prevailing ideology of the right is so strong it still continues to push the contracting out of public provision of services and privatisation, whilst resisting calls for regulation.

Such a singular approach does a disservice to us all. Some on the right adhere to a narrow vision of the ‘good life’, where the promise to those families who work hard, and are deserving, is that they can send their children to the ‘best’ schools (either private or ‘free’) whilst accessing privatised pension and healthcare schemes. However, those same ministers forget to mention how your future can be wiped out by an under regulated free market (think RBS and LLoyds Bank!). Meanwhile the rest of society, the undeserving, can live in a world marked by financial insecurity, mediocre education, rationed healthcare and an impoverished old age.

Economists have already christened such a scenario as the ‘dual economy’; two societies who live side by side, but hardly knowing one another, unable to imagine what life is like for one another. Conservative Prime Minister, Benjamin Disraeli, wrote of such a scenario in 1845, referring to ‘the two nations’

‘Two nations; between whom there is no intercourse and no sympathy; who are ignorant of each other’s habits, thoughts, and feelings, as if they were dwellers in different zones, or inhabitants of different planets; who are formed by a different breeding, are fed by a different food, are ordered by different manners, and are not governed by the same laws: the rich and the poor’

An alternative approach could be to try to close the gap between the dual economies by supporting a sense of shared responsibility between individuals, society and government. In this relationship government would protect the citizens it has been elected to serve from the abuse of power by the free market.

Individuals feel vulnerable and powerless because they are vulnerable and powerless. Is the average user of pay-day loans able to challenge extortionate interest rates on their own? Am I able to challenge the power of the energy companies as another cold winter approaches? Can any of us challenge the power of the financial industry at an individual level?

Many on the Tory right will scream ‘consumer choice’ as if it’s the answer to every woe, however, will changing providers of whatever service it might be really make a difference. I fear not, and that is why I want a government of politicians that understands where many in this country feel they are today, powerless, abandoned and hopeless.

That is not a good foundation from which to build our collective future. Control of one’s own destiny requires more than the fallacy of individual consumer choice in a free market economy, it requires an active and supportive state focused on the distribution of wealth, and the redistribution of wealth through the tax and benefits system along with regulation of key industries, such as the financial and energy sectors.

Well done Mr cameron and Mr Osborne, you are at last beginning to move in the right direction.

Rowan Williams dismissed the governments version of Big Society as ‘waffle’, suggesting this approach in its current form is nothing more than the state withdrawing its responsibility from supporting those most vulnerable in society, especially older people.  He may have a point.

Ageing in the UK can be a dismal experience for many sadly.  From a European perspective research findings suggest older people’s experience of ageing in the UK falls behind that of many of its European counterparts,  with the UK performing most poorly on indicators such as income,  poverty and age discrimination.  A recent report entitled ‘Ageing Across Europe’ by DEMOS, for the WRVS,  states “the UK faces multiple challenges in providing older people with a positive experience of ageing, scoring poorly (although not always the worst) across every theme of the matrix” ( 2012, p.8).  The media  suggests the treatment of older people in care is now so bad that in many cases it meets the legal definition of torture and secret filming has exposed abuse of the elderly in care home settings.

As a society we know there is a problem and we know things have to change. Debate is developing on how the care of older people should be reformed with much discussion focusing on financial matters.  Government is keen to continue to extend free market mechanisms across the public sector.  This approach appears little different than previous governments, which have arguably contributed to the current situation, so it is unclear to me how this might improve the lives of older people.

The  government is entrenched in a ‘public burden’ theory of welfare.  The Coalition government have sought to return to an economic and political approach that more closely characterise New Right patterns of public protection. Building on Thatchers message of individual freedom, responsibility, free markets,  minimal state intervention and the privatisation of previously publicly delivered services to older people, for example pensions and residential/nursing care, and more recently NHS health care. From this ideological perspective the free market transfers power away from government, previously mandated to ensure universal service provision, toward private capital and consumers whose individual choices drive standards up through increased competition between providers.  Successive government have adhered to this belief for over 30 years, has it worked though?

Whilst such an approach is clearly of benefit to market providers, and the public purse, it is questionable whether it has been of benefit to older people, especially those in receipt of private pensions, healthcare and residential or nursing care. It could be argued the focus is on the displacement of ‘responsibility’ from the state to the individual rather than the transfer of power. The transfer of public provision to under regulated financial markets has not ‘redistributed’ power to all older people. There has been a doubling of the number of private care homes going bankrupt leaving older people without secure housing or care provision, whilst the HSBC bank was fined £10.5m for mis-selling care bonds to older people. The Financial Services Authority (2011) found unsuitable sales had been made to 87% of customers, with the average age of those who purchased bonds being 83 years of age, many of whom having already died before HSBC were exposed. The consequences of free market failure are made clear when considering private pension provision. The Telegraph points to recent findings on the mis-selling of pensions,  however, this is not new, many of those who bought pensions in the 1980/90’s find themselves now without the pensions promised.  Is government outraged?  Apparently not since we are continuing along the same well trodden path.  Of course this suits government because casting older people as consumers means the unaccountable decisions of multinational corporations individualises ageing, in that their living in poverty is seen as the problem of the older person rather than market failure, heaven forbid (as the Prime Minister might say to the Archbishop). From a governmental perspective, market failure is a justifiable risk and the mark of a free society, some pension funds will have made gains others losses, that is the nature of financial markets, there is no point moaning about ‘injustice’ !

In essence as individuals we are engaged in a system  where the emphasis on consumer choice masks the dynamic and unpredictable process by which sudden change (and ultimately disadvantage) may visit upon a citizen at anytime.  A report by the World Health Organisation (2008) makes a pertinent point when it suggests many of the negative experiences of older peoples’ lives are linked to structural determinants, i.e. pensions, poverty, access to free health and social care etc,  suggesting tackling such factors is central to improving the lives of older people in the longer term.

Older people’s experiences of ageing in the UK can be improved, and it is all of our responsibility to try and achieve this. However, we first need a coherent strategy to bring about the change desired by so many.  Government in the UK tend to address issues associated with an ageing population ‘within individual silos’ (WRVS,2012,p.103).  Research from Europe suggests those countries taking a joined up approach, where government consider how factors such as income, health, age discrimination and inclusion interact, the more successful policy approaches are likely to be to improve the experience of ageing (WRVS, 2012, p.103).

My views on Big Society  have been stated previously, we must not let Cameron’s idea of  ‘Big Society’  get in the way of looking at our deeper structural problems.  No matter how caring and kind we are to one another we are still at the mercy of the economy and financial systems. For Big Society to be more than ‘waffle’ we need an ‘active state’ (Sullivan, 2012), and maybe more importantly one able to learn from the mistakes of successive governments over the last 30 years, not keep repeating them.

The ‘Big Society’ will not necessarily lead to better elderly care treatment by @dianegalpin

A fantastic blog by our senior Lecturer Di Galpin for LSE Policy and Politics Blog a recommended read!!!

The ‘Big Society’ will not necessarily lead to better elderly care treatment.

Di Galpin looks at the Big Society from a philosophical standpoint and questions whether it can be achieved without encouragement from an active state.

‘Big Society’ and the future of health and social care

David Cameron suggests the Jubilee party was a ‘perfect example of ‘Big Society’.  Whilst it’s okay for a knees up, is it a suitable foundation for improving the quality of care  older people receive in Britain?

Unfortunately, David Cameron’s comments on Big Society do little to help us understand what “it” actually is, and to be honest, I am not even sure he  knows what it is beyond the usual sound bytes of ‘kitchen sink economic theory’*.  However, could the concept of Big Society actually have something to contribute to the debate on the future care of older people?

What is ‘Big Society’?

Big Society has been vilified as a return to the politics of the New Right,  a Trojan horse for smaller government,  and feted as the anatomy of the new politics  on which to establish the legitimate nature, and limits, of the relationship  between the  state and individual in a 21st century system of health and social care.  Phillip Blond is a central figure in the development of the concept of Big Society.  Blond  argues both the political Left and political Right have presided over a collapse of coherent cultural values and a shared commitment to a ‘common good’,  suggesting a redistribution of power from the ‘top’ (state) to the bottom (individual) is required, aligned with a more compassionate form of capitalism, to re-establish the common good.  For the current government this rests on the empowerment of local communities founded on voluntary networks of trust and mutuality.  From this perspective the purpose of Big Society appears to be to extend responsibility for the care of older people to local communities, rather than extending the responsibility of the state.

Policy programmes already implemented by the current government to develop Big Society include the National Citizen Service, which organise voluntary opportunities for young people, and the creation of the Big Society Bank, which will act as a central source of investment income for third sector organisations.  The Localism Bills’ accompanying guidance states ‘Big Society is what happens whenever people work together for the common good.  It is about achieving our collective goals in ways that are more diverse, more local and more personal (HM Government, 2010: p.2).

However, whilst at one level Big Society can be viewed as a mechanism of transferring more responsibility onto individuals, allowing the state to reduce public sector spending (Alcock, 2012) Big Society is also about believing in, and building on, the inherent ‘good’ within humankind.

Jesse Norman suggests Big Society involves moving beyond the ‘two way opposition of state vs. individual’ in the provision of care to ‘the three way relationship of enabling state, active individual and linking institution’ (2010,p.7).  For Norman the former is flawed because it ignores the diversity of human beings and their ability to act morally without interference from the state.  By justifying the legitimacy of the state, it polarises the individual and ignores the positive power and potential of individuals to create and maintain a ‘good society’, which cares for one another for altruistic reasons, rather than because the state legislate that society provide care and support.  Norman suggests state interference is a negative response to care provision, quoting Alex de Tocqueville (1805-1859)

“The more [the state] stands in the place of associations, the more will individuals, losing the notion of combining together, require its assistance.  These are cause and effect that unceasingly create each other.”

The ‘associations’ that mediate between individuals and the state can be conceptualised as operating within civil society.  Civil society is the space of un-coerced human action, the place where people take action as moral beings,  via all organisations and associations above the level of the family and below the level of the state.  The place where your jubilee street party was planned presumably.

Importantly for advocates of Big Society the role of government in this ‘space’ and ‘place’ is minimal.

How does this support the current approach to caring for older people?

From this perspective caring for older people, and ensuring care is dignified, is viewed as something we all agree is a ‘good thing’ and freely engage in, rather than something government should regulate or legislate for.  In this context government relies on ‘phillic’ associations, taken from the Greek ‘philia’, meaning friendship ties, affection or regard that are the essence of the space between individual and state.  Government would rather rely on these to guide human behaviour in the care sector than introducing legislation or regulation.

Hence, the governments  support for the introduction of a voluntary dignity code  (The Telegraph., 2012).

Big Society, freedom and money

However, whilst government may think treating older people with dignity and respect is viewed as a ‘given’, assuming we are all willing to  care for, and protect,  older people,  this is not necessarily true, as evidenced by a number of reports on the poor levels of care provision  older people experience across the care sector.

At the heart of the current debate are two related themes.  Firstly, an attempt to understand how the relationship between the state, private sector and individual should be formulated to fulfil a mutual responsibility in supporting dignified care for older people, and secondly  the affordability of care provision.   Successive governments since Margaret Thatcher have relied on a consumerist approach to improving the quality of health and social care provision. The question is has turning vulnerable older people into consumers improved their care?  For some yes, but for many of the most vulnerable older people in society, those older old people with dementia and who are frail, I’m not so sure.  However, what it has done is hide the abuse and mistreatment of older people from collective view for the last 30 years, and led society to engage in debate that does not move beyond the financial.  Research suggests this has had a detrimental effect on the moral health of society and academics are now suggesting the use of market mechanisms can change people’s attitudes and values, having a  ‘corrosive effect’.    Michael Sandel makes a pertinent point suggesting

It calls into question the use of market mechanisms and market reasoning in many aspects of social life, ……to motivate performance in education, health care, the work place, voluntary associations, civic life and other settings in which intrinsic motivations or moral commitments matter‘ (What money can’t buy, 2012, p122).

It is impossible to ignore the effects of systematic inequalities in liberal societies that effectively exclude, or compromise the rights of a variety of social groups.  Nor can we ignore the corrosive effect successive governments use of a consumerist approach to health and social care might have had on those ‘phillic‘ associations so vital to a ‘Big Society’.   The ‘Osborne Supremacy’  assumes the existence of a single unified ‘big society’ when it actually consists of many ‘societies’ with competing interests where the interests of powerful elites are advanced in the name of defending common interests, whilst the interests of marginalised groups, such as older people,  leave them without support.

Big Society or Big Con?

The answer will depend on your political and ideological viewpoint on the legitimate role, and limits, of the state in the provision of health and social care.  Whilst it is true Big Society clearly already exists, evidenced by the number of people already providing care freely in society, what is in doubt is whether it can be extended any further without an active state (Sullivan, 2012).

* Kitchen sink economic theory -this is a term used in my household to describe David Cameron and George Osbornes approach to the financial crisis.  It refers to a vision I have of a post war couple discussing there finances whilst stood washing up at the kitchen sink.  Gladys turns to husband Frank and says “money is tight Frank, what will we do?”  Frank turns to Gladys and answers “never fear mother, we’ll just have to tighten our belts, don’t worry we’re in this together”.  Of course Frank and Gladys are very naive and do not realise their actions will make no difference because the problem is a global financial crisis and not related to Gladys splashing out on a new apron!

There is a million reasons why ‘big society’ and ‘choice’ are not enough when providing care to older people

Research suggests as many as 500,000 older people are abused each year (Action on Elder Abuse), in the main by those supposed to be providing their care.  Therefore, since the election in May 2010 up to one million older people may have been abused.  

This information is not new, successive governments have been aware of this issue for many years but all have stopped short of introducing a coherent legislative framework to protect those most vulnerable in the care system.  The coalition appear to believe in the power of ‘big society’ and service user and patient ‘choice’ in a market led health and social care system.  My difficulty with this approach is it offers nothing new,  it looks no further than the rhetoric of the ‘free markets’  beloved of every government since Thatcher.  Nobody appears interested in thinking deeper and developing care from a philosophical perspective.  Surely we need to understand what motivates us to care before we can reform the system ?

Historically societal attitudes toward older people have always been poor.  In ancient Greece old age was portrayed as sad with historians arguing the Greeks love of beauty marginalised the old, especially women, sounds familiar!  Cicero’s work De Senecute, written in 44BC, pointed to a variety of individual experiences of ageing, however acknowledging that for those who were poor and without mental capacity ageing is miserable.  Sadly, all of this is still true today with research suggesting those at greatest risk of abuse and mistreatment are elderly women suffering from some level of dementia.  This,  along with the fact that the abuse and mistreatment of older people is a global issue identified by the World Health Organisation over a decade ago, suggests the issue  extends well beyond political systems and party politics in the UK.

I’m with social contract thinkers Hobbes (1588-1679) and Locke (1632-1704) when they suggest as human beings we are inherently selfish and our individual pursuit of pleasure is destructive to society, suggesting the law can be used as an apparatus to modify such human desires.  In my view the  continued economic approach to health and social care has fed such selfishness, to the detriment of certain groups in society, i.e. older people,  and we now require a strong lead from government.

Successive governments since Margaret Thatcher have relied on a consumerist approach to improving the quality of health and social care provision. The question is has turning vulnerable older people into consumers improved their care?  For some yes, but for many of the most vulnerable older people in society, those older old people with dementia and who are frail, I’m not so sure.  However, what it has done is hide the abuse and mistreatment of older people from collective view for the last 30 years, and led society to engage in debate that does not move beyond the financial.  Research suggests this has had a detrimental effect on the moral health of society and academics are now suggesting the use of market mechanisms can change people’s attitudes and values, having a  ‘corrosive effect’.    Michael Sandel makes a pertinent point suggesting

It calls into question the use of market mechanisms and market reasoning in many aspects of social life, ……to motivate performance in education, health care, the work place, voluntary associations, civic life and other settings in which intrinsic motivations or moral commitments matter‘ (What money can’t buy, 2012, p122).

So what can we do? Helen Sullivan suggests ‘a big society needs an active state’.   A useful first step would be for government to accept the Law Commissions recommendations on reforming the law in respect of Safeguarding Adults without delay.  Secondly, abandon the rhetoric of ‘choice’ and ‘free markets’  and develop a meaningful dialogue based on concepts such a honesty, morality and dignity from a philosophical  rather than financial perspective. A new approach might be to have a dialogue that goes beyond party politics (and winning the next election) and begins by asking big society what it wants to afford, rather than politician telling us what we cannot afford.

I am sure many will say we cannot afford to reform the system on philosophical grounds, I would ask those individuals “can we morally afford not too?”