Posts Tagged ‘Public Services and the Welfare State’

Work and social norms: why we need to challenge the centrality of employment in society

Why do the unemployed often suffer from poor physical health and wellbeing? Daniel Sage argues that it is the importance we attach to the ‘work ethic’ that shapes the experience of unemployment, and so to deal with the harmful effects of unemployment we must challenge the centrality of paid work in our lives.

Unemployed people tend to have significantly worse health and wellbeing compared to people in paid work. With hundreds of empirical studies, this is one of the most persistent findings in social science research and holds across time and place.

In trying to explain the impact of unemployment on health, researchers have often been drawn to the social psychologist Marie Jahoda’s influential theory. Jahoda argues that the main problem for unemployed people is that they are unable to access all the positive goods that employment provides: time structure, social activity, teamwork, regular activity and status. In other words, there is something uniquely valuable about paid work for human health and happiness. The best way to deal with the harmful effects of unemployment therefore is to promote work: either through policies like job guarantees or, alternatively, active labour market programmes, which often mimic the environment of work. Promoting, or even enforcing work, can be seen as both a logical and benevolent solution to the maladies of unemployment.

In a recent article I challenge the view that equates paid work with happiness and human flourishing and, conversely, unemployment with the opposite. Rather than somehow being innate to human happiness, I argue that the reason why people in work report such higher life satisfaction is because of the power of social norms and, more specifically, the dominance of the work ethic. In societies that glorify employment as a signifier of identity, respect, and status – and promote paid work as the overriding route to life meaning and worth – it is little wonder that those who are unemployed suffer terribly.

The power of the work ethic in shaping the experience of unemployment can be seen empirically in numerous studies. Unemployed women in countries with high female employment rates suffer more compared to unemployed women elsewhere. Unemployed people who retire experience a significant upturn in their wellbeing irrespective of income gains; they are freed from labour market expectations and there is thus no shame not to work. Daily wellbeing data captured by smartphones shows how paid work is one of the least pleasurable activities people engage in. People do not find pleasure and satisfaction in the actual activity of working but the status and identity that having a job provides.

My own analysis of the European Values Study supports this other research, demonstrating how unemployed people who subscribe less to employment norms tend to have higher wellbeing than those who have stronger work ethics. To put it simply, if you care less about the social value placed on paid work, then unemployment is likely to be a less soul destroying experience than if you care deeply about the importance of work.

These studies have important implications for how we understand unemployment and how we deal with its effects. They suggest that the most powerful way of confronting the harm caused by unemployment is to challenge the power of the work ethic. In this light, attempts to combat the negative health effects of unemployment by emphasising paid work – either with job guarantees or activation programmes – is likely to be counter-productive in the long-term. These interventions reinforce the power and centrality of the work ethic, whereby unemployed people are expected to conform or are coerced into subscribing to the very norms that promote their shame in the first place. The work ethic is both the cause of unemployed people’s misery and the route to escape it.

To combat the harm of unemployment more effectively and enduringly, it is necessary to challenge the importance paid work has to human identity.  The starting point is to consider social policy reforms that change people’s relationship with work: including the value we attach to work, the time we devote to work, and how work frames our judgements of other people.  This will not be easy. In the UK at least, there is a political climate in which both the mainstream Left and Right see paid work as a solution to all manner of economic, social, and moral problems. We are a society divided into ‘strivers and skivers’ and where work frames many social interactions and relationships.

Yet it is possible to imagine policies that are viable within current political, economic and welfare state structures that still hold the radical objective of reconstructing work and the work ethic. Universal basic income (UBI) is one such policy. UBI has many admirers and proponents across the political spectrum, yet a particularly powerful case can be made for the potential UBI has to recast what work means. UBI could dilute the work ethic by making it easier and more common for people to opt out of the labour market: to retrain, get more education, care or enjoy more leisure. The boundaries between work and non-work could blur and our understanding of what ‘work’ means could widen. As the social category of ‘the unemployed’ became more ambiguous, there could be far less shame, and fewer harmful effects, of not engaging in paid work.

There are also other, arguably less radical and more politically viable, policy alternatives for challenging the work ethic. These include expanding paid parental leave for mothers and fathers, enabling people to work fewer hours and empowering people to take periods of paid leave (sabbaticals) from work. We could even, as Jeremy Corbyn suggests, have more bank holidays, although perhaps not only whenever England win a World Cup.

Ultimately, the objective of all of these policies would be to obscure the boundary between work and non-work by enabling people to work less. This could expand our common understanding of what ‘work’ means beyond its current form as a purely economic relation. In this light, people would be empowered to find value, identity, status and reward in forms of work that do not involve wage-labour. And then the misery long found in the experience of unemployment could finally disappear.

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Note: the above draws on the author’s published work in Critical Social Policy.

About the Author

Daniel Sage is Senior Lecturer in Social Sciences at Edge Hill University.

 

 

 

All articles posted on this blog give the views of the author(s), and not the position of LSE British Politics and Policy, nor of the London School of Economics and Political Science. Featured image credit: Pixabay/Public Domain.

The new State Pension is rolling out – but few people know if and how it will affect them

How well does the public understand the roll out of the new state pension and how it will impact them? Kirby Swales draws on joint NatCen and Pensions Policy Institute research to explain that there is a general lack of awareness which, unless addressed, can lead to financial hardship for people in the future.

The State Pension is not the most topical subject in policy research circles, but it is hugely important. It is the single largest item of social security expenditure – about £92bn at the last count. It is the largest source of income in retirement. However, people are yet to realise the importance of the new State Pension and the changes it will bring, according to new research.

You will have probably heard about the change in State Pension age, especially for women aged 60-64. However, there have been really significant other changes in recent years – including eligibility rules, amounts and particularly the removal of additional, earnings-related components (think SERPS, State Second Pension and so on).  The new State Pension will provide a flat rate level of income for all individual adults – currently £8,500 for those with a full contribution record. The new state pension was created to simplify the whole system but also make it more re-distributive, and to improve affordability. The system is now rolling through and each newly retired person will receive it. Currently this is just over 400,000 people.

NatCen has been working with the Pensions Policy Institute (PPI) to help understand the level of understanding of the new State Pension. The briefing note from PPI shows clearly that understanding is patchy, and this backs up previous research. New data from the NatCen Panel shows that the youngest people, not surprisingly, have the least knowledge. Moreover, it is estimated that three in ten of those approaching retirement don’t know that they will receive a State Pension when they are older than they expect. About one in five young people don’t expect to get a State Pension at all (see Figure 1).

Source: NatCen Panel November Wave 2017. Base: Men aged 18-65, Women aged 18-60. Excludes those would he didn’t know (n=1435).

So it seems the new system has not led to a major shift in understanding (and any resulting behavioural change) yet. This raises two questions – i) does it matter and ii) how can it be improved? There are alternative perspectives on the answer to the first question. If people are becoming eligible and also in a workplace pension, then there are no choices that they are not exercising. However, it will matter to those more at risk, such as those approaching retirement soon, or people with intermittent working or caring histories. (You need 35 years of these to get a full State Pension).

On the second question, there is clearly more consensus for action. There are lots of practical ways for how people could be more engaged in the State Pension. It is already possible to check National Insurance records online but a more sophisticated pensions ‘dashboard’ is on the way. This could have a big impact but only if people know about it and use it. Could targeted e-mail and hard copy communications play a role?  Could the state pension update be provided as part of mid-life career checks (a bit like what is happening with the NHS midlife health check)?

So, it really appears we are at the beginning of a journey where the country starts to appreciate the changes made. As well as supporting individuals’ retirement planning, it will have a significant impact on society  –  the new State Pension acts as a sort of universal basic income for the majority of the older population. This research was intended to help stimulate initial discussion, and there is definitely scope for more regular and deeper insight. Getting people to understand the new State Pension at an individual and societal level would have a lasting positive impact.

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About the Author

Kirby Swales is Director of Survey Research Centre at the National Centre for Social Research.
All articles posted on this blog give the views of the author(s), and not the position of LSE British Politics and Policy, nor of the London School of Economics and Political Science.

From Hunt to Hancock: a fresh start for the NHS at 70?

The arrival of a new Secretary of State for Health and Social Care in England is a timely opportunity for a bold new start, based on the funding commitment achieved by his predecessor, writes Tony Hockley. He offers his perspective on this recent development.

As the UK celebrates 70 years of its National Health Service, helped along by another £20bn of tax funding, people up and down the country are making declarations of institutional love for this public service. They do so with a passion that seems strangely lacking in every other country with a universal, comprehensive health system. This is strange given the relatively poor outcomes achieved under the UK system: the “warts-and-all” sort of love.

Aside from the high emotion that survival to 70 has invoked, it is worth asking if the decades ahead might be different to those that have passed. Could the volatility of tax-funding be corrected and replaced with the steady but low rates of spending growth seen elsewhere, closer associated with rate of economic growth? The commitment to an average of 3.4% over the next five years does not bode well for investment in the other public services that actually improve health rather than treat the consequences of ill-health.

What is the plan for the NHS at 70? More of the same, and the NHS taking an ever-greater share of total public spending? Or the usual, expensive, and dangerous rollercoaster of feast and famine that seems the price of funding that comes almost exclusively from general taxation? A birthday may be a time for celebration, but it is also a time to look forward. Those who really care for our health system must hope that the future does not resemble the crisis-ridden past. These financial and organisational troubles were also born in 1948. Change must happen.

Jeremy Hunt played a very difficult hand superbly. He came to the job to pick up the pieces from Andrew Lansley’s complex reforms, which were intended to “liberate” the NHS, but actually tied it in statutory knots. Hunt came free of Lansley’s considerable prior knowledge, allowing him to focus on what most needed attention from the perspective of patients; this included embedding new cultures on safety, transparency, and mental health. He has stuck doggedly to his patient-centred agenda. He also stuck doggedly to the need to make progress in modernising the doctors’ training contract, despite one of the BMA’s most furious campaigns since the government introduced prescribing controls in the early 1980s.

There comes a time, however, when every health minister has become too much of an insider to continue to be effective. As Lansley demonstrated, and as Virginia Bottomley also showed, expertise can become a serious problem. Concern for the detail and for working relationships with the many partners in the health system limits the capacity to make a difference. In the end, every health secretary becomes a large part of the problem, having been built up as a hate figure by union leaders, and it is a rare luxury to bow out with their head held high. Hunt’s legacy for Matt Hancock is extraordinary given the current economic climate. The former Chief Executive of the NHS, Sir David Nicholson, argued on Twitter that: “I do not believe that any other of the Secretaries of State that I have worked for could have got more out of the treasury that @Jeremy_Hunt has … longevity has its benefits”.

Having achieved this commitment to steady funding, compared to a history of volatility, and ahead of both the NHS England proposals on how to spend it, and the green paper on social care, the time was ripe for a fresh face at the Department of Health and Social Care. The NHS needs a new critical friend, as does the taxpayer and patient. Given the extra funding, this will be one of the most important roles for the remainder of this parliamentary term. The Health Secretary must have the full confidence and support of both the Treasury and Downing Street, in order to be able to stand up to the constant pressure from the NHS lobby for cash as the solution to every question and to properly tie the funding commitment to fundamental change.

Matt Hancock has three principal challenges:

  1. To shift the health and social care system from expensive hospitalisation and institutional care, and into the community: finally turning a poorly-performing treatment service into an excellent health service;
  2. To deliver the digital revolution that Jeremy Hunt committed to in his first days at Health, but which largely fell by the wayside amidst other concerns;
  3. Rooting out endemic inefficiencies; running the risk that improved funding will once again entrench current practice rather than foster change.

If he can address these with the determination that Jeremy Hunt has promoted a culture of patient safety, then the funding boost will have secured lasting change and perhaps an NHS that is sustainable for the next 70 years.

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About the Author

Tony Hockley is Visiting Senior Fellow in the LSE’s Department of Social Policy, and Director of LSE’s Policy Analysis Centre. He was previously Special Adviser to Virginia Bottomley and to Stephen Dorrell in the Department of Health.

 

All articles posted on this blog give the views of the author(s), and not the position of LSE British Politics and Policy, nor of the London School of Economics and Political Science. Featured image credit: Pixabay (Public Domain).

Social care and the NHS: how to change the framework of joint working

The NHS and social care systems are turning 70, and for almost as long as they have existed, there have been attempts to join up the services and improve coordination. Despite multiple reorganisations, however, efforts have had limited success. Melanie Henwood explains what the conclusions and recommendations of new analysis by the Care Quality Commission tell us about operating these parallel but separate organisations.

“A system designed in 1948 can no longer effectively meet the needs of increasing numbers of older people with complex health and care needs.” So concludes the Care Quality Commission (CQC) in the report of its review of care for older people in 20 local care and health systems in England. This is both very timely – with the future of care funding and a Green Paper now due in the autumn – and potentially game-changing. The fact that health and care services can achieve better outcomes when they work together is not a new conclusion, and neither is the observation that joint working is not easy, particularly in a system characterised by fragmentation and competition.

Indeed, as Chief Executive Sir David Behan observes in his Foreword, “These are difficult problems to solve. There have been attempts to integrate health and social care since the 1970s.” And none has yet fully succeeded.  But this isn’t simply a repeat of familiar messages and laudable appeals for people to cooperate to improve integration, rather this is moving the debate to another level and concluding that we know enough about what makes a difference and what needs to change to make it happen everywhere. In short, the time for excuses and procrastination has passed; there needs to be a new game in town.

The system reviews examined how well older people move through the health and social care system, with a particular focus on the interface, and identifying what improvements could be made. There were plenty of examples of good practice, but equally many instances where the systems did not work in the best interests of people who use services, their families or carers, because organisations were not sufficiently joined up.

The areas where joined up care pathways need to happen to maximise outcomes for older people are well known, and the CQC analysis identifies the barriers and enablers around key issues of:

  • Maintaining health and wellbeing in the community;
  • Care and support in a crisis;
  • And step-down care and delayed transfers of care.

But what are the factors that predict success or failure?  CQC suggests that there are a number of ‘ingredients’ required, and in particular:

  • Common vision and purpose shared by system leaders, to work together;
  • Effective and robust leadership and governance across the overall performance of the system;
  • Strong relationships at all levels;
  • Joint funding and commissioning;
  • The right staff with the right skills;
  • The right communication and information sharing channels;
  • And a learning culture.

Of all these variables, CQC underlined that “strong, collective leadership is the single most important enabler for success in providing high-quality health and social care for people.”  This seems to be the key to unlocking genuine joined up working and integration, but the structure of health and care services is not generally organised in ways that support and demand whole system focus, so much as maximising individual organisational success. People who try to cross boundaries and to achieve cross-system objectives “have a challenging job, often without mandate and ownership of resources for the task.” The requirement, argues CQC, is for a new approach to leadership, “where leaders are supported and encouraged to drive system priorities collectively.”

In addition to changing organisational culture and relationships, such a shift also requires different metrics and outcome measures to drive it forwards. Whatever the stated values and objectives that senior managers may argue they sign up to in supporting better joint working to improve outcomes, typically their performance is measured at an organisational level rather than that of the wider health and care system.

Targets and measures developed for parts of the system with an apparent aim of improving performance (such as around Delayed Transfers of Care) may be inimical to the pursuit of wider system objectives and may indeed produce unintended consequences of merely transferring pressures from one part of the system to another. Different lines of accountability for care and health both locally and within national governance can create tensions and contradictions. If joint working is to be better incentivised at the local level, CQC argues there has to be a more coherent national framework of accountability that aligns system oversight, regulation and funding.

The system reviews identified examples of positive outcomes achieved by health and care organisations working together with “a clear, agreed and shared vision, strong leadership and collaborative relationships”. But the critical conclusion – and in many ways the most damning finding – was that such efforts were often despite the conditions in which they were working rather than because of them. In other words, despite decades of the ‘only connect’ mantra being repeated by successive governments, and opprobrium being heaped on those who fail to achieve the outcomes attained in some localities, the conditions in which “joined up working across organisational boundaries can flourish are not yet in place.”

Local managers and leaders have a central role to play in agreeing joint goals, developing plans to achieve these, and pooling budgets to deliver on objectives; but this also requires long-term stability and funding agreements from central government departments, and sustainable funding reform “that addresses social care and the NHS together.” In addition, it is also central government that must address the CQC’s other recommendations for changing performance management to a single joint outcomes framework; developing joint workforce planning strategies; and introducing legislation to enable CQC to regulate local systems rather than individual organisations.

The challenge is to tackle the fundamental and underlying structural and systemic barriers to joint working and integration. The CQC analysis focused particularly on older people, but the same principles will be true for meeting the needs of anyone with complex and multiple needs which cross organisational boundaries of care and health (and other services). This is in many ways the swansong report from Sir David Behan who is retiring from the CQC this summer. This valedictory call to address the unresolved issues, and to question “whether leaders working locally and nationally have the bravery and conviction to lead the charge” should resonate through Whitehall and Town Hall.

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About the Author

Melanie Henwood is an independent health and social care research consultant.

 

 

 

All articles posted on this blog give the views of the author(s), and not the position of LSE British Politics and Policy, nor of the London School of Economics and Political Science. Featured image credit: Pixabay/Public Domain.

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