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The 2020 Public Services Trust Blog

Thursday, February 4, 2010

Consensus and Sensibility

By Henry Kippin

I read an interesting paper this morning from the journal Nature – a bit leftfield of my usual reading, but totally relevant to mainstream politics and public services. It made me think.  Yesterday I wrote (well, I copied Martin Wolf anyway) about the challenges of consensus building, and the implications for long term economic policymaking.  The suggestion was that, now that party politicking is back in full swing in the run-up to the election, generating necessary consensus on some serious big issues will be nigh on impossible.

At the same time, we are gasping for such a consensus on some of them – as recent debates over the future funding of social care and our strategic defence planning have shown. 

At the 2020 Commission, we have talked about the need to generate a new consensus on the need for a 21st century blueprint for public services.  The hope of consensus lies behind the very idea of a cross-party commission, and, whilst the development is difficult, the impact is hopefully broader, more powerful and more coherent…. 

Anyway, this article – by Dan Kahan – offers some reasons why consensus is difficult to find.  Cultural cognition – which is the ‘influence of group values…on risk perception and related beliefs’ skew our perceptions of policy, meaning that we ‘endorse whichever position reinforces (our) connection to others with whom (we) share important commitments’.  Bluntly, we have pack mentalities, which magnifies difference and ‘polarises’ debate in artificial ways.   

This might seem obvious to anyone who follows a sports team, but the author also reflects on how these polarised mentalities can often push at the same outcomes (though maybe not in sport):

“citizens who hold opposing cultural outlooks are in fact rooting for the same outcome: the health, safety and economic well-being of their society.”

And he concludes that:

“We need to learn more about how to present information in forms that are agreeable to culturally diverse groups, and how to structure debate so that it avoids cultural polarization.

If we want democratic policy-making to be backed by the best available science, we need a theory of risk communication that takes full account of the effects of culture on our decision-making.”

Easier said than done for sure, especially when the means to achieve outcomes can be as contested as the outcomes themselves.  For instance, all parties responded to the Hills review of inequality with similar horror, but the strategies they use to address the problems it highlights will certainly differ.

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Friday, January 29, 2010

Personal Care at Home: the gathering storm?

By Henry Kippin

There’s quite a storm brewing in certain circles over the government’s personal care at home bill.  I was at an event organised by the SMF’s James Lloyd this week, where a panel was convened to critically reflect on the bill, including perspectives from a local authority that will have to find the cash and capacity to provide the extra care, a measured (but damning) perspective from the Kings Fund, and a searing and direct critique from Lord Warner

Not many people stood up for the bill – and those who did argued in terms of awareness, of keeping social care at the top of the legislative agenda during an election campaign.  Their fear is that a new government would have other priorities, and a greater compulsion to make immediate cuts that would harm those in need of the greatest care. 

But it seems from my perspective that forcing through the bill would seriously undermine the pretty sophisticated debate that has evolved around last summer’s green paper.  The idea of fairly sharing responsibility for the implications demographic change is blown out of the water by the PCAH bill, which – according to the Kings Fund – would have a partially regressive impact, and undermines the idea of partnership between individuals, families and the state.  The question of how local authorities could swallow the extra costs of the proposals (which are currently mooted from efficiency savings) becomes a daunting one if new figures suggesting serious under-estimation are to be believed. 

Next week the 2020PST will be launching a series of working papers – one of which is a paper on social care.  I wrote it before the bill was announced, so it doesn’t offer a perspective on this mess, but as Im not sure how this short term legislation could be squared with the long term goals of the green paper, I’m quite glad I didn’t have to try…

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Posted by Henry Kippin at 5:27 pm
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Thursday, January 21, 2010

Prevention is better than cure: its official?

By Henry Kippin

“Finally we have it: pilot-tested, fully costed, independently evaluated, cast iron evidence that investment in preventative social care services more than pays for itself in savings to the NHS.”

This is David Brindle in yesterday’s Guardian, citing newly published research on the Partnerships for Older People Projects (POPPS), which were set up in 2005 to explore preventative approaches to care through focusing on human needs – loneliness through isolation, poor general health and social disconnection.  The project explicitly aimed to reduce ‘hospital based crisis care’ for older people. 

Policy advocates for preventative approaches should be pleased at these results – overnight hospital stays reduced by as much as 47%, for example.  Jamie Bartlett wrote a good report at Demos about the value of thinking preventatively, and this is more evidence to support a pragmatic, sensible and long-term way of thinking about health and social care. 

As David Brindle points out, the real value of this approach will be found if we start to think about preventative spending across current departmental lines.  He also makes a good point about the potential tension between policies that would promote cooperation and resource pooling in this way, and those that encourage competition.  To get round some of these issues, we need to think more about need, place and scale; and less about institutions and service categories.  This is obviously difficult. 

What also made me chuckle is how difficult it is to turn something that sounds like common sense into a policy idea that could feasibly be rolled out.  “Pilot-tested, fully costed, independently evaluated, cast iron evidence”.  If only Newcastle United’s transfer policy had been so rigorous.

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Posted by Henry Kippin at 12:07 pm
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Thursday, April 9, 2009

Scandalous social care

By Charlotte Alldritt

Tonight, BBC’s Panorama broadcasts a scathing attack on the UK’s social care services for elderly people. The programme depicts a picture of chaos and neglect, as staff are overworked and some haven’t even received any formal training. Research for the BBC found that private companies are delivering care for as low as £12 an hour, £10 less than what it costs local councils. This is an example of public services going to the lowest cost bidder with serious implications for quality.

Yet contracting out of public services is not necessarily a recipe for disaster. And its a good job, given that competition, diversity of providers and choice are the building blocks of a cross-party consensus on public service delivery. This move away from public sector monopoly was designed to ramp up quality and enable ‘citizen-consumers’ to receive personalised care, cost-effective for the taxpayer. Scandalous examples of where this has failed are unforgivable, but do not necessarily call into question the model of contestability and competition in public services itself. Rather, it beckons serious concerns over the quality of monitoring and inspection. It also causes us to ask about the role of central targets, minimum standards, and the benefits of a principle (as opposed to risk-) based regulation system.

The design and reform of public services over the last few decades has seen moves backwards and forwards on policy instruments and the appropriate role of government (both central and local). What remains critical, however, is the need for quality to be at the heart of the system and the needs of the citizen to be paramount. Both parties have acknowledged this in their rhetoric. The NHS Darzi Review has seemingly embraced it in practice. Unfortunately, even then difficult questions remain, not least – as Ben Lucas reminds us (see Is fairness back in fashion? 8 April 2009) – in the face of a serious funding crisis.

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Posted by Charlotte Alldritt at 2:08 pm
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