The Government is paying the political price for the lack of open policymaking in its reforms to the NHSPosted: October 31, 2012
The NHS is facing significant financial pressure as a result of austerity with smaller increases in spending, which are not keeping pace with demand. This has meant that the NHS has to find £20 billion in efficiency savings by 2015. At the same time the health service is facing one of its biggest upheavals ever, which will result in a greater involvement of private companies in the health services. The reforms to the NHS have been introduced in the face of stiff opposition and in many ways represent the opposite to open policymaking – and the Government is now paying the political price.
The opposition to the Health and Social Care Bill was substantial and included the majority of the main health bodies, many of whom were not invited to attend the infamous Downing Street health summit to discuss the bill earlier in the year. Notable non-attendees included:
- British Medical Association
- Royal College of GPs
- Royal College of Midwives
- Royal College of Nursing
- Chartered Society of Physiotherapists
- Royal College of Pathologists
- Royal College of Radiologists
- Royal College of Psychiatrists
Opposition to the bill was widespread in the workforce of the health service. One survey found overwhelming opposition from hospital doctors, with 9 out of 10 professionals opposed to the bill. Strong opposition to the reforms was also apparent amongst the grassroots of the coalition parties. ConservativeHome came out in opposition to the reforms, arguing that it could cost the Conservatives the next election and would distract from important reforms to welfare and education, whilst Liberal Democrat party members opposed the reforms by 2 to 1.
Much of the opposition about the reforms has centred on how complex and fragmented the new health system will be. Clare Gerada, Chair of the Royal College of GPs, has argued that the move to a market-driven health care system will result in a culture of ‘my disease is more important than your disease’, with GPs at the centre of this trying to balance these competing voices. She has flagged her concerns about the lack of experience of GPs in managing relationships with the charities and lobbyists they will face when commissioning in future.
Andy Burnham, the Shadow Health Secretary, agrees on the point of fragmentation of health care, arguing that “my answer is simple: markets deliver fragmentation; the future demands integration.” He has called for a single system for health and social care which addresses the physical, mental and social needs of the nation. He has argued that central government should decide what health services should be delivered and local government how.
Despite the overwhelming opposition, ministers have been happy to write off the protests as ‘business as usual’ when it comes to NHS reform. Simon Burns, the then Health Minister, stated that the opposition from these ‘vested interests’ was to be expected and scare stories about ‘creeping privatization’ are par for the course. Andrew Lansley, the former Health Secretary and architect of the reforms, argued that the Royal College of Nursing only opposed the reforms because of pension changes, accusing them of being ‘a vested interest indulging in trade union -like behaviour’. The appointment of Jeremy Hunt as the new Health Secretary does not inspire hope about a change of policy course, given that he is seen as a proponent of greater involvement of the private sector in a market-driven health service.
The reforms have now received Royal Assent and the Government seems committed to accelerating the involvement of the private sector in the NHS. Research by the Labour Party using freedom of information requests to NHS primary care trusts found that contracts for almost 400 NHS services worth a quarter of billion pounds were signed in early October, representing the biggest act of privatization ever seen in the NHS. The research found that in a quarter of cases, the primary care trust had not been open about its intention to outsource, resulting in a considerable amount of privatisation by stealth.
The biggest privatisations so far have been in community services – those healthcare services offered outside of hospitals including musculoskeletal services for back pain, adult hearing services in the community, wheelchair services for children and primary care psychological therapies for adults. Children’s health care in Devon is now delivered by Virgin Care, as are GP services in Northampton and sexual health services in Teeside. This week’s Channel 4 Dispatches programme entitled ‘Getting Rich on the NHS’ uncovered poor quality services delivered by Virgin Care and concerns from local residents that their local services have been privatised often with little or no involvement from the community in this decision.
Paul Corrigan, the former Labour health adviser, argued in September that outsourcing of services should go further. He proposed that the private sector should be allowed a greater role in the NHS to ‘save’ failing hospitals. This argument is ironic given that this week it became apparent that the flagship outsourcing of Hinchingbrooke Hospital in Cambridgeshire to the Circle Partnership is not delivering on the initial expectations. The hospital, in private hands, has racked up losses of £4.1 million in the first six months of the contract – £2 million more than was expected. Given that the private sector was involved to save the hospital from financial ruin, the experience so far does not bode well.
This closed approach to policymaking and reform is having a real and significant political impact on the Government. A recent survey by IpsosMORI on which party has the best policies on healthcare found that the Conservative’s ratings are at pre-Cameron levels. Only 16% of voters believe that the Conservatives have the best policies on healthcare and they seem to have lost the battle in convincing the public that the NHS is safe in Tory hands. A further recent poll by IpsosMORI points to a re-toxification of the Conservative brand, with a sharp increase in people who don’t like the Tories since they came into government, which the reforms to the NHS are clearly a part of. The Government is paying the political price for the lack of open policymaking in its reforms to the NHS.
Education Secretary Michael Gove has unveiled “rigorous selection” tests for trainee teachers in a move he claims will improve the status of the profession and raise standards in the classroom. It’s a pity his own approach to policymaking doesn’t live up to the same standards he’s asking of teachers.
Announcing the policy, Michael Gove said: “The evidence from around the world is clear – rigorous selection of trainee teachers is key to raising the quality and standing of the teaching profession.” Despite an apparent inconsistency with previous announcements – in July Gove declared that, like their private counterparts and free schools, academies in England could employ people who are not working towards qualified teacher status (QTS) – at least this policy was based on evidence and developed by a review group of headteachers and education experts. For many of his other reforms, Michael Gove seems to make policy in secret, ignore what teachers and other experts think, and go against the best available evidence.
- Provoking two members of the expert panel recruited to redraft the English primary curriculum to resign; one of them, Andrew Pollard, criticized Gove’s plans for undermining teachers’ professional judgment;
- Repeatedly overruling another expert panel established to advise on selling off school playing fields;
- According to the Deputy Prime Minister, not even telling Number 10 of his plans to scrap GCSEs in favour of the so-called English baccalaureate (EBacc), which less than one in four teachers support, which has been developed without any meaningful input from teachers, parents or young people, and which is unlikely to be properly piloted before being introduced;
- Ignoring that, alongside its academic rigour, the main characteristic of the International Baccalaureate is its inclusion of practical and vocational elements – much like the GCSE dismissed by Gove as ‘dumbed down’;
- Dismissing concerns that a stronger emphasis on exams as opposed to coursework could exclude young people with learning difficulties such as dyslexia;
- Extending academies despite government data showing that local authority schools with a similar pupil intake perform better, without any evaluation of the possible impact on the already highly segregated education system, further divorcing schools from local democratic control and effectively centralising a major tranche of government spending with minimum parliamentary accountability;
- Scrapping the Building Schools of the Future programme because there is ‘no evidence’ that it helps to improve attainment – even though his department knows there is;
- Accepting the lack of transparency of academies and free schools, and awarding half a million pounds of public money to the Free Schools Network (which is not subject to freedom of information requests) to promote his £600 million untested flagship project;
- Abolishing the Educational Maintenance Allowance despite independent evaluations finding that it significantly increased staying-on rates and attainment for young people in education;
- Using secret emails to bypass even his own departmental officials (using the alias ‘Mrs Blurt’);
- Turning a blind eye to his department’s generally poor record on freedom of information and lack of transparency on who actually runs schools and what their status is.
Michael Gove’s colleagues have committed the Government to open policy making as well as open government. The Civil Service Reform White Paper published in June 2012 contained a commitment announced that: “Open policy making will become the default. Whitehall does not have a monopoly on policy making expertise. We will establish a clear model of open policy making.” Our project with The Democratic Society is currently examining how open policy making can be made a reality.
The Government has also promoted the evidence agenda, and is considering the case for new institutions that would perform an advisory role similar to the role that NICE plays for the NHS and the Early Intervention Foundation does for early years, to help ensure commissioners in central or local government do not waste time and money on programmes that are unlikely to be effective.
No-one seems to have told Michael Gove about either of these initiatives. No wonder teachers are starting to make their own education policy.
In our previous post we made the simple point that many of today’s politicians don’t look like us. Another reason we feel so disconnected from our politicians is that they seem so detached themselves, and because they express little feeling or passion. The current political class is increasingly technocratic because politics is increasingly a profession rather than a calling. They’re in danger of becoming Stepford politicians, opening up a ‘passion gap’ that can be occupied by dogmatists who do demonstrate their passion but for their own dangerous ends.
If you haven’t already, check out Julia Gillard’s recent speech on sexism and misogyny in Australian politics. Gillard used the speech to brand her opponent, Tony Abbott, who is the Leader of the opposition Liberal Party, a sexist and misogynist. What stood out was her anger and passion. Gillard told Abbott that if he wanted to know what a misogynist in modern Australia looks like then he should look in a mirror. She called him out on a range of sexist views he has espoused during his long political career. It was authentic, passionate and unspun.
The video of Gillard’s speech on YouTube has gone viral with two million views, and the speech was a top ten trending item in Australia on Twitter as well as trending internationally. It made headline news in South Africa, India, Canada and here in the UK. Jezebel, the popular American website for women lauded Gillard as “one badass motherfucker” after what it called her “epic speech on sexism”. Gillard’s approval ratings have risen significantly in the first public opinion survey since her speech. Almost 42% of Australians now think her opponent is sexist and the poll also shows that Gillard is 10 points clear of Abbott as preferred Prime Minister.
Contrast this to President Obama’s performance in the first US Presidential debate. He lacked passion, was detached and professorial, whilst his opponent Mitt Romney demonstrated energy and passion. Romney left the debate with a momentum which has carried through into the polls, wiping out Obama’s advantage. Romney has also been accused of being technocratic and wooden – probably the only reason why the election is close at all. The debate also highlighted one of the weaknesses of Obama’s presidency – his failure to maintain the energy and passion that he engendered in his supporters in 2008. Romney highlighted this in his nomination acceptance speech at the Republican convention:
“Hope and Change had a powerful appeal. But tonight I’d ask a simple question: If you felt that excitement when you voted for Barack Obama, shouldn’t you feel that way now that he’s President Obama? You know there’s something wrong with the kind of job he’s done as president when the best feeling you had was the day you voted for him.”
It’s become a common complaint that today’s politicians lack passion and are too technocratic. Mayor Boris Johnson has been labelled by Tim Montgomerie of ConservativeHome as the “Heineken Tory” who can reach parts of the electorate that other Conservatives struggle to reach in part because of his energy and passion. The same could have been said about Tony Blair in his early days as leader of the Labour Party – he connected with middle England in a way that no other senior politician on the left was able to. Sarah Palin is yet another politician who cut through to energise her party’s base because of her energy and passion – although in her case the euphoria unravelled quickly because of her lack of experience.
Of course, Prime Minister’s Questions has an element of passion – but it’s largely fake, a yaboo politics that disaffects rather than engages. It’s not so much passion that we want as authenticity – the feeling that politicians actually care about something and will take political risks to advocate for it. This is why Gillard’s speech stood out – she really believed in what she was talking about, and her anger and passion were genuine.
Part of the problem can be traced back to the rise of a professional political class. Politicians increasingly see politics as a career rather than a calling. The way to get ahead in politics now is to start out as a researcher to an MP after university, become a Special Adviser to a Minister or Shadow Minister, and then seek selection to a winnable seat before becoming part of the government shortly after entering Parliament. This aspiring politician might have a small period of time working for a think tank, a charity, in PR or the media, but generally in a role connected to politics. We now have a whole class of politicians whose whole careers have been inside the Westminster bubble – they have not held a job outside of politics. David Cameron, George Osborne, Andrew Lansley, Ed Miliband, Ed Balls and Andy Burnham have all trodden this path. The careers of Nick Clegg, Ed Davey, David Willetts and Danny Alexander have all centred on Westminster as well. In fact a third of the cabinet worked for a politician or political party before they became an MP:
- David Cameron: Special Adviser to both Norman Lamont as Chancellor and Michael Howard as Home Secretary
- Nick Clegg: EU policy official and adviser to Sir Leon Brittain as EU Commissioner*
- George Osborne: Special Adviser to Douglas Hogg as Agriculture Minister, worked in No 10 when John Major was Prime Minister and worked in William Hague’s office when he was Leader of the Opposition
- Vince Cable: Special Adviser to John Smith when he was a Cabinet Minister in 1970s
- Ed Davey: Adviser to Sir Alan Beith
- Andrew Lansley: Adviser to Norman Tebbit MP* & Conservative Party (Director of the Conservative Research Department)
- Michael Moore: Researcher for Archy Kirkwood MP
- David Willetts: Researcher for Nigel Lawson as Chancellor, worked in the No 10 Policy Unit when Margaret Thatcher was Prime Minister and is the former head of the Centre for Policy Studies.
- David Laws: Economic Adviser and Director of Policy and Research for the Liberal Democrats
- Danny Alexander: Press Officer for the Liberal Democrats.
*paid as civil servants
The current approach to using interns in think tanks and charities reinforces this closed shop approach to the professional political class. In many ways, policy is the new ‘international development’ – to get a paid job you need to undertake an unpaid internship. This means that policy is increasingly only open to people whose families can support them financially.
This new professional political class lacks the backstory that politicians like Vice-President Joe Biden, Alan Johnson, Paddy Ashdown or David Davis bring to the job because of their experience outside of politics. Joe Biden is a single parent, Paddy Ashdown served in the Royal Marines, David Davis grew up on a south London council estate, whilst Alan Johnson started his career as a postman. Much play was made at the party conferences about the lives of the main party leaders before they became politicians, but no matter how these speeches were portrayed by the spinners, our current party leaders don’t have the wealth of experience outside of politics that the likes of Johnson, Ashdown etc do. They pale in comparison.
What matters here is the content – the policies that politicians advocate for and their real world consequences. Rich Yeselson argues that it isn’t the ‘truth’ of people’s personalities that matters but rather the factors involved in the reality of politics, such as the size of the majority in the legislature that influences policy. However, politicians’ backstories also matter. As Nadine Dorries, the backbench Conservative MP, has argued in relation to Osborne and Cameron:
“I think that not only are Cameron and Osborne two posh boys who don’t know the price of milk, but they are two arrogant posh boys who show no remorse, no contrition, and no passion to want to understand the lives of others – and that is their real crime.”
Politicians can’t be passionate if their real passion is the inside game of politics rather than standing for something that matters to the rest of us. The real danger is that this passion gap creates the space for dangerous dogmatists who do demonstrate their passion – the far right politicians such as Pim Fortyun and Geert Wilders in the Netherlands or the wholly self-interested politicians such as Silvio Berlusconi in Italy. If we want to avoid being subject to someone else’s passion, we will have to find our own – our political class is not providing it.
Andrew Mitchell was eventually forced to resign from the Cabinet on Friday for allegedly calling a police officer a ‘pleb’. Like the best political scandals, plebgate has revolved around a politician telling the truth, because compared to the Cabinet we are all commoners. It doesn’t matter what Mitchell actually said – the real issue in politics today is not individual personalities but the demographic profile of our politicians.
The Cabinet doesn’t look like their backbenches
More than half of the Cabinet attended an independent school (17 ministers), while Theresa May and Michael Moore attended both private and state schools. Whilst 19 Cabinet Ministers attended Oxbridge (61%), 12 didn’t (39%). The full list of Cabinet ministers, their schools, universities and careers is as follows:
|Minister||School||University||Career before becoming an MP|
|David Cameron MP, Prime Minister||Independent (Eton)||Oxford||Politics & PR|
|Nick Clegg MP, Deputy Prime Minister||Independent (Westminster)||Cambridge||Media, EU policy & politics (MEP)|
|George Osborne MP, Chancellor||Independent||Oxford||Politics|
|William Hague MP, Foreign Secretary||Grammar and comprehensive||Oxford||Management consulting|
|Theresa May MP, Home Secretary||Independent and comprehensive||Oxford||Finance & councillor|
|Chris Grayling MP, Justice Secretary||Grammar||Cambridge||Media, management consultant & councillor|
|Vince Cable MP, Business Secretary||Grammar||Cambridge||Politics, economics & business|
|Philip Hammond MP, Defence Secretary||Comprehensive||Oxford||Business|
|Ed Davey MP, Energy Secretary||Independent||Oxford||Politics & management consultant|
|Andrew Lansley MP, Leader of the House of Commons||Independent||Exeter||Politics, civil service & lobbying|
|Michael Gove MP, Education Secretary||Independent||Oxford||Journalist & writer|
|Jeremy Hunt MP, Health Secretary||Independent (Charterhouse)||Oxford||Business & PR|
|Eric Pickles MP, Communities Secretary||Grammar||Leeds Polytechnic||Business, councillor & Leader of Bradford City Council|
|Justine Greening MP, International Development Secretary||Comprehensive||Southampton||Accountant|
|Lord Strathclyde, Leader of the Lords||Independent||University of East Anglia||Politics|
|Grant Shapps MP, Co-Chairman of the Conservative Party||Grammar||Manchester Polytechnic||Business & writer|
|Danny Alexander MP, Chief Secretary to the Treasury||Comprehensive||Oxford||PR|
|David Jones MP, Welsh Secretary||Grammar||UCL||Solicitor|
|Michael Moore MP, Scottish Secretary||Independent & grammar||Edinburgh||Politics & accountant|
|Owen Paterson MP, Environment Secretary||Independent||Cambridge||Business & agriculture|
|Patrick McLoughin MP, Transport Secretary||Comprehensive||Staffordshire College of Agriculture||Farm worker & miner|
|Iain Duncan-Smith MP, Work and Pensions Secretary||Comprehensive & military school (HMS Conway)||Sandhurst||Army & business|
|Maria Miller MP, Culture Secretary||Comprehensive||LSE||Advertising, marketing & PR|
|Theresa Villiers MP, Northern Ireland Secretary||Independent||Bristol||Barrister, lecturer & politics (MEP)|
|Sir George Young MP, Chief Whip||Independent (Eton)||Oxford||Policy & politics (councillor & member of GLC)|
|Kenneth Clarke MP, Minister without Portfolio||Grammar||Cambridge||Barrister|
|Francis Maude MP, Minister for the Cabinet Office||Independent||Cambridge||Lawyer & politics (Westminster councillor)|
|David Laws MP, Minister for Schools||Independent||Cambridge||Banking & politics|
|David Willetts MP, Minister for Universities||Independent||Oxford||Politics & think tanks (Centre for Policy Studies)|
|Baroness Warsi, Minister for Faith and Communities||Comprehensive||Leeds||Solicitor|
|Dominic Grieve MP, Attorney General||Independent||Oxford||Barrister|
This is somewhat different to MPs. 112 MPs were educated at Oxford, whilst 53 went to Cambridge – this means that ‘only’ 25% of MPs went to Oxbridge compared to 60% of the Cabinet. According to Kavanagh and Cowley in The British General Election of 2010 (Palgrave Macmillan, 2010) the parliamentary parties elected in 2010 break down as follows:
- 34% of Conservative MPs went to Oxbridge, compared to 30% of Liberal Democrat and 18% of Labour MPs.
- 54% of Conservative MPs went to an independent school, which is similar to the Cabinet but is higher than the 40% of Liberal Democrats MPs and 14% of Labour MPs who did so.
We have a Cabinet of lawyers, politicos and ex-businessmen and women; this is broadly similar to the party backbenches. Kavanagh and Cowley found that:
- 41% of Conservative MPs elected in 2010 had a career in business before entering the Commons (125 x MPs), 18% were solicitors or barristers (56 x MPs) and 1 in 10 worked in politics (31 x MPs).
- 31% of Labour MPs had a career in politics (as local politicians, union officials or political organisers – 81 x MPs), 14% worked in education (35 x MPs) and 10% were solicitors or barristers (26 x MPs).
- 19% of Liberal Democrat MPs worked in business before becoming MPs (11 x MPs), 18% worked in education (10 x MPs) and 12% worked in politics (7 x MPs).
However, the main Cabinet jobs are held by individuals who have never held a job outside of politics and PR. Cameron, Clegg, Hague, Alexander and Osborne don’t have a background in business or the law in the way that their party backbenchers do. There is also a dearth of local government experience in the Cabinet – only five Ministers – Grayling, May, Maude, Young and Pickles have held elected office as a local councillor.
Parliamentary parties don’t look like the electorate
People educated in the independent schools sector are significantly over-presented in Parliament. Only 7% of young people in Britain are educated in the independent sector, yet over half of the Cabinet went to a private school. Oxbridge accounts for a tiny proportion of the higher education sector in the UK – but over 60% of the Cabinet attended these two elite institutions. (According to the TES – 45% of places at Oxford and 40% of those at Cambridge are taken by pupils from the independent sector.)
Professions such as law, business and politics are significantly over-represented in parliament as well. There are more barristers and solicitors on the Tory benches than there are Tory women MPs. Indeed, there are nearly as many Etonians in Parliament (20 MPs) as there are former manual workers (25 MPs).
Women and people from BME communities are also still significantly under-represented in Cabinet and Parliament. There are only 5 women in the Cabinet (16%), and only 1 BME politician. Women also account for just 22% of MPs elected in 2010. Broken down by the main parties this comprises:
- 16% of Conservative MPs (48 MPs)
- 12% of Liberal Democrats (7 MPs)
- 31% of Labour MPs (81 MPs)
Progress was made in 2010 in the number of black and Asian MPs that were elected, which rose from 14 in the last parliament to 27 in this Parliament. They make up 4% of MPs in the Commons, compared to the estimated 8.7% of the total UK population.
Three women in the Cabinet – Baroness Warsi, Maria Miller and Justine Greening all hail from parts of Britain not usually considered true blue. Miller grew up in Bridgend, South Wales, Warsi is from Dewsbury and Greening from Rotherham. All three of them attended their local comprehensive and had a career before entering politics. Of course, both Warsi and Greening were demoted in the Summer reshuffle.
Attempts to diversify the make up of parliamentary parties have met resistance from party memberships
Party memberships are increasingly different to not only their parliamentary parties but also to the wider electorate – the membership of the Conservative Party is rapidly ageing for instance. It is well documented that the membership of the Conservatives, Labour and Liberal Democrats are in steep decline and compares poorly to the increase in membership of smaller parties such as the SNP, Greens and UKIP. Membership of both the Conservatives and Labour parties has halved since the 1990s, whilst the Liberal Democrats have seen their membership fall from 100,000 in the 1990s to 65,000 at the beginning of this decade. Attempts have been made to diversify the parliamentary base of the main parties but they have met resistance from local party associations. Political parties are no longer the mass movements for change that they used to be but their membership base still controls the selection of parliamentary candidates.
The result, then, is that the main political parties, Parliament, and especially the Cabinet do not look like us. That being the case, why should we expect the policies they propose and support to ‘look like us’ either?
In this post our guest blogger Jane Mansour showcases the Family Independence Initiative in Boston, Massachusetts. The project is a good example of the principles of ‘guerilla policy’ in action. Jane is an expert and consultant in international welfare to work and the commissioning and funding of public services. She blogs regularly at Buying QP. Thanks to Jane for contributing the post, and we welcome your comments.
The argument for the benefits of user and staff involvement in policy making is considerably strengthened by numerous example of projects that have been successfully designed and delivered using this blueprint. These range from actual projects – of which FII discussed below is a great example – to the use of a crowdsourcing approach to gather solutions for identified and specific local needs. These raise questions about the extent to which this approach is scaleable, and how this can be done without losing what made them work in the first place.
This week I met Jésus Gerena, the Boston Director of the Family Independence Initiative (FII). FII families create support networks in their own communities rather than accessing help through a key-worker or institution. As an organisation it has impressive results – in the first six months of operation participating families in the Boston wing of the programme saw their incomes rise by an average of 13% and their savings by 22%. These statistics and many others covering family finances, schooling (both adults and children) and health and activities are compiled monthly. The data is actively uploaded by the participating families themselves. They are paid for this, and for leading, counselling and facilitating the monthly groups they attend. These payments total in the region of $2000 a year per family.
The FII was the brainchild of Maurice Lim Miller; he was honoured this week by the MacArthur Foundation with a ‘genius award’ which carries with it a grant for $500,000. It works by not helping people in poverty. No, that was not a typo. The FII do not help, staff can be (and have been) fired for doing so. What the FII does do is provide an environment in which people have opportunities to succeed. Families work together to problem solve, record their gains and losses and have access to resources should they need them.
There are the three fundamental values that underpin the organisation’s approach. Firstly, the families are in control. Secondly, there is a formal feedback loop consisting of monthly and quarterly meetings and data collecting providing peer accountability. The process of recording information in and of itself, impacts positively on behaviour. Lastly there is access to resources to move forward. These resources are often in the form of matching or doubling the contributions participants make towards education, housing or business goals, but they can also be used to meet urgent practical needs (eg. a car or dental work).
Listening to Gerena’s passion for the FII approach, it is difficult not to get excited about it, about the way that this organisation is not only challenging much of the way that social policy has been cast, but is succeeding in doing so. The scaleability of successful but reasonably small projects is fraught with difficulty. The world of public policy is littered with examples of innovative projects that are hailed, placed in the spotlight, enlarged and ‘replicated’, but that then fail to deliver on the bigger stage. This is then followed by a blame game that often focuses on delivery, sometimes on commissioning, occasionally on design.
In two years the Boston operation has grown from 35 to 200 families. Gerena thinks there is the potential to continue expanding to 1000 families but, and it is an important but, this expansion needs to happen organically through families introducing themselves and others – a combination of ‘core catalyst families’ and ‘ripple families’. Scaling up fails when the guiding values behind success are confused within the method in which they are delivered, when the ‘how’ is mistaken for the ‘why’.
There are broader public policy lessons to be learned from the work being done by FII. These are not that welfare savings can come from the wholesale removal of frontline staff, or that bids to deliver programmes should need to be scored on how often the words ‘family’ or ‘social capital’ occur, or that a new New Deal for Communities is the answer. The lessons are far more challenging than simply producing a shiny new programme.
Miller has written a brief paper identifying the changes he thinks necessary for substantial change in the outcomes for low-income families. It’s worth reading in full. His final call to action identifies four changes that need to happen:
“1. We need to more accurately communicate the resourcefulness, capacity, and caring that is the true picture of lower income families and communities
2. Funders must allow for program approaches that provide help based on family and community initiative and strengths
3. Policy makers, funders and leaders must seek direct feedback from the consumers of programs they create and respond to that feedback
4. The target families must self organize and advocate for themselves and their communities”
As I sat in the FII office, it was striking that there are clear echoes in the UK – in terms of approach, positive outcomes, frustrations with the system, but also in the difficulty in capturing the wins and replicating them either regionally or nationally. Successful, sustainable ideas are evident in individual programmes but somehow the key to why they work gets lost in translation when ‘reform’ or scaling up occurs. Why is it that successful local programmes so often fail on the big stage? To what degree would this failure be mitigated by taking a different approach to both entrenched social issues and institutional frameworks? What impact would the following considerations have on policy design?
Long vs short-term investment: FII is aimed at the working poor – those who are increasingly ineligible for state safety nets, face significant marginal tax rates on any additional earnings and are in real danger of sliding back into poverty (cycling between work and benefits). It relies on the safety nets being there, it is an extension of benefits rather than a replacement for them – any savings to the welfare budget will only be felt in the long-term as people move up the income ladder. When the focus is on cutting spending rather than raising revenue, and results are needed quickly the long-term nature of many interventions is overlooked.
Look for ‘A Duh’ rather than ‘A Ha’ moments (Gerena’s phrase). There is a tendency to look for exciting, new, revolutionary change but often small, practical, simple and obvious opportunities are overlooked. Users and staff are the key to understanding what these are.
It requires a significant power shift to trust in people to make decisions about their own lives, find their own support network and provide the resource to enable them to make positive changes. What could this look like and how can it be supported by the state?
The need to end funding silos for people with multiple needs has been much discussed. The introduction of the Universal Credit in the UK aims to streamline benefits. The focus is on simplifying the benefits people receive rather than on the way they live and how services they interact with are funded and delivered. Bringing funds for the latter into one pot (universal support?) would have a very different impact.
What and how do incentives work for middle and high earners? Can the rewards for initiative they receive be extended to benefit claimants and those on low incomes? Skills policy and funding is an area that immediately springs to mind.
Feedback and data are both vitally important and often overlooked. This involves a change in perspective, from the compilation of simplistic league tables of outcomes towards rich seam data mining of the information gathered on the journeys of individuals as they bounce around the system.
There has been a tendency in policy design in the UK and elsewhere to believe that successful programmes will only come from providing more intensive external support. The experience of FII is that the ongoing cycling between work and benefits can be prevented through the creation of long-lasting social structures and support networks, underpinned by feedback and resources. The challenge is in reproducing co-operative policy making and delivery on a regional or national stage.
 These outcomes have improved over time and the experience of the two Californian programmes is of an income increase of 20%.
 These sums are not included in the increased income calculations