Public services in the community

The measles outbreaks taking place across the country tells us a lot about how public services, such as hospitals and schools, can be reformed so that they have a better relationship with the communities in which they operate.

Much has been written about how much the abuse and neglect that took place in Mid Staffordshire NHS Trust between 2005 and 2008 tells us about how the NHS should be reformed. Much less has been written about what the measles outbreaks tell us about reforming public services (since so much attention has been on the role the media played in causing the outbreaks).

Radio 4’s Today programme featured interviews with mothers in Manchester on why they had or had not got their children vaccinated against measles.

Click here to listen to mothers discussing why they didn’t get their children vaccinated

Strikingly, people did not mention media scare stories as the main reason for not getting their children vaccinated. Instead, they recounted stories about someone they knew being convinced that the vaccine had caused autism and said that this was the deciding factor.

What can an organisation like the NHS do in the face of these community pressures?

Clearly, simply doing traditional public information campaigns using leaflets and posters is insufficient. In addition, the NHS needs to be have a better understanding of how information flows through communities and a better ability to tap into these networks (more on this general argument here).

This leads to 1 of Tony Blair’s 7 questions that the Labour party needs to answer.

How do we take the health and education reforms of the last Labour government to a new level, given the huge improvement in results they brought about?

My answer would be that in general schools and hospitals should be reformed so that they have a better, more dynamic relationship with the communities in which they operate.

Education doesn’t only happen at school

Much of the energy around educational reforms is based on improving the performance of schools. This is an understandable but limited approach.

As we all know, a lot of education happens outside of schools. We learn from our friends and families and we do homework at home or in the library. There is an extensive amount of academic research which shows that the degree of ‘parental involvement‘ is one of the key factors determining a child’s level of educational achievement.

However, many schools and teachers have quite limited interaction with parents. There are parents evenings most terms and parents of poorly performing children are often brought into school for special meetings. In addition, there are often parents represented on governing boards and in PTAs.

This could be dramatically expanded. In America the Learning Dreams approach involves supporting the parents of children who are struggling at school, so that these parents develop a more positive attitude towards education. Closer to home, the Ocean Maths approach does a similar thing.

Health doesn’t only happen in hospitals

Talk to any doctor or nurse and they will tell you about their annoyance with patients. They don’t take their medicine, they miss appointments and they don’t do their exercises.

Behind these frustrations is the simple fact that patients have to put work in to get healthy.

Approaches like the Expert Patient Programme give patients the skills they need to manage their conditions. This is especially important given the rising cost of outpatient admissions for the NHS.

The NHS could learn a lot from the “People Powered Health” movement on how you can work with patients to empower them to better deal with their illnesses and become more healthy.

For a practical example of how this works you can look at the “Connecting People” study. Here is the diagram that shows their approach.

What you can see is that the worker sees that their role is not just to use their skills to assist the individual being helped but also to support that person to develop their skills, connections and confidence.

Public services in the community

Many people involved with reforming public services rightly concentrate on improving the quality of these services. They are right to do so. But if we are to take the reforms of the last Labour government to the next level we need to do some from an understanding that education doesn’t just happen in schools and healing does not just happen in hospitals. Once we recognise that we can begin to think about how schools and hospitals can work with the communities in which they operate to make them better educated and healthier.

Towards a popular left wing housing policy

The death of Margret Thatcher reminds us that she was the last Prime Minister to have a popular housing policy.

The famous right to buy policy is still seen by many people as her greatest achievement. I doubt even their biggest supporters would list the housing policies of Major or Blair as among their greatest achievements.

As I argued last week the Labour party has yet to fully detail a decent, popular housing policy. This post will attempt an initial outline of what such a policy might look like.

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Public Opinion

To design a decent, popular housing policy we need to understand the public’s views on housing.

The most obvious thing to say here is that the public, broadly, want to own a home.

64% of people who rent privately want to own a home and 70% of people living with friends or relatives want to own a home. Fully a quarter of people who live in social housing also want to own a home.

Why do the public think it’s hard to buy a home?

As you can see from this chart, many people say that houses are too expensive for them to buy, that it’s hard for them to get a mortgage or that mortgage repayments are too high.

Finally, what do the public think could or should be done to make it easier to buy a home?

Lots of people are hoping for a windfall to help them buy a home. Short of that, or a pay rise, ideas around reducing house prices or making mortgages cheaper or more accessible are clearly popular.

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State of the industry

As well as understanding public opinion, to design a popular housing policy we need to understand the current state of the housing industry.

Since the credit crunch there has been a dramatic reduction in the number of households getting mortgages. This number seems to have stablised but shows no sign of returning to the numbers we say before the recession.

Similarly, the percentage of households that own their home has been steadily declining since before the recession.

So, fewer and fewer people own their home, fewer people are able to get mortgages and yet people would very much like to own their home.

While that is the overall picture, the facts of the matter look very different depending on where you live. The map above shows the ratio between low wages and cheaper homes in different areas of England. You can see that there are many areas (such as the North East) where cheap homes are not expensive when compared to low wages, while there are other areas (obviously West London but also the South coast) where cheap homes are essentially out of the reach of people on low incomes.

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Principles of a popular left wing housing policy

Before we take the plunge and outline some specific ideas for a popular decent housing policy for the Labour party it is worth pausing and asking, what makes up popular decent Labour policies in general?

I would point to three characteristics (there is not much method here other than this excellent blog by Nick Pierce)

1. They build institutions

You only have to think about how much popular the NHS is than tax credits to understand that people can have much stronger positive feelings towards institutions than other types of public policy.

2. They pool or share risk

The NHS, unemployment benefit (actually a Liberal policy, but there you go) or, to a lesser extent, schools and even the BBC, are delivered by at such incredibly low costs because everyone pays in. This means we can all benefit from sharing the risk in a way that schemes that were offered to much fewer people could not provide.

3. They build a better economy

The modernisation of British industry after the Second World War, through nationalisation, or the introduction of the minimum wage, are both examples of popular Labour policies (at the time!) that not only improved the economy in a dry GDP type of sense but also built an economy that people felt more comfortable with

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Towards a popular left wing housing policy

All that is left for us to do then is to mix together what we have learned about public opinion, the state of the housing industry and the characteristics of popular Labour policies and we can come up with some decent popular policies. Easy, right? Perhaps not. 

Here are some initial thoughts though

– The People’s House

Labour could pledge to begin the construction of a selection of basic homes to buy at low cost. This could be done in a number of ways including allowing councils to set up their own house building companies, having a state owned house builder (as they do in, for example Korea) or, more simply, by giving more support to housing associations to develop homes for sale.

– A People’s Mortgage

Similarly, Labour could pledge to introduce a basic, low cost mortgage for people on low or middle incomes seeking to buy their first homes. This could be done in a number of ways including through the Post Office, credit unions or even the state owned banks.

– Local Homes

Labour should seek to ensure that these housing policies are delivered in a way that is sensitive to the specifics of each area. This could mean using processes like participative design where people get a say on what their future home will look like as well as giving a prominent role to local authorities and other agencies that operate closer to the ground.

– Reforming housing benefit

Housing benefit and local housing allowance currently cover renting. There are other types of government support for people having trouble paying their mortgage and other schemes to help people buy a new home (such as shared ownership homes).

An interesting policy area for Labour might be to look at reforming benefits that are currently given to people to help them pay for their rent so that these benefits could actually go towards buying a home. Countries such as South Africa have given people on low incomes one off grants to help them buy homes. At present, with our high house prices, this seems unthinkable, but perhaps could become a possibility if government was building low cost houses.

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These are some initial thoughts. I would be interested in comments on any aspect of this.

For those of who are interested in this kind of thing you might read IPPR’s recent(ish) housing report, the Labour Party’s policy document on renting or the Resolution Foundation’s work on housing

How to build popular support for social housing

What would a popular, left wing housing policy look like?

Three of the most pressing and controversial areas of government policy in the UK at present are; childcare, housing and adult social care (see for example Nick Pearce’s blog on the subject).

It was no surprise when in his recent budget, George Osborne included announcements of extra money in these three areas.

Briefly, he announced tax cuts to help families with childcare costs, government guarantees for people trying to get a mortgage and a cap on the maximum people can spend on care in later life (the cap will be £72,000).

The left in British politics has been developing strong counter arguments on these topics in recent years. However, I do not believe that the left has yet developed a strong idea that the public will back on how to reform the housing system on the UK.

The left has stronger arguments on adult social care and child care.

On adult social care, the government is doing far less than the Dilnot commission recommended (they recommended a cap of more like £35,000). More impressively, Andy Burnham has been floating the idea of a national care service that would be free at the point of use.

On childcare the government’s announcements seems to disproportionately benefit richer households. In contrast, the Resolution Foundation and others have been making the argument for more universal, high quality childcare services.

In both cases, the left has developed a case that a sizeable percentage of the public would support.

Despite a lot of work I do not think that the same could be said for housing.

For example, Jack Dromey’s response to the new housing policies announced in the budget rightly pointed out the government’s failure to stimulate the construction industry. However, it was weaker on what Labour’s alternative approach would look like.

For many on the left the default housing policy is to build more council houses. One of the major problems with this policy is that it is not popular with the public.

In general the public do not support the idea of building new homes of any type.

By a massive majority the public far prefer the idea of owning than renting.

And, when asked to say which housing policies they most support they chose giving assistance to first time buyers and increasing access to mortgages more than they chose building more council housing.

The challenge for the left then is, can they develop housing policies that both address the major problems of housing need facing the country and are popular with the public.

Any thoughts from readers would be most appreciated.

What can Labour learn from the Obama campaign

Obama has achieved something that has proved impossible for politicians across the world since the credit crunch: he has been re-elected. Can the Labour party learn anything from his success? In particular, what can Labour learn from the Obama campaign’s so-called “ground game”?

Not only can Labour learn from the Democrats 2012 campaign, they can go further. Rather than solely focusing their efforts around “getting out the vote”, the Labour party can build solid and long lasting relationship with citizens.

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THE OBAMA CAMPAIGN

But I’m getting ahead of myself. First, lets look at the Obama campaign. It was a very different beast to 2008. Technology played a far more prominent role than ever before and the operation was run along hyper-professional lines.

This piece in The Atlantic explains some of the ways in which technology ran through the campaign. Gone are the days when a website and a facebook account are seen as modern. The Obama campaign created new tech products such as “Dashboard”, “the Call Tool”, “the Facebook Blaster”, “the PeopleMatcher”, and most importantly “Narwhal”.

And what did they do with these products? They used them to raise money, attract volunteers and target voters.

“The team’s only real goal was to elect the President”

This leads on to the second point. The campaign was a professionally run, modern, effective “get out the vote” operation. There is some contrast here with the idealism and community organizing style of the 2008 campaign. As Anthony Painter says in his New Statesmen piece “the living, breathing organism that was Obama ’08 became a professionalised machine in 2012”

Instead, the campaign used a Starbucks-like approach that included “behavioral psychology, data-mining, and randomized experiments” as ways of targeting voters with an incredibly fine grained approach. Even Karl Rove is impressed.

We should not underestimate how hard it is to run a professional operation of this type. We can see this in the Romney campaign which has been described by insiders as  “nothing short of a fiasco“. For example, their much hyped Orca system did not work properly and volunteers did not know how to use it.

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THE LESSONS FOR LABOUR

The principle lesson that the Labour party can learn from this is the importance of building a polished, professional campaigning staff and infrastructure. Part of this involves brining in people from outside of politics, such as people who have been working in technology developing computer programmes. Another part involves being open to experimental and data driven approaches to campaigning.

So far so obvious.

A further lesson is that the ground game is more effective if given more time to take root. As Adam Fetcher, an Obama campaign spokesman, said;

“Starting a conversation with a persuadable voter months before Election Day allows us to be more effective in responding to that voter’s priorities than if they first hear from us a few weeks out. Building and maintaining our grass-roots foundation takes time and resources, but we believe those early investments will make a difference.”

In the UK we have a tradition of short election campaigns. This can mean that in many areas the only time that voters hear from political parties (apart from on the TV) is in the 6 weeks before the election. To put it mildly, it can be quite hard to really strike up any kind of rapport with voters in 6 weeks. Especially when very few people are members of political parties.

The Labour party should put a high priority in going further than the Obama campaign and should be continually talking to voters, listening, responding and, most importantly, organizing.

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BEYOND GET OUT THE VOTE

The Obama campaign shows that it is possible for political parties to use sophisticated techniques and longer term campaigning to identify and mobilize potential voters. This is of great relevance to the Labour Party as it seeks to secure a majority at the next election.

Peter Kellner at the polling company YouGov has written a very thorough analysis looking at which voters the Labour party needs to attract. He essentially argues that there are three groups of voters who used to vote Labour but no longer do that Labour needs to convince; people who voted for the Lib Dems in 2010, people who stopped voting and people who vote for the Conservatives in 2010.

Kellner’s main argument is that the people who previously voted Labour but started to vote for the Lib Dems will now vote for Labour again at the next election. He argues that this means that Labour should concentrate on the other two groups who are, he tells us, more likely to describe themselves as “centre-right” in their political views and “less likely than [Labour] loyalists to live in social housing, work in the public sector or belong to a trade union”.

If Labour was to adopt wholesale the approach of the Obama campaign they would be identifying with precise detail who these people are, what their priorities are and would then be sending very personalised messages to them.

A more radical approach would be to actual enter into conversations with these people. For example, the Labour party does not have to accept that these people are not in Trade Unions. The party could actually ask people about their experience of work and see if they are interested in joining together with their co-workers so that they can have more influence at work.

 

 

The American President is not a breakfast cereal

Politics is about choices, but not always in the way people think.

It has become common to bemoan the lack of choice people have at the ballot box. You may remember Cynthia McKinney, the Green Party’s candidate for the 2008 American Presidential election, complaining that you have hundreds of choices of breakfast cereal but only two choices for President.

This raises the question; should we choose who is to be the President of America in the same way we choose what to have for breakfast?

Many people think we should.

Recently, late night talk show hosts had some fun with the story that many Egyptians are not enthused by the two candidates for President. ‘Just like America’ they chuckled to themselves.

Martin Bright, Political Editor of The Jewish Chronicle, asked the related and hopefully rhetorical question about the recent London Mayoral elections “How on earth did the Labour Party end up with a candidate many loyal supporters (Jewish or not) couldn’t stomach voting for?”

I say this was hopefully rhetorical because we have to imagine that Martin Bright understands how the Labour party chooses its candidates. I think by looking a bit closely at this question of choosing candidates we can understand a bit more why the American Presidency is actually strikingly different to breakfast cereal.

The short answer to Martin’s question is that Ken Livingstone successfully organized the situation so that he was chosen to be the Mayoral candidate.

Anyone who has had any experience of how Ken’s ‘machine’ works will know that it is pretty formidable. He was able to build an organization that had endorsements, pamphlets, voter segmentation, fundraising, policies, boots on the ground and so on and so on. Oona King, his rival, was not able to match this organization. This is not surprising given that Ken Livingstone has been influential in London politics since before I was born.

We get the same answer if we look at why Egyptians are faced with the choice between an Islamist and an official from the old regime in their upcoming elections; these are the two candidates who organized most effectively. The Muslim Brotherhood and the Generals are both enmeshed in a complex web of patronage and support throughout Egypt. None of the liberal parties has anything like this degree of organization.

Most embarrassingly perhaps we see the same story playing out in the recent unsuccessful attempt to recall Governor Walker in Wisconsin. Not only was it a disastrous political decision to choose to collect enough signatures to recall Walker but it was also an embarrassment that the Democratic Party and the Labor Unions were so comprehensively out organized in a battle of their choosing. Walker personally raised over $30 million while his opponent raised under $4 million.

Walker won because he was better organized. Livingstone was selected because he was better organized. Mohamed Morsi of the Muslim Brotherhood is potentially the next President of Egypt because of their organization.

We might say that the reason that our political choices are limited is that other people limit them because those people want their candidate to be chosen. If we want other choices we cannot just turn up on election day and hope that there will be other candidates available to us. We or someone else actually has to create this choice. A vague disorganized desire amongst a large number of people will always lose out, politically, to a specific and organized desire amongst a much smaller number of people.

Woody Allen once said that 80% of success is turning up. He was absolutely right, but you have to know where and when you need to turn up.

When you are buying breakfast cereal you can just turn up at the supermarket and be pretty sure that you will get something like what you want. When you are voting for a political candidate who will stand up for what you believe in, you better turn up a bit before the election to make sure that your candidate is actually on the ballot…