Monthly Archives: November 2015

Westminster is more powerful than you think, but only if you dismiss its importance

Cowley tweet 4.1.15

When studying the role of parliament in the UK, it is common to argue that it is more powerful than you think. If the dominant narrative is that parliaments are peripheral to the policy process, then let’s show you what is wrong with that narrative.

I’ve done it myself several times (e.g. this article and this book pp104-7), partly because it’s a good hook for publication (and partly because David Judge was my PhD supervisor*). However, when I discuss these issues with students, I tend to conclude that an influence score of more-than-zero is still a low score. It’s a bit like me telling people: ‘I look pasty, but I can run faster than you think’.

I say this after reading Russell, Gover, and Wollter’s (2015) excellent empirical analysis of Westminster’s influence over the past decade. It is ‘more influential than is widely recognised’, but what does that really mean? Let’s break down (what I take to be) the article’s 3 key points:

  1. The non-influential argument is untested empirically. This is a good way to justify Russell et al’s empirical work, but I think it’s a bit misleading. I think there is a lot of empirical work on policymaking out there which fails to pick up on any Westminster influence whatsoever. For example, in a lot of my interview research, it has not occurred to participants (including interest groups and civil servants) to mention the role of Westminster unprompted because it is so far down the list of relevant factors.
  2. The vagaries of the bill process give a misleading picture of low MP influence. When we study the legislative amendment process we find that the majority of successful government amendments are innocuous (exaggerating its success) and many amendments by MPs are designed to prompt debate, not succeed (exaggerating their failure). True. This is partly because, by the time a bill gets to Parliament, it is already a draft Act. The government has little interest in changing something already negotiated in detail with interested groups, and MPs are often looking to make points or seek clarity. Yet, for me, this clarification does little to accentuate parliamentary influence. Rather, it warns against the conclusion of non-influence using misleading measures (not the same thing as demonstrating influence).
  3. To gauge parliamentary influence you need measures which take ‘anticipated reactions’ into account. The government’s bill teams take great care to anticipate parliamentary reaction to bills, and produce draft legislation accordingly. Further, much government legislation is prompted by MPs (via, for example, committee reports and MP bills). Both of these points are important, but they remain partial because government actions are prompted by 101 things. We know that ministers and civil servants take Parliament into account in many cases, but in how many cases can we say that parliamentary influence is decisive or near the top of the list of most important factors? This question is explored in more depth in Russell and Cowley’s excellent article,  but still to challenge the idea that Parliament is completely unimportant. We are still left with the argument: ‘if you think Westminster’s is really unimportant, Westminster is more powerful than you think’.

Where is the public policy analysis?

Russell and Cowley aim to ‘adopt a public policy lens, asking which parliamentary actors and processes exert influence, and at what policy stage(s)’. Yet, they cite almost none of the contemporary public policy literature (not even Jordan/ Richardson’s books after 1979, one of which engages with post-1979 developments).

For me, the value that you’d expect public policy analysis to add relates to its range of perspectives. A focus on networks was often to highlight the limits to ministerial as well as parliamentary power, since the state is so large that elites have to delegate most policymaking to other people, and can only keep track of a small proportion of government activity. Further, a focus on ‘street level’ actors and organisations further accentuates the sense that government policy is often delivered by routine, with a tendency for ministers and parliamentarians to pay attention to a tiny part of that activity. Perhaps most importantly, the contemporary literature tends to highlight the problems with a focus on stages to describe how policy is made. Or, if you are really keen, there is a discussion by Rod Rhodes and colleagues of the extent to which politicians maintain the fiction of the Westminster model of government, which can affect how they describe the role of Parliament and the importance of traditional forms of accountability.

I think that this kind of discussion informs the empirical analysis: if you ‘zoom in’ to look for evidence of (ministerial or) parliamentary influence you  will find some. However, if you are adopting a ‘public policy lens’, it seems worthwhile to also ‘zoom out’ and consider how this evidence connects to the wider public policy literature. A focus primarily on Richardson/ Jordan as the classic 1979 text, then King/ Crewe 2013 as something more up to date, only seems valuable if one wants to stick it to the older generation without engaging with more thoughtful or empirical analysis.

Where do we go from here?

If you are interested in these arguments, you should follow ‘politicsphd’, who is working in depth on the issues as they relate to the Scottish Parliament’s bill process. He has some points which are directly relevant to Westminster analysis, including:

  • We need more measures of influence. For example, we need to measure the overall effect of amendments rather than rely on counting substantive amendments (e.g. by comparing the bills before and after submission);
  • We need to go beyond vague classifications of legislatures. We should focus more on important variations in parliamentary influence, on a bill-by-bill basis, rather than focusing primarily on an often misleading gauge of overall influence according to some bills which may or may not be representative.

My argument is simpler and based on the application of ‘bounded rationality’ to legislatures such as Westminster:

  1. Actors like MPs and MSPs only have the ability to pay attention to a tiny proportion of the issues processed by governments. So, they promote few to the top of their agenda and ignore the rest. They engage in ‘serial processing’: considering one issue at a time.
  2. Elected policymakers partly overcome this problem of serial processing by overseeing ‘parallel processing’ within government. A government breaks down policymaking into a huge number of discrete issues processed in different parts of the organisation. British parliaments tend not to have the resources to perform a similar role or keep up with the policy process in British government.
  3. So, you might expect the parliamentary equivalent of ‘punctuated equilibrium’: a tendency for parliaments to focus intensely on a small number of issues (with the potential for significant influence) at the expense of the vast majority of others.

In other words, think of parliamentary influence in terms of two sides of the same coin: if you identify influence in some areas, recognise the limited influence in most others.

For more of that sort of argument, see Key policy theories and concepts in 1000 words.

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*In my first year as a politics undergraduate I learned that Westminster was only important to the tourist trade (my lecturer was Jeremy Richardson). In my 3rd year I learned that Richardson and Jordan were quite wrong (my lecturer was David Judge). In my 4th year I learned that policy networks were at the heart of explanation and that Parliament rarely featured (David Marsh). During my PhD on networks I put in a chapter on Parliament – CHAPTER_3 – to try to please David Judge. I worked briefly for Mark Shephard and we made the ‘more influential than you think’ case for the Scottish Parliament. Then I went full circle by working closely at Aberdeen with Grant Jordan. I now talk a lot about bounded rationality, which is at the heart of my explanation for limited parliamentary influence: MPs/ MSPs don’t have the resources to be particularly influential.

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The final Scottish devolution settlement is rubbish, and unionists should be worried

Imagine academics were more like a caricature of elected politicians: shouting their beliefs from the rooftops, super-selective with their interpretations of fact, unwilling to express uncertainty about anything political if it harmed their case, and willing to make wildly unsubstantiated predictions about the future.

Here is what I think many would make of the Scottish devolution settlement:

  • The new Scotland Bill represents the final devolution settlement.
  • This is the last chance to get devolution right before the next independence referendum.
  • Instead, it is a horrible mess, produced in a hurry and driven more by political negotiation than good sense (which is the usual story).
  • No-one can understand it and it will be almost impossible to hold any single government to account for many decisions (particularly since the Scottish Parliament will diminish even further in importance)
  • The fiscal framework underpinning the new settlement is a shambles and not worthy of support (David Bell and colleagues use the phrase ‘may not be workable’ when the plan contains contradictory principles).
  • The idea of a powerful Scottish Parliament overseeing incredibly high fiscal autonomy is absolute nonsense, because the Scottish Government does not have the ability to decide who should win and lose from the tax and spending regime (Bell and colleagues say ‘these taxes do not give the Scottish Government a great deal of flexibility in reality’).
  • Politicians would rather discuss their back of the envelope plans in private because they know that they would not stand up to scrutiny if they had to explain them to the general public (Nicola McEwen uses the phrase ‘After the democratic engagement of the referendum campaign, it is disappointing that debates on the Scotland Bill have largely excluded the public’).

If so, I pity the people charged with running the next No campaign, because they will be unable to say that (a) the Scottish devolution settlement is good, or (b) there will be a further settlement if you vote No (nor will they be able to make a convincing case based on British values).  Instead, what they can say is ‘we delivered on our promise for more devolution’ and, perhaps, ‘use the powers you have before you ask for more’.

The general problem with the latter argument is that it currently boils down to this kind of specific argument: if you don’t like UK Conservative cuts to benefits and tax credits, you can now raise taxes to offset them (then, presumably, the plan is to say ‘you didn’t raise taxes, so you are not as social democratic as you claim’).

What I suspect many people will hear is this: we agree that the Tory cuts are rubbish, and you have to pay more money to get back to where you started. In that context, the SNP still has the choice of saying that its hands are tied by the Tories or that it can only do so much to offset the damage. We are not yet, and perhaps never will be, at the stage where people will hold an SNP-led Scottish Government primarily accountable for the taxing and funding decisions that affect people in Scotland. Instead, for most of the run up to the next referendum, the Scottish Government (and Westminster contingent for Scotland) will be led by people, like Sturgeon and Swinney, who will remain more popular and seem more sincere and trustworthy than their UK counterparts.

Of course, the case can be made for problems with the next Yes campaign, including the argument that the SNP’s economic case is redundant and the campaign has to rely on more than emotion. The alternative argument is that the SNP has been doing very well with such limited strategies, and the final devolution settlement has just strengthened its hand further.

But academics don’t speak like that, so I’ll conclude by saying: (a) more research is required, and (b) please see the Special issue of Political Quarterly on this topic (introduced here).

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Key issues in evidence-based policymaking: comparability, control, and centralisation

In other posts on evidence-based policymaking I’m critical of this idea: the main barriers to getting evidence into policy relate to the presentation of scientific evidence, timing, and the scientific skills of policymakers. You may overcome these barriers without closing the ‘evidence-policy gap’ and, for example, spend too much effort trying to reduce scientific uncertainty on the size of a policy problem without addressing ambiguity and the tendency of policymakers to be willing to consider only a limited range of solutions.

In this post, I try to reframe this discussion by generally describing the EBPM process as a series of political choices made as much by scientists as policymakers. The choices associated primarily with policymakers are also made by academics, and they relate to inescapable trade-offs rather than policymaking problems that can somehow be solved with more evidence.

In this context, a key role of policy analysis is to improve policymaking by clarifying key elements of the process in which we produce, understand, and use evidence on policy solutions[i] (in part by encouraging scientists to understand the choices of policymakers by reflecting on their own).

The three Cs: comparability, control, and centralisation

When we focus on the evidence underpinning policy solutions or ‘interventions’, let’s start with three key terms and note the potential to identify a notional spectrum of approaches to the issues they raise. I’ll describe them as ideal-types for now:

  1. Control.

In randomised control trials (RCTs) we conduct experiments to determine the effect of an intervention by giving the dose to one group and placebo to the other. This takes place in a controlled environment in which we are able to isolate the effect of an intervention by making sure that the only difference between the control groups is the (non)introduction of the intervention.

A key tenet of policy analysis is that it is difficult if not impossible to control real-world environments and, therefore, to be sure that an intervention works as intended.

Indeed, some scholars argue that complex policymaking systems defy control and, therefore, are not conducive to the use of RCTs. Instead, we use other methods such as case studies to highlight the interaction between a large number of factors which combine to produce an outcome (the result of which cannot be linked simply to the independent effects of each factor).

As a result, we have our first notional spectrum: at one end is complete confidence in RCTs to conduct policy-relevant experiments; at the other is a complete lack of confidence in their value.

  1. Comparability.

This choice about how to address the issue of control feeds directly into our understanding of comparability. If you have complete confidence in RCTs you can produce a series of studies in different times/places/populations, based on the understanding that the results are directly comparable. You might even say that: if it worked there, and there, and there, it will work here. If you have no confidence in RCTs, you seek other ways to consider comparability, such as by producing case study analysis that is detailed enough to allow you to highlight patterns which might be apparent in multiple cases.

  1. Centralisation.

If a national central government identifies effective policy solutions, should it roll them out uniformly across the country or allow local public bodies the chance to tailor solutions to their areas? At one end of another notional spectrum is the idea that they should seek uniformity to ensure ‘fidelity’ to a successful programme which requires a specific dosage, or simply to minimise a ‘postcode’ lottery in which people receive different levels of service in different parts of the country. At the other end is the preference for localism built on arguments including: one size does not fit all, local authorities have their own mandates to make local policy choices, a policy will not succeed without consultation and local ‘ownership’, and/ or local public bodies need the ability to adapt to quickly changing local circumstances.

What happens when the three Cs come together?

Although we can separate these terms and their related choices analytically, in practice people make these choices simultaneously or one choice in one category influences choices in the others.

In effect, two fundamental debates play out at the same time: epistemological and methodological disagreements on the nature of good evidence; and, practical disagreements regarding the best way for national policymakers to translate evidence into local policy and practice. Such disagreements present a major dilemma for policymakers, which cannot be solved by scientists or with reference to evidence. Instead, it involves political choices about which forms of evidence to prioritise and how to combine evidence with governance choices to inform practice.

Our new spectrum of choice may involve a range of options within the following extremes: oblige policy emulation/ uniformity and roll out policy interventions that require ‘fidelity’ to the policy intervention (minimal discretion to adapt interventions to local circumstances); or, encourage policy inspiration, as people tell detailed stories of their experiences and invite others to learn from them.

These approaches to policymaking are tied strongly to approaches to evidence gathering, such as when programmes based on RCTs require fidelity to ensure the correct dosage of an intervention during a continuous process of policy delivery and evaluation. They are also influenced by the need to adapt policies to local circumstances, to address (a) the ‘not invented here’ problem, in which local policymakers are sceptical about importing policies that were not developed in their area; and, (b) normative arguments about the relative benefits of centralisation and localism, regarding the extent to which we should value policy flexibility and local political autonomy, and the generation of normative principles guiding service delivery (e.g. include service users and communities in the design or ‘co-production’ of policy) as much as alleged effectiveness.

What is the value of such discussions?

First, elected policymakers are often portrayed as the villains of this piece because, for example, they don’t understand RCTs and the need for RCT-driven evaluations, they don’t recognise a hierarchy of evidence in which the systematic review of RCTs represents the gold standard, and/ or are unwilling to overcome ethical dilemmas about who gets to be in/ out of the control group of a promising intervention.

Yet, there are also academics who remain sceptical of the value of RCTs, have different views on the hierarchy of evidence (many scholars value practitioner experience and service user feedback more highly) and/ or who promote different ways to gather and use comparable policy-relevant evidence (see for example this entertaining exchange between Axford and Pawson).

Second, EBPM is not just about the need for policymakers to understand how evidence is produced and should be used. It is also about the need for academics to reflect on, for example:

  • the assumptions they make about the best ways to gather evidence and put the results into practice (in a political environment where other people may not share, or even know about, their understanding of the world).
  • the difference between the identification of evidence on the success of an intervention, in one place and one point in time (or several such instances), and the political choice to roll it out, based on the assumption that national governments are best placed to spread that success throughout the country.

Third, I have largely discussed extremes or ideal-types. In practice, people may be willing to compromise or produce pragmatic responses to the need to adapt research methods to real world situations. In that context, this kind of discussion should help clarify why scientists may need to work with policymakers or practitioners to produce a solution that each actor can support.

Further reading: EBPM and best practice 5.11.15

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[i] Note:  we can generate and use evidence on two elements – (1) the nature of a problem, and (2) the value of possible solutions – in very different ways. A conflation of the two leads to a lot of confused debate about how evidence-based a policy or policymaking process tends to be.

 

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Looking ahead: will policy and policymaking change with constitutional change? #POLU9SP

This is the final lecture, and it should take us full circle to the first lecture which began with this statement: ‘A key part of this course is to examine critically the idea that political practices in Scotland are distinctively Scottish’. I provide a brief summary below, but most of the information is in this podcast, which you can download (right click on mp3 or mp4a) or stream here:

Devolution represents a major change in Scottish politics, but it did not produce major change in all aspects of Scottish politics. Instead, some expectations came to fruition while others remain unfulfilled.

Similarly, further devolution or Scottish independence may produce a similar sense of major change in politics and society, but we should not assume that it would produce major change in policy and policymaking.

In that context, let’s revisit the key themes/ questions of the course, ask what has changed in Scottish politics, and use our answer to think about any likely changes in the future:

  1. What aspects of Scottish politics and policymaking are ‘territorial’ and ‘universal’?
  2. Did devolution produce major political reforms and new forms of democracy?
  3. What aspects of the ‘Scottish policy style’ and ‘Scottish approach to policymaking’ are clearly distinctive?
  4. Can you meaningfully describe ‘Scottish politics’ when so much policymaking is multi-level?
  5. Did devolution prompt major policy change and/ or policy divergence between the Scottish and UK governments?

It is in this context that we can produce an informed discussion of the likely effects of major constitutional change in the future. For example, would Scottish independence:

  1. Change the way we study Scottish policymaking?
  2. Produce further political reform and democratic practices?
  3. Change the Scottish policy style?
  4. Have an effect on the multi-level nature of policymaking?
  5. Produce further policy change and/ or divergence?

In many, if not most cases, I think the answer is ‘no’.

 

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Case studies: early years, compulsory, further, and higher education #POLU9SP

This is the third of three posts which use case studies of cross-cutting and specific policy areas to add more depth to our discussion of Scottish politics and policymaking.

One of the SNP Government’s main aims is to abolish inequalities in education attainment. First Minister Nicola Sturgeon put it in this stark way in a speech in Wester Hailes in August:

‘My aim – to put it bluntly – is to close the attainment gap completely. It will not be done overnight – I accept that. But it must be done. After all, its existence is more than just an economic and social challenge for us all. It is a moral challenge. Indeed, I would argue that it goes to the very heart of who we are and how we see ourselves as a nation’.

This specific aim raises important questions about the likely success of such policies when governments (a) seek to reduce the impact, not existence, of socioeconomic inequalities, (b) recognise the limits of their powers, and (c) make choices which seem to undermine their aims. In other words, we need to compare these high expectations with other statements, expectations, and policies pursued in other parts of education and government.

Sturgeon’s uncompromising language is important for three reasons

First, it implies that governments can have this profound level of influence on socio-economic outcomes. It reminds me of two former ambitions of the post-war UK governments: to maintain ‘full employment’, an aim long abandoned by both UK political parties; and to reduce health inequalities by setting up a National Health Service, an ambition exposed as unfulfilled by almost every major publication since the Black Report in 1980 (see also the previous lecture on health). These days, ministers don’t tend to make such bold statements of their likely success (for good reason).

Second, we should remember the point that normally remains unsaid: the SNP-led Scottish Government, like the UK Government, has no stated ambition to go to the ‘root cause’ of the problem to reduce the socio-economic inequalities through a far more redistributive tax and benefits system. It is not yet possible for the Scottish Government to take an approach, often linked to the idea of ‘Nordic’ social democracy, to combine (a) spending decisions based on an appeal to universal service provision, and (b) redistribution through fiscal policy. Instead, there is great potential for inconsistent UK/ Scottish strategies: the Scottish Government to oversee a spending regime that favours the wealthy and middle classes (on universal free services with no means testing) while the UK Government maintains a tax and benefits policy that many people will perceive to be insufficiently redistributive. Nor has the SNP made a firm commitment to redistribution in the event of Scottish independence in the future.

Instead, in almost all cases, we are talking instead about the use of public service delivery to mitigate their effects: a strategy that relies largely on the idea of ‘prevention’ policies to intervene as early as possible in people’s lives – through interventions such as parenting programmes – to improve their life chances.

Policymakers’ language is normally more realistic

Third, it is a language that stands out from most other Scottish Government discussions of education attainment, which reflect a more careful, or less ambitious, focus on realistic progress and change at the margins (as well as the continuous reminder of the Scottish Government’s limited policymaking powers while it remains part of the UK Government system).

One aspect of the more careful language relates to the limitations of government, and Scottish Government in particular. In February 2015, Sturgeon stated: ‘We must do all we can within the powers and resources we have to narrow the gap and drive up standards at all levels’.

This statement accompanied Sturgeon’s announcement of a £25m per year (over 4 years) scheme to encourage new initiatives and learn from success stories such as the London Challenge, a project driven by a similar ‘moral imperative’, and combining a focus on leadership/ collaboration and the relative performance in schools situated in areas with similar socio-economic backgrounds.

Sturgeon followed up this announcement with a focus on the partial return of testing pupils at key stages in schools. This plan forms part of a National Improvement Framework for Scottish education, which ‘will ensure that we are making progress in closing the gap in attainment between those in our most and least deprived areas’.

These decisions will take time to play out, and will involve some Scotland-specific debates about more uniform testing. Testing in this way is a strategy that was previously rejected in Scotland, and opposed by teaching groups, largely because of its association with a system in England built increasingly on league tables of performance, increased school autonomy (from local authorities), competition, and parent/ consumer choice. In other words, note the symbolic as well as substantive importance of testing. However, it may be necessary to have some kind of testing regime to gather data to allow the Scottish Government to demonstrate progress in attainment at key stages.

Is this new aim consistent with older Scottish Government choices?

Education policy sums up the political limitations to broad strategies such as ‘prevention’. The broad idea of ‘early intervention’, to make an impact on people’s lives as early as possible, to help reduce inequalities and the costs of public services, enjoys magnificent levels of cross-party support. Yet, it competes badly with more specific political commitments with the potential to undermine these broad aims.

In Scotland, the best example is current policy on free tuition fees in Universities which, in the absence of redistributive fiscal policy, and the presence of an attainment gap, reinforces inequalities in education three-fold. The first relates to the reduced likelihood of University attendance in school leavers from a deprived background. Lower educational attainment is linked strongly to poverty, and Scotland exhibits a significant gap in attainment in key areas.

Second, as Riddell et al argue, funding inequalities are often masked by a ‘universal’ approach in which higher education is free to eligible Scottish students. Yet, the absence of tuition fees benefits the middle classes disproportionately, while the debt burden is higher on poorer students. The maintenance of University funding also seems to come at the expense of the college places more likely to be filled by students from lower income backgrounds.

Third, there is a famous description of education spending by James Heckman, who argues that spending on early intervention and pre-school education is far more effective in reducing inequalities than spending on schools and universities (an argument that seems to be accepted by the Scottish Government). So, although the Scottish Government has made a commitment to extend funding on pre-school provision and early intervention programmes, these efforts at ‘transformational’ change compete with resources to maintain University funding.

Is there much money available for attainment and early intervention?

The new agenda on abolishing the attainment gap in schools has the potential to address only one of these issues, and it is potentially undermined by the high financial costs of the commitment to maintain other policies such as free tuition fees. Further, most of the real rise in education spending since devolution – e.g. 46% from 2000-11 – relates primarily to a combination of a new teacher contract and a commitment to a target of 53000 teachers, in part to further related targets such as on reduced primary school class sizes (Cairney and McGarvey, 2013: 229). In the past, when challenged on the value for money of such initiatives (in the early to mid-2000s), the then First Minister Jack McConnell defended the policy as a way to aid industrial relations and overall education attainment without identifying progress on inequalities in attainment (Cairney, 2011: 194). These policies continue (and take up most education resources) at the same time as new initiatives on inequalities.

Overall, I expect that we will look back on this one speech – on the ‘moral challenge’ to ‘close the attainment gap completely’ – as an outlier. It is an aim that sounds impressive as a rhetorical device, but it is not backed up by a coherent set of public policies designed to fulfil that end (at least in my lifetime).

 

 

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Case studies: healthcare, public health, mental health #POLU9SP

This is the second of three posts which use case studies of cross-cutting and specific policy areas to add more depth to our discussion of Scottish politics and policymaking.

Most aspects of health policy have been devolved since 1999, and many were devolved before 1999, so we can generate a relatively long term picture of policy change/ divergence in three key areas: healthcare, mental health, and public health. We can then revisit the idea of prevention and inequalities raised in the first lecture.

Healthcare

The NHS has always been a little bit different in Scotland, which enjoyed administrative devolution – through the Scottish Office (a UK Government Department) – before 1999 and maintained its own links with professional groups.

Scotland has traditionally trained a disproportionate number of UK doctors and maintained an unusually high presence of Royal Colleges. This greater medical presence boosted the Scottish Office’s policymaking image as ‘professionalised’, or more likely to pursue policies favoured by the medical profession than the UK’s Department of Health. For example, it appeared to be less supportive of reforms based on the ‘marketisation’ of the NHS.

Devolution turbo boosted this sense of Scottish policy difference (see the Greer and Jarman discussion).

For example, while the UK Labour Government furthered the ‘internal market’ established by its Conservative predecessors, the Labour-led Scottish Government seemed to dismantle it (for example, there are no Foundation hospitals). It also bought (and effectively renationalised) a private hospital, which had a symbolic importance way above its practical effect.

Since 2007, the SNP-led Scottish Government – often supported publicly by UK-wide groups such as the British Medical Association (and nursing and allied health professions) – has gone big on this difference between Scottish and UK Government policies, criticising the marketization of the NHS in England and expressing, at every opportunity, the desire to maintain the sort of NHS portrayed by Danny Boyle at the Olympics opening ceremony.

This broad approach is generally supported, at least implicitly, by the important political parties in Scotland (the SNP is competing with a centre-left Labour Party and the Conservatives are less important). It is also supported by a medical profession and a public that, in practice, tends to be more committed to the NHS (in other words, opinion polls may not always show a stark difference in attitudes, but there is not the same fear in Scotland, as in the South-East of England, that doctors and patients might defect to the private sector if the NHS is not up to scratch).

Public health

Scotland won the race to ban smoking in public places and is currently trying to introduce a minimum unit price for alcohol. It has also placed particular emphasis on the wider determinants of health and made the right noises about the balance between public health and acute care. However, there are also major similarities in Scottish and UK Government approaches. For example, the UK tops the European league table on comprehensive tobacco control (and England/ Wales beat Scotland to ban smoking in cars with children).

Mental health

To some extent, early Scottish Governments developed an international reputation for innovation in some areas relating to wellbeing. It also reformed mental health and capacity legislation in a relatively quick and smooth way – at least compared to the UK Labour Government, which had a major stand-off with virtually all mental health advocacy groups on psychiatric-based reforms. Part of the difference relates to the size of Scotland and its government’s responsibilities which can produce a distinctive policy style; it often has the ability to coordinate cross-cutting policy, in consultation with stakeholders, in a more personal way. However, this is a field in which there tend to be often-similar policies beyond the Sun-style headlines.

The bigger picture of continuity: a tax funded service

These Scottish-UK differences should be seen in the context of a shared history and some major similarities. Both NHS systems are primarily tax-funded and free at the point of use, with the exception of some charges in England (which should not be exaggerated – for example, 89% of prescriptions in England are tax-funded). Both governments have sought to assure the public in similar ways by, for example, maintaining high profile targets on waiting times. Both systems face similar organisational pressures, such as the balance between a public demand for local hospitals and medical demand for centralised services. Both governments face similar demographic changes which put pressure on services. Both have similarly healthy (or unhealthy) populations.

The bigger picture of prevention and health inequality

Although the Scottish Government pursues an agenda on prevention to reduce service demand and health inequalities, many other policies based on the idea of universal provision have the potential to exacerbate inequalities.

For example, a real rise in spending (cash spending adjusted with the GDP deflator) on health policy of 68% from 2000-11 did not have a major effect on health inequalities (Cairney and McGarvey, 2013: 229). Instead, Scottish Governments tended to use the money in areas such as acute care to, for example, maintain high profile waiting list (non-emergency operations) and waiting times (A&E) targets which did not have a health inequalities component (Cairney, 2011: 177-9). It has also phased out several charges, such on prescriptions and eye tests, which increase spending without decreasing inequalities (particularly since the lowest paid already qualified for exemptions for charges).

It has pursued strongly a public health strategy geared, in part, towards reducing health inequalities, but with the same tendency as in the UK for healthcare to come first. This process includes interesting overlaps in aims and outcomes, such as in tobacco control where smoking is addressed strongly partly because it represents the single biggest element of health inequalities, but most initiatives do not necessarily reduce inequalities in smoking.

Further Reading

I discuss these issues in more depth in Scottish Politics and The Scottish Political System Since Devolution. See also this draft chapter on prevention and health policy by the Scottish and UK Governments

 

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Case studies: prevention and early intervention to address austerity and inequality #POLU9SP

This is the first of three posts which use case studies of cross-cutting and specific policy areas to add more depth to our discussion of Scottish politics and policymaking.

We begin with a broad focus on ‘prevention’ policy for 4 reasons:

  1. It is a major Scottish Government priority, to use ‘prevention’ and ‘early intervention’ to reduce socioeconomic inequalities and/ or public service costs.
  2. It is an integral part of the ‘Scottish approach to policymaking’, with a strong emphasis on the changes to joined-up national government and partnerships in local government.
  3. It highlights multi-level policymaking and key overlaps in Scottish and UK Government responsibilities.
  4. We can compare the Scottish Government’s initial statement – committing itself to a ‘decisive shit to prevention’ – to actual outcomes.

But what is prevention policy?

Broadly, prevention and ‘preventative spending’ describe a range of policies designed to intervene as early as possible in people’s lives to improve their wellbeing and reduce demand for acute or reactive public services. The argument is that too much government spending is devoted to services to address severe social problems at a late stage. The aim is for governments to address a wide range of longstanding problems – including crime and anti-social behaviour, ill health and unhealthy behaviour, low educational attainment, and unemployment – by addressing them at source, before they become too severe and relatively expensive.

Prevention policy is described periodically as the solution to three major crises in politics.

  1. If we don’t make fundamental changes to the way we fund and deliver services they will go bust.

Prevention symbolises the desire to shift from expensive demand-led reactive services – such as acute care hospitals, jails, and police and social work interventions for ‘troubled families’ – towards intervening as early as possible in people’s lives to improve their life chances and reduce their reliance on the state. The classic intervention may be a public health policy to encourage healthy behaviour, or an early intervention programme to improve the life chances of teenage mothers and their children, but prevention is broad enough to include a campaign to reduce falls among older people, aimed at keeping people out of NHS beds.

  1. Prevention policies can reduce major inequalities within society.

The broad aim is to address the ‘root causes’ of social problems – such as poverty, social exclusion, and poor accommodation – while specific projects focus on early interventions, such as pre-school provision and parenting programmes, to address major gaps in key indicators, such as education attainment, that can be identified from a young age.

  1. Prevention is a solution to modern crises of government.

A prevention philosophy goes hand in hand with a governance philosophy which identifies the failures of top-down centralist government. The general rhetoric is about policy failure when governments try to do things to you, in favour of making policy with you. It comes with a commitment to: ‘holistic’ government in which we foster cooperation between, and secure a common aim for, departments, public bodies and stakeholders; ‘localism’, or fostering the capacity of local communities to tailor national policies to their areas;  tailoring public services to their users, encouraging a focus on the ‘assets’ of individuals, and inviting users to participate and ‘co-produce’ their services; a shift from simplistic short term targets and performance management towards meaningful long term outcomes-based measures of policy success and population wellbeing; as well as some reliance on ‘evidence based policy making’ to identify which interventions produce the most benefit and deserve investment.

How does prevention relate to the ‘Scottish approach’?

In other words, prevention policies generally combine specific ‘interventions’ with the broad governance principles, including ‘localism’ and the inclusion of users in the design of public services, that we discussed in relation to the ‘Scottish approach’ (but which is also pursued, in different ways, by the UK government). For example, the Scottish Government pursues prevention policies primarily via Community Planning Partnerships and the Single Outcome Agreements produced largely by local authorities.

Have a look again at the descriptions of the Scottish approach by Elvidge and Housden (including Elvidge’s belief that ‘traditional policy and operational solutions’ based on a ‘target driven approach’ would not produce the major changes in policy and policymaking required to address major problems such as inequalities).

What aspects of ‘prevention’ does the Scottish Government control?

The UK government controls monetary and fiscal policies, largely determining the budget used by the Scottish Government to spend and invest, and limiting its ability to redistribute income to address economic inequalities. It controls most aspects of social security, including the ability to address inequalities through direct payments, and determine the rules relating to benefits and unemployment.

Therefore, although the Scottish Government has primary responsibility for most areas of delivery relevant to prevention – such as health, education, housing, local government, and criminal justice – as well as some aspects of economic regeneration and employability, it does not have the responsibility to ‘join up’ taxation, social security, and the delivery of public services. For example, its ability to address health and education inequalities by using taxation policies to address income inequalities is very limited (even after proposed changes in the Scotland Acts of 2012 and 2016). It could not reform the benefits system to supplement its powers to influence ‘employability’ policy, or emulate the UK Government’s attempts to pass on social security savings to the local authorities implementing its ‘troubled families’ programme.

How does it fit in with the bigger picture of policy change since devolution?

Although the Scottish Government referred rarely to ‘prevention’ before 2010, it identified several ways to address inequalities. From 1999, it began to address ‘social inclusion’, which ‘become a shorthand label to refer to individuals alienated from economic, political, and social processes due to circumstances such as unemployment, poor skills, low incomes, poor neighbourhoods, bad health and lack of access to childcare’ (McGarvey and Cairney, 2008: 211). The most direct responses, to encourage employability or provide social security benefits, were UK responsibilities, and the Scottish Government relied on UK Government’s policies such as ‘welfare to work, the minimum wage and the Working Families Tax Credit’ (2008: 211).

The Scottish Government’s main response was to address disadvantages by focusing on economic regeneration in specific geographical areas, and reducing ‘unequal access to services such as education, health and housing’ (2008: 210). Its approach to governance reflected a developing ‘Scottish approach’, with an emphasis on social inclusion as a cross-departmental theme and the development of ‘Social Inclusion Partnerships’ (SIPs) which resembled CPPs (2008: 211).

Yet, overall, Scottish social inclusion policy did not differ markedly from the UK Government’s ‘social exclusion’ initiatives, and both governments have continued to promote concepts such as community and individual resilience rather than push for redistributive policies to address exclusion.

Further, the Scottish Government shared with the UK Government a tendency to focus on high profile issues or policies designed to improve outcomes overall without necessarily reducing inequalities of outcome (see the next two lectures/ posts on health and education).

Is there an implementation gap? Or, how do outcomes relate to initial expectations?

Until policymakers make sense of prevention, and turn it into a series of specific policies, it remains little more than an idiom – ‘prevention is better than cure’ – with little effect on government policy.

Although it is probably too early to detect an implementation gap associated with the ‘decisive shift’ in 2011, we can identify the great potential for unfulfilled expectations  based on the lack of progress associated with previous efforts. For example, the Christie Commission, which set the Scottish Government’s new prevention agenda in 2011, stated that:

on most key measures social and economic inequalities have remained unchanged or become more pronounced … This country is a paradoxical tapestry of rich resources, inventive humanity, gross inequalities, and persistent levels of poor health and deprivation … In education, the gap between the bottom 20 per cent and the average in learning outcomes has not changed at all since devolution. At the same time, the gap in healthy life expectancy between the 20 per cent most deprived and the 20 per cent least deprived areas has increased from 8 to 13.5 years and the percentage of life lived with poor health has increased from 12 to 15 per cent since devolution. The link between deprivation and the likelihood of being a victim of crime has also become stronger.

However, note the ‘bottom up’ element to this new agenda: does it make sense to identify the top-down idea of an implementation gap, when the Scottish Government is so keen to set a broad strategy and delegate policymaking responsibility? For me, this is a fascinating dilemma for governments: how to they ‘let go’ of policymaking and make sure that their broad aims are met in a meaningful way?

We can explore these issues in more depth in the next two posts which focus on two of the most devolved policy areas: health and education.

See also: Can the Scottish Government pursue ‘prevention policy’ without independence?

 

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