Monday 20 July 2020

Is it always best to think local?

I’m quite a fan of the New Local Government Network (NLGN).  Their starting point is that government in the UK could be more efficient and effective if more power lay in the hands of local authorities and local communities.

In the past few weeks, their director, Adam Lent, and today deputy director, Jessica Studdert, have made points that have got me thinking about where localism might not quite work as a policy solution.

As in so many areas of politics and policy, debates can end up framed as adversarial – in this case, a choice between ‘localism’ and ‘centralism’.  Given that any conclusion will involve some level of both central and local control, the argument needs to be framed as finding the right balance.  I know that advocates of localism would acknowledge this this, and their fundamental argument is simply that we’ve got the balance wrong, but I want to suggest that too often this leads to suggestions that a local solution will be better when experience tells us something different.  I think more than this, though, I want to be pragmatic about the politics.

First, I want to consider Adam’s critique of Michael Gove’s speech on the future of government.  I think this sets the scene well for the sorts of issues both localists and centralists (if that’s not perpetuating the false binary) are grappling with – and offers an insight into why localism is a powerful idea.

Gove* suggests that there are two key problems with government today: (i) there is rising inequality; (ii) people have lost trust in the ability of (central) government to improve their lives – and these two issues are linked.  Paraphrased by Adam Lent, Gove’s argument is: ‘government is not very good at understanding what makes people’s lives better. As a result, government rarely does make people’s lives better – hence inequality – and the people no longer trust government to actually make their lives better – hence mistrust.’

Gove’s solution is for more expertise in government, to be achieved by two key changes.  First, different people should be recruited to the civil service: more mathematical and scientific experts, rather than ‘those with social science qualifications’.  Second, these staff should be given more stability in their posts, allowing them to develop deeper experience.  These experts will then be brought closer to the people literally: more government should be based in places like Newcastle (in contrast to Sheffield and Bristol, apparently).

The critiques of this that I have seen are twofold.  First, as Abby Innes has argued, the solution to genuine complexity and unpredictability is not simply more ‘expertise’ and ever more complex statistical models; it’s accepting that there will always be issues and situations where decisions have to be made with imperfect information and uncertain consequences.  This approach, she suggests, has more in common with the post-Stalinist Soviet Union than English conservatism.

(I have to say that I find this apparently renewed emphasis on the tenets of New Public Management disappointing almost to the point of feeling exhausted, given that it seemed this might be receding - a development celebrated in the work of people like Toby Lowe and Simon Parker.  In practical, personal terms, my job commissioning substance misuse treatment services has been changed by the fact that the central control and emphasis on ‘performance data’ from the National Treatment Agency has been replaced by advice and support from Public Health England, but more of that later.)

The second critique is that locating ‘experts’ in Newcastle won’t bring government closer to people in any real sense.  As Adam Lent concludes (unsurprisingly for the Director of a think tank that champions the value of localism), what is really needed is ‘a major programme of decentralisation of power and resources; a more participatory and deliberative approach to democratic decision-making; and a fundamental shift away from the paternalism of councils and public sector towards a community-led model.’

I agree with the core of this – that for people to feel trust and a sense of connection to politics, we need ‘a more participatory and deliberative approach to democratic decision-making’ – but I worry that the idea of ‘a major programme of decentralisation of power and resources’ sets up an adversarial debate between ‘centralism’ and ‘localism’, where we have to pick sides.  And it is itself a major programme of bureaucratic reorganisation.

I think this is particularly clear in Adam’s recent comment on the idea that a national social care service could be established to raise the profile of social care and improve its quality and efficiency.  He states: ‘The NHS is an overly hierarchical, bureaucratic, unstrategic institution with a poor organisational culture. Plus it is far too subject to the whims of politicians. Why anyone would want to emulate that in social care is beyond me.’

Again, the solution instead is ‘to localise the NHS under the control of councils and their communities not centralise social care under the control of Westminster.’  Jessica Studdert has expanded on this in today’s piece in the Guardian.

I am not an unequivocal supporter of the NHS.  I have written before about how it is often unfairly used as a way to criticise local commissioners of services, who are seen as ‘privatising’ provision and preferring private or third sector providers.  It can be disappointing.

However, my experience of commissioning substance misuse treatment services since 2011 suggests there are two key advantages to the NHS – or, rather, a national care organisation.

The first point is about funding and politics.  As Jessica notes, “At one level, the issue for social care begins and ends with money”.

Crucially, almost all public sector funding comes from national sources.  We can imagine a world in which regional or local government had more control over revenue-raising, but it seems a long way off at the moment.  And many sources are likely to remain national: VAT, income tax, duty on imports and products such as alcohol and tobacco, to mention a few.

The trouble with local government is that the operation of the service is separated from the source of the revenue.  Central government raises and distributes revenue, then local areas make decisions.  This is why local government has been targeted as part of austerity: it allows central government to effectively outsource the cuts.  The blame for what has been cut and how can be placed onto the local decision-makers, not Whitehall.

A national politician is held to account for a national service.  This is why the health services in the NHS have seen their budgets largely protected (in cash terms, at least), in contrast with those in local authorities (like sexual health, school nursing, health visiting and substance misuse treatment), which have seen theirs cut by 20%.

Civil servants supportive of substance misuse treatment effectively made a gamble when deciding where to put it as a result of the 2013 health reforms: should it go into local authorities or the NHS?  Prior to this it had straddled both, with PCTs commissioning some services and local partnerships generally led by councils commissioning the rest.

It ended up in local authorities, the theory being that substance misuse funding in the NHS had never effectively been ringfenced; it was often used to cross-subsidise other (under-funded) areas like mental health.  As critiques like those of the NLGN suggest, money is too easily lost in such a large, unaccountable organisation.  (Or rather such large organisations, as the NHS is not one entity with a single culture.)

In local authorities, it was thought, the funding could be more easily insulated.  This is probably true,  But it wasn’t foreseen that budgets (including the public health grant) could be more easily cut in local authorities than in the NHS.  Yes, the budget has been relatively well insulated when compared to the NHS, but it’s still got smaller and smaller.

So having social care as a national service might mean that national politicians would be more likely to protect the funding.

Of course it could be argued that we need to revolutionise local government finances, allowing councils to raise more money themselves, but I still struggle to see how there could be genuinely local taxes to generate sufficient income to support all their services, or how this could be equitable across the country.  Is there enough business to support the care needs of the ageing population through local taxation in a rural council area like Dorset?  Or to support the complex needs of a town like Blackpool?  There would surely have to be national funding agreements, and with them the reality of national politics.

Even if we could fund social care locally, I’d suggest there’s another benefit to a national arrangement.  Let’s think again of substance misuse treatment.  The CQC regulates some (though not all) services, but you can’t rely on their occasional inspections to ensure quality provision.  That needs other forms of management and quality assurance.  And the design of services is left up to local areas too, as well as the prioritisation of different issues.

In the eyes of advocates for localism, this is a boon: it means that services can be adapted to local need and preferences.  These days, not every local authority has to have a ‘crack strategy’ to deal with crack cocaine if they feel this isn’t an issue.  And if pharmacies aren’t the best way to deliver needle exchange in their area, they can use other sites instead.

But at the same time, this approach can be inefficient.  Every local authority writes its own audit plans.  Every local authority writes its own specifications.  And so on.

Yes, there can be collaboration, and we’re hopefully seeing this with the creation of a national substance misuse commissioners forum.

But think of what this variation means in practice.  We know that the NHS isn’t truly a national service.  Different medications are available in different areas.  This is also true in local substance misuse services.  In the past, for example, you were more likely to be prescribed buprenorphine in Dorset than in Bournemouth.

But the variation in local services is about more than this: the actual dosages varied dramatically, despite national guidance suggesting that the therapeutic range was typically between 60mls and 120mls of methadone.

This was down to local organisational culture, and part of a pattern (of almost random variation) that could be seen across England.  I’m not suggesting that these kind of variations don’t happen in the NHS; simply that the broader oversight, with national data collection and comparison, means they are less likely. (A positive development on this front is that the National Drug Treatment Monitoring System as of this financial year now collects prescribing data.)

Moreover, although Adam worries about the NHS being dependent on the ‘whim’ of national politicians, the variation in these doses and drug choice is partly dependent on local politicians.

Decisions that shaped these patterns were based on NHS or local authority commissioners and managers interpreting national guidance, with their interpretations inevitably shaped to some degree by both local and national political rhetoric.

Low medication dosages and falling numbers of people in treatment are the result of a ‘recovery’ agenda, most prominently expressed by Iain Duncan Smith, but also embraced by many local council officers and politicians.  Politics and rhetoric affected the quality of the treatment available.

If ‘success’ was defined locally as reducing the number of people in treatment, so it looked like fewer people had a ‘drug problem’, that could be engineered (albeit not always consciously).

What this means is that every local authority has to win the argument to provide treatment in line with the evidence base.  National guidance is not enough.

It might seem that this is less risky than centralisation: if political issues mean that Bournemouth struggles with this, for example, at least we haven’t necessarily lost Dorset into the bargain; whereas a national decision covers everywhere.  But the apparent weakness of the NHS is also a key strength: it may be hard to manoeuvre, but that means it’s also harder to universally manipulate.  If this sounds like a distrust of politicians, it’s not my distrust, but Adam’s.  We’re back to those dangerous 'whims' of politicians again.

The issue comes down to where one sees the greatest risks, and I’m not clear about the answer.  I certainly can’t say the solution is obviously either centralism or localism.  Do we have the level of resource and expertise to invent the wheel in almost 150 local authorities in England?  Or are we better off getting something more nationally controlled and mandated?

In my experience, looking at the history of substance misuse treatment, we were better off with the inefficiencies of the centrally-controlled regime, rather than attempting to create independent solutions in every area.  People who seemed to hate the National Treatment Agency at the time now seem to long for it.

And as Jessica points out, “care is essentially about people and relationships, not buildings and services”.  I’d absolutely echo that point.  But I’d therefore emphasise that the key is not to think too much about the structures, given that what makes a difference is people.

And let’s not imagine that this wouldn’t constitute a form of bureaucratic reorganisation.  We’re all agreed that the current arrangements are unsustainable.  Jessica suggests that “There is no question that the care system is in urgent need of funding reform, but nationalising social care wouldn’t solve its problems”.  I would argue that without changing the political arrangements, there can be no funding solution.  Of course, I don’t want to position myself into the same adversarial central/local argument that I started this piece by describing, and there are other options for organising services that we should be considering.  But I worry that the dream of localism could lead to a reality of poorly funded services with inadequate quality assurance.


*I’m never quite sure how to refer to people in these kind of pieces.  In an academic article, you’d just say ‘Gove’, ‘Lent’ and ‘Studdert’ and not worry about it.  But this seems oddly formal and stilted for a blog.  Here, I’ve decided that I’m saying ‘Gove’ because I’ve never met him, and this seems appropriate for a national politician, whereas I’m referring to ‘Adam’ and ‘Jessica’ because I have once met them – and they’re not national politicians who are often referred to only by their surnames.  I hope that seems reasonable and sufficiently human!

Thursday 9 July 2020

The rise and fall (and rise and fall) of neoliberalism in alcohol policy?

Between 2006 and 2009, I was doing research into alcohol and the night-time economy.  This still felt like a time of ‘peak booze’.  The new licensing laws had come into force in 2005, and it wasn’t yet clear that our drinking had started to decline at a population level.  Generation sensible was nowhere to be seen as the papers panicked (and gawped) at ‘Binge Britain’.  Urinating on memorials isn’t a new thing.

A dominant debate at this point (which fortunately for my attempts at academic publishing continued under the Coalition government) was about the relevance of the idea of ‘neoliberalism’.  I’ve wrote about this quite often (particularly here – or here for free), including on this blog.  In my understanding, neoliberalism in alcohol policy is about having your cake and eating it: liberalising regulations, but then complaining when things unfold exactly as other have predicted.

Words and concepts that are valued in this understanding include ‘market’, ‘rational’, ‘individual’, ‘responsible’.  Some of the best descriptions of neoliberalism can be found in the work of David Garland and John Clarke.

It’s not classical liberalism, because you’re not accepting that a person’s own choices about their own life are by definition the most sensible for them.  But it’s not the classic post (First World) war consensus approach, because you’re not changing the environment to re-shape people’s choices.  (Don’t imagine that Thaler and Sunstein were the first people to think about choice architecture and nudging people towards healthier choices – alcohol policy reports were talking about food offers, glass size and vertical drinking in the 19th century, and putting this into practice by the early twentieth).

Paul Chatterton and Robert Hollands used a very helpful model to structure discussions of alcohol policy – think about consumers, producers and regulators.  Their focus was on public drinking – or the ‘night-time economy’, and so producers, of course, could be the people who actually brew the beer, for example, or the retailers who sell it (like nightclubs); they’re both ‘producing’ the night-time economy space.

A neoliberal approach by ‘regulators’ (i.e. local and national government) could be characterised by a tendency to blame individuals for behaving poorly, while freeing up the producers to make alcohol more available and affordable.  A contrary interpretation would be claim that those changes mean that young people are ‘invited to binge’, and so the blame should lie with regulators and producers for being irresponsible and disingenuous.  This was an academic debate as well as one of policy and politics – that phrase ‘invited to binge’ comes from an exchange in the journal Town and Country Planning from 2004.

I feel like these debates have largely faded away in politics recently.  Perhaps this is because I’m not in academia now, so I’m not analysing politics and policy as much as experiencing them through local government.  It’s also a function of Brexit blocking out all other issues.  But there’s something more: alcohol isn’t the political issue it was in 2004.  (Or at least it wasn’t until recently.)  We’ve had our debate about licensing, ‘binge Britain’ is perhaps less visible, and minimum unit pricing (MUP) for alcohol has effectively been framed as an issue of devolved governments, with Scotland and Wales introducing it, rather than something to be argued over at Westminster.  (It’s hard for the Conservatives to oppose it too much, as they committed to it in their 2012 Alcohol Strategy.)

But now these debates about ‘responsibility’ are back, brought into focus again by COVID-19.  The photos of people on beaches – and particularly drinking in Soho – have led to discussions of whether it’s irresponsible drinkers, greedy producers or negligent regulators who are to blame.

Suddenly, I thought, those ideas of neoliberalism and alcohol policy might be valid again: the economy needs a boost, and people need the distraction that a good night out can give.  And having evidence that some groups (possibly unlikely to vote for them in any case) may not have adhered to guidelines may not be the worst thing for a government preparing for a ‘second wave’.

Perhaps one difference this time round might be local authorities, I thought.  Rather than embracing the night-time economy as a way to re-create Bologna in Birmingham and Madrid in Manchester (and raise much-needed revenue), this time round, perhaps influenced by their Directors of Public Health, it seemed like drinking in a time of COVID-19 might case them a headache.

But fundamentally, we were straight back into these age old debates of whether we should trust people to make ‘sensible’ decisions (and blame the ‘irresponsible minority’ when they don’t), or be more pragmatic and controlling and re-shape the environment to actively encourage (or even enforce) ‘responsible’ drinking.

Then came yesterday’s budget – sorry, ‘Plan For Jobs’.  In this, the VAT cut and ‘meal deals’ announced by the Chancellor, Rishi Sunak, explicitly did not include alcoholic drinks.  This will boost some pubs and venues, and not others.  This seems to be the result of an acceptance that consuming alcohol during lockdown may be an issue, but it is distinctly at odds with the divide and rule approach of New Labour, as outlined by Tessa Jowell in proposing the 2003 Licensing Act: “Our role is to give adults the freedom they deserve, while giving the yobbish minority the rough and tough treatment that they deserve.”

This is the same approach I thought I was seeing in the government’s approach to re-opening the pubs, and the public reaction to scenes in Soho and elsewhere.

Perhaps, as with the claim to be drawing on FDR’s New Deal, there is a tension within government.  Maybe this is Rishi Sunak positioning himself as responsible centrist, interested in rules, as opposed to the neoliberal individualism of Dominic Cummings and Boris Johnson.  But given that it’s Michael Gove talking about FDR, this could simply be a case of the government having an interest in presenting (trialling?) a range of approaches.

Whatever it is, it seems a good time to be dusting off all those references from the 1990s and 2000s.  I’ve written before about the false dawn of some kind of communitarianism or post-liberalism – at least in relation to alcohol policy.  In fact that was my first published article going over these arguments about neoliberalism.  And the Coalition never did introduce MUP.

Saturday 4 July 2020

Wetherspoons in a time of COVID-19

I originally started this blog as a place to write about things I wasn’t too sure about – developing ideas that weren’t quite up to academic standards of peer review.  Somewhere to say what I ‘reckon’, rather than necessarily what I definitely ‘know’.  (Yes, of course, all knowledge is contingent etc, but you know what I mean.)

Recently, I worry that I’ve been too cautious in just writing about what I ‘reckon’, for fear that I might be wrong, so this is an attempt to get back to that original approach.

Sometimes I feel nervous about this in relation to discussions of drinking and alcohol policy.  The field seems hugely coloured by people’s personal preferences and experiences – those who don’t enjoy being drunk often don’t seem to understand those who do, for example.  Politicians seem to believe that anyone who uses their freedom to behave differently simply needs more ‘education’ or ‘information’ – as if there is one ‘rational’ way to behave in relation to a drug that is attractive precisely because it removes rationality.

(Of course, my ‘objectivity’ is equally compromised, but it is possible to claim some moral (or epistemological) high ground by at least being aware of this, and acknowledging some of one’s own biases.  It’s then up to other people to see how useful my ‘reckoning’ is.)

Maybe I’m overplaying it, but I feel like Wetherspoons is some kind of lightning conductor for these personal views about alcohol (mixed, of course, with concerns about class).  This has probably ramped up, given the controversies around Tim Martin’s position on Brexit, and his use of Wetherspoons to get his message across.

Seeing a discussion of this on Twitter got me thinking this could be the perfect way to get back into writing about what I 'reckon'. (Actually, talking about alcohol and class isn’t just what I ‘reckon’; it’s one of those rare bits of my thinking that has gone through peer review - here and here, for example.)

Wetherspoons is often portrayed as not being a ‘real’ pub, or being a kind of immoral capitalist organisation that exploits its own staff and the breweries it buys from.

The objections are also aesthetic and cultural.  There’s a common argument that Wetherspoons are just ‘drinking barns’, to used Deborah Talbot’s phrase.

But spaces are also what people make of them.  The question is about community.  Wetherspoons brings together a range of people united partly by price and convenience (but also by culture).  They are the classic ‘chameleon’ venues, welcoming business travellers for breakfast, families and work groups for lunch, students in the evening, and so on.

To me, this is a key quality of a pub, and genuinely public, social drinking.  If people’s time is split simply between home and work, with limited interaction while shopping (particularly given how much is done online), then we have pretty narrow social circles, mediated only by social media.  A good local pub, by contrast, offers an opportunity for people to interact more widely (though obviously there’s plenty of research, including mine, on how venues segregate and distinguish between people).  Check out work by people like Claire Markham, for example.

But this isn’t just about price.  People actively choose Wetherspoons and it can provide a shared culture.  Perhaps it’s different in cities, but in towns like Dorchester, where I live – or even Bournemouth – you can see this sense of community in Wetherspoons.  Apart from the nightclubs or late opening pubs with ‘loud music and dancing’ (apparently the new definition of a ‘nightclub’), Wetherspoons – with neither of these features – is the place most likely to have ‘free and familiar contact’, with people bumping into old friends and different conversation groups interacting.

Around Christmas it’s genuinely a joyful place, full of community, with local football clubs bumping into each other (don’t ask about the rivalry between Piddlehinton and Puddletown) and former schoolmates meeting up as they’re back visiting parents.  Or even on an ordinary Friday night, as work groups merge as people bump into friends of friends.

And this is before we get into the David Gutzke idea of Wetherspoons being more welcoming to people who typically feel uncomfortable in traditional pubs.

This isn’t to praise Wetherspoons, or claim these things don’t happen in other venues.  If offered a choice, this isn’t my personal favourite venue in Dorchester.  And maybe I’m over-sensitive about these criticisms of it, as I see them feeding into the broader classed narratives of what are ‘good’ venues and what is ‘responsible’ drinking. 

I’m certainly sensitive to the fact that people who have comfortable houses and gardens or can afford more expensive venues are particularly privileged at the moment in being able to resist the temptation of the pub.  I always think of Robert Roberts’description.

Or perhaps the pub simply isn’t a temptation, and people don’t understand the attraction, just like I don’t understand gambling.  Either way, let’s not be too lazy in thinking about Wetherspoons.  My perspective is certainly that I have lots of good, locally-specific, sociable memories of them.