Basic Income is an existential question for Labour

Reading Stephen Bush's article Does the Basic Income work? I was struck by his preamble that:

The difficulty with the “what do you think about basic income?” question is that it’s a little bit to being asked “what do I think about tax relief?”

For me, Basic Income challenges how the Labour Party defines itself in the modern world.

What I want to raise here is the function of money, the nature of work and the defining of value. If Labour are to become relevant to the majority of the electorate then these issues need to be wrestled with.

In the real economy, money acts as the lubricant for human interaction and activity. The electorate supports the principle that money should reward activity. Working Tax Credits follows this principle as participation in work is rewarded. This also fits squarely with Labour Party traditions which supports work and activity.

Basic Income challenges this relationship by disconnecting activity from reward. This places it in opposition to where the electorate are. As Nick Clegg's recent memoirs show, welfare could be cut without thought to societal consequences precisely because George Osborne could frame the cuts as fitting a principle.

As for the nature of work, many feminists will argue that work is exponential but reward is limited to what society judges valuable whereas predominantly female areas such as childcare or care professions are devalued. Those with experiences of the charitable and voluntary sectors will also point to large amounts of activity that has societal benefits that are not rewarded financially. As an example, unpaid care is estimated to be valued in excess of £200bn based on the national minimum wage.

To argue that Basic Income is required to compensate for an absence of work is essentially a male perspective which ignores a substantial part of the real economy. Work is always available because it is about human activity and interaction. Basic Income is therefore positioning itself for compensating for a lack of rewarded work.

This poses a challenge for the Labour Party. Basic Income is an acquiescence to the logic of the free market determining value and merely offers compensation to that logic. Isn't this what New Labour was criticised for? And lets be honest, a UK economy underpinned by Basic Income has the potential to expand the amount of unpaid work through devaluing contributions which will fall disproportionately on women.

Can a Labour Party committed to values such as rewarding work, equality and building strong communities really be comfortable with adopting a policy of Basic Income?

I think not.

Instead, a radical Labour Party would work with its traditions and the principles of the British public to expand and reward activity. This is particularly important for those areas of activity that are undervalued or just unpaid. Tackling structural changes in work such as the 'gig economy' does require building additional buffers that support that workforce but such buffers need the support of the electorate.

At its essence, any debate about Basic Income is about the ambitions of the Labour Party as a progressive influence on British life. It can cement itself in the electorate's eyes as the compensation party by adopting Basic Income as a policy or it has to set out a programme that rewards contributions to society whilst protecting those that cannot contribute. Only one of these is acceptable to the British public.

Convenient Conditional Solidarity

If there is one thing that worries me particularly about Jeremy Corbyn and his core team is that it appears the notion of solidarity is driven by whether it is convenient to their cause.


The recent contrasting statements on Labour Party staff is a case in point (bold my emphasis):

Exhibit A (Jeremy Corbyn 23rd August 2016)

I am not telling you anything new when I say that working in politics can be stressful at times. However this has been exacerbated at times by attacks on individuals or groups of staff in the national media. In my own view, that is totally unacceptable. It is only right that elected politicians recognise that as party staff, you do not have the right of reply in the media and often have to operate in a political landscape over which you have limited control.

You therefore must not be used as a political football by anyone in the party. I hope you all feel that if you are put in difficult or unacceptable circumstances, you can raise the issue with your line manager, other senior members of staff, or your trade union representatives.

Exhibit B (John McDonnell 25th August 2016)

The decision by Labour party officials to suspend the bakers' union leader, Ronnie Draper, from the party and deny him a vote in Labour's leadership election over unidentified social media posts is shocking, and appears to be part of a clear pattern of double standards.

Unfortunately for McDonnell, it appears that Draper has fallen foul of the NEC ruling on proscribed words when he tweeted about "deselecting traitors" on 29th June 2016.

The NEC, as Iain McNicol pointed out to McDonnell, is the elected body which determines how Labour Party rules are applied. It is not in the gift of party officials who funnily enough have "limited control" of the "political landscape". McNicol in his role as General Secretary of the Labour Party is defending his staff from being a "political football"

What is striking about John McDonnell's intervention in what is being described as #LabourPurge2 is that he cannot find solidarity with workers in his own party. Instead because they are not aligned with his own interests, they are accused of "double standards".

If we reflect on the task at hand of the understaffed and underfunded compliance unit within Labour HQ, they are operating to arbitrary simple rules as laid down by the NEC to ensure that, as far as possible, everyone voting is a supporter of the Labour Party's aims and values. Given that last year's leadership election saw boasts ranging from Tories to Socialist Worker Party members that they had participated, a tightening up of the process isn't unexpected to manage an electorate of 600,000.

The problem is that simple rules can make for crude results. This is most obviously seen in soft left floating between the Green Party and the Labour Party as there are natural overlaps in values here. Tweeting support for a Green candidate in a previous election shouldn't automatically result in exclusion. Irony and nuanced opinion can also be crushed under the simplistic application of the rules. I have sympathy for those caught up by such rules who should be welcomed into the party.

I maintain solidarity with party workers who have a thankless task applying the will of the NEC.

While the rules are simplistic, I don't consider the NEC decisions unfair given the task at hand and the undercurrent of nastiness that surrounds the party currently. Learning lessons around making the process fairer to encourage inclusion whilst maintaining the values of the party is something the NEC needs to look at after September.

I don't have much sympathy for Ronnie Draper. It is hard to reconcile Labour values such as solidarity with tweeting about "deselecting traitors".

Solidarity requires the gift of support without expectation of reciprocation as well as recognising common cause. If you tweet about traitors then you're denying both of those attributes. The point of the Labour Party is that it is a broad coalition where people come together under common cause even if they disagree on the methodology to achieve it. Strength comes from being able to vigorously argue opinions without casting aspersions on others motivations.

If you attack MPs or councillors or members for being 'traitors' then what you are saying is that you only offer support if they agree with your opinions - it is entirely conditional. That's not solidarity. That's not the behaviour of a broad coalition. That's not seeking common cause. That's not the behaviour of a social movement.

My question to John McDonnell is how do you expect me to have solidarity with Ronnie Draper when he doesn't have solidarity with others?

The problem with such behaviour is that there is always the next 'traitor' to identify. We see that in the variety of abuse sent on social media whether misogynistic, homophobic, ableist, antisemitic, Islamophobic etc. All these are deemed acceptable if against the 'cause'.

Far from being a social movement, this behaviour will exclude and narrow itself further. If you're queer, disabled, female, Jewish, Muslim, black, foreign then you'll be asking yourself when do I become the traitor if my viewpoint doesn't fit?

The thing with solidarity is that it requires generosity of spirit. Something that appears missing from the current atmosphere. Instead there is a clear disconnect between the words of inclusion and the actions of exclusion that come from the current leadership and its more vocal supporters. Such actions have consequences which includes how rules are applied in leadership elections.

Far from being "double standards" as John McDonnell claims, the #LabourPurge2 is entirely consistent with the lack of generosity that has come with the convenient conditional solidarity that McDonnell and Corbyn offer.

Funny that.

Resolution 2 what does it mean?

In conjunction with the senior management team

This is really expressing a subjugation to the senior management team and as such is the most important clause in this rambling nonsense. The complaint made on January 2nd 2016 from Sara Ryan to Southern Health's Governors details a series of failings by the executive board/senior management team. It placed a duty on the governors to act in accordance with their responsibilities:

As an NHS foundation trust governor, you hold your foundation trust’s non-executive directors to account for the performance of the board and represent the interests of members and the public. [Monitor 2014]

This requires the governors to act independently in a scrutiny role. Instead, they have 'agreed' to collude with the executive board/senior management team according to this clause.

the Trust will explore with local Members of Parliament

Note this has nothing to do with the governors. This is purely a dialogue between senior management and MPs. The word 'explore' here means we will undertake a ritual bollocking from powerless MPs in order to make them feel a little bit important.

with the aim of requesting the Secretary of State for Health to further investigate

Again nothing to do with the governors. This part of the resolution has three separate indicators of action without there being any necessity for action on anyone's part: aim; requesting; further investigate. That such non-action clauses follows the ritual bollocking from MPs underlines the powerlessness of that ritual to achieve change.

the change in the organisational paradigm of the NHS and the Trust necessary

Again, what does this have to do with the governors? This resolution isn't asking for any change in the practice of Southern Health. Nor is it asking for any change in the 'organisational paradigm' (whoever thought that was an appropriate phrase is a delusional cockwomble) but merely that Jeremy Hunt reflects on said paradigm. It is passive in voice while attempting a slight of hand.

to enable the creation of a no-blame management culture

This is possibly the only honest part of this resolution: stop blaming us. This is very much the language of Jeremy Hunt being used so it suggests some possible collusion between the Department of Health and Southern Health. Which further begs the question about the usage of 'requesting' in this resolution. Fortunately for the senior management team, their governors already appear to believe in a no-blame/no-accountability culture.

and the achievement of a cost-effective, high quality, customer-driven world class standard integrated health service

The only surprise is that '7 day' wasn't including in this specious ending. Was this copied and pasted out of the 2015 Conservative manifesto? Was this meant to be a rousing ending so that everyone could wave their bunting as if they were listening to Jerusalem at the Last Night of the Proms? Gawd knows what it has to do with the duties and responsibilities of being an NHS Foundation Trust governor.

Not a single thing within this resolution has anything to do with the board of governors. Not that there are any actions within it that compel Southern Health to change anything. If anything did occur then it will be the result of external agency (MPs, Secretary of State etc). This resolution demonstrates that no part of Southern Health's governance is capable of change or learning. It is completely broken.

To reiterate, in response to a detailed letter from Sara Ryan, the board of governors resolved to undertake two actions. The first was to talk to senior management. The second was to collude with senior management.

These people are both monstrous and dangerous. 

UPDATE: Perhaps the governors aren't completely broken. This motion sent to Sara Ryan if adopted at an extraordinary meeting would mean withdrawing the nonsensical resolutions in the previous letter. Lets hope so.

The Biting Dog and Corporate Gaslighting

This morning I woke up with a very vivid metaphor.

In my dream, I saw a beautiful dog distressed and biting itself/yelping with pain. On closer inspection, the dog had placed on its front leg a sock puppet made to look like another dog. Unable to remove the sock puppet, the dog was reduced to attacking itself causing both physical and psychological pain.

Like Androclus and the lion's paw, I befriend the dog and am able to remove the offending sock puppet. No longer distressed, the dog and I bond as healing takes place. 

This feels a remarkable metaphor given what happened to Sara Ryan yesterday. The leaking of an August 2012 document as part of Southern Health NHS Foundation Trust's due diligence on their takeover of Ridgeway in Oxfordshire. To quote Sara:

A Quality and Safety Review, conducted as part of the Governance Work Stream. That details lack of clarity in care plans, risk assessments not updated or appropriate, issues with RiO, lack of assessment from the wider team, dirt, lack of maintenance, crap about Mental Capacity stuff, and so on. And so on.

Everything that contributed to the death of Connor Sparrowhawk was known before Southern Health took over the site and its services. And this document, circulated at executive level, was kept from the police, the coroner, the Inquest, the auditors, the Care Quality Commission, NHS Improvement, NHS England and the Department of Health it appears. Certainly none of these NHS bodies would want to admit they knew this document existed.

We also have the testimony of Lesley Stevens for the corporate body of Southern Health at last year's Inquest.

In that testimony, in response to a question from Adam Samuel re the staffing levels at STATT where Connor was detained, Stevens replied "well we make savings where we have to make them".

The jury then asked two significant questions that directly relate to this latest leaked document. The first asked what work had been undertaken in the 18 months leading up to Southern Health's takeover of Ridgeway. Stevens responded that there was a great deal of due diligence done by Southern Health ahead of takeover and that the Quality Director spent a lot of time in STATT. The follow-up question asked whether any of that work raised alarm bells. Stevens replied "not at STATT".

Despite knowing that the staffing and governance at Ridgeway was poor, the corporate executive at Southern Health not only pushed on with their takeover, they reduced staffing without resolving any of the issues raised by their own due diligence. This isn't just neglect, it is wilful disinterest in the safety of patients. This is corporate manslaughter territory and the police need to not only reopen the investigation but aggressively interrogate Southern Health's IT systems for further evidence. The non-disclosure of this document demonstrates that they cannot trust the word of this NHS Trust.

The other issue here is the potential of perjury by Lesley Stevens at the Inquest. No alarm bells raised as a result of their 18 months of due diligence? It is an incredulous claim.

And this is the sock puppet of corporate Southern Health: their incompetence.

No more will I collude with this. Instead lets call Southern Health what they are: Corporate Gaslighters.

Their actions are intentional and deliberate. Designed to confuse and create mitigation in the eyes of others through sowing doubt. By colluding with their sock puppet, we harm ourselves by not acknowledging the truth.

Sara and her partner Richard Huggins have written to Jim Mackie, David Behan, Jeremy Hunt and Simon Stevens to bring attention to this document and raise several questions/points. I would add these questions to Mackie, Behan, Hunt and Stevens - how long are you willing to tolerate an NHS Mental Health Trust abusing patients, families and staff through their gaslighting? How long are you willing to be gaslighted?

The dreadfulness of what has occurred is deeper and nastier than I thought possible. Resignations are inadequate. The corporate board at Southern Health need to be removed, prosecutions pursued and sine die written in regards to any further involvement with the NHS. Nothing less will do.

An Open Letter to Stephen Crabb

Dear Stephen,

congratulations on your appointment as the new Secretary of State for the Department of Work and Pensions (DWP).

In the spirit of your opening statement to the House of Commons where you stated that you wanted to lead a new conversation with disabled people, charities and the wider community, I would like to offer some initial thoughts as you take on this complex department.

Take time to appreciate the Social Model of Disability

Although the Social Model has been around for a few decades, none of the major political parties has truly appreciated its radicalism and opportunities for policy design. The first articulation of the Social Model came from the Union of the Physically Impaired Against Segregation who stated in 1975:

In our view it is society which disables physically impaired people. Disability is something imposed on top of our impairments by the way we are unnecessarily isolated and excluded from full participation in society.

In the forty years since then, the Social Model has broadened its scope as other disabled cohorts have identified with its basic principle that society creates barriers through how it is organised to turn people's impairments into disabilities and makes them vulnerable.

The UK's response was largely to compensate disabled people for the additional costs incurred. This included the John Major administration in 1992 introduced Disability Living Allowance (DLA) for working age adults (something that you and your fellow Conservatives should feel proud of).

Yet the nature of a compensatory system meant that disability benefits were exposed when the collapse in government income occurred in 2008. While I disagree with the reasoning employed by your predecessor in cutting certain disability benefits such as abolishing the Independent Living Fund or the arbitrary 20% reduction in the DLA replacement Personal Independence Payments (PIP), what it demonstrated was that the gains that disabled people achieved re the Social Model in the 80s and 90s were shallow rather than deep-rooted.

The opportunity available to you Stephen is to have that debate of what does good Social Model policy design and practice look like. Conservatives should be happy to embrace the principles of participation and controlling one's life that the Social Model demands that people with impairments should have. What objections can a Conservative have to helping people to help themselves?

The good thing about framing the discussion through the Social Model is that the conversation isn't dominated by amounts of spending but rather about outcomes. That will prove challenging to some of your current policies that act in opposition to the Social Model. Yet some disability campaigners and charities will also find that framing challenging.

What I found encouraging about your statement on Monday Stephen was that you stated that you were willing "to think beyond the artificial boundaries of organisations, sectors and Government Departments to an approach that is truly collaborative". Adopting a Social Model framework would enhance such thinking.

Employment and Support Allowance (ESA) has structural problems

I have no doubt that ESA was developed with good intentions. The problem is that good intentions doesn't always lead to good policy and ESA falls into that category. The decisions made in 2010 by your predecessor to roll out the Work Capability Assessment (WCA) exacerbated the flaws within the benefit.

The first issue with ESA was that it attempted to simplify by processing those with short-term health difficulties with those with long-term illnesses and/or impairments/disabilities. While it superficially made sense to have one process, the needs of these two cohorts are very different yet the system asks them to access the system as if they were to be long-term recipients of the benefit and all requiring to be assess for work capability. This doesn't just confuse the purpose of ESA, it generates unnecessary bureaucracy and backlogs.

For claimants with short-term health conditions preventing them working, they are signed off by their GP and those Doctor's Notes generates the ESA benefit for the period proscribed at assessment rate which is the same rate as Jobseekers Allowance (JSA). When the Doctor's Notes end, so does their access to ESA. This happens before any WCA is able to be scheduled. It would make sense to split ESA into a short-term benefit and a longer-term benefit. The short-term benefit (say a maximum of 6 months with mechanisms for extension/transfer into longer-term benefit) can be regulated by Doctor's Notes alone.

The longer-term benefit would allow you to address the second issue with ESA. Namely the artificial split between those in the Work Related Activity Group (WRAG) and the Support Group who have longer-term health issues and/or impairments/disabilities.

On a practical level, the comparable off-flows into work from both the WRAG and the Support Group indicate that the current system isn't that good at identifying who is nearer the workplace. It also demonstrates that its not about the levels of impairments someone has but whether those impairments can be minimise by reasonable adaptation to allow access to the workplace. Individuals are better at judging the balance and support required than a tick-box exercise like the WCA.

I also have considerable sympathy with Matthew Oakley's argument in his recent paper Closing the Gap that the ESA Support Group provides fiscal support for more than just being out-of-work with a premium for the income penalty of longer-term health issues and/or impairments/disabilities which the WRAG currently provides. Instead of this additional payment being access through other parts of the benefit system or social care, it has been confusingly attached to ESA Support Group. I agree with Oakley that the distinction between WRAG and Support should be abolished with the payment rate set at WRAG level. This is partly why I hope that you will reconsider the £30 reduction in WRAG payments for new claimants from 2017.

The other reason to reconsider the £30 WRAG reduction is that the JSA rate is set as a temporary level assuming that people will move off that benefit quickly. With WRAG, the expectation is that it will take longer to support people into work hence the premium to reflect that length of time as well as their health and/or impairments. Even if the WRAG and Support split remains, lowering the WRAG payment by £30 risks exacerbating claimants health issues.

Further to this, the idea floated by Iain Duncan Smith on Sunday morning that more people would be moved into the Support Group as a result of this change to the WRAG in 2017 would imply parking more people on benefits. Given the criticisms of Incapacity Benefit for exactly those reasons, this policy feels rather confused. It certainly isn't compatible with the Social Model discussed earlier.

The third issue for ESA is the nature of the WCA itself. The design of the WCA means that in order for your impairments to be recognised, the claimant has to disabled themselves. It promotes anti-Social Model behaviour and discourages participation in society. The act of disabling is very painful and damaging especially for those with mental health problems and/or cognitive issues (autism/learning difficulties etc). It pushes people away from the workplace and towards greater health and social care needs.

There is an inherent contradiction between politicians wanting a system that supports what people can contribute whilst designing a policy that only recognises what they cannot contribute.

There is also an understandable rational response in not wanting to be constantly reassessed by the WCA given it is a painful process. Therefore taking risks and entering the workplace is undermined by the barrier that is the WCA if that risk is unsuccessful as you go back to the beginning of the assessment process.

A quick win for you Stephen in generating goodwill could be in offering, say, an 18 month period where if an ESA claimant in the WRAG or Support Group enters employment and then leaves it within that timescale, they would return to the WRAG or Support Group without another WCA. It would be an interesting trial as to whether that would make a difference to off-flows into work and encouraging risk and opportunity.

Ultimately ESA needs fundamental reform as its not fit for purpose.

Small concessions on the Bedroom Tax would go a long way

One of the qualities of your predecessor was that the DWP would fight every legal challenge beyond what many observers would call reasonable. A good example of this is this Court of Appeal judgment in January this year which your department is appealing to the Supreme Court.

What seems particularly bizarre is the DWP argument that discretionary payments covered the panic room costs. If the costs are to come from Whitehall whether in Housing Benefit payments or Discretionary Housing payments then for what is a small cohort, the reputational damage to your administration alone should outweigh any argument as to how the money travels from Whitehall to the local authority.

Equally the discrimination of the policy that disabled adults can have an extra bedroom for overnight carers but disabled children cannot have overnight carers just makes the DWP look petty and vindictive. It is inequitable as a policy and dropping the appeal to the Supreme Court would send a signal that your words in the Commons about recognising that "behind every statistic there is a human being" matches your deeds.

Another concession that would make a difference is exempting homes that have been specially adapted for someone's impairments. This is currently particularly cruel when an area doesn't have a wide mix of housing stock to choose from. It is also economically inefficient to have to adapt another property for the same needs when the provision already exists.

These three small concessions would make a significant difference to how you are perceived without incurring significant costs.

Closing the Gap is an honourable aim

If anything defines your predecessor, its the continued state of Universal Credit (UC) for which substantial time and resources have been devoted. Given the latest estimated costs of the programme are £15.8bn, the incentives to return to work have been downgraded by the Treasury to below the current Tax Credits system, and even if the complexity of the IT system can be resolved, the business case for UC looks extremely shaky.

Instead a worthy challenge for you and your department to focus on would be the gap that disabled people have with the workplace. Using the framing of the Social Model discussed above and looking critically at the barriers created by current policies and benefits such as ESA, such a determined approach would enable bridges to be built with disabled people and charities that have been damaged by recent policy decisions. Who knows, you might find that supporting people with their impairments to be contributing members of society actually does a lot for the welfare cap as well as fitting with the best traditions of One Nation Conservatism.

As you stated on Monday Stephen, this is a complex piece of work. Improving this area has benefits for health, social care, social cohesion and welfare. I would suggest it has more tangible benefits to the country than the speculative financial benefits of a reorganisation of how benefits are paid.

Thoughts on Jonathan Reynolds article re Basic Income

Recently the Labour MP Jonathan Reynolds wrote an interesting article in the New Statesman of how the concept of Basic Income was becoming increasingly attractive especially given how the uber-slow-motion car crash of Universal Credit that is unfolding. I am pleased that this concept is being discussed more seriously given the changes occurring to how modern economies work. Below I give my two-pennies worth as to how Labour could think about the challenges identified in Reynolds article.

Both the concepts of Basic Income and Universal Credit are seductively simple but in practice don't lend themselves to bringing simplicity to people's lives or in delivering policy intentions.

Uuniversal Credit has been plagued by IT problems as the complexity of people's lives and how the State interacts with them overwhelms any technical solutions. The biggest problem that cannot yet (ever?) be resolved by technology is the level of conditionalities expected for Universal Credit. Ironically its the lack of universality in Universal Credit that stops the system from delivering its declared outcomes.

The pure system of Basic Income has the opposite problem as the lack of conditionality results in perverse policy outcomes. Declan Gaffney's article in The Guardian discussing the problems of implementing a Basic Income programme in an imperfect world. Gaffney rightly points out that conditionality is used within the current system to correct unfairness which a pure Basic Income system wouldn't achieve.

Yet the research of Professor Jane Costello into the effects of a stipend on a community of 8,000 Cherokee Indians from their new casino in North Carolina (this is a good discussion of that research) perhaps offers (dare I say the words) 'a third way' to consider instead of a pure version of Basic Income or Universal Credit.

As ever, it requires being clear on policy intentions. In Reynolds' article, his friend Gordon poses a good question: “How....will we ensure sufficient support for people as they have to retrain throughout their working lives - not just for several different jobs, but for several different careers?”

What I would suggest are three specific policies to work together. The first policy would introduce a 'Income Buffer' available to all working age adults set (for illustration) at £3,000 per annum. The second policy would be an annual 'Lifelong Learning Grant' to all adults again set at £3,000. The third policy is to make Jobseekers Allowance time-limited and contribution based abolishing long-term unemployment.

Income Buffer

Rather than seeing Basic Income as a replacement for multiple benefits, an Income Buffer would be an additional scheme to the existing benefits system which would adjust their awards accordingly.

While I would make the Income Buffer universal for working age adults, I wouldn't make it unconditional. Instead I propose using the Income Tax system to create a taper so that as personal income increases so less buffer is required. I would designate the Income Buffer as part of a person's taxable income. Given that someone working 40 hours a week on the Osborne Living Wage in 2020 would be earning £18,700 gross per annum then any taper needs to be considered as to its starting point.

This would have beneficial effects for those affected by zero-hour contracts as it would create some stability to plan around. It would strengthen the positions of the self-employed. It would also reduce the cliff-edges between being in-work and out-of-work that have become increasingly sharp with current government policy.

Essentially its a mitigation policy for the current transitionary work environment that exists in the UK for a large part of the population. While such a policy doesn't have the ambitions of savings that a pure Basic Income system implies, it would give a working model that with further developments could integrate other benefits into the Income Buffer.

Lifelong Learning Grant

One of the many things that frustrated me about Labour's 2015 election campaign was the £3,000 cut in university tuition fees proposed. While there was a good back-end argument about the affordability of the Student Loan book to Government and the effects of that debt on graduates activity in the economy, Labour spokespeople couldn't articulate this or respond to the fact that for universities, the front-end funding was very successful for their budgets and students were discounting the future to attend university in the present. It was also a very limited cohort to appeal to (part of the 'vote Labour get a toaster' problem).

Instead, what I would propose is an annual Lifelong Learning Grant that everyone over 18 would be given to spend. Each Lifelong Learning Grant would be time-limited so that people would either spend it or lose it as each grant cannot be rolled over to the following year. The grant would have to be spent on accredited courses but these should vary from universities, further education colleges all the way through to evening classes.

So for the student facing £9,000 of tuition fees, they can use their Lifelong Learning Grant to offset some of the costs whilst keeping the financial benefits for universities. However the potential is in developing an educational culture across all sections of society generating economic activity and allowing people to develop new skills or retrain whilst in work or if they have been made redundant.

In particular, I would localise the accreditation process allowing local authorities to encourage and influence what is provided to support their economies. Yet such a policy supports personal choice as ultimately it will be each individual who chooses how to spend their Lifelong Learning Grant.

Abolishing Long-Term Unemployment

This also stems from another frustration with the 2015 election campaign. In particular not having the courage of our convictions so were left having a mealy-mouth set of policies that was designed to appeal to the Daily Mail but was incoherent regarding work and unemployment.

Likewise, we have senior politicians who will reflect the public desire for contribution-based unemployment benefits but don't have the confidence to follow that logic through. Any contribution-based system is time-limited by necessary.

As my local Labour MP says 'the clue is in the name - Labour'. The Labour Party formed by workers who believed in fair pay for fair work and a decent society. Its not difficult yet that seemed lost at the last general election. We're now seen as the party for benefits and for the marginised. We need to return to our roots.

So lets adopt a contribution-based unemployment system but with the quid pro quo that once the time limit expires, there will be employment available at the 'Osborne living wage'/minimum wage. Not work for your benefits as Rachel Reeves suggested last year. If you work, you are paid a wage. Traditional Labour values that actually simplify the relationships between the person and the State.

My instinct on the time-limit is that everyone would be entitled to three months then you have to earn each incremental increase in time by how long you have put in. The system, that tops up the Income Buffer, could be as generous as some of our European neighbours are (depending on contributions!). Also the time-limited nature of this system is the sanction. We'll treat people as adults, provide help and support but when your time is up, its up.

The quid pro quo for a contribution-based system is, I admit, still in the formation stage of my thinking. Yet if we look at the direction of travel of current welfare policies and the last Labour manifesto then it isn't a big leap to make. This is where we need to keep in mind that there is often a difference between socially useful activity and economically valued activity. I also think we need to consider the space that local authorities have withdrawn from.

So that's the compact with the British people that I would draw - the State will support you if you support your community. So valuing work of social value. This would align the State more towards the development of the 'gift economy' that is emerging and being discussed by thinkers such as Paul Mason. Delivering this will need a shift away from centralised procurement in Whitehall.

Thoughts

If Universal Credit has taught us anything, its that 'Big Bang' solutions to policy problems are fraught with simplistic utopian thinking for which the consequences are often worse than the current policy delivery. A pure Basic Income system would also suffer from this effect.

Hence why I would suggest thinking about an Income Buffer concept. It shouldn't be difficult to make arguments for this policy in television studios and on the doorstep. Defending against criticisms such as 'affordability' will require some thought.

An Income Buffer would directly respond to the financialisation of people's lives especially in the South-East while creating more economic stimulus in the poorer communities of the country. It also reflects the increasing fragmentation of the modern economy by lubricating people's working activities. It would create room for people to retrain and reskill in conjunction with the Lifelong Learning Grant. It also creates the opportunity to reform unemployment benefits so that they are contributory as public opinion would like them to be.

For the policy to be accepted then it needs to be set at a level where it isn't possible to live off and shouldn't be seen as being generous to 'scroungers'. Hence why existing benefits should be reduced in accordance with the Income Buffer. Currently £3,000 is approximately the JSA rate for 18-24 year olds so whether you have a lower buffer set for this cohort would need to be considered. Access to other support such as Housing Benefit would have to be linked with the social compact discussed above.

As with any policy change, there will be winners and losers. I'm sure that many problems will be pointed out. Yet as with Jonathon Reynolds' article, I would argue that the role of Government is to achieve policy outcomes as to what sort of society we want to live in, what resilience needs to be built into our communities to adapt to a changing world and how to stay true to Labour values. Its not an easy challenge.

Contract imposition and the opportunity for the BMA Doctors

Jeremy Hunt yesterday in Parliament stated that he would impose the new contract.

There is for the BMA and its 'Junior' Doctors an opportunity here for industrial action which is more effective than strikes as a protracted dispute with work to rule or strikes will reduce public sympathy.

It comes in this simple fact - no contract can be imposed on those possessing the current contract. There has to be a termination of your existing contract in August. The new contract will be laid out and by continuing to work without challenging that contract means you accept the new terms.

It is the space between termination and acceptance that the BMA and its Doctors should exploit.

The BMA should set up an exclusive employment agency for Doctors to join in August at the point of termination of their existing contracts.

The Doctors should then inform their current employers that: they'll be accepting redundancy in August as a result of their contract termination; they'll be expecting the statutory redundancy pay (for those entitled); they'll be joining the employment agency at the point of termination; any work undertaken after the point of termination as a result of shift pattern will be voluntary and not an acceptance of a new contract; any further retention of their services will be through the employment agency and its terms and conditions.

Through collective action, having tens of thousands of Doctors only accessible through this employment agency will impose significant additional costs onto NHS Employers while having to accept significantly better working conditions and practices. What are the NHS Employers going to do? Who else will they find by August?

You "cannot buck the market" as Tories are so fond of saying. This is a market response to the non-market practices of Hunt and co.

By terminating the employment contracts of Doctors, the NHS frees them to organise their lives in a better way for themselves. Exploit that opportunity. Embrace the market and watch the panic rise with NHS executives as their projected budgets and services spiral out of control. By controlling the future, a better settlement can be negotiated today.

Goodbye David Willis

2015 ended on a low note with the death of my cousin David at 5:30pm Thursday 31st December.

He been diagnosed with terminal cancer in the summer of 2014 and given 3 months to live. He surprised me and many others by living for another 18 months and everyone got to cherish his kindness and passion for life during those precious months. His death was announced later in the evening on his Facebook wall and the tributes on there are testimony to the lives he touched.

David is my mum's cousin and her childhood friend as they spent holidays together. As my parents aren't regulars on FB, I was the one to break the news of David's death to her this morning when I phoned her. That wasn't a pleasant experience. Loss, even when expected, remains painful.

I'll remember David from various family get-togethers as a kind, gentle soul who in his own idiosyncratic matter lived his life on his terms. Traits that I could do a little more of in 2016 onwards. 

Goodbye David, it remains lovely to have known you.  

New modelling and old tricks for Birmingham adult social care

So this year's budget consultation for 2016-17 onwards started with language at the press launch about savings that appeared to be a Macguffin to make the overall numbers fit to present a balanced budget. Thankfully, once I heard Alan Lotinga (Service Director for Health and Wellbeing or whatever title he possesses this week) speak at last week's consultation event at Cannon Hill Park, the vagaries of the new Council Leader John Clancy and the consultation paperwork were dispelled.

In essence, the consultation papers present the savings to BCC adult social care budget. What it doesn't distinguish is the difference between a reduction in council costs with the expenditure of the department. In this case, £20m of the proposed £30m savings is made up of Better Care Fund monies replacing BCC spending with £10m of identified cuts making up the £30m. This is common practice across the country as the Better Care Fund is used to prop up social care (the Kings Fund estimate that the national 10% cuts to adult social care would be 17% without the BCF).

Now, given that John Clancy had only been in post for little more than a week, I can forgive him being misled by ill-defined consultation briefing papers and I suspect that his inherited cabinet member responsible Paulette Hamilton hasn't articulated this clearly enough either.

So last Friday, I experienced relief that it was only £10m of cuts (smaller than this year cuts). This is the reality of being involved with the last few years consultations, you get ground down into accepting big numbers like £10m. I made a point of thanking Alan afterwards as he had given real information.

That's not to say that there won't be funding choices within that £20m towards redesigning services as part of Birmingham's collaboration across care pathways with local NHS bodies. The nine workstreams set out in the local Better Care Plan and the pooling of budgets between BCC and the NHS are recognition that with all parties facing austerity (see the 5 year forward planning to deliver £20bn of efficiency savings in the NHS) that alternative ways of working have to be found to cope with these pressures.

However, if there is one thing designed to depress, its the claim for usage of methodology by Birmingham City Council which has been shown to be less than adept at generating the remodelling and cost savings claimed. Not only by other councils and academic studies but in practice by BCC itself.

I do find this particularly troubling. When I look at the workstreams of the BCF plan, I see the opportunity to develop genuine person-centred care and place-based care yet the language being used by politicians to describe remodelling is around personal budgets, direct payments and independent living. It is strange to see the city both ahead of the curve and a decade behind simultaneously.

Professor Martin Knapp of the London School of Economics and Political Science has done work on personal budgets and direct payments and found that although people may be happier with the decisions being made in their care, it doesn't reduce care costs but merely changes the delivery of those costs. The take home point here is simple - that meeting people's need requires money and changing how the money flows doesn't reduce that need. Also given that BCC recent survey of service users showed significant resistance to moving to a direct payments system, this appears to be a rather optimistic position to take.

As for independent living, the last couple of years experience should have disabused BCC of the idea that this is an area to claw significant savings in the timeframes being discussed. To explain, Birmingham is an outlier in terms of the percentage of service users in residential care for which the city bears all costs within its budget. With independent living, the housing costs can be drawn down from Whitehall in the form of the Housing Benefit grant. So officers compared BCC current position with that of the local authority with the highest percentage of independent living and then calculated the savings if BCC had the same percentage. There was nothing else to the methodology (I asked) and this 'saving' was presented to successive cabinet members as a way of contributing to the savings the city needed to make.

The reality of attempting this has been very different. The process has been run with integrity and found a large level of inertia. There isn't the market response to remodel existing service provision or move service users to new facilities. Perhaps most importantly, there isn't the willing to disrupt people's homes and their support. While numbers can be shifted on a spreadsheet, real people in real situations are very different.

Birmingham needs to face up to the fact that through its past actions, it has a legacy of residential care that will take a significant period of time to reduce. Its easy to make airy claims of moving from "dependence to independence" as Cllr Hamilton does but I've heard the same thing from her two immediate predecessors Steve Bedser and John Cotton. It is a weakness that this cabinet post has seen rapid turnover meaning that any learning disappears too quickly.

There also needs to be an acceptance that there are other factors of inertia that influence this dependence vs independence issue such as the fact that benefits use a deficit model of disability and award funding for what people cannot do. Even social care assessments undertaken by the council have strong deficit-modelling within them despite the best intentions for an 'asset-based' approach (like John Clancy, I dislike this term). With the pressures on finance and making the most of limited funding, the pressure is towards filling the deficits.

This contradiction between intention and practice also concerns me with the intention to only offer direct payments to young adults with disabilities transitioning from children's services to adult services. This isn't just crude in application but could be counter-productive when we consider that Better Care plan and pooled budgets. There is a difference between independent living (a technical definition) and independence of living (a philosophy). For example, young adults with learning difficulties could be in a semi-residential setting where they have access to pooled support enabling them to make choices throughout the day and evening whereas other young adults with learning difficulties could be living in 'independent living' yet be effectively curfewed due to lack of support available.

Not only does this policy not take into account costs on the health side (both immediate and longer-term) which the Better Care plan is meant to do, it ignores the first rule of independence which is the choice to choose their living arrangements. It, sadly, is part of that old Birmingham habit of doing things to people because it is good for them.

While the principle of maximising independence cannot be argued with, the city need to avoid changing one fixed pattern of behaviour with another. There are no easy paths to remodelling the needs of the city. Its a slow and continuous process which requires flexibility in approaches.

Likewise, I would urge caution as to the potential savings from the Better Care process. For example, while there are duplication of service provision in the NHS and BCC, it doesn't follow that there is double counting of need. My strong suspicion is that a proportion of the population is happy with drawing disability benefits and using the NHS while avoiding BCC and social workers altogether. The city has to be aware that a Better Care mapping exercise may present a larger cohort with identified needs to plan for and deliver services to in an integrated form.

This isn't an exhausive list of risks facing the city as it hopes to achieve £40m of savings in the next few years, I could mention the lowering of what qualifies as substantial need as a result of the 2014 Care Act compared with how the city currently operates or the expanded duties and requirements contained within the Care Act being enforced through judicial review. Its hard therefore to envisage the savings being delivered. So what can Birmingham do?

The first thing that the city could do is commit to using a significant proportion of John Clancy's 'bonds for housing' concept into generating activity in the adult social care marketplace. As I touched on earlier, there is sizeable inertia/lack of diversity in the market currently and there are numerous warnings of the market collapsing due to rising costs and a lack of purchasing power by local authorities. Offering partnership and patience financing would support the market and help towards achieving the savings required.

Related to that is around commissioning. The sense I get is that the city is more concerned with process rather than outcomes and struggles to move beyond rigid ideas (such as only offering direct payments for independent living above) which frustrates partners/potential partners in the private and 3rd sector. Without damaging certain controls, there needs to be an adoption of metrics that allow more art into commissioning services. Which brings me to the Better Care plan.

If the Better Care process is to facilitate real change then the city and its partners need to commit to its direction of travel, namely place-based care, explicitly. This is the recognition that approximately a fifth of healthcare outcomes result from clinical treatment with the majority of benefits come from lifestyle, environment, family and social networks. This is also the direction of travel that is explicit with the wellness agenda within the 2014 Care Act.

Rather than make bland statements about "remodelling adult social care" or "doing things differently" which are intangible and unmeasureable, this city needs to make a statement as to what it wants to achieve. Modelling adult social care along place-based principles would enable the development of milestones that can be measured and agreed with both service users and the wider electorate. It also offers a scope to expand and support other city objectives when we eventually move beyond austerity (one day...).

It also fits into the Better Care process in that local authorities and the NHS need to develop common metrics that allow both parties to measure success and savings on both sides. Such metrics should feed into commissioning especially where pooled budgets are concerned. I'm not yet convinced that enough thought has gone into this.

There are other thoughts I have about the consultation with regards to adult social care, let alone other parts of the consultation. For this part of the consultation, my plea is for greater recognition of the risks and a commitment to thinking beyond the narrow options proposed to achive remodelling as they won't. This city needs to be a lot smarter and creative in how it tackles this incredibly difficult situation.

Note: this is the product of late-night blogging. Links and labels will be added later.

Mazars and the Parliamentary Urgent Question

This morning, the Secretary of State for Health Jeremy Hunt responded to an urgent question from his shadow opposite Heidi Alexander on the leaking of the Mazars Report into unexpected deaths between 2011 and 2014 under the care of Southern Health Mental Health Trust.

I don't want to discuss the substance of the report here as it is ably being discussed elsewhere. Rather I wanted to focus on the 30 minutes in the House of Commons.

Because of the current unpublished status of the report, even with Parliamentary privilege, MPs were rightfully careful of their language. Yet the manner of Jeremy Hunt's statement should leave no doubt as to the status held of it by the Government and NHS England. 

Jeremy Hunt's Statement

The whole House will be profoundly shocked by this morning’s allegations of a failure by Southern Health NHS Foundation Trust to investigate over 1,000 unexpected deaths. Following the tragic death of 18-year-old Connor Sparrowhawk at Southern’s short-term assessment and treatment unit in Oxfordshire in July 2013, NHS England commissioned a report from audit providers Mazars on unexpected deaths between April 2011 and March 2015.

The draft report, submitted to NHS England in September, found a lack of leadership, focus and sufficient time spent in the trust on carefully reporting and investigating unexpected deaths of mental health and learning disability service users. Of 1,454 deaths reported, only 272 were investigated as critical incidents, and only 195 of those were reported as serious incidents requiring investigation. The report found that there had been no effective, systematic management and oversight of the reporting of deaths and the investigations that follow.

Prior to publication, or indeed showing the report to me, NHS England rightly asked the trust for its comments. It accepted failures in its reporting and investigations into unexpected deaths, but challenged the methodology, in particular pointing out that a number of the deaths were of out-patients for whom it was not the primary care provider. However, NHS England has assured me this morning that the report will be published before Christmas, and it is our intention to accept the vast majority, if not all, of the recommendations it makes.

Our hearts go out to the families of those affected. More than anything, they want to know that the NHS learns from tragedies such as what happened to Connor Sparrowhawk, and that is something we patently fail to do on too many occasions at the moment. Nor should we pretend that this is a result of the wrong culture at just one NHS trust. There is an urgent need to improve the investigation of, and learning from, the estimated 200 avoidable deaths we have every week across the system.

I will give the House more details about the report and recommendations when I have had a chance to read the final version and understand its recommendations, but I can tell the House about three important steps that will help to create the change in culture that we need. First, it is totally and utterly unacceptable that, according to the leaked report, only 1% of the unexpected deaths of patients with learning disabilities were investigated, so from next June, we will publish independently assured, Ofsted-style ratings of the quality of care offered to people with learning disabilities for all 209 clinical commissioning group areas. That will ensure that we shine a spotlight on the variations in care, allowing rapid action to be taken when standards fall short.

Secondly, NHS England has commissioned the University of Bristol to do an independent study of the mortality rates of people with learning disabilities in NHS care. This is a very important moment at which to step back and consider the way in which we look after that particular highly vulnerable group.

Thirdly, I have previously given the House a commitment to publishing the number of avoidable deaths, broken down by NHS trust, next year. Professor Sir Bruce Keogh has worked hard to develop a methodology to do this. He will write to medical directors at all trusts in the next week explaining how it works, and asking them to supply estimated figures that can be published in the spring. Central to that will be establishing a no-blame reporting culture across the NHS, with people being rewarded, not penalised, for speaking openly and transparently about mistakes.

Finally, I pay tribute to Connor’s mother, Sarah Ryan, who has campaigned tirelessly to get to the bottom of these issues. Her determination to make sure the right lessons are learned from Connor’s unexpected and wholly preventable, tragic death is an inspiration to us all. Today, I would like to offer her and all other families affected by similar tragedies a heartfelt apology on behalf of the Government and the NHS.

No-one reading that should take credibly the claims in the HSJ article this morning which ran with the counter claims of a tame academic appointed by Southern Health and having a partial extract of the report shown to them. Still its another example of the desparate lengths the Trust are prepared to go that is in the public arena. NHS England take note.

This was a shocked chamber that listened to and responded to Hunt's statement. There were two questions that reoccurred that need highlighting. 

The first question was when did the Secretary of State know about the concerns over Southern Health. The answer was early 2014. The issue about repeating this question is that there has been a delegation of power from the Department of Health to NHS England through the 2012 reforms. The Secretary of State cannot be hands on as previous secretaries of state were. 

As a result of repeated marketisation reforms, the NHS banner contains numerous separate legal entities. The ability to act has to be lawful and consistent. It is, in my opinion, this space that has allowed Southern Health to make 300 challenges which will have been legally argued as required. Here its worth noting Jeremy Hunt's response to Andrew Turner:

The commitment I have from NHS England is that it will be published before Christmas. I am confident that, whenever it is published, it will generate huge media interest, rightly so and partly thanks to the shadow Health Secretary’s urgent question. When the draft report was sent to the trust, it came back with 300 individual items of concern, and it was right for NHS England, in the interests of accuracy and justice, to consider fully all those concerns. It has given me an assurance, however, that, whether or not it can reach an agreement with the trust about its contents, the report will be published before Christmas.

An agreement with the Trust. Yet also note what Hunt said to Heidi Alexander that [w]e will not allow any further arguments about methodologies to stand in the way of the report being published before Christmas. I would suggest that any goodwill within Whitehall towards Southern Health has been burnt up.

The second question was around families not having access to legal aid to challenge NHS bodies. This placed Jeremy Hunt in a difficult position because it isn't his turf but that of the Lord Chancellor Michael Gove and the members asking the question knew that. Hence the line that with a properly accountable NHS with full family involvement that there wouldn't need to be litigation. A sentiment that I would like to see fulfilled as it would be an extraordinary achievement. Until that perfect world, the Ministry of Justice needs to be lobbied in order that the scales of justice are balanced. 

This 30 minutes merely sets the context for future events. Once the report is published then a full debate will follow. This is where the House of Commons can give direction to the Secretary of State and that then empowers NHS England. Publication shifts power balances and serious reports require serious actions.

I would want to see Southern Health broken up, the earth salted and its ashes scattered to the winds. Its board and senior management were too remote and separate from the actual practice of care. Its size and empire (property) building are emblematic of an unfit culture. I believe, based on experience, in rooting management in the community so that values are shared and mutually understood. This sector of the NHS appears aloof and outside of those processes. When the debate occurs, I hope consideration is made on that point.

Black Swans, Pink Flamingos and Southern Health NHSFT

Sometimes a concept serendipitously appears that helps shape my thoughts and today I came across Dr Frank Hoffman's Black Swans and Pink Flamingos article which does exactly that. Hoffman uses the concepts in relation to defence planning but they have wider utility. Since the inquest verdict into the death of Connor Sparrowhawk on Friday, I've been reflecting on its meaning.

The Black Swan concept has been popularised by the writings of Nassim Nicholas Taleb who used it in relation to financial events. As Hoffman describes “[a] black swan is an event or situation which is unpredictable and for which the consequences could not be measured”. You cannot plan for black swans but only cope with their aftermath.

A Black Swan event is exactly what two of my closest friends experienced when their youngest child contracted and died of neuroblastoma. The thing about neuroblastoma is that it is a childhood cancer which has no known genetic or environmental markers. It is a random cruelty that visit children under the age of ten.

It still pains me to remember their hurt, grief, dignity and bravery when their child died. The funeral is still fresh in the memory. That no-one witnessing that cruelty would be anything but heart-broken by it. It was a profound event for me and has been one of my motivations for my involvement with #JusticeforLB and #LBBill. The unconscionable behaviour that Southern Health NHSFT display towards Connor's family has been untempered by any empathy or sense of responsibility.

That sense of outrage remains after the considered, comprehensive and damning jury verdict. A verdict which fits Hoffman's Pink Flamingo concept. To quote Hoffman:

Thinking historically about the future means dealing openly with those things we want to avoid or are in denial about. These are what I call our pink flamingoes. A pink flamingo is a predictable event that is ignored due to cognitive biases of a senior leader or a group of leaders trapped by powerful institutional forces. These are the cases which are “known knowns,” often brightly lit, but remaining studiously ignored by policymakers.

Having read the timeline for @LBInquest (as tweeted over the fortnight by the phenomenal George Julian) and then the written verdict of the jury, I find Hoffman's concept resonates powerfully. The jury found that Connor's epilepsy was a known known, brightly lit by his family, and was studiously ignored.

Here 'policymakers' refers to both the clinical practice team at STATT and the corporate structures within Southern Health. Many of the criticisms of the jury should have been picked up by due diligence in Southern Health's takeover of Ridgeway which previously operated STATT. I thoroughly recommend Chris Hatton's blog Diligence My Arse for those wanting a more detailed analysis.

The take home point for the corporates in Southern Health NHSFT is that the jury has pointed accountability at you. Mouthing platitudes to the media and sacking a low level grunt doesn't absolve you of your responsibilities. However there is some useful advice in Frank Hoffman's article which you might reflect upon especially this: “[a] crash in the real world is not subject to “no fault” rules; there truly are consequences to complacency and to faulty strategy”.

In this case, the devastation inflicted on a family.

The jury agreed that multiple 'very serious failings' occurred under the watch of Southern Health NHSFT leading to a preventable death. Fault occur at all levels. It wasn't an unpredictable event.

To be honest, I'm still struggling with that. I can't imagine how Sara, Rich and their family can reconcile those facts. Life can be randomly cruel, it really doesn't need so-called caring organisations to inflict further cruelties. Yet Southern Health actions, especially post July 4^th 2013, have done exactly that.

As the media reports have given Katrina Percy the last word, I shall direct my final comments to her: kindly shut up, take some responsibility and resign.

Rose Tint My World a message for Labour leadership candidates

It was great when it all began

I was a regular Tony fan

But it was over when he had the plan

To invade Iraq and Aghanistan...

Ian Dunt has today written an article on stategy, cynicism and idealism which resonates with a twitter discussion I had yesterday with a fellow Labour Party member on using themes such as Tax Justice to make the Party more electable. To quote Ian's salient point:

Labour seems to have split into three factions: The beige, the red and the white. The beige – represented by Andy Burnham and Yvette Cooper - are mechanical, seemingly without political values, poor to middling media performers and change according to the prevailing political weather. Burnham, for instance, was a Blairite under Blair, a Brownite under Brown and a Milibandite under Miliband. Under none of those personalities did he appear to be a winner. The whites, representing the white flag contingent and currently led by Kendall, have only one tactic: surrender. They are Blairites without any of the intellectual underpinnings. The reds, under Corbyn, are singing from the same socialist hymn sheet as ever, with absolutely no changes, either ideologically or tactically, since the 1970s.

Is it so much to ask that we could ignore the beige, but have a little bit of red and white together? It is possible to get a genuine leftist into Downing Street, but it requires giving up on some of the political purity which seems to motivate Corbyn's supporters.

Ian Dunt ends his article by stating that Jeremy Corbyn and Liz Kendall have a lot to learn from each other if they sat down and listened to each other. I agree with this sentiment.

What I found interesting about the theme of Tax Justice was that Jeremy and Liz were approaching the subject from opposite ends but both were developing the theme: e.g. Liz's request of Margaret Hodge to look at the world of corporate welfare and Jeremy adopting the arguments of Richard Murphy that HMRC should calculate tax revenues using GDP (tax gap in excess of £100bn) rather than their own tax returns (tax gap of £35bn).

The ideas of how we collect taxes and where we spend them are two sides of the same coin.

So my proposal to my comrade was a mixture of cynicism and idealism. I proposed that part of the increased revenues from an aggressive HMRC operating on Tax Justice principles be used to reduce income tax on middle earners up to £100k to 35p in the pound.

We know that the wealthy through various accountancy-inspired schemes pay around 35% of income. The middle classes therefore pay a higher proportion of income. So reducing the percentage paid in tax by this cohort has some notional fairness to it.

I also think we shouldn't forget the lesson of the 1992 election when John Smith's tax proposals scared those who were struggling particularly in the over-heated South-East despite having what seemed reasonable salaries. The same conditions exist today so the Party needs to avoid scaring people with headlines about high taxation.. So by having a policy that supports the 'middle-classes' as defined by the Daily Mail would park the tanks on traditional Tory ground.

Given the increasingly blunt tool that is Income Tax for collecting from high earners, being creative in alternative tax devices to capture from the wealthy would be sensible and show some learning from George Osborne. This would mean giving up the symbolic 50p threshold that defines the Party as being anti-hard-working-families types (pass the sick bucket vicar). Less symbolism, more practical policies please.

Tax Justice with ensuring that the majority benefit from it would cause the Tories some difficulties and present problems to right-wing newspapers as well. It is a policy that is both cynical and idealistic.

So my message to the four leadership candidates is to rose-tint our world with smart polices. Don't dream it, be it...

Beyond the Valley of the DoLS

A quick post on why Deprivation of Liberty Safeguards (DoLS) are a shared problem.

It is perhaps the most depressing part of recent social media comments I've read that describe DoLS as an industry within social care. This fails to recognise that Local Authorities (LAs) are responding to the 2014 Chester West & Chester Council v P judgment which found that LAs were applying DoLS (part of the 2005 Mental Capacity Act) incorrectly.

The response to this judgment is that councils up and down the country have had to scramble reassessments to ensure that their placements were within the law. Figures gathered by Andy McNicol show that 110 councils have identified almost 18,000 cases.

The essential problem is that judicial oversight is required because people's liberties have been compromised. Despite the attempts of Justice Mostyn to rule for a more 'common sense' approach to DoLS, that has been overruled by a higher court. Given where we are, the current consensus is that judicial oversight is better than the alternatives.

The difficulties that LAs have is that this additional cost comes out of current budgets and resources. There is no unlimited Whitehall pot to draw down funding for the assessments and the court costs. A one-off  £25m has been found but this is inadequate given the scale of the problem. The time and the majority of the expense has to be found internally. This at a time when LAs grants are being squeezed considerably. Half a million people have stopped receiving social care support as a result of austerity in local government. Diverting money to resolve the DoLS crisis adds to that number.

There is no benefit to LAs for this situation as it creates a beggar my neighbour approach in deciding budget expenditure. To call it an industry ignores other service users who are seeing their services reduced or cut and it also ignores that LAs have had this additional workload thrust upon them.

The lack of court applications shown by Andy McNicol (286 applications out of 17,829 identified cases) is further evidence of this crisis. There is simply not the resources available to cope. An industry? LAs are being criticised for not making applications as Steve Broach does in his recent blog on the subject.

The author of the "industry" quote, Mark Neary, has an interesting blog on how DoLS assessments are being extended to assess supported living arrangements such as his son Steven by Hillingdon Council. This extends the provisions into the area that Lucy Series has argued should have been the case since 2005. My suspicion is that the broad concept of 'Wellbeing' in the 2014 Care Act has informed Hillingdon's decision here.

If you talk to everyone involved with DoLS, they'll tell you that we need to find a better way of protecting people's rights without the level of cost or legal requirements currently involved. Everyone will be in favour of a Goldilocks solution. Getting agreement on that Goldilocks solution however feels a long way away. How do you enforce a framework without recourse to the law? What happens if judicial oversight is re-enforced by a further Supreme Court judgment (a back to square one scenario)? What if you cannot separate DoLS from judicial oversight as trust in LAs are non-existent (see Mark Neary)?

 This is a shared problem between service users, carers, local authorities and the legal system. If everyone acts in opposition to each other then hope for a reformed DoLS working will be pie in the sky. There is no magic framework that the Law Commission can provide or an unlimited cheque from Whitehall to fund judicial oversight or increase social care budgets to resolve this issue. The first step is to accept it is a shared problem. Only then can we move towards resolving it.

A clash of ambitions

Today (Tuesday 3rd March) has been an interesting day for the contrast between my morning spent in London discussing the 2nd draft of the Laughing Boy Bill (LBBill), a movement to see enacted in law changes that will improve the lives of people with learning difficulties and/or autism, and this afternoon/evening spent following the debate to set the 2015-16 budget for Birmingham City Council (BCC) where the Labour administration is having to enact £85m of cuts for the next financial year alone.

Now I have considerable sympathy for the position that Sir Albert Bore et al find themselves in. This is unprecedented in terms of scale. Yet some of this has been self-inflicted by successive administrations to favour the city centre development over citywide responsibilities. So in my area of interest, adult social care, Birmingham City Council is underspending comparatively with other metropolitan areas by 2.5% of budget or £39million in cash terms. That is an outlier that is significant by any stretch of the imagination.

It cannot be said with confidence that the budget that will be set today will meet the statutory requirements on the city as the 2014 Care Act comes into effect from April. Its an difficult juxaposition where Whitehall expectations are increased while the grants for BCC are decreased. If the consultation, budget or any service provision were tested legally, BCC would probably have more difficulties than the contingency fund would allow.

Against this, the 2nd draft of the LBBill sits as a statement of intent. In particular, clause 4.4 of the 2nd draft which asserts duties above financial resources. As a principle, this is absolutely right. In practise, if this culture of austerity for local authorities continues, it will inflict more pain on the functioning of any authority. It makes me uncomfortable because I know that 2015-16 isn't the worst point for Birmingham City Council. 2016-17 and 2017-18 will be harder still as the cuts drive deeper. Its against this background that I and others hope that Sir Albert, John Cotton etc will start working with us and others interested parties from May 8th to help the city mitigate the worse aspects of 2016-17 onwards and close that gap with comparable cities. Its a hard road ahead.

Against that, the 2014 Care Act does reduce the ability of local authorities to use financial considerations as a basis for setting who qualifies as having statutory needs. The imposition of national standards does challenge the 1997 Gloucestershire Judgement that local authorities have used to tighten qualification of substantial or critical needs. So clause 4.4 can be said to work with the 2014 Care Act. This will be tested in court soon I suspect.

So the optimism I felt this morning at Monckton Chambers with the diverse and knowledgeable individuals and organisations around the table, both in person and the disembodied voices on speakerphone, has been tempered by the ugly reality that is occurring in Birmingham's Council House.

Yet the ambitions of LBBill has to happen. We cannot compromise on the principle that underpins LBBill that is everyone has the right to live their lives however messy that may be. That it may make local government's life more messy is something we'll have to live with.

Evaluating Simon Stevens Dowry

After over a year's wait for a blog, two come along inside a week...

After Tuesday's blog describing the discombobulation of NHS England's Simon Stevens when asked  to consider the concept of fairness, I have found myself continuing to think about the dowry proposal made prior to that moment. It needs to be unpacked as a concept because I think it tells us a lot about the thinking that is happening and thinking that is not happening currently.

If we look at the exchange as transcribed here:


Q63 Austin Mitchell: I just want to pursue the financial imperative. The targets were overambitious for financial reasons: the fact that the money did not follow the patient created local resistance to having the patients. Paragraph 2.24 says, “Meeting the needs of people in the community, who NHS England previously funded in hospital, is a material cost to local commissioners. This can affect their ability to provide appropriate and sustainable care packages. Hospitals subsequently experience significant delays in discharging patients while complex negotiations continue”. This must mean that you can speed up the process through a fairer, better financial arrangement with the CCGs and local providers.

Simon Stevens: What makes this complex is that you have two sets of things going on there. One is that there are a group of people who have been in institutional care for a very long time. When you talk about moving them, as we will be when we are closing some of these facilities, you need to take the old mental health model—we talk about dowries and funding endowments that move with people, and those might be partly with the local authority and partly with the local CCG. If you look at the fact that a fifth of people in in-patient settings have been there for more than five years, those are the sort of folks for whom you are talking about dowries. But for people who have been in an in-patient setting funded by specialist care for three or six months, that is not so much about their ongoing support for ever; that is a moment in time when they are getting something. Distinguishing between those two categories is what we have to do. Some of this will have to be dowry-type arrangements; some will just have to be about a recognition that, actually, this is the CCG’s or the local authority’s funding responsibility, and they will have to step up to the plate.


On a superficial reading, the response made by Simon Stevens could be read as though some thought had occurred before sitting in front of the Select Committee. However there are some jarring inconsistencies of thought occurring that are troubling if we are to take the rhetoric seriously.


The first point of contention comes with the notion of the dowry itself. What exactly will NHS England be funding with this dowry? If the care plans are accurately assessed then the needs of the individual receiving the care package have to be statutorily met. So will any such dowries be providing additional non-statutory needs or is this an implicit admission that the funding streams of CCGs/LAs are not sufficient to provide statutory needs? Is this about the needs of the service user or the needs of service funders?

Then there is the usage of years institutionalised to determine whether the individual requires a dowry as oppose to those expected to be pick-up by CCG/LA spending. How exactly will NHS England determine the qualification for this dowry? Will it focus on enablement? A problem with this is that there doesn't appear to be any evidence for that particular cohort being any more requiring of deinstitutionalisation than those who are there for six months or three years. This isn't person-centred policy based on needs but rather an arbitrary qualification of time that seems to have been plucked out of the air. I can't help but think of Mark Neary's excellent blog and that one of the consequences of his son Steven having spent a year in an ATU has been the need to permission-seek for actions such as going to the toilet as a result of his previous institutionisation.

These questions are particularly important in terms of the concept pursued by the members of the Select Committee of "the money following the patient" (NB for the Select Committee - they are people who aren't ill just because they have LD/ASD). In this context, the dowry concept seems less about facilitating this concept as blocking it. My cynicism would suggest that Simon and his colleagues should be viewing this issue as an efficiency opportunity for NHS England. That isn't a bad motivator in itself as it is more likely to see some change forced through. But for that motivator to work, the incentive needs to be that NHS England retains a sizeable proportion of the spending or in other words ensuring the money doesn't follow the individual. The dowry concept with its years incarcerated qualifier would allow NHS England to retain 80% of its spending. But as I said, I'm cynical.

Indeed with the challenge that Simon Stevens has set NHS England of finding £20bn of efficiency savings and our current cohort of politicians indulging in magical thinking as to bringing together two underfunded services (Health and Social Care) and expecting them to find that their deficit funding disappears, its no wonder that throwing a bone such as dowries occurs.

So I have questions for the Select Committee - what exactly are you attempting to achieve by this notion of "the money following the patient"? What exactly are you funding with it and for what purpose? What does fairness look like to you in this context?

Perhaps I'm being unreasonable to the Public Accounts Committee here but there doesn't appear to be much awareness of how the funding creates action or resistence. Simon Stevens is clearly telling the Select Committee in the answer quoted above that he needs to retain a significant proportion or there isn't the incentive to create change. Hence the discombobulation when Austin Mitchell followed up with the "so you think the funding is fair?" question. Fairness to the individual was the last thing on Simon's mind.

Yet I think Simon has a reasonable argument here given the financial pressures NHS England are under and that if keeping a significant proportion of the spend to allocate elsewhere sees the majority of ATUs shut down then that is a compromise worth making.

What I would advise Margaret Hodge and her colleagues on the PAC is to focus on a more holistic approach to achieving the goals of reducing institutionalisation. Abandon the money following the individual approach and instead split the money being spent on this cohort in three ways: a transitional fund to help CCGs/LAs budgets when any individual moves into the community (this can be graduated for need); developing more community-based specialist mental health services; allowing NHS England to redistribute the remaining savings. The precise proportionality can be debated but lets create incentives to move people into the community and support them when they are there.

The statutory responsibilities on CCGs and LAs to provide care and support  need to be funded properly in themselves. This is where the direction of travel re merging health and social care provision needs to be discussed with honesty rather than magical thinking. Just grabbing part of NHS England's budget as Margaret Hodge suggested to Simon Stevens is also counter-productive as it creates resistence and most likely perverse outcomes. The environment of health and social care post May 7th will be a very contested space regardless of what sort of government emerges.

The need for more thinking about what outcomes you want to achieve and less glib statements that sound good is necessary more than ever. Trouble is I think it will be a long long time before it happens. Perhaps that why this song is in my head this morning.

Simon Stevens Failure is not an Option

Another in a very occasional series of blogs.

Yesterday (Monday 9th February 2015) in the Boothroyd Room of Portcullis House, the House of Commons' Public Accounts Committee chaired by Margaret Hodge met to receive evidence for their inquiry into Care for people with learning disabilities.

As noted on Twitter by Chris Hatton, there was a real disconnect between the mood of the Select Committee and those witnesses appearing in the second half of the hearing. 

Those witnesses were: Una O'Brien, Permanent Secretary, and Jon Rouse, Director General, Social Care, Local Government and Care Partnerships, Department of Health, and Simon Stevens, Chief Executive, and Jane Cummings, Chief Nursing Officer, NHS England.

There was a feisty attitude to the committee members questioning as to why the stated target to move approximately 3,000 Learning Disabled (LD) and/or Autistic Spectrum Disorder (ASD) people out of units following the outrage of Winterbourne View by June 2014 failed.

This was a target that had little bearing on the reality of how commissioning and supply works for LD/ASD people and although traction for the target wasn't helped by the 2012 health reforms, the cultural issues surrounding responsibility and accountability extend further back. It is therefore with a raised quizical eyebrow and copious amounts of salt that I took Simon Stevens commitment to "substantial transition" in the next eighteen months.

This isn't to disbelieve the sincerity of Simon when he states that they "cannot defend the indefensible" but rather that the siren voices of caveats and funding will lure his attempts onto the rocks.

The most significant exchange for me starts at 16:37:30 when Austin Mitchell, whose questioning style is generally languid, starts discussing the failure of the money to follow the LD/ASD individual and that there are disincentives in local authority funding to facilitate the transfer into the community.

This point re local authority funding is vitally important to grasp. To explain, lets use another NHS and local authority cooperation - the transfer of elderly people with care needs out of hospital and into community facilities. This is a constant dialogue between the NHS and LAs with peak demand for flow happening in the winter. To meet the peak demand requires a market response to provide the community spaces and support required and markets respond to funding signals. Yet the funding flow from NHS to LAs operates as if the market capacity responds to a 'just in time' signal. Such an approach is fine if you have automated assembly lines but less so when the largest resource is people. If you are not prepared to pay for excess capacity then time lags will occur and any additional monies thrown at the problem as Jeremy Hunt has done is asking people to retrofit capacity.

So funding flow is important and consistency of funding is important to developing the market capacity required to enable the stated ambitions of Simon Stevens here. Austin Mitchell touches on this when finishing his question by suggesting that the process of transfer could be speeded up by a "fairer" funding settlement.

Simon Stevens response to this is to separate those trapped in the system for a long time (more than five years) and suggests using the dowry model that facilitated the closing of mental institutions in the 1980s with those who been in the system for three to six months where the CCGs or LAs will have to pick up the tab. Note that those who been in the system for 1-4 years aren't being considered in this response.

Austin Mitchell then asks the killer question at 16:39:40: "so you think the funding is fair?"

To use cricketing metaphors, this was the equivalent of a medium paced mid-70s mph trundler bowling a 90+ mph throat-high bouncer that Mitchell Johnson would have been proud of. Watching Simon Stevens body language disintegrate faster than an English batsman facing Mitchell Johnson was quite amusing.

Simon then pulls himself together with the cop-out phrase "its an accident of history". Ladies and gentlemen - welcome to the bullshit zone.

I have to thank Austin Mitchell for asking the right question here as it exposed the thinking here as being limited to "Houston, we have a problem". I don't knock the acknowledgement as the journey has to start with this step but its clear that the stated aspirations as reported by David Brindle haven't remotely been thought through.

This is why two and a half years down the line, work around pooled budgets remains at the starting gate when discussed at the PAC yesterday. A fair settlement starts with what it means to live as a LD/ASD person in their community and to live life to the full. Not as Jane Cummings suggests "as normal as possible" but to live a messy life of their choosing. Any funding settlement needs to follow and facilitate those principles. Its why campaigns such as the LBBill are so important - these need to be legal rights. Those committee members agreeing with a rights-based approach should take note.

My lasting impression of yesterday was that any thinking around this was couched in terms of the conflict of funding streams between health and social care rather than cooperation. The contested space that is the Better Care Fund which is being used more to retain existing LA services than developing new cooperative working as the NHS resents the top-slicing occurring as they experience real terms cuts to their budget. Against this background, it felt as though costs were expected to be pushed from one part of the system to another. Any idea of "fairness" in funding was therefore a shocking concept.

The top-down instruction to get people out of ATUs isn't a bad thing but we need to pool our intelligence to design the mechanisms properly else we'll Heath Robinson the process and create problems down the line. So thinking of Apollo 13 again, this scene resonates somewhat...