Monday, 20 April 2009

Whose Cradle? Whose Grave? A Response to Chris Dillow

One of bloggers I respect the most, Chris Dillow, is in left-libertarian gadfly mode, and is asking whether the left should support a small state, or if the state should even be trusted as a vehicle for increasing equality. It's all jolly fun, even allowing him to quote mad axe-man Althusser, of all people, on Ideological State Apparatuses in one of the older posts he links to. What it doesn't do, though, is look at the specifics of how state run and funded welfare services have actually worked historically. So I offer this note, a version of something I did for a friend last year, as a cautionary note.


Let's start with Attlee and Beveridge, although of it course it didn't really start with them. But they are the two figures it is conventional to see as the embodiment of the post war consensus on social welfare matters, a consensus which has only been seriously questioned in active political terms in the last 15 or 20 years. The consensus they supposedly represent is one in which the State takes responsibility of ensuring a 'cradle to grave' security for all citizens from what the 1942 Beveridge report described as the five "Giant Evils" in society: squalor, ignorance, want, idleness and disease.

This version of a welfare state rested on some fairly profound unstated assumptions, foremost of which was the notion of a population organised almost entirely into nuclear family households, dependent on a male wage earner. Such families might need help in times of trouble or ill health, or assistance in redistributing income between different phases of their lives, but they were seen as essentially self dependant units of social organisation as long as any repeat of the mass unemployment of the 1930s was avoided. This hid the unremarked on fact that most childcare and most care of elderly or disabled persons was, in reality, carried out by the female members of these nuclear family households. Precisely because this was so the borderline between formal 'care' and 'health' was often hazy: because most elderly people – or mentally ill people, or people with learning disabilities – lived with their families, the range of state services for those that couldn't get support in this way was often overly-medicalised and very institutional. The formal welfare state of Beveridge and Attlee rested on an unseen army of female caring labour, and sometimes provided less than ideal alternatives to this labour.

It also rested on some unstated assumptions about the likely demand for services. Its very centrepiece, the National Health Service, was originally planned on the assumption that once a backlog of health problems in the population had been addressed, demand for services would stabilise or subside. This proved hopelessly wide of the mark.

Not all 'classic' state welfare services were about individual incapacity: some were, originally at least, most definitely about self improvement. Council housing is the key example here: its large scale expansion was the answer to a massive post-War problem of privately rented slum housing and bomb damaged housing stock. But this wasn't a response that was indiscriminately or objectively bestowed on all people in these circumstances: you had to qualify for council housing, partly through the grim experience of waiting on a list and partly through some less objective tests which measured your moral suitability to be given access to this scarce resource.

It's important to note, despite the conventional view to the contrary, that this never, even at the beginning, implied that the State necessarily directly delivered all the relevant services. A moment's thought about the historic role of the Anglican and other churches in the field of education shows this idea to be untenable. Nor did the State necessarily even exert a strong regulatory function over all welfare services – for more than a generation after its founding, the primary form of practice regulation in the NHS was professional self regulation by the medical colleges and BMA. But it is broadly true that the State took responsibility for funding these services and was seen as the universal source of health care, social care, education and social insurance, as well as an important source of service options in housing and pensions, at least for those who couldn't or wouldn't make private provision for themselves.

From the very beginning, a number of conservative and libertarian thinkers claimed the assumption of such roles by the state was a fundamental threat to freedom per se, whilst some on the left objected to the way state intervention steamrolled prior systems of localised mutual self help out of existence. On the one hand, predominantly conservative or New Right thinkers built an increasingly sophisticated theoretical case that public services, especially those free at the point of use, needed to demonstrate they didn't undercut individual responsibility, and weren't subject to 'provider capture' - being run for their staff rather than users. On the other hand, the 1960s was widely seen as the decade in which poverty was 'rediscovered', and during which so many of the major campaigning and service providing Third Sector organisations that loom so large in the housing and social care fields today were founded. In most cases, these bodies originally conceived of their role as supplementing the existing welfare state; demonstrating new and better practice which might be adopted by the state; and/or lobbying the state on behalf of the interest group or need they spoke for.

Underneath all this ferment of idea more profound changes were afoot. 30% of the population of all UK households contained only a single person in 2001 and only half of all adults lived in a marriage; by 2005 over two thirds of all mothers were in some sort of paid employment. Beveridge's default assumption of a nuclear family with a male wage earner being the norm is clearly not sustainable. The 'unseen' army of female caring labour which underpinned his 'cradle to grave' vision has quietly slipped away as household size changed, or been forced to juggle two sets of conflicting responsibilities. So more had to be done by the public services, and this, coupled with the ceaseless march of the cost of medical and other welfare technology, and periodic public outcries to improve standards, led almost inevitably to a crisis in the Attlee/Beveridge model which has been slowly unfolding since the mid 1970s.

The political response to this crisis has been piecemeal and – certainly compared to industrial or economic changes in the same period – rather slow. This is no accident: large parts of the 'old' welfare state long retained a loyalty and even affection amongst many sections of the community. But it has gathered pace, and now there is a substantial consensus for change across all the main political parties.

The first big political breach in the old consensus came in the form of a populist challenge to the very idea of collective provision: the sale at discounted prices of council houses to their tenants by the first Thatcher administration. This redrew Beveridge's boundaries between state support and individual self improvement in a radical way. It was massively popular – at least with its beneficiaries - and laid the ground for the further development of the theme of individual choice as the centre piece of welfare policy and, less prominently, the closely linked theme of individual responsibility. Almost unnoticed at the time, Third Sector providers, housing associations - not the local state – became the governments default choice for providing new social housing. Again, this shift was justified on grounds of increasing choice.

Under increasing financial pressure, the State pursued two further strategic aims in the 1980s.

Firstly it tightened the regulatory framework on many parts of the welfare state in significant ways, especially in education which saw a whole new framework of inspection, league tables and tightly defined national curriculum imposed on it. It also moved against 'provider capture' of services in other ways, especially in the health service which saw a series of managerialist reforms designed to curb the perceived power of doctors, and boost those of general managers working to supposedly ideological neutral principles of general management. Such reforms were generally described as attempts to make the services concerned more responsive to 'customer choice'.

But the real breakthrough came later: the increasing emphasis on, if not always a full blown internal market, at least the formalisation of a 'purchaser/provider split in health, social care and social housing. This move was only politically possible because of a number of prior developments, not all of them on the ideological right.

Whilst it is true that the idea of a purchaser/provider split is an answer to the Right's fear of provider capture, it is also a response to the Left's concern about state provision of inappropriate services to disempowered communities. The Livingstone led Greater London Council of the early 1980s had pioneered not the state provision of services but the funding of community groups from different demographic constituencies to provide a more nuanced and responsive pattern of service. So important sections of the Left had accepted that, in some arenas at least, the model of universalist state run provision wasn't the way forward. Much dispute was raised at the time about the supposed strengths or failures of internal markets, be they in the NHS or elsewhere, but the more fundamental shift to a welfare world organised into purchasers and providers was less remarked on.

Or less remarked on outside the Third Sector, anyway. There was a quite a lively debate amongst voluntary organisations, charities and other not for profit bodies about this change. On the one hand, this new paradigm obviously offered what had often been small and marginalised bodies the chance to acquire a much more significant role as they replaced or supplemented the 'old' statist welfare structures of the post war consensus. On the other hand the very idea of dividing the world into 'purchasers' and 'providers' was a direct challenge to those whose motivation for engagement with welfare services was because they themselves self identified with the problem to be addressed. Some Third Sector services- women's refuges run by former domestic violence victims, substance misuse projects run by ex-users, some specialist minority ethnic groups and the like - found the idea of dividing the world up into 'professionals' and 'clients' difficult enough, let alone acknowledging a further division with the 'professional' caste of purchaser and provider. The old idea of self help or mutual self improvement seemed to have completely disappeared. Many more organisations had traditionally seen themselves as both providers and campaigners or lobbyists for their particular interest group. Adapting to a world where they had to increasingly choose between these options – because it was purchasers, not lobbyists, who influenced how resources were distributed – was not always easy.

Yet it is this paradigm which has prevailed. There have been, and remain, very important differences in how different parties, at different times, have attempted to develop specific sets of policy proposals within this paradigm. Jargon encrusted policy succeeds jargon encrusted policy - but there are differences. Compulsory Competitive Tendering is different from Best Value. The prospect of a Voluntary Sector Compact that actually worked, is a very different world to the one we sadly inhabit. Nonetheless, an underlying unity of purpose can obviously be perceived. It is a world of purchasers and providers. A world where in theory at least – because, in practice, there is a large amount of relative inertia in the system – most core welfare services outside of education are subject to periodic review and potential contract termination. Even in the education field, we have the phenomenon of a central government increasingly pushing a greater degree of structural autonomy for state funded schools - an autonomy subject to definite limits, and potential closure, in the event of failing to deliver the required results.

The 'modernisation agenda' of the New Labour government has largely been about achieving this situation – and, more recently, about re-addressing the long standing financial crisis of the welfare state through efficiency reforms. Insofar as the Third Sector has engaged in this agenda – and most of it has had no choice but to do so – it has been subject to central government targets and scrutiny for performance against these targets.

Furthermore, both major political parties appear – or seem to appear once one negotiates their rhetoric – less than totally enamoured with the existing Third Sector. We are constantly told that 'faith communities' should be invited to contribute more to the actual running of welfare services, despite the fact thatfaith communities are already major players in the sector. Some of this, of course, is merely a rhetorical cover for policies designed at the social inclusion of Muslim communities after 9/11 and 7/7. But some of it reflects a slowly growing recognition that the Third Sector per se may not fit quite as easily into the purchaser/provider marketised split as theorists once hoped. In the sector where these developments have perhaps gone furthest, that of social housing, government first 'fattened' the Third Sector providers through prioritising them as vehicles for development; then created opportunities for them to bid for the management of services previously run by the local state. But, still, performance wasn't considered sufficiently robust, and recently capital funding for new social housing has been made available to the private sector as well as non for profit bodies. This is perhaps a canary in the coalmine - as the logic of the purchaser provider split bites more deeply in health, social care and even education then perhaps more Third Sector bodies will be found similarly wanting.

The Conservative Party is currently extremely critical of centralised target setting, and the diminution of local autonomy. It seems likely they will alter the system if they re-assume office, perhaps increasing the degree to which local, rather than central, government acts as purchaser. They also seem to have learnt from their experience in government in the 1980s and 1990s that, whatever theorists might say, one can only deliver welfare services in partnership with the professions in the field, not against them. Such a stance is perhaps typical of an opposition party. It remains to be seen how far it will survive the experience of government.

The basic problems remain, however. The old 'invisible' system of welfare provided by unpaid female labour is doomed. The 'modernised' system state has found it necessary create a whole tier of low paid term time/school hours Teaching Assistant type jobs in schools, for example. But this just emphasises that, today, women have to be paid for doing what, 60 years ago, they were assumed to do 'automatically'. The issue of the financial crisis of the welfare state rumbles on - hence the endless repetition in government documents about the importance of choice and prevention and personal responsibility and partnership between state and individual. It's about creating the mood music for sharing the eye-watering bill for welfare services between state and individual.

When Chris Dillow and fellow left-libertarians question the value of the 'big state', they mean something very different from this, I know. They mean something like the 'happy' ending ( there is another one) David Edgar foresaw in his still-very-readable short story Novel Approaches, in the August 1989 issue of Marxism Today.(Go read). I want that happy ending as well: a new social democracy, revitalised by localism and community control.

But it's not what we're being offered - we're being offered the language of libertarian welfareism dolloped liberally over the reality of the steady withdrawal of the state from facilitating certain kinds of mutual insurance.

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