How would Lisa Simpson and Monty Burns make progressive social policy?

Many of us may have a broad idea about how to make good, ‘progressive’, social policy. Or, we might find a lot of agreement on a collection of (albeit often-vague) terms to describe a philosophy of policy and policymaking.

This may relate to a drive to reduce inequalities, and perhaps the costs of public services, by getting to the ‘root cause’ of problems, or encouraging a focus on the ‘assets’ of individuals, encouraging people to participate and ‘co-produce’ their public services, and developing the ability of local communities to tailor national policies to their areas.

In some cases we might focus on the idea of ‘wellbeing’, to develop meaningful outcomes-based (and generally non-monetary) measures of improvement, or ‘early intervention’ and ‘prevention’, in which we address the root causes of problems by tailoring public service interventions to meet needs at the earliest point of a person’s life, rather than addressing problems as they become acute. Some of this policy may be universal, but we might also recognise that some people can be usefully targeted as ‘higher risk’ or in greater need of support.

We might also focus on the importance of employment and economic activity, as a key part of a drive to improve people’s mental health or wellbeing by encouraging them to participate (when possible) in society and develop meaningful social networks.

So far, so good. At this level of generality, this collection of ideas might generate cross party support. For those on the ‘left’, it offers a sense of social justice and reduction of inequalities. For those on the ‘right’, it offers the potential to reduce public service costs and shrink some parts of the state.

Yet, this agreement is often illusory, with the potential to break down dramatically when people turn a broad agenda into concrete policies and draw on additional ideas about, for example, the types of groups that deserve the state’s ‘benefits and burdens’.

There is an episode of The Simpsons which sums up this potential (albeit it’s totally made up and the example is to do with environmentalism): Lisa Simpson and Monty Burns agree on the nature of the problem, and both seem to be well intentioned, but they come up with fantastically different ideas about the practical solution (and how we should treat other animals).

To a large extent, this similarity and difference can be found in the mix of UK and Scottish Government policy and policymaking. If you look at key documents, they now talk in an almost-identical language, focusing on root causes, inequalities, public health, parity between mental and physical health, the importance of employability and employment, the assets-base of individuals, co-production, early intervention, the benefits of localism over central direction, and the need for central government to share policymaking responsibility with local government, public bodies, and a wide range of actors in the third and private sector. They are both making choices that often raise profound questions about the ethics of state intervention into the lives of individuals and families. They also both make the right ‘noises’ about the benefits and risks of state intervention, and this kind of language would, I think, be welcomed broadly across the public sector and in social policy circles.

Yet, what comes next is a different matter. The Scottish Government has cultivated a reputation for taking the Lisa Simpson approach, generating a sense of benevolent state intervention and making sure that its interventions receive fairly wide ‘ownership’ in key parts of the public sector – albeit while generating some dissent in key issues, such as on public health measures (most notably, a minimum unit price of alcohol) and the state guardianship of children (most notably, the idea of a ‘named’ person for each Scottish child). a regular feature of interviews with England-based interviewees is that they look fondly to Scotland and its social policies.

The UK Government, on the other hand, often looks like the Monty Burns character, by producing controversial policies on, for example, major welfare retrenchment, reducing entitlement to benefits related to unemployment, particularly for people with recognised disabilities (but based in part on the importance of employment to wellbeing) and a Troubled Families programme which is often described as punitive and stigmatising (but based in part on the principle of early intervention and the identification of the root causes of social problems).

In other words, the same basic principles can be used in a way that produces profoundly different policies.

Part of our current work is to try to explain why those differences in policy and policymaking, by the UK and Scottish Governments, might arise, and what their effects may be. It is too simple to state that the differences relate to the political parties in office: the SNP in Scotland and the Conservatives in the UK, largely because we are talking about long term trends that transcend parties. Other possible explanations include:

• Their division of responsibilities. The UK Government still has responsibility for hot button issues such as welfare reform and employment. It still takes the ‘hard choices’ that tend to divide people politically, and produce highly visible winners and losers.
• Their consultation and ‘governance’ processes. The Scottish Government has a reputation for inclusive and consensual policymaking (between governments and interest groups), which could relate generally to a policymaking ‘culture’ but does relate specifically to the scale of its task (its responsibilities are limited, and it is small enough for policymakers to form often-meaningful personal relationships with participants). It also has a reputation for a ‘governance’ style that values partnership with the public sector, and a relatively high acceptance of long term measures of success, compared to the UK Government which often combines a focus on ‘localism’ with short term targets and performance management to maintain central control and accountability.
• The broader ways in which they characterise and treat ‘target populations’. We should resist the tendency to think that, in terms of political culture, Scotland is the home to left wing social democracy while England is increasingly right wing, intolerant and small state. The social attitudes surveys do not support this dichotomy of image. Yet, if we can detect a level of political competition based on these broad categories (in other words, Scottish parties may be more likely to compete using ‘left wing’ language), we might identify a tendency by their respective governments to articulate the same broad policies in very different ways.

With Emily St Denny, I am looking at these issues in a number of ways, albeit focusing primarily on the study of Scotland as part of the broader work of the Centre on Constitutional Change, and I can provide further links to these studies as we go along. Current examples include:

• Our earlier work on defining ‘prevention’ and ‘early intervention’
• My current paper on mental health policy

 

Does anyone know what the UK Government’s mental health policy is?

This post is based on my paper for the Political Studies Association annual conference in 2015.

In policy studies we are used to defining policy as a collection of three things: the statements of intent by policymakers, policy delivery, and policy outcomes. This allows us to identify important disconnects between these processes, such as when governments don’t deliver on their promises, or there are unintended consequences to their actions. It is normal to expect a substantial gap between intention, delivery and outcome. However, in many cases, the gap is so large that it may prompt us to reconsider the nature of policy: if it is so distant from the stated intentions of government, do we actually know what policy is? A good example is mental health policy for England.

In the modern history of mental health legislation, you can get the broad sense of a direction of travel undermined, to some extent, by a gap between intention and outcomes. Mental Health Acts in 1959 and 1983 began to include reference to the right to adequate therapeutic treatment – the idea that, if the state deprived you of your liberty based on your mental illness, it should also provide services to treat the illness. However, those services were often inadequate. A policy statement, involving a promise to be treated by suitable services, often remained unfulfilled; services were not delivered and the outcomes were often unintended. ‘Policy’ appeared very different if you focused on the long term outcomes rather than the initial choices.

Three more recent examples provide an additional element.

Mental health legislation meets opposition

First, in the case of the Mental Health Act 2007, much of the UK Labour Government’s policy did not even make it to the statute book. Instead, after rejecting an initial report in 1998 – summed up by the statement ‘if you enforce compulsory powers over an individual, then they are entitled to a minimum quality of care’ – in favour of an approach based much more on preventive detention and public safety, it engaged in a 9-year standoff with the ‘Mental Health Alliance’ (a major collection of professional, third sector and service user groups), which led to legislation that neither side favoured. Indeed, the 1983 and 2007 Acts are still in need of further reform to deal with issues regarding, for example: the relationship between police detention to provide a ‘place of safety’ (under s136 of the 1983 Act) and low hospital capacity to provide follow-up treatment; the inappropriate use of the 1983 Act to secure access to in-patient hospital services; the negligible effect of community treatment orders (CTOs) on hospital admissions; and, the greater use of CTOs for black patients (see the House of Commons Health Committee, report; press release). ‘Policy’ is a combination of a partly-fulfilled statement, problematic delivery, and often-unintended outcomes.

Parity meets localism

Second, the UK Coalition government’s policy of ‘parity’ between mental and physical services marks a major contrast in consultation style – No Health Without Mental Health received widespread support – but not outcomes. It contains a major principle – ‘We are clear that we expect parity of esteem between mental and physical health services’ – and a set of aims on improving mental health in the population, helping people ‘recover’ from mental health illnesses, improving the physical health of people with mental health problems, improving care and support, enhancing services to prevent the development of some mental health problems, and reduce the stigma associated with mental illness. Yet, it also contains a major commitment to ‘localism’, through a mixture of delegating policy delivery to NHS England, devolving service delivery to local areas, and encouraging long term and often-vague outcome-measures (not specific, short term, high salience, NHS targets). This has contributed to a major disconnect between policy intention and outcomes: funding decisions by NHS England and local commissioners have undermined this parity strategy. In the past, we expected ministers to intervene directly in the running of the NHS. The phrase ‘command and control’ was a feature of the previous Labour government. Now, they criticise the decisions of public bodies without intervening to change them. A policy statement on parity, combined with a localism and ‘hands off strategy, has produced nothing of the sort.

Public mental health meets troubled families and fit notes

Third, the idea of public mental health – and related terms such as ‘prevention’ and ‘wellbeing’ – relates to wider ‘root causes’ of ill health, joined increasingly to strategies to identify connections between socio-economic status, housing, education, employment and health. There is some hope that ‘early intervention’ will address many problems before they become acute, reducing inequalities and/ or costs in the process. In general, this is often problematic in mental health, since many conditions are not preventable and early intervention is unlikely to reduce costs in highly pressured acute services. There is also a localist approach to service delivery in this area, built around the user and/ or involving major cooperation between a range of public bodies (such as local authorities and Public Health England), with the emphasis on central government delegating policy and sharing responsibility for outcomes with the public sector.

In this case, a combination of public mental health and localism can be a tempting solution for governments, since they can reduce budgets at the same time as delegating responsibility for policy outcomes to local authorities and their partners, knowing that they can exhort local public bodies to shift to preventative policies to reduce long term costs even though long term policymaking suffers during periods of austerity.

Or, we may simply not know how policy will play out, since preventive public mental health potentially means everything and nothing. A focus on wellbeing can involve positive frames, relating to the production of measures to compete with GDP as a measure of a country’s progress, or negative frames about anti-social behaviour, when a focus on ‘prevention’ and an appeal to the root causes of inequalities is be used to describe ‘Troubled Families’, in which the government seeks to identify a core group of families with intergenerational problems (regarding, for example, unemployment, chaotic lifestyles and low education attainment) and ‘turn them around’ in a relatively short space of time.

Or, public mental health and an ‘assets based approach’ (focusing on the assets people have, not their problems or limitations), can be combined with the UK Government’s framing of economic inactivity and excessive welfare dependence, to describe its controversial reform of social security policy, replacing ‘the paper-based sick note’ with ‘an electronic fit note’. This policy’s implementation is perhaps the most criticised aspect of government policy by the mental health third sector, even though in principle it can be framed as an important aspect of preventive public health.

What are the implications?

Who is accountable?

It is difficult to know for which part of this policy we hold elected policymakers to account: their statements, organisational practices, and/ or the outcomes? This broad movement towards sharing responsibility, for public service delivery and outcomes, between ministers and public and private organisations, might be (a) a pragmatic response to the complexities of government and the inability of ministers to control what goes on in their name, but is certainly (b) replacing the traditional idea of democratic accountability, in which ministers account to the public via Parliament and regular elections, with forms of institutional and service user accountability in which it is much more difficult to know who to blame when things go wrong.

What is the role of evidence based policymaking?

To know if policy is ‘evidence based’ we need to know what policy is. If we conclude that the UK’s sincere policy is parity between mental and physical health services, we can conclude that it is based on a growing intellectual consensus and the accumulation of evidence on the links between mental and physical health, as well as the importance of a wide range of environmental factors. If policy is a range of practices, or outcomes (including the unintended consequences), who knows what its link to the evidence is? If a long term focus on parity is undermined by short term funding decisions on salient acute physical services, we know that evidence plays a part only some of the time.

If the outcomes are so different, is a statement of intent really a policy?

Most of these problems are faced by most policymakers, however cynical or sincere they may be – but note how much of the ‘what is policy?’ question we answer by filling in the gaps with our assumptions about the motivation of politicians. If we say that they are cynical policymakers, we conclude that it is their policy to use a commitment to parity as a veneer; that they know they won’t achieve their stated aims and are happy to accept or contribute to the factors that undermine it. If we say that they are sincere, we conclude that it is their policy to pursue parity as an ideal and do all they can to address obstacles and unintended consequences. Only in the latter case can we meaningfully say that their policy is parity (even though it makes no practical difference).

Is this an England-only problem?

The policy process in Scotland is often described as different in style and substance (often by me). However, all governments face the need to account for their high-profile choices while accepting that they will struggle to control the nature of public sector delivery and its outcomes. Many, if not most, of these problems are ‘universal’ rather than ‘territorial’.

Policy Concepts in 1000 words: Critical Policy Studies and the Narrative Policy Framework

(podcast download)

‘Critical policy analysis’ (or studies’) is a broad term to describe a wide collection of texts, and it is difficult to come up with a definitive account, beyond the idea that it is perhaps based on the equally broad description ‘post-positivism’ and methods such as discourse analysis (also note the phrase ‘argumentative turn’). However, a discussion of ‘post-positivism’ is incredibly valuable even if you wouldn’t see yourself as post-positivist.

One key account of the intellectual basis of this literature is by Fischer when he describes the failings of ‘positivist’ policy sciences to describe, aid and explain policymaking (at least if measured against certain, rather unrealistic, hopes). In particular, he takes to task the idea of objective science in which we can separate facts from values and accumulate knowledge using scientific tenets such as hypothesis generation, revision and falsification. This argument ties in to one of the big questions about the nature of the world and the extent to which it exists independently of our knowledge or experience of it. Fischer stresses the social context in which knowledge is produced, to argue that scientists do not produce what can meaningfully be called ‘objective truth’. Instead, they are part of communities which produce knowledge according to rules, and that some professions, following particular rules, receive more respect than others in a notional hierarchy of knowledge production. This shifts our focus to the idea of ‘interpreting’ the social world rather than uncovering its truths, and provides a case for considering the value of many (often less respected) approaches even if they do not follow the same ‘positivist’ rules.

This is an important conclusion when we consider that many of the theories discussed in the ‘1000 word’ series would be described by Fischer as ‘positivist’. In particular, debates between Fischer and Paul Sabatier (the ACF) were based largely on their very-different views about how you do science and which approaches deserve support in published academic texts.

On that basis, the Narrative Policy Framework (NPF) is interesting because a key aim is to take insights from critical policy analysis, about the importance of interpreting and framing the world, and use them to produce work that would satisfy the kinds of scientific requirements associated with Sabatier. They argue that, although the study of policy ‘narratives’ (often using discourse analysis) is associated strongly with post-positivist scholarship, they can be examined in a ‘systematic empirical manner’ – and that the study of narratives can be an important way to hep reconcile (to some extent) positivist/ post-positivist studies.

The NPF seeks to measure how narratives are used in policymaking. Narratives are stylized accounts of the origins, aims, and likely impacts of policies. They are used strategically to reinforce or oppose policy measures. Narratives have a setting, characters, plot, and moral. They can be compared to marketing, as persuasion based more on appealing to an audience’s beliefs than on the ‘facts’. People will pay attention to certain narratives because they are boundedly rational, seeking shortcuts to gather sufficient information, and prone to accept simple stories that confirm their biases, exploit their emotions, and/or come from a source they trust.

So far, so good – as discussed, this description would not look out of place within the literature on argumentation and persuasion. There is nothing inherently post-positivist about identifying how people use information selectively to persuade people about the merits of an argument. The same might be said for discourse analysis, if we define it broadly as the study of the meaning of language, by examining the use of statements within specific contexts. It might have become associated with one philosophy, but it need not follow inevitably that one’s choice, regarding ontology and epistemology, produces an inevitable link to a particular method, or that a method can be claimed by one group of scholars.

Nevertheless, this topic raises the problem about how we combine the insights of policy studies when they may be produced by people with fundamentally different (and potentially ‘incommensurable’) ways of understanding, describing, and seeking to explain the world. Two different scholars may study narratives, and even draw on a form of discourse analysis, but see their task very differently, and find it difficult to produce a common language (beyond the superficial) to determine the meaning and significance of their results. One might see themselves as the purveyor of value-free knowledge to settle policy debates, while another may describe socially constructed knowledge used to aid deliberation. These kinds of debates may seem exaggerated or artificial (particularly in relation to the way I just described a form of naïve empiricism that may not be practiced by many scholars), but we should not ignore them completely.

In my opinion, this discussion is crucial even if you end up rejecting critical policy analysis as an important way of seeing and researching the world. It should makes you pause and reflect about how you understand the world and re-examine the assumptions you make when you engage in research.

See also: Policy Concepts in 1000 Words: Combining Theories

Policy Concepts in 1000 Words: Feminism, Postcolonialism, and Critical Policy Studies

Tuition fees for England and Scotland: two very different stories which are difficult to challenge

Tuition fees remains a hot button topic, and one which differs markedly in Scottish and English debates. Policy for England now relates to Labour’s plans to reduce fees to £6000 per year. My impression is that this move has been received remarkably badly under the circumstances. Consider the fact that, as recently as 2010, the idea of putting fees up to £9000 was highly controversial. It is the issue that helped the Liberal Democrats break their pre-election promise (no fees) in a spectacular way, and showed that the Conservatives wanted to go much further than the Browne review’s recommendation of £6000. If Labour had been elected in 2010, and put fees up to £6000, it would have been heavily criticised. Now, it is being criticised for reducing them to that level. What does this experience show us? First, the centre of gravity can shift very quickly, and parties have to address a tendency towards treating the status quo as the normal position. They are now asked routinely where the money would come from to fund the policy, which has become an effective limit on party ambitions even though the question is rather artificial (governments don’t plan overall funding in this ‘rational’-looking way). Second, the UK coalition has a good story to tell about the £9000 fees: Universities get more money, they use some of that money to give grants or services to students from low income families, and people on low wages may end up not paying the fees anyway. This is hard for Labour to challenge, since its policy can be portrayed as spending money (when times are tight) to subsidise the students that will have higher wages after graduation. Of course, the figures are rather arbitrary (why not raise fees to £12000 and have the Universities redistribute even more?) but the status quo is important.

In Scotland, we can see the other extreme: tuition fees remain free for Scottish and EU students, and there appear to be very few votes in a policy to increase them. Rather, the SNP has made it a line in the sand to keep zero fees (note Alex Salmond’s ‘the rocks will met in the sun’ remark, now immortalised on a stone carving) and Scottish Labour is now claiming that it abolished fees in 2000 (in fact, it reduced fees to £4000 over four years, renamed the repayment the ‘graduate endowment’, and removed the up-front element of payment – which makes little difference when students take out a loan, payable after graduation, anyway). In this case, parties tell a different, but equally effective, story: the Universities get a lot of money direct from government, and student debt is much lower in Scotland than England.

We now have the odd position in which policy for England increases overall debt but can reduce inequality, while policy for Scotland reduces debt – a student in Scotland generally pays less than their equivalent in England – but increases inequality within Scotland. Both systems are remarkably different, and underpinned by very different stories, but they both represent the default position in two areas of the same country during a UK general election.