A Parliamentary answer draws my attention to the Government Equalities Office and its website, which is a bit nothing at the moment, but has some interesting factsheets and publications; we might hope for more and better once it gets going. Its advisory group are doing the study of whether social class affects other strands of inequality; in interesting place to watch.

http://www.equalities.gov.uk/Default.aspx

On the same theme, it’s Lord McKenzie of Luton (27th January) this time, on carers’ allowances. Yes, carers are a jolly good thing, but not reforming their allowances, which takes second place to our wider reforms in welfare.

This is what he said: In the White Paper Raising Expectations and Increasing Support: Reforming Welfare for the Future, we accepted that there is a need to look closely at the challenges that the current system of benefits presents to carers. However, it would not be right to do this in isolation. Many of the challenges faced by carers occur because of the interaction between different aspects of the wider welfare system, not just the rules of carer’s allowance. Therefore, we remain committed to looking at carers’ benefits in the context of our wider ambitions for the welfare state and to ensuring that the needs of carers are central to the future reform of the benefit system.

Lord Darzi had the job in the House of Lords recently (27th January) of telling campaigners for an improvement in the personal expenses allowance (pea) in care homes to piss off of behalf of the Department of Health. The pea is the amount of money that people in care homes are allowed to keep from their pensions for personal expenditure (daily newspapers. biccies by the bed and so on), and actually pea is about the size of it. No, they were not going to consult on an increase (some groups asked for £40.00 per week) because allowing people to have a bit more pocket money would not increase the ‘…availability, choice or quality of care services or support the transformation of adult social care provision, which must be our priority for the future.’

True, but it would do a bit to help older people in care homes feel a bit more human. But no deviation from the objectives of the government in achieving its care elysium in the future.

The full statement: http://www.publications.parliament.uk/pa/ld200809/ldhansrd/text/90127-wms0001.htm#09012744000057

An absolutely astonishing debate in the House of Lords (29th January) on choice and inequality. I say astonishng because I do not usually think of a legislature as a place where they have such an informed and thoughtful discussion on a fairly high-flown topic. Daily politics in the trenches it was not, but political it certainly was, because it drew attention to arguments that public choice does not necessarily benefit individuals and that participation in everything is not all it’s cracked up to be.

It starred, you can only put it that way, the eminent philosopher and bioethicist Onora O’Neill and the equally distinguished economist Lord Desai. The point of their contributions to the debate was to emphasise that making choice available to people does not ensure equality, and anti-discrimination legislation should look at the outcomes for individuals, not only the statistical proxies of communities that may suffer high levels of inequality.

Here are some gems:

Baroness O’Neill of Bengarve: …Many of the more established arguments for greater choice have stressed the supply side. The complaint has been that monopoly providers fail service users, be they patients, parents, pupils or others. The hope has been that choice by service users will empower them, incentivise all providers to do better and sanction the worst providers. Ideally, on this argument, everyone gains except the inadequate providers—and that is all right.

However, these are not the only effects of increasing choice. The more obvious effects are on choosers, not on the chosen—on the public, not on providers. Choices will differ and the subsequent experience and opportunities for those who choose variously will also differ…Someone who chooses to smoke will increase their risk of illness and earlier death. These very obvious features of choice suggest that we should expect choice in public services to lead to varied inequalities.

We therefore have to decide which choices matter and should be protected and which equalities matter and should be supported. Inevitably, protecting some kinds of choice will produce inequalities. If individuals are free to choose to work long hours or to pursue the fabled work/life balance, then working hours, earnings and leisure are likely to differ between those who choose differently. Some inequalities will be judged fair because they reflect fair processes and differing choices. In others, we judge equality as more important than choice. For example, we do not allow individuals to choose not to pay the same tax as others in like circumstances…

Anti-discrimination legislation seeks to prevent discrimination on irrelevant grounds. However, it also requires discrimination on relevant grounds. Anti-discrimination legislation, for example, requires employers to discriminate on the basis of relevant skills and experience, both in making job offers and in promoting…
However, a great deal of discussion around the Bill is not about prohibiting discrimination on irrelevant grounds but about achieving what is called a more representative social and ethnic composition within each line of employment or each profession, or among students or holders of public office…

The attraction of focusing on this statistical equality is presumably that it looks like a way of reconciling choice with equality provided that…the people choose the right way. But people do not. In a diverse population, choice leads to different outcomes for individuals and for groups. So a question that we shall face in debating the equality legislation is whether a quest for more representative cohorts of employees, students and office holders is compatible with prohibiting discrimination on irrelevant grounds. Is this very abstract statistical equality—equality in the social composition of groups—compatible with genuine commitment either to choice or to substantive equality for the individual members of those groups? The reality is that trying to secure a representative composition within each group neither respects choice nor furthers equality for individuals.

It is worth asking whether representative participation is an important social aim for which we should be prepared to sacrifice both choice and other equalities. Perhaps the best case that can be made for it is that it matters for policy-makers who are looking at participation levels for some benefit or activity that is expected to be universal. Here population-level evidence is, I think, useful. For example, the United Nations Development Programme looks at the relative proportion of boys and girls in primary education in different regions. However, from the point of view of the little boy or girl who loses out, it does not really matter whether boys or girls are doing better in their region—they have lost out. Public health policy-makers also need to look at the social composition of those who do not receive immunisation. However, information about the unrepresentative composition of the group of children being immunised is, frankly, of little value to the children who lose out or to their parents. What matters to them is substantive equality of treatment…

Lord Desai:… given that the distribution of endowments may be, and often is, unequal, economists would argue that, given choice, each person can move to a better position than what the initial endowment gives them. Inequalities are not altered very much by that, if at all, but the level of individual satisfaction or utility is enhanced thereby. That is all that economists ever say. One of the questions about the notion of equality is the end-state that we want to achieve. By what measurable or at least comparable indicator would we judge whether we have achieved equality?

What struck me about British society when I arrived here 44 years ago was the strong notion—partly due to the influence of the Second World War, a very egalitarian experience for a very unequal society—that uniformity is equality. In the field of education, which I know something about, a lot of debate around equality in the choice of subjects and schools is hampered by the fact that people do not discuss the prior condition that career paths are very narrow and very few. We all take it for granted that the only high road to advancement in life is GCSEs, A-levels, university and onwards. If that is the only path involved, certain comparisons are indicated. The first would be to question the narrowness of the path. Why should there be only this path?

…We have to change our notion that there are right royal roads, and only a few of them, to advancement. We have to allow society to open up and create alternatives…

…There is great debate today about reserving jobs in government or places in higher education institutions for people who are deprived by social origin. Again the question is: should you judge an individual by membership of a certain category—you cannot avoid being a woman or black, for example—or should you judge individuals qua individuals? It is often the case that one member of a community which is on average deprived may be less deprived than another member of a community which is on average better off. Therefore, we do not want to subject people to a community label. Most importantly, when women are assigned to communities—a woman can be described as a Muslim or a Hindu, for example —it may often lead to greater disadvantage than if one just treated the person as a person, because the Muslim or Hindu society in question may have its own forms of discrimination which we may want to overcome.

The subject of our search for equality is the individual; it is not communities. We go by communities because they are rough indicators of where discrimination lies, but we have to remember that the subject is the individual and the end-state is how well the individual achieves the maximum potential that he or she can. The measuring of maximum potential may lead to problems, and involve categories such as happiness or income, but we have to be absolutely clear that in searching for equality, we do not restrict either the subject of our search or the end-state by which we define equality. In both, choice is crucial.

The full debate at: http://www.publications.parliament.uk/pa/ld200809/ldhansrd/text/90129-0008.htm

A recent series of questions in the House of Lords reminds me that prisoners are entitled to equal access to healthcare, but disability awareness and training is not all it should be. The debate started off with the eminient campaigner on disability rights raisaing an example:

Baroness Masham of Ilton…Is he aware that when I was a monitor at a young offender institute a young man of 17 died of asthma, having told the prison officers that he might die, and they did not believe him? (House of Lords, 29th January)

The whole discussion: http://www.publications.parliament.uk/pa/ld200809/ldhansrd/text/90129-0001.htm#09012985000734

I wonder what the progress is on ensuring that dying prisoners get end-of-life care equivalent to what they would get in the community – and I specifically do not mean palliative care – there are a lot of older people in prison who need advance care planning. Something we should think about?

A Parliamentary answer introduced me to a new health campaign, which I rather liked, for responding to someone who may have had a stroke; I think this is such an important illness condition that we do not do enough about:

Baroness Thornton: …Next Monday, on 9 February, we are launching what we call the FAST campaign, which aims to make the general public and relevant healthcare professionals more aware of how to identify stroke and the necessity of speedy emergency action. FAST stands for: “Face—is there facial weakness?”; “Arm—can the person lift both arms and hold them there?”; “Speech—can the person speak and are their words slurred?”; and “Time—is it time to dial 999 for an ambulance if you see any of these signs?”. (House of Lords, 2nd February)

The full stuff on: http://www.publications.parliament.uk/pa/ld200809/ldhansrd/text/90202-0001.htm#0902021000363

I’m always a bit doubtful about people who set up organisations and then say everyone else is threatened by them, because the psychoanalyst in me thinks that this is probably someone projecting their own anger onto someone else. Rod, as the chair of a volunteering organisation I’ve never heard of, v, has been saying, according to Third Sector Daily http://www.thirdsector.co.uk/News/DailyBulletin/877549/Sector-saw-v-threat/10CA47E3D9385D5B79DF93DF98852913/?DCMP=EMC-DailyBulletin that people just don’t understand. Justin Davis Smith from Volunteering England is quoted as pointing out that they’ve had millions of pounds of government money and it causes resentment in people who are already doing the job and get some government organisation parachuted in to do it in a nucool way because you old fuddies just don’t know how to do marketing to these young chappies. You can tell from the website http://www.vinspired.com/ that it’s supposed to be a nucool organisation, because it’s colourful, twisted from the vertical, looks like YouTube (only the nucool know about YouTube of course) aimed at young people and doesn’t tell you much about itself (especially that it’s a government front organisation).

Another thing is that those of us who’ve been involved with the voluntary sector for forty years or more have wearied of yet another generation of government ministers creating a new scheme for national service. These ghastly youngsters who are interested in what they’re interested in and not what politicians want them to be interested in just need some clever marketing to get them ‘participating’. What generations of people in the voluntary sector have been pointing out to the generations of politicians who think this is a good wheeze for making them look good, is that the whole point of a voluntary sector is that it’s voluntary; you decide what you want to do, you don’t get the government telling you. So Rod needs to think whether chairing another government marketing front on volunteering rightly leads to suspicions about you.

On the same theme, I see that the Department of Health has set up a Cooperation and Competition Panel to give advice to NHS bodies about how to deal with conflicts about competition between private bodies and between NHS funders and private bodies. Now that patients are supposed to have freedom of choice in choosing their NHS services, I suppose the NHS does have to have some basis of dealing with disputes or (whisper it) bribery in awarding NHS contracts. You do wonder thought whether all this infrastructure to get some nice simple healthcare services provided is worth it.

Looking at the CCP (not far away in initials from the old Soviet Union – you remember all those spacemen with CCCP on their helmets?) took me to the official guidance on how pcts can be fair in deciding between ‘any willing provider’ who wants to provide their services for them. All sorts of rules about level playing fields and good practice which hospice managements trying to get their pcts to pay a fair rate for the job might take a look at.

Department of Health (2008) PCT Procurement Guide for Health Services. London: DH. http://www.ccpanel.org.uk/content/PCT-Procurement-Guide.pdf

The Cooperation and Competition Panel: http://www.ccpanel.org.uk/index.html

What is ‘a public function’? With the increase in private organisations offering various services that used to be public services and everyone thinks of a public services, what rights do the people receiving have? Often, hospices as charities don’t have to comply with the same duties that public organisations have. This is true in combating various inequalities, for example. But I think that in general private organisations providing public services should have to meet all the same standards. Hospices will doubtless complain that they don’t have the bevies of lawyers to protect them that local authorities have and staff to deal with all the bureaucratic requirements. However, people’s rights should not be lost just because it is government policy to offload public responsibilities to non-government organisations and then not pay properly to cover all the rights that they would have had.

I was caused to think about this because writing the previous post led to me looking up the organisation that Jack Straw was speaking to, the British Institute of Human Rights. I came across their briefing, done with other groups, on the fact that the Human Rights Act didn’t cover older people in private care homes, or possibly provided with private social care services in their own home. This is old information, because the campaigners successfully got the Health and Social Care Act 2008 s 145 changed to include everyone who provides services in a private care home to be treated as though they were carrying out a public function.

The Health and Social Care Act 2008 at: http://www.opsi.gov.uk/acts/acts2008/ukpga_20080014_en_12#pt5-pb3-l1g145

The briefing on human rights in private care homes: http://www.bihr.org.uk/sites/default/files/HealthAndSocialCareBill_briefing2.pdf

The British Institute of Human Rights at: http://www.bihr.org.uk/