I think we should replace the rhetoric about ‘cuts’, from the government as well as from its critics, with something more sensible. In this first post of a series on the Big Society and health and social care reforms and budgets, I argue that we must change the culture of our society away from the love of money (by big government, big finance and big anti-cuts campaigns) and towards the love of providing quality services.

After the weekend of the large TUC-organised anti-cuts march in London, I suppose I should say that I am not an enthusiast for the ‘cuts’ rhetoric. This starts up in the press, among right-wing enthusiasts for the small state and among people with genuine concerns about public provision whenever an international financial crisis leads to our government retrenching on its financing of public services. I sympathise, but I think we have to look at the bigger picture.

The bigger picture is, first, to understand the role of the economy in balancing the public and private sectors in health and social care provision. Second, the bigger picture involves understanding and achieving the complex balance of professional standards, regulation and economic drivers that maintain good quality care. I’ve said before in the blog that, for me, if I’m up against it, no organised care can ever possibly replace my lovely wife’s care, and this will not be available 24 hours for weeks or years ahead, no matter how hard she tries. So the reality is that all care is not the best we would want. The problem is to make sure that it’s good enough.

Economic drivers: the positives

Look, for example, at Southern Cross, the private sector nursing and care home organisation that has been in trouble for some months. It’s in the news again today, with the chief executive having achieved the honour or ignominy of being interviewed about his troubles on the Today programme, although he was treated very kindly.

What’s the problem here? There are two points, according to the Financial Times. One is that during the good times, they have agreed high rents with their landlords, which they now can’t afford, and are having to renegotiate them. The CEO was sanguine about this on the radio: it’s in the landlords’ interest that Southern Cross doesn’t go bust, so they’ll have to do a deal. His relaxed style on this was probably a bit of show for his worried investors, but nonetheless what you are seeing here is the impact of economic drivers on a private sector company. They did not drive hard bargains in the good times, but they’re now being forced to do so. The FT suggests that good quality providers might replace Southern Cross in some of these homes, if they can make the maths work, so in some cases quality for the residents might actually improve.

You can see a fairly comprehensive diagnosis in the FT: http://www.ft.com/cms/s/0/d550d81c-4e82-11e0-98eb-00144feab49a.html#axzz1HBYad3p9

The second problem is that one of the reasons why the high rents don’t stack up is that local authorities and health trusts have been cutting back on their placements and cutting back on the charges they are prepared to pay. There are also some good points about this. First, it’s the economic drivers again. The public sector commissioners of care did not drive hard enough bargains in the good times, now they’re doing so. Both they and Southern Cross are being forced into doing the job for the minimum possible expenditure.

Second, one of the things the health and social care commissioners are probably doing is providing alternative packages in people’s own homes, rather than shoving people who don’t need it into care homes. Everyone, including the people being cared for, would agree that this is a good outcome. However, there’s a ‘but’ there, which I’m coming to.

Economic drivers: the negatives

There are also some negatives that we should factor in. Ask the question why Southern Cross is in this mess. Some of its troubles have to do with the fact that for several decades running care homes has primarily been a property-oriented business. A lot of money has been made from the properties, rather than giving priority to care. Because of this, it has now hit the buffers as the property bubble has collapsed. If everyone involved (including the landlords) were less concerned with extracting money from the property and more on giving an absolutely first class care service, you can’t help feeling they would not have lumbered themselves with inappropriate property costs, and instead would be focused on how they can provide the best care.

I think of the Railtrack debacle, when the privatised providers of railway track came a cropper because they spent their time extracting money from the property rather than focusing on running a safe railway. Or the numerous high street shops that have gone west because their private equity fund owners were extracting so much money from buying and selling companies and properties that they took on big loans and property costs that, with a retail downturn, they cannot afford. Perfectly good chains of shops have disappeared because of this.

And the lesson from this is not, as our anarchist rioters would have us believe, the evil of capitalism, or at least not directly. The problem is that the people who are doing capitalism these days think it’s only about making money for themselves, instead of the boring old job of running a good service. They get the money to run good shops and care homes, not to line their pockets. I feel I have to mention in passing bankers’ bonuses: there’s another lot of people who think it’s about making money for themselves instead of making the economy run properly by doing their job.

People I know who run businesses, but do not get big bonuses, work very hard to provide a good service. It’s these businesses that people go back to and will survive and build from the recession. But once they are big enough to get into the hands of the money men, their job becomes making money instead of providing a good service. Wrong priorities immediately result. One of my friends who was running an expanding business decided to reduce his expansion so that he didn’t need to get any loans from the banks, because the bank started getting too interested in telling him what he should be doing instead of leaving it to him. Sitting back with no bank loan, he’s living well enough, and nobody interferes with him.

What this tells me is that an overweaning interest in making money is actually a negative in providing all kinds of services, and also I suspect in manufacturing as well.

It’s a bit like Colonel Gadafy, also in the news this week. I can’t help thinking that if he decided to do a really good job of running Libya over the last 40 years, instead of lining his pockets and the pockets of his relatives, he would be generally regarded as an all round good egg and nobody would be wanting to rebel or bomb him.

As the Bible (or at least 1 Timothy 6:10) says: the love of money is the root of all evil. So it is in health and social care. It’s not the economic drivers, but the love of the money that economic drivers bring, that is the problem.

The other negative we should think about is that the downside of pressure from economic drivers, even if they have positive effects, is sometimes to drive down quality. Of course, Southern Cross will have to drive down the rent it pays, but it may also be forced to drive down the quality or amount of care it provides. The people on the streets this weekend, who are concerned about the use of economic drivers in public care, are the most concerned about that and rightly so.

Why economic drivers drive down quality in health and social care

Of course, it does not have to be. You only have to look at John Lewis to realise that people will pay more and flock to an organisation that focuses on providing a reasonable service rather than just the minimum. The problem is that care service users often do not have enough money to go to the John Lewis of care provision. Instead they have to use Poundland health and social care. I go to Poundland a lot, for a look round. It’s efficient at what it does, but a lot of the goods it provides (once you go beyond the small packets of big name goods at the front) are tat; they look glittery and something like what John Lewis offers, but in their manufacture and ingredients, they are cheaper and nastier. I do not want Poundland health and social care. Neither do I want Curry’s health and social care; their products are as good as in John Lewis, but the staff are so ignorant or unpleasant that you positively want to avoid the place.

Quality of care, then, is about the product – in care, the environment and the care processes –  but it’s also about the attitude of the people providing the product. These two aspects interact, in a complex way. Economic drivers do not deal with that complexity: you need other factors.

One problem with economic drivers in the complexity of care is that the people who pay, local health and social care commissioners, are not the people receiving the service, so they have no economic interest in good quality service. That comes from the professional standards of the people providing the service, but the split between commissioner and service provider in health and social care also splits the people who pay from the people who provide the quality. Previous governments have so twisted the organisation of health and social care that ‘effective commissioning’ and similar clap-trap, has become the marker of professional standards in health and social care management rather than the best service. The end product of ‘effective commissioning’ is Poundland health and social care, good if you’re lucky but tat that only looks like good care if you’re not.

The problem of workers’ interests

The second reason for the difficulty over economic drivers in health and social care is that people worry that the definition of quality is too bound up with the personal interests of the professionals. I’m in favour of discretion in applying professional standards for deciding what good care provision ought to be like, because in the end having high professional standards is the only way of ensuring good services in every detail. That has to be alongside genuine rights to decision-making by service users, so that services can be clear what they want and are driven by their choices. However, back to the anti-cuts march this weekend, it is hard to avoid the accusation that trade unions are using the ‘good standards of care’ banner mainly to support good pickings for health and social care staff. I’m one myself, and I think it’s right for us to be paid a fair salary and to have good conditions of work. This ultimately benefits the people we serve, and I’m happy for trade unions to work for improvements.

The problem is that nobody, but nobody (and including me), will believe that focusing on the wish to employ more public sector staff, pay them better and give them good conditions of employment will necessarily lead to improved quality of provision. Lots of very good people aim to provide the best services for service users work in health and social care. In the long run, history shows that if you run down pay and conditions in the public sector as compared with the private sector demoralisation results. People who can will make their exit, while people who can go elsewhere before getting involved in health and socila care never work for the public sector in the first place. But as we’ve seen, there are economic drivers, and they do prodce some benefits. The problem is to mitigate the downside of using economic drivers and boost the upsides.

What does make a difference

Several friends where I live have elderly parents in a local care home – we’re all that age. They were all worried a little while ago when a new manager was appointed and the standards slipped – they all became quite anxious about the safety and quality of life of their parents. The economic drivers didn’t change, the overall management didn’t change. What changed was the skill and professional ability of the manager.  Being middle class, they applied pressure. The regulator seemed suddenly interested. The external management took action, the manager was replaced, standards shot up again. Economic drivers didn’t change, the overall management didn’t change. Checks and balances led to improvements.

You could say this was an example of the Big Society in action. At least, it’s an example of the John Lewis contingent in action. But in Poundland health and social care, services can’t afford enough good people to maintain quality; you get what there is, mostly it’s okish cheap and cheerful, sometimes it’s less good, now and then you’re lucky and it’s great. Economic drivers don’t work because the people who are affected (isolated older people or inexperienced or inarticulate relatives) are not well involved in making caring choices and so don’t have the power of their active engagement in the services.

Would personal budgets make a difference? They are not a good economic driver, because they are about minimalist provision. The aim of introducing personal budgets is to provide the basic; you add to it, if you want a reasonable standard. You cannot use a personal budget to get improvements from an unsatisfactory care home unless you can assess quality of life, negotiate for improvements, and have the self-confidence and choices to move your budget elsewhere. There is just not that much choice in care homes at the lower end of the market, so unless you are rich enough and middle-class enough to add to the basic amount and get extras or you have good negotiating skills, you cannot get improvement or change.

We need to change the culture of our care systems. The only thing that provides good quality care is good quality people trying to achieve the best possible professional standard, well-regulated and, yes, encouraged to be as economical as possible by the economic drivers, because in the end that means more service for more people. And with social workers advocating on behalf of the people who cannot get what they need. Getting the balance between all these factors right is complex, but it’s twisted by an emphasis on economic drivers, because that encourages people to focus on loving money rather than quality. And that’s why cuts rhetoric is also wrong. It also focuses on financial rewards instead of quality of service.

Love quality not money. That will be the basis for my prescription for good palliative health and social care during this week’s series of posts.

Today: replacing the cuts rhetoric. This week I am going to post every day about some aspect of the Big Society policy, NHS reform and palliative care. The topics to be covered are too vast and complex to be dealt with in one post; but I will put them all together at the end on my Scribd website, where you can see past documents from this website and past publications, together with information about me.

Malcolm Payne’s Scribd website: http://www.scribd.com/m_payne5153

If you’re not used to Scribd, when the page comes up, click on ‘Shelf’ then on ‘+ See All’ for a complete listing of the papers and publications available.

Regular readers of this blog will know I’m a keen supporter of advance care planning, a voluntary discussion between people approaching the end of life with their carers, doctors, nurses care homes and relevant others about how they would like to be cared for at the end of life. It makes clear how you want the services to handle the time when you might get inappropriately blue-lighted into the local accident and emergency unit. By saying what you want, you have a better chance of achieving it, particularly if you involve your relatives and informal carers in the planning, because people will be less frightened of being blamed for doing something wrong.

I go further than this. I support the Scottish system of anticipatory care planning which extends this planning process back to when someone first enters the care system, and updates it all the way along. There are less surprises for everyone as you go along, and social care and health services can also plan more in advance and don’t feel the duty to do the max when you want something else, because they’re clear what you want, even if they come upon you in an emergency.

This is an international debate of course, and some interesting debates have recently been going on in the US; you can see something of what happened by looking at this account in  the New York Times:

http://www.nytimes.com/2011/01/05/health/policy/05health.html?_r=1

What seems to have happened is that, following the trend to promote advance care planning, the Obama administration included it in the options open to Medicare patients, the older people who currently get some help from the US state with their healthcare. Then there were objections from some Neanderthals about ‘death panels’, so lacking the courage of good sense and thoughtful care, the administration withdrew the proposal, to the fury of people involved in palliative and hospice care.

Why am I bothering to tell you about this? Because this is the sort of thing that is going to happen in the Lansley-proposed NHS. The elements of care that provide good quality, such as voluntary end-of-life care planning, are going to disappear under efficiency-driven financing. Of course, as the American example shows, it’s perfectly possible for doctors to have voluntary discussions of this kind with their patients, and for social care staff to have such discussions throughout care. But if the commissioner of the service wants a tight definition of what is to be provided and is not prepared to pay, there will be pressure on the quality elements of palliative care, particularly if they’re a bit controversial, or there is no wide agreement that they should be pursued. This example shows how that happens in a competitive, funding-strapped system.

The Department of Health has a website on the Health and Social Care Bill:

http://healthandcare.dh.gov.uk/

And it contains currently some statements from interested organisations about the proposed reforms, mostly brief excerpts from longer statements and links to them. Nothing reallly on palliative care, but there’s an Age UK comment.

And now, the Health and Social Care Bill and end-of-life and palliative care.

First, there is no specific coverage of end-of-life or palliative care, so we have to surmise what the issues might be for us.

Second, there is a focus on greater integration between health and social care systems, and this is given particular force by the role of local authorities in keeping an eye on healthcare services in their area and supporting advocacy and policy advice for healthcare providers and commissioners. There are no more guarantees of reducing health-think blindness than in the present system, and the strong role of GPs in the new system, many of whom are ignorant and want to remain ignorant and moralistic about social issues does not give much hope either. However, not all GPs are totally hidebound, and some are positively thoughtful, so this coordinated commentary and advisory local authority role offers some hope in more imaginative local authorities (as opposed to the Neanderthal ‘we do care management assessments – duh’ places; local authorities can be as, if not more, hidebound than GPs) that social care services and social thinking might have a greater impact on the inward-looking tendency in health services. Also the removal of the PCTs and even more the arrogant SHAs (‘oh, we’re so much more important than you pygmies’) has some hope of removing some of the more blighted buro-think in the NHS; most of them are in PCTs. The impact assessments say that perhaps 40% of PCT and SHA staff will transfer to consortia: let’s hope it’s the imaginatve ones.

The combined impact assessments here: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_123635.pdf

Therefore, we might hope for better influence in social care on end-of-life issues and better understanding of social care from GPs. And social work thinking might infiltrate at least some of the commissioning consortia.

Third, since a lot of palliative care in the UK is in the voluntary sector, existing non-NHS palliative care providers will have a clearer role of being licensed providers and will be able to compete. They are likely to be more experienced in getting in on the act than nursing and social care staff setting up social enterprises, and they have a track record.

The problem is gauging what the attitude of consortia will be. You can imagine that GPs will want to do as much end-of-life care as they can themselves, gearing up their own nurses to doing it. This would probably be cheaper, nearer to the community and liked by patients, who of course don’t know how much better it might be with their local hospice. Because patients and families will have a higher degree of choice, assuming a hospice provider is not too expensive, marketing the quality of hospice provision will become more important. However, the local reputation of many hospices and the fact that many GPs and community nurses like the help and support that home care services offer might encourage them to do a deal.

Fourth, however, there is the matter of the tariff, which will set the levels that consortia can pay for a service, unless there are specific arrangements. There is no national tariff at the moment, and previous efforts to create one descended into disorder. But we might move into the American situation in which there may be limits on what the consortia will agree is palliative care, and set requirements for admission, as the American insurance companies do.

Fifth, will private providers come into this? It’s hard to imagine the private hospitals aiming for this sort of thing, they will focus initially on providing predictable elective surgery. But you may well get private nursing homes and residential care homes competing to do end-of-life and palliative care on the cheap compared with the multi-talented hospices. After all, we’ve been working hard to train them to do this better, so they’ve been upping their skills in this area. And you might get private community care agencies moving into end-of-life homecare; it would be a natural extension of their domestic and domiciliary care markets.

One of the worrying things this points to is the advantage, in a competitive system, of not sharing knowledge and expertise. We would perhaps do a lot better not to train hospital and care home staff in palliative care, then they would have to come to us for services. Or are we going to focus on being training and development agencies? That would go against the Cicely Saunders principle of gaining the expertise to train and develop from actually doing the job.

Sixth, I think one of the important developments of recent years is hospital palliative care. To me, it is really important that end-of-life care in hospitals is the best quality, because so many people come to the end of their treatment or are admitted in emergencies and need good end-of-life care because they cannot be moved elsewhere. Are GP consortia going to be prepared to pay for this? They will want quick cure and out into cheaper accommodation. Perhaps the aim for hospices is to get themselves seen as cheaper providers of high-end end-of-life care to get people out of hospitals to cut costs. Here, the nursing home market will be strong competitors.

Finally, there is the general aura of competition in the Bill. Reading the Bill gives you a very clear impression that it is setting up the system to be strongly competitive; the arrangements for competition are there in every section, and priority is given to it wherever they can achieve this.

What is going to be the unique selling proposition of hospices? And how are they going to market themselves?

Guardian summary of the Bill:

http://www.guardian.co.uk/society/2011/jan/19/health-bill-main-points?CMP=twt_gu

The Guardian and its commentators on the ‘chorus of concern’:

http://www.guardian.co.uk/politics/2011/jan/20/andrew-lansley-health-bill

The Campaign Company blog comments on the increased role envisaged for local government:

http://thecampaigncompany.wordpress.com/2011/01/20/health-and-social-care-bill-the-increasing-role-for-local-government-within-health

Health Policy Insight blog critique of missing features (e.g. post implementation evaluation):

http://www.healthpolicyinsight.com/?q=node/917

Health Policy Insight blog on risks of the reforms:

http://www.healthpolicyinsight.com/?q=node/914

This is based on a more lengthy comment by Sir David Varney (who has experience running a Foundation Trust) for Civitas (but HPI covers the main points):

http://www.civitas.org.uk/pdf/VarneyRiskequity.pdf

NHS Confederation: 12 pointers on reducing the risks of the change:

http://www.nhsconfed.org/Documents/Implications%20for%20policy-makers.pdf

Nuffield Trust: lessons on GP commissioning from the US

http://www.nuffieldtrust.org.uk/publications/detail.aspx?id=145&PRid=756

Royal College of General Practitioners comments:

http://www.rcgp.org.uk/news/press_releases_and_statements/health_and_social_care_bill.aspx

A lot of relevant stuff from the NHS Alliance (brings together GPs and related groups) cautiously supportive of GP commissioning:

http://www.nhsalliance.org/documents/white-paper

A BBC film of ‘experts’ commenting, reasonably neutrally:

http://www.bbc.co.uk/news/health-12229547?utm_source=twitterfeed&utm_medium=twitter

Access the bill and related offical publications at:

http://www.dh.gov.uk/en/Publicationsandstatistics/Legislation/Actsandbills/HealthandSocialCareBill2011/index.htm

Access the political justification on the Conservative website at:

http://www.conservatives.com/News/News_stories/2011/01/Modernising_the_NHS.aspx

Early comments from the Royal College of Psychiatrists at:

http://www.rcpsych.ac.uk/press/pressreleases2011/healthsocialcarebillresponse.aspx

Like many medical and union commentators, their concern is speed of implementation and possble chaos. quality going down because there will be pressure to go to the cheapest supplier and fragmentation of services because there will be many potential providers.

In psychiatry, they don’t say so (perhaps being polite to their GP colleagues), but you can understand a concern that mentally ill people will lose out because a lot of GPs will have to, or will choose to, give priority to more popular patient groups.

Other comment later.

The government’s green (consultation) paper on ‘Giving’ is frou-frou (see the end of the post for a definition if you need to); even so I am going to spend quite a bit of space on it. This is because it gives us an important clue and direction sign to how the ConDems understand the idea of the ‘big society’ and how they are going to implement it. It also has considerable implications for how end-of-life care is going to be supported and funded by the present government, since most of it is charitable.

The paper is on the internet at:

http://www.cabinetoffice.gov.uk/sites/default/files/resources/Giving-Green-Paper.pdf

So you see that it comes from the Cabinet Office and is a document that applies across government and implements the government’s philosophy, rather than just being about a particular department’s interets. It is, therefore, an important general signal about what the government is trying to do.

Starting point

The government’s Green Paper on Giving is mainly white, but has shifted to a new yeuchy-yellowish-green theme colour. I presume their marketing people think this is cool; I think it’s like vomit.

Green papers are theoretically consultations about policy. However, do not be misled. You are not being consulted about the policy; you are being asked to come up with more ideas than the government has come up with to do what it has decided to do. What you cannot do (or you can but they obviously won’t take any notice) is say: ‘Well actually I wouldn’t mind paying a smidgeon more tax to help provide state services, if everyone is going to pay according to their wealth and income, and especially if bankers are going to stop leaching off the country and pay their own way’. No, instead you can have ideas about how they can arrange to get money and more volunteers to support the services they’re not going to provide, through your donations or money and time to charities and similar organisations, provided they’re run like businesses. Not, God forbid, to the state.

A good way, according to them, is to take a slice of your money every time you use your bank’s hole in the wall to pay presumably to a few charities that the government has selected to do the things that it won’t be doing. I wonder what the banks are going to charge for that? Presumably proportionately more than the Inland Revenue (sorry Her Majesty’s Revenue and Customs) would cost for adding the same amount on to my tax bill. Well, don’t worry, because on principle I, along with everyone else I know, will not be cooperating with this in any way at all, so the banks are not going to be overcharging me for that as well. This is a worrying politicisation of giving to charity, which is going to turn a lot of people off, certainly a lot of people I know.

The real weakness of this document is that it is written by people who are in marketing and believe in it. Frou_frou.com will lead you to a heaven in which cool, computer-linked , computer-kinked all-sharing people who have lots of frou-frous that don’t matter too much to them will contribute their frou-frous that you didn’t know you needed and improve your community custard tart.

I repeat what I’ve often said on this blog: the voluntary sector is created by what people, voluntarily, themselves want to do. It would not be created for what the government wants to do; if the government wants it done, it should do it. In a small way, the voluntary sector sometimes gets money from the government to provide some of its services. Most voluntary organisations don’t do this. Those that do, like hospices, get a fairly small proportion of their income from government. A few (usually noisy) voluntary organisations get most of their money from government. They have to be noisy because they have to influence policy to make sure they continue to get that support. But as soon as the government sees the main purpose of voluntary activity as providing what it wants to provide, then it ceases to be voluntary, because it ceases to be free to decide on how and what it is going to help.

The government seems to think that by setting up lots of local community organisations, social enterprises and supporting voluntary organisations, they will be able to have a flock of providers keen to reduce the monolithic character of government health, social care and other things. But the problem is that independent organisations do not necessarily do what you want them to; the government cannot implement their policies by telling independent organisations what to do. The history of edgy NHS relationships with GPs (whose practices are small social enterprises that have been in existence for more than 60 years) should tell them this. And then, of course, all these little local organisations may sell out to big multinationals. Or big multinationals may be preferred providers because they’re less trouble to contract with. But they also, of course, have considerable power to do what they like. Then, like banks, if they are providing most of your services, you can’t let them go bust. I see 2035 as the date for the bailout of the health and social care multinationals.

You’ll have gathered that I don’t come to this Green Paper very enthusiastically, but I have nerved myself up to it, because as major providers of excellent services to the public, palliative care organisations and hospices, not to mention other voluntary sector organisations have a very real interest in how the government is going to go about this. And our patients and everyone else has an interest in how they think they are going to make the ‘big society’ work.

The context: a culture change

The Introduction to ‘Giving’ (it’s not just money, it’s your energy and commitment) puts this bit of their policy in context; this is helpful direction-setting, trying to identify the network of footpaths that will lead to the big society. The aim is:

-        Empowering communities – policies and actions to encourage or allow local communities to do things for themselves.

-        Opening up public services – allowing (in this order) charities, social enterprises, private companies, employee cooperatives to take on running public services

-        Encouraging social action – encouraging people to give time, money, assets, knowledge and skills ‘to support good causes and make life better for all’.

They will do this through:

-        a localism bill, giving people the power to change their local community

-        public service reform, allowing people more involvement in local services.

The main values expressed are to ‘acknowledge the limits of government’, emphasising ‘the role of reciprocity’ and to use technology, particularly ‘social media’ (things like Facebook and Twitter). There is a big emphasis on culture change, the assumption being that we don’t do enough collectively for other people. They hope to get local communities to play an important role and businesses to provide ‘support’ by enabling their employees to do more.

On ‘community’, the sociologist in me comments that this is all about local communities rather than communities of interest (people who share similar interests) or, indeed, online communities, which sociologists have recently begun to recognise. Bearing in mind their interest in using new technology for many of the things in this paper, it ’s rather surprising the paper seems to miss out on this; to a ConDem obviously only ‘local’ counts as community. This is fifty years behind the sociological times.

There is also nothing in this about families and carers. Not, I think, that they are against family and carer support, but the emphasis in this interpretation of ‘giving’ is on organised support outside the family. I wonder why this is, since all the research shows that people are more likely to offer support to relatives than neighbours and more distant members of their community. I also don’t think that localism necessarily generates mutuality and shared interest; we get more support from people with shared interests, wherever they are. Social networking connects with this: some people make their connections in ways that do not slot in to localism. It also fails to tell you how all this new giving is going to interact with families and carers; it’s too busy pulling together examples of cool things that it wants to do to think and plan about how it fits in with the most important forms of support in our communities. Alongside families and carers all this sort of thing is frou-frou.

On the other hand, social networking has to be taken a step further than computer or mobile or Twitter communication; it requires real human interaction to cement it into a group of people prepared to take action in some way. I think we have to be more thoughtful about how we turn technological social networking into interpersonal social networking. That transfer from networking to action cannot be taken for granted. Some of that reciprocity has also to be there and it has to be planned for and worked at.

And, on top of all that, I go back to the government getting what they want. The whole principle of any kind of giving is that givers choose what they give, how they give it and what they give it for. The whole history of social action is littered with examples of governments encouraging community participation and then finding that what the communities want from their participation is something the government doesn’t like. As a result, participation gets taken away pretty smartly. That is going to happen here too, if the frou-frou social marketing-speak ever gets taken towards anything real on the ground.

The people I talk to are saying fairly clearly that the government is not going to get what it’s looking for from these initiatives. First of all, people won’t give if they believe the government is giving up. Second, it takes a lot of hard work to create community initiatives and people are not going to do it for objectives that they don’t agree with and that don’t really benefit them. A local community organiser said to me a couple of weeks ago that she wasn’t doing newsletters and trekking round the streets in her estate just to do something that she wasn’t interested in and that the government should be doing anyway. Looking at the recent social care ‘vision’ document, I commented on the idea that dealing with adult safeguarding (stopping granny-bashing in normal-speak) through a neighbourhood watch model will not work. People are just not going to sit in the front rooms and check up on neighbours who neglect their elderly relatives. They expect to be able to report it to officialdom and for there to be a lot of well-trained officials to do something about it.

The main actions

To achieve its desired culture change, this sections tells us what the government is going to do. Perhaps you won’t see this in the typography, so I’ll point it out; it comes as an acronym or possibly a nemonic: GIVES. This kind of cutesy stuff turns me off government documents. It makes it more marketing frou-frou than an effort at engaging me, and I do not like to be marketed at; I don’t know a lot of people who do.

Here it is:

-        Great opportunities, so it’s exciting and convenient to do giving;

-        Information, so we know how to go about it;

-        Visibility, so we see other people giving and do more ourselves. This is a sort of ‘keep up with the Jones-Smythes’ on the giving front, obviously we’ll all want to do what our friends are doing.

-        Exchange and reciprocity, so we all see the benefits of giving much more.

-        Support communities and charities to take on more responsibility and scale up what they’re doing.

Great opportunities

You’ve seen the press comment on easy giving using new technology. Examples are; every time you click on the internet, every time you get money from the hole in the wall, rounding up to a pound every time you make a card payment, easier donations through the internet, on your mobile phone, volunteering slivers of time from home through the internet. Yes, come on, offer your sliver of time via your computer to the person dying in the next bed to me; I’m sure the highly qualified nurse will find it very useful. Volunteering is real people in real places when required, not an exciting marketing concept. And real professionals have to provide the services, and not spend all their time organising slivers of time from people on their computers at home.

Other ideas are creating ‘trigger moments’ that catch people’s attention, getting civil servants and local government officers to volunteer, for example providing training. Dying as a trigger moment might get a lot of people’s interest, but I happen to think a service providing for people’s needs during dying and bereavement is demeaned by seeing it as a ‘trigger moment’ in a marketing campaign for increased giving to charity.

From the point of view of an ordinary, possibly donating, member of the public and from the point of view of the common or garden hospice in their local community, I’d like to know how I choose who I’m donating to. Will it be some government-selected charities that they like, perhaps those that are helping them fill in for their cuts in services? Or will I be able to select any of the thousands of local charities for my slivers of money and time so conveniently donated? I can see that every local bank might be able to offer a choice of, say, a local community fund as well as three or four national charities to choose from in the fourth pages of my hole in the wall process (which already has too many buttons to press to get my cash), but how is that fund going to choose the organisations that get the money locally?

We’d all better start buttering up the bank managers who design what charities are on the front page of the bank machines, or fund organisers who decide on the local grants. I’ve actually done that job for a local fund years ago, and what it led to is a few thousand a year at most, more often just a hundred of two, for many local charities. And anyone who’s worked for a grant-giving charity (or government department) will tell you they spend much of their lives with people pitching clever re-designs of their organisation to meet the latest cool criteria that teh fund-gier has come up with so that they can market their exciting grant-giving to the outside world and the trustees. And it always leads to grants given for projects, in the same way that foundations provide now. This is not the way the provide funding for solid continuing local care services. It’s likely to be no good at all to your local hospice spending a few million a year on supporting dying and bereaved people with a consistent service.

Then on to volunteering. The offensive paragraph about volunteering is apparently drawn from the Commission on the Future of Volunteering; did this really say that volunteers provide ‘a personal, human touch that staff might be prevented from providing, making services feel genuinely caring’? Obviously, nurses, doctors, chaplains and social workers can’t provide genuine human caring according to the Commission. Or at least the way some ignorant marketing professional working for the government has re-written it. Neither can they provide ‘innovation and a fresh perspective’ and ‘a source of local and other knowledge’. Not too knowledgeable all these qualified staff, and of course our nurses and health care assistants doing shifts all day and night must be living miles away from the hospice and have no local knowledge at all. In case you didn’t realise, that sentence was ironic. Perhaps the staff will be so driven because of all the cuts in services that only volunteers will be able to do anything human. I’m sure that sentence was ironic too. And perhaps that one was.

One of the laughable examples is how another of the government’s green papers aims to stimulate people into local social action in providing effective punishment, rehabilitation and sentencing of offenders. I must make a note to read that document, because my lifetime’s experience (I was working in offender services forty years ago was on the board of one more recently and retain a concern) is that people do not want to get engaged in voluntary working with the nasties in life. The number of people wanting to help punish, rehabilitate or sentence offenders through local community action is likely to be infinitesimal (except in the local teenager castration clinic, but probably the government is not going to want to go that far). I can see that loads of people might enjoy being a volunteer for the Olympics (another example). It’s time-limited, it’s nice, it’s in the summer, so they’ve had a lot of applications. And, yes, hospices might be OK because although people do tend to say that they can’t imagine working in a place where a lot of people die, when they’ve experienced the services, they find it interesting and worthwhile. But there are not going to be a mass of volunteers to work with middle-aged alcoholics, or twenty-something druggies or prostitutes.

And I’d forgotten we’re going to have ‘National Citizen Service’ for over 16s to give their time. I’m sure lots of them will, particularly since so many are going to be unemployed and not going to university or getting education maintenance grants: but are we really going to run the country on this basis? Apparently so, because there’s going to be some funny money to support ‘a volunteer infrastructure programme’ for organisations that are recruiting, training and supporting volunteers. That’s presumably to make up for all the local authority grants that are going to be withdrawn from local volunteer centres that have been doing this job for decades (I ran one in the 1980s and there are several very good ones in the St Christopher’s area, that have been imaginative in supporting volunteers with special needs) Of course, the government knows about these organisations, but presumably also knows that it needs to come up with some realistic financial support for volunteering, because it’s not cheap, it involves a lot of people to support and train volunteers effectively. The problem is, I think, that training and support is best done close to the service that the volunteers are working in; on the hospice ward, in the hospice home care services, in the day centre or chaplaincy. Some generic support agency does not really have the expertise in the job to be done. Of course, I’d forgotten that only volunteers have knowledge and the human touch, so it’ll be all right; sorry.

Information

One of the ways slivers of time and money is going to work, apparently, is to have websites set up for volunteers to apply through and for charities to show what they’re doing and for donors to track the impact of their contributions. I’m sure there’ll be funny money to support this initiative too, so what this means is that there’s going to be lots of jobs for redundant local authority workers organising local charities to provide information about how all this money and time is being used, and they’ll need even more volunteers, because the staff are going to be run ragged providing all this evidence of impact. My job’s safe: there’ll be many more audits to persecute doctors, nurses and social workers with so we can feed information to these websites to demonstrate to everyone what they’re doing.

Here’s an interesting point; ‘There’s much that we can do as government to make sure the right information exists’ (p 12). What can this mean? Is there loads of information existing that’s not right, and the government’s going to correct it? Or is it: ‘Ve haf vays to ensure zat your information fits vat ve vant it to be’. Here’s the answer: ‘The volunteering initiative ‘Work Together’ was launched earlier this year to encourage all unemployed people to consider volunteering and to ensure that people have access to the information they need to find local opportunities’ Ah, so it’s: ‘Ve haf vays for you scroungers to find out how voluntary arbeit mach frei’.

And then there’s transparency. Apparently, people are not concentrating on the ‘right metrics’ (p 12) in deciding who they are going to donate to and support. Ah, so it really is: ‘Ve haf vays of making sure zat your information fits vat ve vant you to sink’.

Visibility

Logically, if you’re going to make everything transparent (see above), you’re going to have problems with visibility. This section is about making sure people are aware through social and traditional media that it’s OK to give time and money to charity, and that all their friends are doing it too. And celebrities that they’ve heard of. Delia will be tweeting every time she buys her eggs: ‘I’ve rounded up the price and given the money to the anti-obesity project for community cooks’. In case you hadn’t counted that’s only 78 characters, so there’s plenty of space for the donation website URL. But I suppose Delia, while trusted, may not be exactly cool with the younger set: Cheryl Cole, then, but while she may be supporting anti-obesity, it probably won’t be community cooks.

But don’t worry, the government is going to lead by example. That’s actually a sub-section heading; I have to quote this in its entirety:

Government has the opportunity to encourage its employees to lead by example, and in so doing help build new social norms. Plans are already underway to develop a ‘civic service’, whereby civil servants are encouraged to contribute to their communities. Our aim is to provide civil servants with opportunities to use their skills to support civil society organisations and to play their part in growing the Big Society. We will do this by promoting social action as a means of professional development for civil servants, and providing better recognition for those giving their time.

Phew, that’s all right then, the government is not going to lead by example: George (Gideon Oliver, Wikipedia tells me) Osborne is not going to be at my bedside to provide that human touch as I shuffle off this mortal coil, they’re only going to encourage their employees to do it. I thought there weren’t going to be any surplus civil servants, so how are they going to be building new social norms from their central London base in Whitehall? And if there were, they don’t have any worthwhile skills, do they? According to the government, skills only come from business.

Are they including all the hospital nurses and doctors alongside the local jobcentre clerks among their employees? The NHS as a really big government employer is obviously going to be a big target for this sort of project; not really worth it to get volunteers for the London area from the comparatively few pen-pushers (sorry, keep up to date Malcolm: keyboard-tappers) they have in Whitehall. Might be good to have nationwide civil servants from the NHS, though – judging by Casualty, I’m sure local hospital doctors and nurses could all fit in an extra shift at the local hospice once they’ve completed their undemanding day jobs. And all those unemployed PCT civil servants too.

They’re also going to promote the charities they work with on government websites – yes, Nick Clegg and his civil servants want to tell you that their favourite charity ‘Keep your word at any cost’ is a really top-notch place to volunteer and donate your hard-earned slivers of money. No, on second thoughts, it will have to be like cigarette packets. They discovered that the only way to give credibility was to say: ‘The Chief Medical Officer says smoking kills’ (I’ve never seen a cigarette packet in recent years so I don’t actually know what it says, but the point is it was definitely a no-no to send a message from the government). Being approved of by a government in decline (in three or four years time, of course) is going to be even less of a recommendation.

I also just have to quote the next one:

Finally, we want to consider whether we should be trying to establish social norms directly. For instance, some have advocated that we aim to make giving one per cent of income a social norm – but others would say that the level should be far higher, as much as ten per cent, which is in line with tithing levels. And there are similar questions about levels of giving of time. The government can play a role in creating the choice architecture and entrenching norms for giving… (p 15, emphasis original)

Well if giving 10% should be the social norm, it’s all right to put taxes up by 10% to pay for government services, isn’t it? But I agree I don’t want to pay it to the government. I’d happily pay it to my local council or the local NHS though, because they provide really useful direct services.

And ‘choice architecture’? Did anyone tell them about meaningless business jargon being a real turn-off. Either they all speak like this, or nobody with any connection with the real world read this before they published it.

Exchange and reciprocity

We’re nearing the end now. Here we go again, a quotation:

While powerful motivators in many situations, the prospect of feeling good about ourselves, making new friends or gaining experience, are not enough on their own to encourage us to give in new ways, to new causes or for non-givers to start.

So making a contribution to good in the world is not a relevant motivator then; bit inconsistnt with the rest of the document perhaps? Therefore:

Peer-to-peer lending and financing platforms like Zopa, IndiGoGo and Sponsume allow people to give money to individuals or projects who post requests for funding online. They enable a clear sense of connection between sponsors and those needing funds, and allow for reciprocity – in the form of benefits in kind, or a real financial return on money invested.

So sponsor St Soandso’s Hospice and we’ll reserve a bed for your wife when she’s dying. That won’t work because nobody thinks that they or their wife is going to die and she might not die for ages yet. And are only the donors going to get the beds? ‘I’d better get a quick donation in now my wife’s got cancer’. Working for a hospice, I have met some people who think this way, but it’s not the way I want end-of-life care provided in this country. The government shulds realise that this form of reciprocity is just not a realistic approach for many of the activities that charities provide for.

Then there is a list of organisations like freecycle that have come up with a good and useful idea (for those who don’t know, it’s an e-bay-like website where you give away things you don’t need to other people who do ). I know young people for whom this has been a godsend to find free furniture and household items; it’s a mutual Salvation Army clothing and furniture store on the internet without the SA as an intermediary. The government would like to encourage more of this. But such ideas are round the edges of life. I want to give away some palliative care books, but it doesn’t seem to have worked: perhpas death and dying freecycle could pass them on to someone who can use them. If you’re dying or bereaved, you want a coherent, consistent service available from trusted people. Yes, it’s supportive to get reliable information from the internet, but at the centre of the service there need to be well-qualified competent people; you know, those human being types that we used to see around so much.

Finally, support

People in communities will be encouraged to ‘step up’ to take on responsibilities. This business motivational jargon implies that they wouldn’t be able to and they’re not prepared to.  In forty years of being involved with voluntary organisations, I’ve seen people prepared to ‘step up’ to massive responsibilities if it connects with them and they believe in it. Let’s be clear that nobody is going to ‘step up’ to do what they think the government should be doing. People are not all failures in community commitment, in fact most people are very committed to helping others around them, but on a human-to-human basis with people they know and about issues that they feel connected to and believe they can make a contribution with.

So, here comes the funny money; since this is all about marketing, I’m going to start calling it funny munny.

Funny munny 1: a ‘community first’ programme will provide grants to help local people implement projects and plans (and employ all those unemployed people on short-term contracts until the project is up-and-running, when they can move on to the next project).

Funny munny 2: £50m of ‘matched funding’ to support community endowments. Matched with what? Local business is going down the tubes, self-interested banks won’t lend, so they certainly won’t donate (how can they justify it to their shareholders across our globalised world?) and more people are going to be cautious because they’re more likely to be unemployed. And endowments don’t lead to immediate projects, that people can’t use the internet to track their slivers of time and other contributions so that they can see that they’re ‘making a difference’. They imply a build-up of funds over decades, so the banks and financial services can invest it to produce income for the future. So, is this really a goody for the banks? If it is, let’s remember that investments are not earning real rates on interest at the moment, and stocks and shares have not increased in value for quite a while. There will be no community endowment, because endowments don’t grow in the present economic climate.

Funny munny 3: A ‘community organisers’ programme to train 5,000 people to ‘galvanise’ (p 17) people around them to be more active. What this will be is more money to employ unemployed community work lecturers or support courses in universities and colleges which are struggling because nobody is funded to do adult and further education. On short-term training projects, rather than building up solid, long-term education courses.

Then there’s ‘Every Business Commits’. This was a Cameron announcement at the Business in the Community AGM in December, so you may have missed it through not being focused on community development in the run-up to Christmas, which is the time most people make donations to charities, so I can see you’ll have been busy. It appears on their website: http://www.bitc.org.uk/business_and_the_big_society/business_commits/index.html as a series of recommendations by Bitc that all businesses should pursue; the government seems to have taken it up. The five main points are:

-        Reduce carbon and protect the environment

-        Support your community

-        Improve skills and help create jobs

-        Improve quality of life and well being

-        Support small and medium-sized enterprises

Alongside gems like ‘pay suppliers on time’ which funnily enough over decades no one has been able to get government organisations or big businesses to do, the supporting your community stuff is what the Giving green paper covers; these proposals are all circular. To improve quality of life and well-being, the following clear and concrete proposals are:

-        Make your workplace more family-friendly and offer flexible working wherever possible

-        Take further steps to improve the health and well-being of your workforce

-        Support diversity in the workplace.

This is the equivalent of: ‘Now I do hope you chappies are going to do jolly nice things in the future’.

But don’t worry, it’s not just business they’re supporting. There’s going to be more funny munny to help charities and social enterprises encourage volunteering:

Funny munny 4: The volunteering match fund of £10m to match private donations that support volunteering projects. I can already see voluntary organisations redesigning their accounts and talking to donors to prove they’ve got donations coming in to support volunteering. This is just another wheeze to take some money from state services and claim they’re supporting voluntary effort.

Funny munny 5: A Volunteering Infrastructure Programme of £42.4m (that is £10m a year again; you’ll remember I mentioned this above) to provide brokerage and ‘front-line’ support to volunteers that organise and manage them. This is another job creation programme for unemployed people to shift from public sector employment to supporting volunteering.

Funny munny 6: They’ve already announced a Big Society Bank that will ‘capitalise the market’ (p. 18) for social investment. If this is like Chris Huhne’s similar project supporting eco-friendly  projects, I presume the Treasury will stamp on it in case it overspends and nobody ever repays its loans, so it will not become a genuine bank that can borrow money and support social projects, but will be another grant-making scheme to help ‘social enterprises’. So I count this as more funny munny. This is not for charities because of course they are not real businesses, even if they provide useful services, and so therefore cannot be capitalised. I suspect there might be a bit of corporate redesign among the aspects of charities that can turn part of themselves into social enterprises.

Funny munny 7: A Transition Fund of £100m to help charities hit by local authority voluntary sector cuts over the next financial year, until the massive growth in business and community support for voluntary organisations in the new Big Society replaces it (you may think that was another ironic comment, but it’s actually not far from what the document assumes to be the truth). Since they say that local authorities should not be cutting stuff because they should be more efficient, it’s not quite clear to me how they’re going to allocate this. Hence, I designate this too as funny munny. But I presume at the end of the year, the big society won’t have arrived yet (just slightly delayed of course) so I anticipate an outcry at the withdrawal of this support which will embarrass the government, leading to the ‘transitional support’ becoming ‘pro-transitional’ and in later years ‘post-transitional’. Another wait and see there.

Finally, there is the suggestion (they are consulting on this; you may have a view) that they will make foundations pay out a minimum every year. So this is the new free choice Britain: ‘Ve haf vays of making you pay, even if you don’t vant to’. There no suggestion of a problem with this limitation on the freedom of decision-making of foundations. Apparently some other countries do it; I’d like to know where and I’d be interested to know how it works, because my long experience of people who make donations to charities is that they really, really want to support things that mean something to them, and they don’t like being told what to do by government.

But I wonder how the government thinks they’re going to do it, since they haven’t managed to get the much richer banks to lend, or even reduce their bonuses. Of course, foundations are much less powerful in the economy, when bankers won’t make ‘yes’ as an answer, so perhaps it’s easier to bully them.

And another aspect of free choice is venture philanthropy: get a grant from our tame foundation stacked full of businessmen and management consultants who are no longer employable because the government is cutting back on business consultants, and they will interfere with your objectives and management because being a real business they will have much better management skills than your pygmies. Many of their staff probably come from banks and financial services companies for example, real examples of entrepreneurial skill. Sorry, that’s another ironic comment; I must stop this. Perhaps some charities might go for this, because it might be better than having local government and NHS bureaucrats interfering with their objectives and management on grounds not of ability but democratic accountability for their grant-aid.

Now you mention it, there’s not been much so far about democratic accountability in this green paper. Of course, you don’t need that if everyone is building the big society outside government; nobody has to be democratically accountable to anyone. Except that I suspect the government is going to continue to take a very close interest in the big society doing what it wants, not what people in the big society want. This is because I don’t think they can quite imagine that some people don’t think like them, so it will be quite a shock when quite of lot of people start creating a big society that disagrees with the government. It’s happened with every other community development initiative in the world.

The supporting evidence

This account covers about half the pagination of the green paper. So what about the rest? The next big section offers the evidence in support of the proposals. This can be summarised as evidence that there is wide variation in giving across the population, and a lot of them simply aren’t asked, so if you can get at more people they will give more money and time. Also, as NCVO has said in one of its reports, if you make the ‘ask’ clear and attractive, you will get better support. Then there is a comparison between the UK and other countries: the UK already does better than most developed countries in getting people to give  to charity and 70% of people volunteer in some way. The US does a lot better, but has a completely different culture; presumably the government’s culture change is designed to emulate that culture.

However, there are a string of statistics here which show that many people don’t give money (or time but most of this section is about money and shows where the government’s main emphasis is) and there is mention of making it easier to make tax reclaims, to give larger sums, to engage a wider range of corporate donors and so on. All of this is predicated on the evidence that some people (or corporations) give, but more people (or corporations) don’t. The paper therefore makes the assumption that more people and corporations would give if giving was marketed to them better. Marketing rules OK.

I think it might have something to do with how rich the potential corporate donors are (I notice manufacturing and media companies are not big givers and I suspect this is because they are under the competition cosh, so can’t afford it) or what they can achieve by donations (I notice financial services give a lot, possibly to try to improve their seriously tarnished image, and they and other retail companies need to gain public approval and charitable giving is a useful marketing device to this end).

Consultation

At the end, there are several pages of consultation questions. These are more about how they can do what they intend to do, so mostly are not worth answering if you don’t accept the basic premises of the way they talk. I don’t, so I’m not going to bother with them.

The government believes that they can get community involvement through stronger marketing of their opinion that everything would be better if everything was run like a business but not by government. My view is that community work is a longstanding and well-established profession, with a long history of achievement across the world. It has demonstrated again and again that to engage people in community and mutual support you have to make a personal and human connection with them and get them involved in things they believe in and can make a personal commitment to through social relationships with like-minded people. Marketing is not going to work. And social networking has to develop an interpersonal interface to extend its reach into real community support.

On frou-frou

You may be wondering what frou-frou is. My internet dictionary says: 1. Fussy or showy dress or ornamentation. 2. A rustling sound, as of silk.

Yes; that’s what I think of the thinking behind this document.

You’ll have seen all the flurry about the housing benefit changes, which may well lead to heavy losses in benefit for people occupying housing in expensive areas of the country, and average losses of £12.00 a week.  Palliative care and other social care colleagues might, however, have missed an element of the changes announced by the DWP. Here is its statement:

The Government is also responding to concerns that the criteria used to determine the size of property a customer requires only take account of people who live in the customer’s dwelling as their home. Therefore a paid carer who resides with the customer is reflected in the size criteria but no allowance is made for carers who provide overnight care but who normally live elsewhere.

In recent years, local authorities have increasingly been asking for advice as they have come under pressure to include an extra room for the use of non-resident carers. This has led to inconsistency in treatment of non-resident carers. In some areas, the additional cost of a sleep-over room has been met by social services. Elsewhere the local authority has met the cost through a Discretionary Housing Payment but, on other occasions, the customer has had to meet the shortfall themselves. The Budget measure to fund an additional bedroom for non-resident carers puts right this unacceptable position.

What a nice positive way of putting this change. It means that if your carer is a live-in carer, you are likely to lose money, especially in a high housing cost area, but if they only sleep over, an extra room is paid for under the housing benefit. So there is potentially a small goody here for patients and clients who have carers not living with them.

But…

Remembering the effects of the cohabitation rule on my clients in the past, I can’t help thinking that it won’t be long before the DWP is taking someone to court for fraud because they have made a (larger) claim for a sleeping-over carer when it should have been a (smaller) claim for a live-in carer. I look forward to the DWP definition of when you’re living in rather than sleeping over. Will it be like Blackpool landladies: you have to go out after breakfast and not come back until the evening? Or perhaps your bedroom will be examined to make sure it doesn’t have the appurtenances of living in (no home comforts, perhaps, no telly, book, kettle in evidence)? Or perhaps sleeping-over carers will not be allowed in the living room with other people in the household.

You can look at the DWP impact statement on who will be affected by size of house, area etc; it is instructive about the sums of money individuals will lose (although not necessarily a high proportion of the population), at least outside London:

http://www.dwp.gov.uk/local-authority-staff/housing-benefit/claims-processing/local-housing-allowance/impact-of-changes.shtml

Scroll down to click on the impact statement. People have criticised the DWP assessment, so don’t take it as gospel. You can look for how it will affect your area.