Archive for ‘Uncategorized’

June, 2014

The Political Nature of Planning: What Happens if UKIP Get In?

Dr Mike Beazley

Director of the Centre for Urban and Regional Studies (CURS)

ukip

I have always thought that planning is critical to the saving human’s agenda. The origins of planning that were tied up with a housing and public health legislative response to the squalor and deprivation we found in our 19th century cities provided a strong drive to improve the quality of life for people living in our cities. The concept of the “public interest” has been a central feature of the system since then – although this concept has been contested at times planning has been very much about making our towns and cities better places to lives and to improving the quality of life for local residents. Recently it is a very interesting time for the urban planning in England. Planning in many ways has been under attack. We have witnessed considerable planning reforms since the Coalition Government were in power with the arrival of the National Planning Policy Framework, the revocation of the Regional Spatial Strategies and introduction of the neighbourhood planning and community rights agenda under the Localism Act 2011. Moreover, planning never seems to be far from the news particularly in relation to the current housing crisis, building homes on the green belt, the potential re-emergence of garden cities, major infrastructure projects such as HS2, developers potentially running amok in the British countryside and this government’s clear antipathy towards wind farms.

The recent surge in the popularity of UKIP got me thinking about what might happen to planning if UKIP got into power and having control over local councils in any meaningful way. According to a recent edition of Planning magazine their manifesto has some interesting planning proposals including:

  • Measures to attack “major developers with large cheque books”
  • Pledges to protect the countryside from house building by controlling immigration
  • Identifies potential “incentives” to bring 800,000 empty homes into use
  • Pledges for referenda on major local schemes
  • A proposal to scrap planning gain mechanisms such as section 106 agreements
  • A proposal to return the old system of local and county development plans
  • Opposition to both HS2 and wind farms

Wind farms

HS2

It seems that a lot of these proposals are actually a bit contradictory and certainly do not seem to add up to a sensible way forward. Certainly the proposal to potentially scrap section 106 agreements is highly questionable as this has been an important tool for planners to negotiate important community benefits from developers in return for planning permission including affordable housing. These are described as “community bribes” in the manifesto but are in reality an important part of the planner’s toolkit to secure appropriate development.

Unlike the other parties the UKIP agenda presents a very anti-development stance and certainly flies in the face of the pro-growth planning agenda of this government. But it could appeal to a number of voters who potentially feel threatened by recent housing proposals or major projects such as HS2 and provides and interesting challenge for both planners and developers should UKIP manage to gain any further momentum in future local elections. But I suppose the issue is to watch this space and to see how UKIP’s stance on planning and development issues develops into the future and toward the next elections.

 

June, 2014

Quality Management at the Cancer Research Clinical Trials Unit (CRCTU)

Isobel Hawley – Quality Assurance Manager

110614 image

When I was a child my father drummed into me the importance of paying attention to detail. His actual words were, “always pay absolute attention to absolute detail”. I remember a lot of rolling of eyes (on my part), but he was right (and still is for that matter – thanks Dad!). Now it’s my job to pay attention to detail – as Quality Assurance Manager at the Cancer Research UK Clinical Trials Unit (CRCTU). It certainly wasn’t what I was planning when I graduated with a degree in Russian and French…but many years later, my focus in life changed when a friend’s 3 year old child died of cancer. My previous mild interest in things medical (a lifelong addiction to watching Casualty on Saturday nights) developed into an earnest desire to make a contribution to cancer research, and in 2006 I applied for a job as a Clinical Trial Monitor at CRCTU in the University of Birmingham and I’ve been a member of the Quality Management Team ever since.

Clinical Trials are vital for improving cancer treatments and making them available to patients. The Quality Management Team plays an important role in supporting the conduct of clinical trials at CRCTU, by developing and maintaining a Quality Management System which provides a framework of Standard Operating Procedures, tools and templates to assist all staff in conducting trials to the highest possible standards and ensures adherence to relevant legislation. In the UK, the conduct of clinical trials of Investigational Medicinal Products (trial drugs) is governed by complex legislation and guidance including the 2004 Medicines for Human Use (Clinical Trials) regulations, the Data Protection Act, the Research Governance Framework, Good Clinical Practice and the Declaration of Helsinki.

The regulator in the UK is the MHRA (Medicines and Healthcare Products Regulatory Agency) and CRCTU is subject to inspection at regular intervals. The legislation has recently undergone a review and will soon be replaced by a new European Clinical Trials Regulation which aims to speed up and streamline the conduct of trials across Europe. It is hoped that the new Regulation will achieve its aims – many of the paediatric trials coordinated by CRCTU need to embrace international collaboration in order to recruit sufficient patients to complete the trial in an appropriate timeframe; recently the BEACON trial for children with neuroblastoma opened to recruitment in France and will open in further European countries over the coming months.

Our team of dedicated Monitors travel the length and breadth of the UK, visiting the hospitals where the clinical trials take place. The team is currently responsible for on-site monitoring of more than 30 trials, across multiple diseases (breast cancer, prostate cancer, lung cancer, leukaemia, sarcoma and all paediatric cancers) including the AdUP prostate cancer trial mentioned in Monday’s blog and the STOMP trial for lung cancer patients discussed in Tuesday’s blog. The Monitors meet with the Clinicians and Research Nurses to discuss the trial, providing training, updates and feedback from the Trials Office and a friendly face to help out with any queries. They perform checks on the paperwork at the hospital site – reviewing the medical notes of the trial patients to ensure that all patients are eligible for the trial according to the protocol criteria, checking that the patients have given their written consent to participate in the trial, that the correct trial treatment protocol has been followed and any adverse effects of the treatment have been reported to CRCTU. These on-site monitoring visits help to safeguard the rights and well-being of the trial patients and ensure high-quality data is obtained for analysis by the trial statisticians, ultimately leading to evidence-based improved treatments for patients with cancer.

Further useful links:

May, 2014

The Risks of #BringBackOurGirls

Dr Scott Wisor

Two years ago, the #Kony2012 campaign was launched by the activist group Invisible Children, and the accompanying video quickly became the most watched in the history of youtube. The campaign aimed to make the leader of the Lord’s Resistance Army ‘famous’, so that his crimes would be known and governments would be pressured to capture him, ending the LRA’s reign of terror in Central Africa. Despite the initial popularity of the campaign, it was widely derided by activists and academics, especially from Uganda. Among other complaints, the campaign was factually inaccurate, completely detached from the actual social and political context, focused on one particular strategy (military intervention) to the exclusion of a more comprehensive approach to peacebuilding and development, and it overrode the priorities of local civil society groups.

A number of commentators have discussed the similarities and differences between #Kony2012 and #BringBackOurGirls. Unlike #Kony2012, #BringBackOurGirls was started by local activists, and is at least somewhat consistent with their goals—namely, to pressure the Nigerian government to secure the release of the kidnapped girls.

Nonetheless, there are still risks that the campaign will prove counterproductive. First, local activists may lose control of the campaign’s message, especially with regard to policy requests that are being made of governments.

Second, the immediate reaction of many public officials has been to call for Western military intervention. It is hard to think of a greater recruiting tool for Boko Haram than a Western military presence in Nigeria. And if US troops were deployed, and some injured or killed, would they be drawn into further conflict? Might the risk of foreign intervention jeopardize negotiations for the girls’ release?

Third, many people embracing the campaign are entirely unaware of the context in which these kidnappings have occurred. Perhaps there was no more blatant dismissal of the national level political and economic dynamics in which Boko Haram has arisen than when Senator John McCain, never one to turn down an opportunity for military intervention, proclaimed that he would send in troops to rescue the girls “in a New York minute”, without the permission “of some guy named Goodluck Jonathan”. That some guy, President of Nigeria, Africa’s second largest economy, is precisely the person Nigerian activists are pushing to secure the release of the kidnapped. Perhaps best for the girls, and more general diplomatic reasons, not to brush him aside.

Fourth, and most importantly, the huge amounts of publicity being generated by the campaign are playing directly into Boko Haram’s hands. The entire point of terrorist activities is to spread a message among a wider population (in contrast to tactical military attacks). This message may be used for a variety of purposes (recruiting new members, portraying an adversary as weak, drawing an adversary into drawn out asymmetric warfare, etc.), but it requires a megaphone to work. With the spread of #BringBackOurGirls, in the words of Will Moore, “Boko Haram is winning, and you are helping”.

Fifth, by portraying Boko Haram as terrorist kidnappers, the Nigerian government may be portrayed as the good guy, escaping criticism for its own poor record on human rights. Many critics of the #Kony2012 campaign noted that the Ugandan government deliberately protects Kony when international forces are close to capturing him. This allows the Ugandan government to continue to receive military assistance for its efforts and to avoid scrutiny for its own violations of human rights.

And finally, the campaign focuses exclusively on domestic causes of human rights violations, ignoring the causal role played, for example, by the conduct of Western oil majors in harming local communities and the role of oil revenues in undermining the capacity and responsiveness of the Nigerian state.

So while there are important differences between #Kony2012 and #BringBackOurGirls, activists must still reflect on their own power, the context of human rights violations, and the unintended consequences of well-intentioned advocacy. It is possible to contribute to local activist efforts to prevent and remedy human rights abuse, but outsiders must tread lightly, be aware of local context, and guard against unintended harm.

Further links:

Mahmoud Mamdani, Saviours and Survivors

Alison Jaggar, Saving Amina

Linda Martin Alcoff, The Problem of Speaking for Others

International Crisis Group, Background to the Conflict

Beyond Kony2012

May, 2014

Piketty and the Vicious Circle of Inequality

Dr Scott Wisor

seesaw

The academic book of the moment (perhaps the decade) is Thomas Piketty’s Capital in the Twenty First Century. You are not a serious member of the public commentariat unless you have aired your views on the book’s length or the author’s looks. Capital is primarily about the evolution of economic inequality in developed economies. Piketty has built an enormous dataset tracking inequality over time in France, Britain, the US, and the UK. To a lesser extent the book examines inequality in other countries.

Some commentators on the book have argued that Piketty’s predictions that inequality will continue to grow in this century will not pan out. They argue that rising global growth rates, driven by ongoing industrialization in emerging markets, may outpace the rate of growth of capital. Or that the rate of growth of capital may decrease if technological advances slow or some other exogenous shock reduces returns on investment.

But the important insight from Piketty is not that there is an iron law by which inequality grows under capitalism, but a risk that it will grow if constraints are not in place. Important here is not simply the economics of inequality, but the politics.

In the US in particular, there is a risk of entering (perhaps this has already happened) an inequality spiral. Two previous ‘big books’ in development make just this prediction. James Robinson and Daron Acemoglu argue in Why Nations Fail: The Origins of Power, Prosperity, and Povertythat countries with extractive political institutions fail to prosper because entrenched special interests prevent innovative growth from occurring. The authors suggest that the US may be moving from inclusive to extractive institutional arrangements. Similarly, Angus Deaton, in The Great Escape: Health, Wealth, and the Origins of Inequality, suggests that high income inequality risks turning a democracy into a plutocracy, which in turn will undermine the possibility of innovative growth and shared prosperity.

What is the mechanism by which this occurs, and what is its impact on individual lives?

Think of an individual’s well-being as a function of three features of their economic life: the value of the income they receive, the loss (or gain) from taxation and post-tax transfers, and the value of publicly provided goods, both direct (such as health care, security, and environment) and indirect (such as a clean environment) from which they benefit.

In a highly unequal country, where pre-tax income rises for the best off and stagnates or falls for others, if there are not strong constraints blocking the excess political influence of the best off, one anticipates several inequality-causing political phenomena. First, the very well-off will work to restrict the political influence of the worse off. This may happen through limiting restrictions on campaign finance or increasing restrictions on political participation. Second, one expects this increased political power to be used to reduce taxes (especially but not only for the best off) and a related reduction in post-tax transfers. Third, one expects reduced support for publicly provided goods, like health care and education. Because the financially wealthy and politically powerful can afford to educate their kids and pay their doctors, they see less need to support public health and education.

So perhaps it matters less whether an inherent feature of capitalism is rising economic inequality and more that there is a likely connection between economic inequality and political inequality, which threatens to create greater inequalities not just in income, but in public goods more generally.

Further useful links:

Capital in the 21st Century 

Why Nations Fail 

The Great Escape 

‘Fixing’ campaign finance is only making it worse

Supreme Court Invalidates Key Part of Voting Rights Act

The Rise of the Super-Rich Power Resources, Taxes, Financial Markets, and the Dynamics of the Top 1 Percent, 1949 to 2008 

Power fluctuations and political economy 

Inequality and Unsustainable Growth: Two Sides of the Same Coin?

Image: http://www.cagle.com/2011/11/seesaw-inequality-2/

 

 

May, 2014

Taking Global Poverty Stats for a Joyride

Dr Scott Wisor

Earlier this month, some very committed and talented people at one of my favourite think tanks, the Centre for Global Development, took global poverty estimates for a bit of joyride. (A similar effort occurred at the Brookings Institution, but I will focus on CGD here). The occasion was the release of the International Comparison Program’s latest round of price information. To compare economic activity across countries, it is necessary to compare the purchasing power of different currencies. This information cannot be gleaned from currency exchange markets, which fluctuate wildly and don’t tell you anything about how much you can buy once you change your pounds into rupees and arrive in India to spend them. To compare purchasing power across countries, the International Comparison Program tracks prices for a huge range of goods from all across the globe. By comparing like to like, you should be able to determine how many rupees are required to purchase the same quality items you purchase in the UK.

If you think the World Bank’s method of calculating absolute poverty at USD 1.25 per day is a reliable way of tracking the levels and trends of global poverty (I don’t), you might think a quick update on global poverty statistics based on the latest ICP is in order. Although the method used by researchers at CGD and Brookings cannot give any meaningful interpretation of the state of global poverty, they nonetheless gave it a try. By using the new ICP data, the authors estimated new poverty counts for all countries and found a considerable drop in the number of poor people. However, these efforts mistakenly assume that the new price information applies to national consumption and income figures but not to the setting of the poverty line itself. (Instead, the authors simply update the global poverty line using US inflation). As Martin Ravallion, former architect of the Bank’s poverty assessments notes, this is misguided and deceptive. The poverty line itself needs updating using the new price information, rather than simply updating the line using the US consumer price index. Kashuk Basu ,chief economist at the World Bank, also cautioned against using the new ICP data for international poverty comparison.

I don’t like the Bank’s method for measuring global poverty, and its flaws are inherited by other efforts undertaken by Brookings and CGD. Briefly, the method for setting the poverty line is implausible (an averaging of the poorest countries national poverty lines even though those poverty lines may not be plausibly anchored or even democratically discussed), and the method of making comparisons across contexts and over time takes account of the amount and prices of goods consumed across the whole economy, rather than focusing on those goods that are most consumed by poor people. This greatly risks understating the extent of global poverty. Why? Because if the prices of basic necessities rise (for example, the price of food) while the prices of goods consumed by middle and upper classes fall (for example, the price of big screen televisions), both will affect calculations of global poverty, even though only one is relevant to determining how well or badly poor people are faring.

One way to independently assess whether the global poverty figures are giving good information is to examine other indicators of human deprivation that are not related to figures on income and consumption. For example, how did it come to be that only 8.3% of Indians are poor after the new poverty calculations, but according a recent report on India’s children “approximately 60 million – are underweight, about 45% are stunted (too short for their age), 20% are wasted (too thin for their height, indicating acute malnutrition), 75% are anemic, and 57% are Vitamin A deficient.” Surely it cannot be that a child is at once free from poverty and unable to meet minimal nutritional requirements to grow.

Consider how a single country was treated in these revisions. The Philippines’ poverty rate plummeted dramatically according to CGD’s PPP revisions. Only 2.5 million people (about 2.6%) in the country are poor. On the Philippines’ own national poverty lines (one based on the cost of only simple foodstuffs, the other based on the cost of basic foodstuffs and other basic needs) the figures are much higher (10% and 24%, respectively). Using the multidimensional poverty index, the Philippines poverty rate is also higher than CGD estimated. In measurements using the Individual Deprivation Measure developed with several colleagues over the last four years (to be debuted later this summer), we found in a nationally representative survey that 48% of Filipinos count as deprived, very deprived, or severely deprived. Using the World Bank’s old method of calculating poverty at the higher 2.50 USD 2005 PPP line, 41% of Filipinos are poor. When CGD pronounces that almost no one in the Philippines is poor, as opposed to half the populations as other measures indicate, then one gets the impression that poverty is a small problem.

In my view, it is professionally irresponsible and morally objectionable to proceed with analysis of global poverty statistics in a way that implausibly suggests poverty is in fact much less of problem than previously supposed. (I equally think it is irresponsible to overstate the extent or trend of global poverty, as much commentary does). Why? Because how people perceive global poverty matters. If it is a problem that is not so big after all, and diminishing over time, then it is not very urgent that people take steps to end it.

Once this information is posted, it spreads. The Washington Examiner (as one example) ran an article headlined ‘Number of global poor falls in half’. Well, that is great news. Except that it probably isn’t true.

The CGD blog post ends on a puzzling note. They write: “Perhaps most importantly, it is worth repeating what didn’t change between Tuesday and Wednesday.  The people who have just been classified as ‘not absolutely poor’ don’t actually have any more money than they did yesterday, and will still struggle in terms of getting a decent job, and many still face grim daily tradeoffs between buying school supplies or ensuring their kids are well nourished.  In fact, if the new PPP numbers suggest anything it is that the quality of health or education or access to services associated with a given income has just gone down. The new numbers are good news for people who care about poverty, but they matter much less for people who are poor.”

But there aren’t two moral perspectives here, one the view of the poverty statistician and the other the view of the poor person. The only morally relevant consideration is the deprivation and hardship that people face. It is hard to see what good came from proclaiming that much of this deprivation and hardship is not evident in a rough calculation of new poverty numbers. Better to not make any pronouncement at all on the implications of the new price comparisons than to proclaim rapid poverty reduction as a result of calculations which are arguably mistaken and misleading.

 

May, 2014

Offsetters or Activists?

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Dr Scott Wisor

Last month the IPCC released the third of four reports due out this year, updating assessments from 2007 on the problem of climate change. The findings are stark, but more or less consistent with past estimates. Despite ongoing international attention since at least 1992 (in the form of the Kyoto process), concerns by governments dating back to the 1950s, and a global financial crisis that slowed some of the economic activity that contributes to climate change, in the 5 years since the last IPCC report, greenhouse gas (GHG) emissions have continued to increase. The IPCC now gives us about a decade to begin to turn the rising tide of GHG emissions, or the costs of avoiding catastrophic climate change (exceeding 2 degrees Celsius global temperature) will be extremely high.

What are individuals morally required to do in light of the ongoing harm caused by GHG emissions? Perhaps no one in the world is better positioned to answer this than John Broome. Initially trained in economics and having held a full Professorship in Economics at the University of Bristol, before shifting to full time appointments in philosophy, Broome is now White’s Professor of Moral Philosophy at Oxford University, one of the most distinguished positions in the field. He is also a lead author of the IPCC reports.

The ethics of climate change involves some difficult questions, including how to compare various apparently incommensurable values, how to make decisions under uncertainty, how to weight lives existing today against those that have not yet come into existence in the future, and how to compare harms against humans versus those against non-humans. Broome’s previous books, Weighing Reasons and Weighing Lives, discuss many of the key philosophical issues one must address to develop a comprehensive answer to how humans ought to deal with climate change. Furthermore, he is no newcomer to the field—his first publication on climate change was released in 1992.

Given this background, I was surprised to find how thoroughly I disagreed with Broome’s recommendations in Climate Matters: Ethics in a Warming World (Norton, 2012). In that book, he argues that individuals have duties of justice and duties of beneficence. Duties of justice are strict, to not harm others, and duties of goodness are imperfect, to improve the wellbeing of others. If this is right, individuals have strict duties not to harm others through their GHG emissions. Given this strict duty, Broome argues that individuals have a strict duty to offset all of their emissions. Offsetting involves making payments to organizations that undertake activities, such as replanting forests that recapture GHGs which have been released into the atmosphere. This is not the sole duty—individuals also have an obligation to support governments that are willing to combat climate change. But Broome believes that first they are required to offset their emissions.

There are four reasons to think Broome is wrong in prescribing offsets as what justice requires of individuals in the face of climate change. First, by offsetting an individual’s net emissions, rather than offsetting emissions with each purchase, consumers and companies face no precise incentives to shift away from carbon-intensive activities and towards low-carbon activities. When you go to the grocery store and consider buying a British steak or a Brazilian banana, you have no price signal telling you which required less carbon. Second, the proposal relies on the remarkable goodwill of an astounding number of individuals to have an appreciable impact on climate change. People are meant to tally up at the end of the year their carbon emissions and offset them. But even well-intentioned people are going to reach the end of the budget year and find it hard to turn down the extra Christmas gift or holiday that they could get with the money set aside for offsetting. Third, the proposal has no impact on the underlying structure of economic activity that permits greenhouse gas emissions to continue growing. It creates no reasons for manufacturers to move toward energy sources that emit few GHGs or for fossil fuel companies to figure out ways to reduce emissions. Finally, I am less optimistic than Broome that most offsetting programs actually pay for new GHG reductions rather than for projects which were already underway. It is striking that Broome concedes many of these points, but believes nonetheless that strict duties of justice require offsetting, and a separate political morality should govern the solution to climate change.

In my view, individuals seeking to discharge their duties of justice that are considering donating money (or time) should direct their efforts to organizations seeking to find a political solution to the problem. They can fulfil their duties of justice by committing to (admittedly uncertain) efforts to find political solutions to climate change. Individuals should back organizations that work to place a price on carbon. By putting a price on carbon that rises over time (a proposal Broome endorses), the prices of low carbon activities naturally fall in comparison to high carbon activities. This shifts consumption towards low carbon activities, and gives companies reasons to develop low carbon ways of providing goods and services to consumers. Individuals have a moral obligation to fight climate change. This is best undertaken through joint political activity rather than individual carbon offsets.

Further useful links:

Climate Change 2013: The Physical Science Basis

Weighing Lives

Climate Matters: Ethics in a Warming World (Book Review)

Ethics & Global Climate Change

Climate ethics: Essential readings

Ethics of International Action on Climate Change: How Would Mahatma Gandhi Have Looked at it?

Climate change and hybrid ethics: a review of four ethical theories

EPA Social Cost of Carbon

Carbon pricing Policy (Au)

Image: By Vera Buhl (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)%5D, via Wikimedia Commons

 

May, 2014

From old to new migration: the emergence of a new era of superdiversity

Superdiversity

Professor Jenny Phillimore

The past twenty years have seen enormous changes in the way we live, as societies and cultures across the world have become connected through communication, transportation, and trade.   Globalisation as this process has become known, has impacted on almost every area of life. Globalisation has accelerated the speed and scale of migration, brought changes to migration patterns, and led to the development of the phenomena of new migration. The “old” post-colonial migrations of the 1950s to 1980s brought large numbers of relatively homogenous groups of people to a small number of places with which they had some kind of connection, for example Indians and Pakistanis to the UK, Surinamese and Moluccans to Netherlands, and North Africans to France. This old migration was characterised by relatively static clusters of migrants who moved to manufacturing centres to take up jobs, and were later joined by their families.

New migrant populations are less fixed. They are spread across the developed world, and connected transnationally to friends and family in many other countries. They may settle permanently in one location, or move around the country of migration or super-national region. Thus we see global communities such as Somali migrants who move in and between Bolton, London and Birmingham or between Sweden, Netherlands and the UK, and Kurdish migrants between Germany, Sweden and the UK. New migration sees relatively small numbers of people from countries across the world arriving to very many places with which they have little or even no historical connection. Professor Stephen Vertovec introduced the term, superdiversity to describe the population consequences of new migration.   Increasingly industrialised societies are becoming superdiverse because new migrants are diverse across a wide range of variables including ethnicity, immigration status, rights and entitlements, labour market experiences, gender and age profiles, and patterns of spatial distribution. The scale, complexity, heterogeneity and pace of new migration far exceeds that of the early post-Commonwealth arrivals.

Over the last 20 years, in excess of 26 million people have migrated to the EU15 The poor quality of migration and ethnicity data does not enable an accurate estimate of the numbers, ethnicities and statuses of migrants, while the presence of large numbers of undocumented migrants means that it is difficult to build an accurate picture of the size and location of new migrant populations. In 2009 the percentage of overseas citizens living in the EU was 6.4% although across Europe populations varied enormously. Luxembourg topped the list at 43.5% of residents born overseas followed by Switzerland (21.7%) and Latvia (17.9%). The UK came in 13th out of 30 countries with 6.6% While it is acknowledged that rural and urban areas have become more diverse, the scale and scope of superdiversity varies by country and by settlement area with large urban centres most affected. Although London is generally thought of as the most diverse UK city, with 29% of residents from ethnic minority backgrounds (GLA 2005), regional cities such as Birmingham, likely to become one of Britain’s first minority majority cities in 2020, are becoming increasingly diverse. The extraordinary nature of Birmingham’s superdiversity is visible in GP registration data[1] which shows migrants moved there from 187 different countries between 2007 and 2010 Superdiversity is in evidence in other European cities from Milan where 19% of the population are born overseas and have arrived from 138 different countries (Comune di Milano 2008) and Amsterdam where 45% are born overseas and come from 170 countries .  Such diversity provides a range of challenges for humankind. The Institute for Research into Superdiversity (IRiS) http://www.birmingham.ac.uk/research/activity/superdiversity-institute/index.aspx has been established at the University of Birmingham to develop new knowledge around the emergence of superdiversity. This week we use some of the data collected as part of IRiS’s recent research projects to explore some of the key challenges associated with superdiversity in particular around poverty, maternity and integration and hope to finish the week by outlining some of the actions we might take to take advantage of a superdiversity premium and to adapt our societies and economies to a complex and rapidly changing new reality.

 

[1] GP registration data is not complete. Migrants generally choose to register with a GP only if they need medical attention. Undocumented migrants are reluctant to register at all. Furthermore the database only includes those migrants who have registered directly after arriving from overseas. Nonetheless GP registration data is the best source of data for identifying the nature of the new migrant population. It should be viewed as partial and a picture of the minimum levels of diversity.

 

Other Useful Links:

It is migration, stupid: http://www.voxeu.org/article/european-public-opinion-migration-and-welfare-benefits

Population of foreign citizens in the EU27 in 2009 Foreign citizens made up 6.4% of the EU27 population: http://epp.eurostat.ec.europa.eu/cache/ITY_PUBLIC/3-07092010-AP/EN/3-07092010-AP-EN.PDF

Superdiversity: A new reality: http://www.birmingham.ac.uk/Documents/college-social-sciences/social-policy/iris/2013/sd-new-reality-jp.pdf

Comune de Milano: http://www.comune.milano.it/portale/wps/portal/CDM?WCM_GLOBAL_CONTEXT=/wps/wcm/connect/contentlibrary/Ho%20bisogno%20di/Ho%20bisogno%20di/Popolazione_Pubblicazioni_Archivio&categId=com.ibm.workplace.wcm.api.WCM_Category/IT_CAT_Bisogni_18_05/72d7488047ce0a86aa84fb1c76f51828/PUBLISHED&categ=IT_CAT_Bisogni_18_05&type=content

London- The World in a City, 2001 Census results: http://legacy.london.gov.uk/gla/publications/factsandfigures/dmag-briefing-2005-6.pdf

Superdiversity and its implications: http://s3.amazonaws.com/zanran_storage/www.kuwi.europa-uni.de/ContentPages/2477873343.pdf

Towards a sociolinguistics of superdiversity: http://link.springer.com/article/10.1007/s11618-010-0159-y#page-1

Population superdiversity and new migrant enterprise: The case of London: http://www.tandfonline.com/doi/abs/10.1080/08985620903420211#.U2oXg9iG_To

Reporting Superdiversity. The Mass Media and Immigration in New Zealand: http://www.tandfonline.com/doi/abs/10.1080/07256860903213638#.U2oXrNiG_To

 Professor Jenny Phillimore is Professor of Migration and Superdiversity at the University of Birmingham.

May, 2014

Independence pays? The implications of personal budgets

image

Professor Jon Glasby

As we head towards a 2015 general election, all the signs are that the future of health and social care will be a key battleground. However, one area where there seems to be more agreement (superficially at least) is around the need to ‘personalise’ services so that they are much more tailored to the needs and circumstances of the individual. This language appears in many different contexts, whether it’s involving people more meaningfully in decisions about their care and about service services generally, carrying out more person-centred assessments of need, giving people greater say over what services are provided or working together as equals rather than assuming that ‘doctor knows best’.
Particularly important are the concepts of direct payments and of personal budgets. The former were invented by disabled people and their organisations seeking to achieve greater ‘independent living.’ This doesn’t mean doing everything for ourselves, as none of us are fully independent (we’re all interdependent on others to meet various of our needs). It simply means having the same choice and control over your life as a non-disabled person. In this context, a direct payment involves giving the person a cash equivalent of the service they may otherwise have received so that, with support, they can design their own care and, if they wish, hire their own care staff.
Linked but slightly different is the more recent concept of a personal budget – which involves being clear with the person upfront how much money is available to spend on meeting their needs and allowing them greater say over how the money is then spent. This could be through a range of 6 or 7 different mechanisms from a direct payment at one end of the spectrum to more of a notional budget at the other end (where the social worker and the Council retains the money and spends it on the person’s behalf, but where the person knows how much there is to spend and controls the decisions that are made). The crucial element is knowing straight away how much there is to work with, so that the person and the practitioner can be creative and innovative in seeking to meet need. It’s also about getting decisions that really matter to people as close as possible to the people they affect – ideally so there are taken by the person themselves (but if this isn’t possible, then by someone who knows the person well and cares about them).
For many disability rights campaigners, these could be some of the most important reforms introduced since the creation of the welfare state – yet there are significant tensions. In particular, it’s possible to emphasise direct payments and personal budgets for two very different reasons. On the one hand, it is argued, is a neo-Liberal agenda which wants to reduce public services, promote individual responsibility and ‘roll back the frontiers’ of the welfare state. On the other are groups of civil rights campaigners who see this as a political struggle for greater citizenship, very much like similar struggles that have taken place around gender and race. Both groups tend to promote the same concepts – but their value base and desired outcomes are fundamentally different. The danger throughout has been that different groups (and often fairly uneasy bedfellows) come together to call for change but that things unravel once the change is introduced (because we all meant something different by the changes and have different notions of what we want to achieve). Early on this can be a good thing as it creates a real momentum – but further down the line problems tend to occur.
At the moment we are trying to personalise services whilst also taking large amounts of money out of them in a period of austerity – and there’s a risk that we simply use the language of personalisation as a smokescreen for cuts. Direct payments and personal budgets could be two of the most radical reforms the welfare state has seen in decades – but we have to be clear about our motives and we have to pursue them for the right

reasons.

Jon Glasby is Director of the Health Services Management Centre (HSMC) and Professor of Health and Social Care. For further information on HSMC, see http://www.hsmc.bham.ac.uk.

For HSMC’s work on personalisation, see: http://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/work/personalisation.aspx.

Key books also include:
• Needham, C. (2011) Personalising Public Services: Understanding the Personalisation Narrative, Bristol: The Policy Press
• Glasby, J. and Littlechild, R. (2009) Direct Payments and Personal Budgets, Bristol: The Policy Press

May, 2014

If integration is the answer – what was the question?

Professor Jon Glasby

Over time, governments of all persuasions have sought to achieve more integrated health and social care. This ranges from the Joint Consultative Committees and joint finance of the 1960s and 1970s to care co-ordination in the 1990s, and from New Labour’s emphasis on ‘joined up solutions to joined up problems’ to the Coalition’s promotion of ‘integrated care’. The latest version is a series of ‘integrated care pioneers’ (which the University of Birmingham helped to select), with learning from these sites shared with other areas of the country to promote more holistic care.

Despite all this, we continue to have a very divided health and social care system (even if we have found ways of blurring the boundaries from time to time). Deep down, our approach is based on the assumption that it’s possible – and possibly even desirable – to distinguish between people who are ‘sick’ (who we see as having ‘health’ needs met free at the point of delivery by the NHS) from people who are merely ‘frail’ or ‘disabled’ (who we see as having ‘social care’ needs met by local authorities and subject to means-testing and significant user charges). This may once have made sense – but feels increasingly unsustainable and counter-productive with an ageing society. At best, it causes frustration, duplication and inefficiency; at worst it can lead to people with complex needs falling through the gaps in the safety net which services are meant to provide. Whether it is child protection scandals, mental health homicides or older people discharged from hospital before community services are ready for them, the consequences of not working together can sometimes be catastrophic.

In response, the emphasis on ‘integrated care’ is welcome – but the problem is that this can mean so many different things to different people. It is also becoming something of an automatic policy response (just as ‘partnership working’ did under New Labour) – put forward as a solution to a range of different ills. All too often, this leads to a situation where we use warm words, but where everyone ends up frustrated because no one way of organising could ever deliver all the potentially mutually incompatible aims that individual partners may want to achieve.

As a result, a key contribution which HSMC when working with policy makers and front-line services makes is to ask: if integration is the answer, what was the question? Although this sounds basic, we need to know what we’re trying to achieve before we decide how best to go about organising our service responses. While some sort of co-ordinated effort may be required for some outcomes, a single agency working by itself might be just as effective for other issues. Being clear what success would look like is also a crucial first step to being able to evaluate ‘what works’. However, we often fail to do this – partly because public services have such multiple accountabilities that being clear about what success looks like is really difficult; but also (slightly cynically) because if we aren’t able to be clear about what success looks like, it’s also hard to be clear about what failure looks like. Joint working is also very time-consuming and it takes significant commitment to build long-term relationships. Reserving such a labour-intensive way of working for situations where it will have maximum impact feels crucial.

In the current financial context, it is even more important to work together than ever before – but calling something a ‘partnership’ doesn’t make it so. If we’re not careful, then concepts such as ‘integrated care’ could become an end in themselves, rather than a means to an end – and people using health and social care deserve more than this.

Jon Glasby is Director of the Health Services Management Centre (HSMC) and Professor of Health and Social Care.

For further information, see Glasby, J. and Dickinson, H. (2014) A to Z of inter-agency collaboration and his new book with The Policy Press on Partnership working in health and social care: what is integrated care and how can we deliver it?

Other useful links:

What is integrated care?

Integrated care: A position paper for the WHO

Integrated delivery networks: a detour on the road to integrated health care?

Patients need to be the focus of integrated health care

 

May, 2014

Long-term care for older people

Professor Jon Glasby

Image from istock: Give Me Your Hand

Image from istock: Give Me Your Hand

As part of the ‘saving humans’ theme, a number of contributions from across the University are likely to focus on the causes and implications of climate change – potentially one of the most significant current and future threats we face. At first glance, all this feels a long way away from the day-to-day reality of front-line health and social care (which is our area of specialism here at the Health Services Management Centre). And yet, there’s an unusual but uncanny similarity between debates on climate change and current controversies around the future funding of long-term care for older people…

This probably sounds odd initially – but different Ministers and governments over time have started to look for solutions to the funding debate and shied away when things got too difficult. Although it’s often neglected as a policy issue, the quality and funding of services for older people is a major social issue that touches us all in different ways and at different times of our life. Yet devising a solution to such a complex, embedded series of problems will inevitably be long-term, controversial and unpopular. Crucially, the benefits won’t be felt for many years – so a current political leader will have to take significant pain and criticism for unpopular measures that don’t pay dividends until much later (when someone else gets the credit). Faced with a potential backlash to any of the solutions that might actually work and with an election looming, it’s tempting to kick the issue into the long grass and leave it to the next person to sort out.

For me, this is precisely like the climate change debate. Deep down, many of us as private individuals know there’s something serious at stake here and that something fundamental will need to change. But it’s so long-term and so difficult that it’s easier just to put it off to tomorrow and assume that someone else will sort it out…

In long-term care, we’ve seen this time and time again – from New Labour’s failure to implement the central recommendations of the Royal Commission on Long-term Care, the lack of a response to Sir Derek Wanless’s review, the failure to implement plans for a ‘national care service’ and what many now feel is a watering down of the proposals of the most recent Dilnot Review. And yet the issues at stake are serious and far-reaching. We have a health and social care system designed with 1940s society and demography in mind which has felt increasingly unfit for purpose over a number of years, and is now ready to burst at the seams. Putting this off until another day simply isn’t a credible response – but it wouldn’t surprise me if – like climate change – this is exactly what we do (again)…

Jon Glasby is Director of the Health Services Management Centre (HSMC) and Professor of Health and Social Care. 

In 2010, HSMC worked with Downing Street and the Department of Health to review the future funding and reform of adult social care. Our subsequent report was launched by the Prime Minister and was a key plank of the government’s subsequent White Paper – see:

Glasby, J., Ham, C., Littlechild, R. and McKay, S. (2010) The case for social care reform – the wider economic and social benefits (for the Department of Health/Downing Street). Birmingham, Health Services Management Centre/Institute of Applied Social Studies

Other useful links:

 

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