Tag: libertarian paternalism

Demos say the DWP should be axed, I disagree. Here’s why

Image result for DWP

A leading cross-party thinktank has proposed that ministers should consider abolishing the Department for Work and Pensions.

In a provocative paper that marked the start of Demos’ research examining the Department of Work and Pensions, Tom Pollard, formerly of the mental health charity Mind, who has also completed an 18 months secondment to the Department for Work and Pensions (DWP), illustrates a bureaucracy blighted by “historic dynamics and averse to radical thinking.”

Pollard’s paper identifies three problems with the DWP. First, the department is afflicted by a “benefits lens”, where case handlers perceive employment support as a condition for receiving benefits, rather than a means of enabling claimants to pursue fulfilling work. Where benefits are the carrot, sanctions are the stick. Sanctioning claimants for misdemeanours such as arriving late to meetings creates a “confrontational dynamic of power asymmetries.” In other words, it strips citizens of their autonomy.

Many neoliberals have also claimed that welfare strips citizens of responsibility, though there has been no convincing evidence of this to date. 

Second, Pollard argues the department is impoverished in ambition. DWP staff are often promoted from frontline roles working in job centres. While such expertise is valuable, he argues that staff often seem “incapable of thinking about radical solutions”, and repeat the mistakes of the past, gravitating towards punitive systems of conditionality and sanctions.

These factors contribute to the DWP’s “injured reputation” among frontline users. Productive engagement between case handlers and claimants is dependent on trust. “There’s such a rift between the DWP and hard to help groups that I don’t know how you could get back to engaging on meaningful terms – there’s too much baggage”, Pollard says.

In the thought-provoking paper, entitled Pathways from Poverty: a case for Institutional reform, Pollard explains why he believes that the DWP is institutionally and culturally incapable of making the reforms needed to deliver better outcomes for society’s most vulnerable and sets out a radical new vision for the future of welfare provision.

Most of the work of Amber Rudd’s department could be carried out more effectively by other Whitehall ministries, according to Pollard. He calls for the DWP to be stripped of responsibility for these “hard-to-help groups”, with the health department and NHS helping the ill find work, local government taking over Jobcentre Plus, and benefits and pensions delivered by HMRC. The charitable sector could also be given a bigger role. 

Some criticisms

Pollard critically discusses the culture within the DWP, implying that the key problems and devastating social consequences arising from the government’s welfare reform programme are simply a result of staff attitudes and inept administrative procedure within the department. 

The crisis in our social security system is the result of government’s policies, which have embedded traditional prejudices about people experiencing poverty, and that have led to the institutionalisation of discriminatory practices within the DWP. There is no guarantee that moving the functions of the DWP somewhere else will bring about any change in attitudes and practices, or improved outcomes for people relying on social security as a lifeline. 

The DWP has come under constant fire from many campaigners, academics and charities for serious problems with universal credit, and for the catastrophic work capability assessments of those who are unfit to work. Rudd is attempting to repair The department’s reputation by tinkering with the roll-out of universal credit and fighting with the Treasury to end the freeze on working-age benefits. However, these gestures are nowhere near enough to put the major shortcomings of the system right and to mitigate the cuts to support that univesal credit and other benefits entail. 

The report concludes that while the DWP has been able to “help” people with minor difficulties into employment, the outcomes are “much poorer when it comes to supporting people with more complex needs”, such as the ill, disabled, older people, those with drug and alcohol problems, ex-prisoners and those who are homeless.

Pollard proposes that if the removal of these functions from the DWP proves to be a success, a more comprehensive approach could see the department abolished altogether”.

He says: “If the department as it stands remains at the heart of employment support for ‘harder-to-help’ groups, we will face further years of well-intentioned reforms and programmes yielding disappointing outcomes, because of how they will be formulated and how they will be received.”

The problem is that the reforms are not “well-intentioned”, and the outcomes are not “disappointing”, they are catastrophic. The policies were intentionally punitive, leading to the consequences we see: people experiencing hardship have been punished by as system that was designed originally to support them and mitigate the circumstances of  hardship.

Pollard accuses the DWP of seeing claimants through a “benefits lens”, in which conditions were placed on their payments as a way of forcing them into work. He warns that the department’s reputation among many groups is now so bad that it may prove impossible and expensive to improve. “A bad reputation is far harder to lose than a good one,” he says.

However, the problem is rather much larger than the poor reputation of the DWP. It is the policy framework that determines the set of administrative practices which in turn, shapes the “culture” within the DWP.  It is the distress and harms that are being experienced by people claiming support, most of whom have also paid into the Treasury – that is the most pressing issues here, not reputation ‘damage limitation’ strategies, or an exercise in PR trust building for the government.

Abolishing the DWP, merging it with the Department of Health and involving charities in service delivery, as proposed by Pollard, will send out the clear message that social security is no longer a discrete function or key priority of the state. It also permits the state to withdraw from providing social security.

Responsibility for budgeting for and administering welfare will become diffuse. Placing social security side by side with healthcare is also risky, as it may further stigmatise jobseekers. We have already seen the government consistently stigmatise those who are out of work, implying that unemployment is some kind of psychological disorder. Others, such as Adam Perkins, have even proposed that there is a “genetic welfare trait.” , that runs counter to Conservative notions of “good citizenship”. 

The NHS is also suffering from chronic under-funding. How will it prioritise welfare provision, when it is already struggling to deliver health care, in the face of the increasing rationing of treatments and procedures?

Historically, charities administered welfare. But the provision was patchy and varied from area to area. There were no consistent standards of support for people in hardship. During times of economic recession, charities were often unable to provide people with any support at all, at a time when they needed it most.

Local authorities are now struggling to deliver statutory services because of government cuts. Essential provisions are being rationed as a consequence. There is no guarantee that any additional funding would be ringfenced. We have already seen social services sending vulnerable young people to other areas – sometimes back to their hometown, for example – to shift the burden of cost to another local authority.  The old Poor Law saw parishes moving poor people out of their area, they were pushed from parish to parish, refused ‘relief’ in order, often, to keep local rates bills low.

A recent paper entitled “Dependency, Shame and Belonging” examines the practice of making the poor wear badges from the 16th century through to the compulsory identification of all parish paupers under a 1679 statute, differentiating between those deemed ‘deserving’ and ‘undeserving’. By the late 17th century, magistrates and legislators decided to deter potential badge applicants by making life on the parish as unattractive as possible. Badging became a means of preventing begging and shaming holders, made compulsory in 1697.

The proposal from Demos simply exchanges one form of expensive, intrusive and ineffective bureaucracy with another. How would the Department of health and charities be allocated funds to carry out this publicly funded state function? How would they be held accountable? 

As I touched on earlier, unless the policy framework is also radically changed to one that is supportive, rather than punitive, and to one that isn’t about administering cuts to people’s lifeline support, then the perverse incentives to apply conditionality and sanctions will remain embedded in administration practices. 

A government that does not support a social security programmme – and the anti-welfarism of the Conservatives has been apparent for a long time – is likely to see the shift in responsibillity for delivering social security as a further step in abolishing welfare provision entirely, which has always been their long term aim. 

Finally, it’s worth noting that Demos produced a paper in 2011 advocating reducing the costs of disability benefit by “engaging with the private insurance industry” and proposing that: “reform to encourage individual responsibility and income protection is genuinely of mutual benefit.” The approach laid out in this report builds on the theory and practice of the profoundly antidemocratic ‘libertarian paternalism’ or ‘nudge’ theory. 

Other papers from the thinktank peddle the views of antiwelfarist James Purnell, who, for example, proposed charging interest on crisis loans to unemployed people and pensioners made by the Department for Work and Pensions, which were interest-free, at a rate of up to 26.8% per annum. This was met with great hostility and was blocked by the intervention of the Prime Minister, Gordon Brown. It was Purnell who announced the Work Capability Assessment, triangulating the Conservatives. Purnell advocated Unum’s approach to “claims management”, in a bid to cut costs of disability support. (See Rogue company Unum’s profiteering hand in the government’s work, health and disability green paper for more detailed discussion). 

The Conservative’s ideological position has been used politically as a justification to reduce social security provision so that it is no longer an adequate amount to meet citizens’ basic living needs. The aim is to discredit the welfare system itself, along with those needing its support. The government have long wished to replace the publicly funded social security provision ultimately with mandatory private insurance schemesas have some ‘blue Labour’ neoliberals, including Purnell. 

The th empirically unevidenced idea that welfare creates ‘dependency’ and ‘disincentivises’ work has been used as a justification for the introduction of cuts and an extremely punitive regime entailing ‘conditionality’ and sanctions. The government have selectively used punitive behavioural modification elements of behavioural economics theory and its discredited behaviourist language of ‘incentives’ to steadily withdraw publicly funded social security provision, which is the ultimate ideological goal. That is the root of the problem. 

In light of this, the timing of Pollard’s set of proposals is also rather suspect – see The Centre for Social Justice say Brexit is ‘an opportunity’ to introduce private insurance schemes to replace contribution-based social security.

A DWP spokesperson has responded from the government’s crib sheet of crafted statements: “This report is completely misguided and we have no plans to reduce functionality at a time when unemployment is at its lowest, welfare reforms are rolling out across the country and millions are saving for a private pension for the first time. Jobcentres are a local presence yet benefit from a national framework. DWP supports around 20 million people to get into work and save for their retirement, as well as giving stability to those who cannot work, and will continue to do so as one responsible organisation.”

 


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Cash for Care: nudging doctors to ration healthcare provision

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Today, while everyone is being distracted by the continuing resignations from Theresa May’s disintegrating government, the Conservatives are openly talking among themselves (again) about charging for NHS services. So much for the government’s continued reassurances and promises about UK healthcare continuing to remain ‘free at the point of access.’  

The NHS has never been safe in  Conservatives hands.

Last week I wrote an article about the stealthy creep of rationing of treatments in the NHS, and how gatekeeping has become a watchword within our public services over the past seven years. It’s being driven by the government’s deep affection for neoliberal dogma, the drive for never-ending ‘efficiency savings’ and the Conservatives’ lean, mean austerity machine. Perish the thought that the public may actually need to use the public services that they have funded through their contributions to the Treasury, in good faith. 

One important point I didn’t raise in the article was about how the marketisation of the NHS has given rise to ‘perverse incentives’, which violate the very principles on which the national health service was founded. Neoliberal policies have shifted priorities to developing profitable ‘care markets’ making ‘efficiency’ savings and containing costs, rather than delivering universal health care.

Another shift in emphasis is the “behavioural turn”. It’s politically convenient to claim that people’s behaviours are a major determinant of their health. Some illnesses are undoubtedly related to lifestyle – type two diabetes, for example. But it is difficult to blame individual’s behaviours for type one diabetes, which is an autoimmune disease, and these may happen to people who lead very healthy lifestyles, as well as those who don’t. This ‘behavioural turn’ shifts emphasis from the impact of structural conditions – such as rising inequality and poverty – on public health. It also provides a political justification narrative for cuts to healthcare and welfare provision. (See also The NHS is to hire 300 employment coaches to find patients jobs to “keep them out of hospital”. )

Behavioural economists have claimed that ‘nudge’ presents an effective way to ‘change behaviours’ within the NHS and ‘improve outcomes’ at lower cost than traditional policy tools. Back in 2015, the Nudge Unit were looking for “many potentially fruitful areas in which to use behavioural insight to improve health and health-service efficiency, either by retrofitting existing processes or by designing completely new services most effectively.” ‘Fruitful’ as in lucrative for the part-privatised company, but not so lucrative for the NHS.

Behavioural economists are working for the government and public sector to “harness [public] behaviours to shift and reduce patterns of demand in many public services.” The problem is that human needs arising from illness are not quite the same thing as human behaviours and roles, yet the government are increasingly conflating the two. (See discussion on Talcott Parsons and the ‘sick role’ in this article, for example, along with that on ‘work is a health outcome’.)

Public services are associated with fundamental human rights, which in turn are based on notions of fundamental human need. Addressing basic human needs is fundamental to survival.

As Abraham Maslow concluded, motivation for behaviours is is closely related to fulfilling our basic needs, because if they are not met, then people will simply strive to make up the deficit as a priority. This undermines aspiration and human potential. Fulfilment of psychosocial needs will become a motive for behaviour only as long as basic physiological needs ‘below’ it have been satisfied. Health is a fundamental human need. To paraphrase Maslow, we don’t live by bread alone, unless there is no bread.

Public services are an essential part of developed democracies, they ensure all citizens can meet their basic needs, and therefore, the provision promotes wider social and economic wellbeing and progress.

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Maslow’s hierarchy of human needs

The Nudge Unit had already run a trial in Nottingham, which provided feedback to doctors of the cost of a commonly used discretionary lab test. This prompt retained clinical freedom, and did not ask doctors to order fewer tests – but the number of
tests fell by a third.

anttibiotic resistance

In 2016 the UK government set a target to half ‘inappropriate’ antibiotic prescribing by 2020. The Nudge Unit set out to “improve prescribing in line with government ambitions”. 

Behavioural economists from the Unit claimed that by informing doctors that they are prescribing more antibiotics relative to 80 per cent of their peers, they are reducing the number of ‘unnecessary’ prescriptions by 3.3 per cent (more than 73,000 prescriptions) – helping to address what the Chief Medical Officer has identified as perhaps the greatest medical threat of our age – antibiotic resistance. 

Between 2014 and 2015, the Behavioural Insights Team sent letters to 800 GP practices, telling them that other practices were recommending the use of antibiotics in fewer cases. (There is no evidence presented to determine if this was actually true, and judging by the template letter, it’s highly unlikely that it was true.)

The nudge method employed is called ‘social norming’, which operate as a kind of community enforcement, as norms are unwritten rules that define ‘appropriate’ behaviours for social groups. We tend to conform to the expectations of others. Changing perceptions of norms alters people’s expectations and behaviour.

Understanding norms provides a key to understanding social influence in general and conformity in particular. The Conservatives have traditionally placed a significant emphasis on social conformity.

There are ‘hotspots’ where more antibiotics are prescribed. However, the fact that these places tend to be some of the most deprived areas of the country strongly hints that there are underlying socioeconomic factors at play that cannot be solved with a nudge or prod. Research indicates that community socioeconomic variables may play a significant role in sepsis-attributable mortality, for example.

Social problems such as poverty and inequalities in health arise because of unequal distributions of wealth and power, therefore these problems require solutions involving  addressing socioeconomic inequality. As it is, the government is unprepared to spend public funds on public services to redistribute resources. 

The behavioural study did not include any consideration of socioeconomic variables on rates or severity of infection, or types of infection. 

The idea that ‘changing the prescribing habits in hospitals’ and GP surgeries will impact on antibiotic resistance is based on an assumption that doctors over prescribe antibiotics in the first place. There is no evidence that this is the case, and it’s very worrying that anyone would think that targeting doctors with behaviourally-based remedies will address antibiotic resistance and assure us, at the same time, that antibiotics are actually prescribed when appropriate, and tailored, ensuring the safety and wellbeing of the patient, rather than being prescribed according to arbitrary percentage norms distributed by behavioural economists.

The trials did not include sufficient data regarding clinical detail or diagnostic uncertainty that might justify antibiotic prescribing in individual cases.

One of the nudge unit team’s key aims is to design policies which reduce costs. They say: “The solution to the problem of AMR is not just to produce new and better drugs – that takes time, and a great deal of money. We must also reduce our use of antibiotics when they are not needed. Sadly, it seems that they are used unnecessarily twenty percent of the time in the UK”.

The various Nudge Unit reports on behavioural strategies that target doctors don’t mention any follow-up research to ensure that the reduction in antibiotic prescriptions did not correlate with an increase in the severity of infections or poor outcomes for patients. In fact one report highlighted that those who were admitted to hospital because their condition deteriorated were excluded from the trial, as they no longer met the inclusion criteria. That effectively means that any adverse consequences for patients who were not given antibiotic treatment was not reported. And that matters.

The authors say “We as the authors debated at length as to whether we should emphasise the fact that 80% of the prescriptions are being used in necessary cases.” 

There is no indication of how ‘necessary cases’ are determined, and more to the point, who determines what is a ‘necessary case’ for antibiotic treatment. Furthermore, the report uses some troubling language, for example, doctors prescribing antibiotics ‘above average’ were referred to more than once as the “worst offenders.” However, as I’ve already touched on, patients needs may well vary depending on a range of variables, such as the socioeconomic conditions of their community, and of course, complex individual comorbidities, which may not be mentioned in full when doctors write up the account for the prescription.

Sepsis, which may arise from any kind of infection is notoriously difficult to diagnose. It is insidious and can advance very rapidly.  It’s even more difficult to determine when a patient has other conditions. For example, sepsis can arise when someone has flu. That happened to me, when I had developed pneumonia without realising that I had. It’s standard practice for paramedics to administer a broad spectrum antibiotic and intravenous fluids to treat suspected sepsis and septic shock. This can often save lives. Sepsis kills and disables millions and requires early suspicion and antibiotic treatment for survival.

Once the causative agent for the infection is found, the IV antibiotics may then be tailored to treat it. The wait without any treatment until a firm diagnosis is potentially life-threatening. But the biochemical tests, such as CRP, and X-rays take time. 

Treatment guidelines call for the administration of broad-spectrum antibiotics within the first hour following suspicion of septic shock. Prompt antimicrobial therapy is important, as risk of dying increases by approximately 10% for every hour of delay in receiving antibiotics. This time constraint does not allow the culture, identification, and testing for antibiotic sensitivity of the specific microorganism responsible for the infection. Therefore, combination antimicrobial therapy, which covers a wide range of potential causative organisms, is tied to better ‘outcomes’. 

In the trial, behavioural economists referred to medical notes, and if there is no diagnosis, the necessity of the prescription is then questioned. Knowledge of complex medical histories may also influence doctors’ decisions, and this may not have been mentioned on medical record. A cough and breathlessness is a common symptom influenza. However, a patient with a condition that compromises their immunity, or someone who needs immune suppressants, for example, is rather more at risk of developing bacterial pneumonia than others, and someone with COPD or asthma is also at increased risk.  

If a person dies because treatment was not given promptly in high suspicion cases of severe infection and sepsis, who is to be held accountable, especially in a political context where treatments are being rationed and prescriptions are being increasingly policed?

It’s also worth bearing in mind that massive doses of antibiotics are added to livestock feed as a preventative measure and to promote growth before the animals are slaughtered and enter the food chain. Using antibiotics during the production of meat has been heavily criticised by physicians and scientists, as well as animal activists. The pharmaceutical industry is making billions annually from antibiotics fed to livestock, which highlights the perverse incentives of the profit motive and potentially catastrophic impact on humans. It is estimated that between 70 – 80 percent of the total of antibiotics used around the world are used within the animal farming and food industry. No-one is nudging the culprits. 

The potential threat to human health resulting from inappropriate, profit seeking antibiotic use in food animals is significant, as pathogenic-resistant organisms propagated in these livestock are poised to enter the food supply and could be widely disseminated in food products.

Antibiotics used on farms can spill over into the surrounding environment, for instance through water run-off and slurry, according to a report from the UN’s environment body, last year, with the potential to create resistance to the drugs across a wide area.

In 2013, researchers showed that people who simply lived near pig farms or crop fields fertilized with pig manure are 30% more likely to become infected with methicillin-resistant Staphylococcus aureus bacteria.

Cash for care – rationing referrals to hospital consultants and diagnostic testing

It was announced in April this year that General Practitioners (GPs) across England will be able to “better manage” hospital referrals with a “digital traffic light system” developed by the Downing Street policy wonks. This nudge is designed to target the ‘referral behaviours’ of GPs.

GPs are being offered cash payments as an ‘incentive’ to not refer patients to hospitals – including cancer patients – according to an investigation by Pulse, a website for GPs. 

Furthermore, a leaked letter sent by NHS to England to Clinical Commissioning Groups (CCGs) and seen by Pulse magazine last year, asks that all family doctors in England to seek approval from a medical panel for all non-urgent hospital referrals.  

A “clinical peer review of all referrals from general practice by September 2017”, will be required, the letter said. 

To ‘incentivise’ the scheme, the letter said that there will be “significant additional funding” for commissioners that establish peer-led policing schemes. It added that it could reduce hospital referral rates by up to by 30 per cent. NHS England said that they want to introduce the “peer review scheme” whereby GPs check the referrals of one another to ensure they are ‘appropriate’. However, experts warn this increasingly Kafkaesque layer of bureaucracy could lead to more problems and possible conflict with patients’ safety and standard of care. 

In a trial of the nudge scheme, four NHS clinical commissioning groups (CCGs) have been using “profit share” initiatives to ration care, to help them ‘operate within their budgets’. Clinical Commissioning Groups hold the budget for the NHS locally and decide which services are provided for patients. 

Through this scheme, GPs are told they will receive up to half of the money that is saved by fewer patients going to hospitals for tests and treatments.

So to clarify, surgeries are being offered financial ‘incentives’ for not sending patients to hospital to save money, that is then reinvested in part to implement further rationing of healthcare. The move has been widely condemned as a “dereliction of duty” by the community of medical experts and professionals. Referrals to consultants often involve important diagnostic procedures, therefore there is often no way of knowing for sure in advance of the referral whether or not it is “warranted”.

The NHS has had ‘referral management centres’ in place for many years.  However, last year they were at the epicentre of a scandal when it was revealed that the use of these centres has increased 10-fold over recent years. Furthermore, the centres are privately run and extremely expensive to employ, diverting funds that could simply be spent on patient care.

Moreover, those who were reviewing the referrals were also found to have varying levels of clinical knowledge, and so were not always able to correctly identify which referrals were ‘necessary’. They were also extremely inefficient as patients were forced to wait a long time for appointments. 

The Pulse investigation into referral incentive schemes being run by NHS clinical commissioning groups (CCGs) across England found some regions offering GPs as much as 50 per cent of any savings they can make. The “profit-share” arrangements mean practices stand to benefit financially by not sending patients for treatment or to see a specialist.

Hospitals are paid for operations and other activity, so by sending patients to cheaper services run by GP practices – such as diabetes and pulmonary clinics – or by keeping them out of hospital altogether, practices can increase the size of savings. GPs are not paid per procedure. Rather, they receive a single payment when each patient is registered with them. 

Currently, when doctors are referring patients for appointments with hospital consultants, the nudge – in the form of a “Capacity Alert System” – operates by displaying a red light next to hospitals with lengthy waiting times, and a green light next to those with more availability, on the system. 

The system underwent two trials in north-east and south-west London over the winter. During these pilots the number of referrals made to overburdened hospitals was reduced by 40%, while those made to hospitals with ‘spare capacity’ rose by 14%, according to NHS England. There was no comment made regarding the impacts of the scheme on patients’ health.

GP leaders have also said it is “insulting” to suggest doctors are sending patients to hospital arbitrarily, and raise significant conflicts of interest.

“Cash incentives based on how many referrals GPs make have no place in the NHS, and frankly, it is insulting to suggest otherwise,” said Professor Helen Stokes-Lampard, chair of the Royal College of GPs.

Of course, it’s important to take measures to ensure that GP referrals are appropriate and high-quality, but payments to reduce referrals would fly in the face of this, and erode the trust our patients have in us to do what is best for them and their health.” 

The NHS has been squeezed for increasingly drastic ‘efficiency savings’ in the past eight years. It’s absurd, however, that a huge amount of money is being spent on restricting access to healthcare, rather than on simply adequately funding healthcare provision.

Dr Peter Swinyard, chair of the Family Doctor Association, said the profit-share schemes were “bizarre”, adding: “From a patient perspective, it means GPs are paid to not look after them.

“It’s a serious dereliction of duty, influenced by CCGs trying to balance their books.”

Meanwhile, NHS Barnsley CCG has identified a £1.4m funding pot to pay its practices if they achieve a reduction in referrals to specialties, including cardiology, pancreatic surgery, and trauma and orthopaedics.

The CCG said the 10 per cent target was “ambitious but achievable”.

Last year it was discovered that the NHS has to spend £1.5 billion in legal costs when patients don’t get what the standard of care expected and pay for from their healthcare providers. In 2015/16, there was a 27% increase in the number of claims and a 72% increase in legal cost, which amounted to £1.5 billion.  With the amount of money that the NHS is spending on legal costs for medical blunders, the NHS could have paid for the training of more than 6,000 doctors. Or eased the rationing of essential healthcare provision.

The purpose of the NHS has been grotesquely distorted: it was never intended to be a bureaucratic gatekeeping exercise that rations healthcare. The purpose of all public services is to provide a public service, not ration provision. Such is the irrationality of the government’s ‘market place’ and ‘profit over human need’ narrative. 

Dr Eric Watts, a consultant haematologist for the NHS, says that the British government couldn’t care less about the fall of the NHS. He said, “This is a triumph of secrecy and implacable lack of care about the NHS by a Government determined to watch it fail then fall.” 

One CCG told Pulse“Ensuring treatment is based on the best clinical evidence and improving historical variation in access is essential for us locally.

“Financially, it is an effective use of local resources which will improve patient experience and outcomes and increase investment in primary care in line with the Five Year Forward View commitments.” Those ‘commitments’ are the increasing implementation of cuts to healthcare provision and funding.

Cuts to care may well improve financial ‘management’ but it cannot be claimed that healthcare rationing “improves health outcomes” for patients. That flies in the face of rationality.

NHS England also said last year that funding will be available for CCGs to start “peer review schemes”, where GPs police each other – checking that their colleagues are referring ‘appropriately’, but it is not clear what it thinks about direct payments linked to cutting referrals.

The “Cash for Cuts” investigation, by GP publication Pulse, asked all 207 CCGs in England about their processes for cutting referrals. Of the 180 who responded, 24 per cent had some kind of incentive scheme aimed at lowering the numbers of referrals. 

This included payments for getting GPs to “peer review” each other’s referrals or other strategies. 

Dr Chaand Nagpaul, from the British Medical Association (BMA) has  also criticised the nudge scheme. He says “It’s a blunt instrument which is not sensitive to the needs of the patient and is delaying patient care. 

“It has become totally mechanistic. It’s either administrative or not necessary for the patient. It’s completely unacceptable. Performance seems to be related to blocking referrals rather than patient care.”

The CCGs have defended the schemes, saying that at the time they were pushed through, the NHS was struggling through the worst winter ever in its history and had not been able to hit target waiting times since 2015. The CCGs have said that the scheme is only to help reducing ‘unnecessary referrals’ and therefore improve outcomes for ‘genuine patients’, and not to reduce numbers overall. Who decides which patients are ‘genuine’, and on what criteria? 

Dr Dean Eggitt, who is the British Medical Association’s GP representative for Barnsley, Doncaster, Rotherham and Sheffield, also disagrees with the scheme. 

“The scheme is unsafe and needs to be reviewed urgently,” he said. 

The BMA’s GP committee have said that it had raised concerns nationally where CCGs have set an “arbitrary target” for reducing referrals. 

Before Christmas, Jeremy Hunt, the Health Secretary, announced that he wanted hospitals to find another £300m in savings on basic items like surgical gloves and bandages, and a long-awaited pay rise for nurses is contingent on staff boosting “productivity”.  

A Department of Health and Social Care spokesperson said: “Patients must never have their access to necessary care restricted  – we would expect local clinical commissioning groups and NHS England to intervene immediately if this were the case.” 

I’ve asked NHS England whether it would be reviewing cases where GPs stand to profit financially for not referring patients, along with others, but I have had no response at time of this publication. 

The NHS was founded on the principle of free and open access to healthcare provision for everyone. The nudge schemes I’ve outlined have introduced ‘perverse incentives’ that prompt GPs to ration health care. I have argued elsewhere on many occasions that nudge and the discipline of behavioural economics more generally is technocratic prop for a failing  political and socioeconomic system of organisation – neoliberalism. Rather than review the failures of increasing privatisation and ‘competition’, the government chose to deny them, applying increasingly irrational ‘solutions’ to the logical gaps in their ‘marketplace’ dogma. 

Yet it is blindingly clear that citizens needs and their human rights are being increasingly sidestepped by the absolute prioritisation of the private profit incentive. 

Nudge isn’t about ‘economics theory and practice adapting to human decision making’, as is widely claimed. It isn’t about remedying ‘cognitive biases’. It isn’t about people making ‘flawed decisions’.

It’s about holding citizens responsible for the problems created by a flawed socioeconomic model. It’s about a limited view of human behaviours and potential, because it frames the poorest citizens in an increasingly unequal society as ‘failed entrepreneurs’. Those members of the public who need to access public services are increasingly being portrayed as an economic ‘burden’. As such, nudge places limitations on and replaces genuine problem-solving approaches to public policy.

Nudge is about authoritarian governments using a technocratic prop to adapt human perceptions, behaviours and expectations, aligning them to accommodate inevitable  catastrophic social outcomes. These outcomes are symptomatic of the failings and lack of rational insights of wealthy and powerful neoliberal ideologues, who are determined to dismantle our public services. Without the consent of the majority of citizens. 

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The NHS was never safe in his hands. The company he keeps has made sure of that.

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The Nudge Unit’s u-turn on benefit sanctions indicates the need for even more lucrative nudge interventions, say nudge theorists

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Some context: the new neuroliberalism and “behavioural insights”

The behaviourist turn in government administration – the use of targeted citizen behavioural conditionality in neoliberal policy making –  has expanded globally and is linked to the growth of behavioural economics theory (“nudge”) and a New Right brand of “libertarian paternalism.”  

Reconstructing citizenship as highly conditional stands in sharp contrast to democratic principles, rights-based policies and to those policies based on prior financial contribution, as underpinned in the social insurance and social security frameworks that arose from the post-war settlement.

The fact that the poorest citizens are being targeted with behavioural theory-based interventions also indicates discriminatory policy, which reflects traditional Conservative class-based prejudices. It’s an authoritarian approach to poverty which simply strengthens existing power hierarchies, rather than addressing the unequal distribution of power and wealth in the UK.

Some of us have dubbed this trend neuroliberalism because it serves as a justification for enforcing politically defined neoliberal outcomes. A hierarchical socioeconomic organisation is being shaped by increasingly authoritarian policies, placing the responsibility for growing inequality and poverty on individuals, side-stepping the traditional (and very real) political/structural explanations of social and economic problems.

Such a behavioural approach to poverty also adds a dimension of cognitive prejudice which serves to reinforce and established power relations and inequality. It is assumed that those with power and wealth have cognitive competence and know which specific behaviours and decisions are best for poor citizens, who are assumed to lack cognitive competence (because they are poor and therefore make “the wrong decisions”). Apparently the theories and insights of cognitive bias don’t apply to the theorists applying them to increasingly marginalised social groups. Policy has increasingly extended a neoliberal cognitive competence and decision-making hierarchy. 

It’s very interesting that the Behavioural Insights Team now claim that the state using the threat of benefit sanctions may be “counterproductive”. The idea of increasing welfare conditionality and enlarging the scope and increasing the frequency of benefit sanctions originated from the behavioural economics theories of the Nudge Unit in the first place. 

The increased use and rising severity of benefit sanctions became an integrated part of welfare conditionality in the Conservative’s Welfare “reform” Act, 2012. The current sanction regime is based on a principle borrowed from behavioural economics theory – an alleged cognitive bias we have called loss aversion.

It refers to the idea that people’s tendency is to strongly prefer avoiding losses to acquiring gains. The idea is embedded in the use of sanctions to “nudge” people towards compliance with welfare rules of conditionality, by using a threat of punitive financial loss, since the longstanding, underpinning Conservative assumption is that people are unemployed because of alleged behavioural deficits and poor decision-making. Hence the need for policies that “rectify” behaviour.

I’ve argued elsewhere, however, that benefit sanctions are more closely aligned with operant conditioning (behaviourism) than libertarian paternalism, since sanctions are a severe punishment intended to modify behaviour and restrict choices to that of compliance and conformity or destitution. At the very least this approach indicates a slippery slope from “arranging choice architecture” in order to support the “right” decisions that are felt to benefit people, to downright punitive and coercive policies that entail psycho-compulsion, such as sanctioning and mandatory workfare. 

Psychology is being misused by the government to explain unemployment (it’s claimed to happen because people have the “wrong attitude” for work) and as a means to achieve the “right” attitude for job readiness. Psycho-compulsion is the imposition of often pseudo-psychological explanations of unemployment and justifications of mandatory activities which are aimed at changing presumed beliefs, attitudes and dispositions. The Behavioural Insights Team have previously propped up this approach.

Welfare conditionality and its experimental approach to behavioural change doesn’t operate within an ethical framework, citizens cannot withdraw from behavioural experiments, nor is this framework based on informed consent. The impact of state directed psycho-compulsion and potential harm that it may cause citizens is not being monitored. 

The Behavioural Insights Team (BIT) is composed of mostly behavioural economists, who also claim the title of libertarian paternalists (and who have a clear and distinct ideological premise for their behavioural theories, while attempting to claim “objectivity”.)

They claim that while it is legitimate for government, private and public institutions to affect behaviour the aims should be to ensure that “people should be free to opt out of specified arrangements if they choose to do so.” Apparently, that proviso doesn’t apply to poor citizens.

The nudges favoured by libertarian paternalists are also supposed to be “unobtrusive.” That clearly is not the case with the application of extremely coercive and punitive Conservative welfare sanctions.

When it comes to technocratic fads like nudge, it’s worth bearing in mind that truth and ethics quite often have an inversely proportional relationship with the profit motive. It’s a cognitive bias, if you will.

And when one nudge theory fails, there are always lucrative and political opportunities to generate more.

Of course Dr Kizzy Gandy, a leading researcher at the policy unit says: “We are optimistic that behavioural science can help government departments to better design policies to help those who are ‘just managing’ in order to prevent and overcome poverty.”

In a new report released today from the Behavioural Insights Team, the authors say: “There is evidence that welfare conditionality in the UK – mandatory behavior requirements such as attending meetings with work coaches or providing repeated evidence of disability in order to receive benefits – is associated with anxiety and feelings of disempowerment.” 

“However, as far as we know no one has examined whether welfare conditionality has cognitive depleting effects.”

It’s particularly worrying that there is a proposal in the report for further experimental pseudo-psychological approaches to policies aimed at the poorest citizens. The researchers call on the Department for Work and Pensions to conduct experiments into whether welfare conditionality actually had any positive effects and suggested that “self-set” and “enforced goals” might be a better way of “helping people into work.” Although this allows for a little tokenist self-determination and permits a little autonomy, it is still an approach ultimately based on coercion and enforcement.

There is a clear distinction to be made between “behavioural science” – which is almost entirely about economic outcomes; what is politically deemed “best” for citizens and social conformity, and mainstream psychology – which embraces a much broader and deeper perspective of the complexities of human potential and wellbeing.

For anyone curious as to how such tyrannical behaviour modification techniques like benefit sanctions arose from the bland language, inane, managementspeak acronyms and pseudo-scientific framework of “paternal libertarianism” – nudge – here is an interesting read: Employing BELIEF: Applying behavioural economics to welfare to work, which is focused almost exclusively on New Right small state obsessions.

(Update 27/10/17 – the link to the original document no longer works. But I found a copy with the same page layout here, luckily: – https://www2.learningandwork.org.uk/sites/default/files/publications/CESI_employing_BELIEF.pdf).

Pay particular attention to the part about the alleged cognitive bias called loss aversion, on page 7.

And this on page 18: The most obvious policy implication arising from loss aversion is that if policy-makers can clearly convey the losses that certain behaviour will incur, it may encourage people not to do it,” and page 46: “Given that, for most people, losses are more important than comparable gains, it is important that potential losses are defined and made explicit to jobseekers (e.g.the sanctions regime).”

The recommendation on that page: We believe the regime is currently too complex and, despite people’s tendency towards loss aversion, the lack of clarity around the sanctions regime can make it ineffective. Complexity prevents claimants from fully appreciating the financial losses they face if they do not comply with the conditions of their benefit.”

The Conservatives duly “simplified” sanctions by extending them in terms of severity and increasing the frequency of use. Sanctions have also been extended to include previously protected social groups, such as lone parents, sick and disabled people. 

The paper was written in November 2010, prior to the Coalition policy of increased “conditionality” and the extended sanctions element of the Tory-led welfare “reforms” in 2012. I wrote about this at length earlier this year, here: Nudging conformity and benefit sanctions: a state experiment in behaviour modification.

The Behavioural Insights Team, (otherwise known as the Nudge Unit) was set up by David Cameron in 2010. In their most recent report called Poverty and decision-making: How behavioural science can improve opportunity in the UK, the nudge researchers now say that burdening unemployed people with responsibilities, using the threat of sanctions might actually be making it harder for them to get jobs.

According to the behavioural economist theorists authoring this highly jargonised report, government policies designed to help people are reducing and impairing people’s so-called cognitive scope and abilities.

However, it’s difficult to imagine how punitive sanctioning, which entails the removal of people’s lifeline income, originally calculated to meet the costs of only basic survival needs, such as for food, fuel and shelter, could ever be seen as “helping people.”

I don’t believe that Orwellian semantic shifts can ever provide a genuine and effective solution to poverty and inequality. 

Some major inconsistencies and incoherences in the report

In the latest BIT report, loss aversion is mentioned again:  “People dislike losses more than they like equivalent gains. Babcock, Congdon, Katz, and Mullainathan (2012) hypothesise that people may experience loss aversion if they consider taking a job paying below past earnings. Therefore, they may stay on unemployment benefits longer than they should. Unrealistic wage expectations may be reinforced when the social status and personal identities of workers are strongly tied to their previous job.” [My emphasis]

Note the phrase “unrealistic wage expectations” and later incoherent comments in the report about in-work poverty, which I will highlight.

The summary report states in the introduction: A third of the UK population spent at least one year in relative income poverty between 2011 and 2014.

Traditionally policymakers and anti-poverty organisations such as the Joseph Rowntree Foundation (JRF) have focused on boosting people’s economic capital (e.g., income) and human capital (e.g., educational attainment) to reduce poverty. While investments in these areas have led to important gains in opportunity for many Britons, emerging research from behavioural science shows that other less tangible resources, which derive from psychological, social and cultural processes, significantly influence people’s ability to overcome disadvantage.

BIT was commissioned by JRF to examine the role of individual decisions in shaping people’s experiences of poverty in the UK and to identify the drivers of these decisions. This reflects JRF’s interest in looking beyond traditional, structural drivers of poverty. Our findings, based on a review of the published literature, are presented in a new report, launched today.”

 

Let’s cut to the chase. The entire document is framed by the use of a distinct and established narrative; it’s composed of a pre-loaded ideological language, references and signposts, using comments and phrases like “[…] we explain some of the ways that cognitive, character and social capital influence social mobility, via decision-making.”  

And a sub-heading:Character capital: Self-efficacy and responsive parenting.” Apparently, “home visits by health workers have had positive effects in preventing intergenerational poverty.” That’s quite a remarkable claim, given that the document acknowledges poverty is actually increasing in the UK.

The whole concept of character capital is itself founded on the notion that people with an “internal locus of control” tend to perform tasks better than those with an “external locus of control.” This is about where people place the responsibility for what they achieve – either “inside” individuals, based solely on notions of merit, specific skills and talents, or external to individuals – “outside” of them, based on environmental conditions such as competition, chance, opportunities, socioeconomic, employment market context and so on. However, the cited evidence to support this theory was later contradicted in the report.

It’s also worrying that it is implied those who believe that achievement is linked with structural conditions are “under-performers.” It reads a little like a Samuel Smiles Victorian treatise on “thrift, character and self-help.”

It’s also an almost subliminal method of dismissing the impact of structural constraints on the opportunities available to individuals. It serves to make invisible what was once a key consideration in public discussions about poverty: the unequal distribution of power, wealth, resources and opportunity.

Also of note: “low levels of financial literacy” was conflated with notions of “human capital”, which “potentially exacerbate the effects of depleted cognitive capital among low income groups when choosing between credit options.”  Nothing to see here, then, regarding the behaviour of lenders. I mean whoever heard of a bank offering an overdraft to people who actually need one. Still, thank goodness there are generous companies like Wonga, always ready to step up to the mark, with eye-watering interest rates to offer those on low incomes.

The research authors seem to think that the only human potential worth recognising is that of our economic decision-making. Yet when people are materially poor, budgeting and decision-making are invariably constrained – that’s intrinsic to the very nature of poverty.

Limited decision-making and reduced available choices don’t cause poverty: they are the subsequent exclusion effects of poverty.

It’s telling that none of the recommendations made in this document actually address the structural and political causes of material poverty and growing inequality in the UK.

There is a substantial incoherence in some of the claims made, too. For example: “The world of work is possibly the single most important policy area for maximising individual and household resources to prevent and overcome poverty.”

Yet: “Just under half of those in poverty in the UK live in a workless household (Joseph Rowntree Foundation, 2014)”. So work clearly doesn’t pay for over half of those people in poverty. 

In fairness, it is later acknowledged that: “However, simply being in work is not sufficient to prevent or overcome poverty. Nearly two-thirds of children in poverty live in working families.” 

This heavily jargonised rhetoric is, on the whole, about looking for cheap individualist “solutions” to poverty that disregard the need for improving people’s material and financial situations, by extending on an existing neoliberal narrative of alleged individual fault, character deficits, cognitive bias and decision-making flaws.

None of this will raise the profile of crucial issues such as the conditions imposed by austerity and neoliberal policies, socioeconomic organisation and political decision-making, that are having a profound impact on growing inequality and increasing poverty in the UK. The persistent use of the word “workless” rather than “unemployed” is another linguistic signpost for neoliberal competitive individualism, too. 

Geographer David Harveydescribes neoliberalism as a process of accumulation by dispossession: predatory policies are used to centralise wealth and power in the hands of a few by dispossessing the public of their wealth and assets. The report does not refer to the mode of political-economic organisation of which growing inequality and poverty are an intrinsic and inevitable feature.

Proposed solutions: more of the same

Summary of recommendations:

MINIMISING COSTS

Consumer credit

1 Make it easier to access low cost credit through extending access to interest-free Budgeting Advances; assisting credit unions to expand online services; and providing tax relief to individuals taking out payroll loans.

2 Further restrict practices by high cost credit providers that play on consumer biases, and test remedies that will improve consumer credit decision-making.

3 Continue to evaluate financial capability programmes through initiatives like the Money Advice Service What Works Fund.

(Access to credit does not alleviate poverty in the long-term.)

Savings

1 Test ways of automating rainy day savings through employer enrolment, default savings accounts with banks, and Universal Credit payments.

2 Evaluate the effectiveness of financial apps for helping people save.

3 Optimise the Help to Save matching scheme, through testing auto-enrolment and prizes for regular saving, to encourage low-income groups to save.

(Poor citizens do not have sufficient funds to make savings. And research shows that absolute poverty is growing in the UK, which means that many people often don’t have sufficient funds for meeting even fundamental survival needs, such as for food and fuel.) 

MAXIMISING RESOURCES

Work

1 Use identity-building activities in Jobcentres to cultivate intrinsic motivation for work in order to improve the quality and sustainability of jobs that people find.

2 Collect longer-term and more holistic outcome measures of labour market interventions to understand their full impact on poverty.

3 Develop a simple tool for Jobcentres to identify capital deficits in order to match interventions to individual job seeker needs.

Entitlements

1 Develop a common “cognitive load stress test” that measures how easy it is for eligible groups to access government entitlements.

2 Use annual entitlement summaries to prompt existing welfare recipients to apply for other assistance they may be eligible for, and to help them budget.

3 Experiment with the design of welfare conditionality to boost cognitive capacity and self-efficacy, such as having claimants set their own payment conditions.

PREVENTING INTERGENERATIONAL POVERTY

Parenting

1 Provide families in or near poverty with free access to evidence-based online parenting programmes.

2 Develop community to strengthen social ties between parents from different backgrounds.

3 Conduct research into whether small and inexpensive adjustments to housing conditions can reduce cognitive load and improve parental decision-making.

Post secondary education

1 Make the application process for post-secondary education as simple as possible, for example, by pre-populating application forms.

2 Use personalised assistance and prompts to encourage students and parents to apply to post-secondary education.

3 Link formal information about returns to post-secondary education with informal information (from peers) about what post-secondary education will be like.

Every single intervention recommendation fails to address the structural causes of poverty, which lie outside of the control of people experiencing poverty. Yet most of these recommendations are aimed at prompting the state to act upon individuals.  

Proposals such as providing access to parenting programmes, “identity-building activities in Jobcentres to cultivate intrinsic motivation for work”, “rainy day savings”, and to “develop a simple tool for Jobcentres to identify capital deficits in order to match interventions to individual job seeker needs” all sound like a New Right blame-storming exercise. Again, the problem of poverty is regarded as being intrinsic to the individual, rather than one that is about material deprivation which arises in a wider political, economic, cultural and social context.

Post secondary education costs money and isn’t supported by the state. The Education Maintenance Award (EMA) was withdrawn by the Conservatives, and the cost of a university education is now far too much for many young people from poorer backgrounds because of the tripling of fees and reduction in maintenance support. It’s the government that need a nudge, here. This is a good example of how opportunities and choices are being limited for poorer citizens by cuts and constraints imposed by the neoliberal ideologues in office.  

The government never question the decision-making of the powerful and wealthy, yet it certainly wasn’t the poorest citizens that caused the global recession in 2007, nor was it the poorest citizens that imposed damaging austerity policies. The poorest people are burdened with a disproportionate weight of austerity cuts to their income and support. The wealthiest citizens have meanwhile been gifted with substantial tax cuts. 

Nudge is a state prop for neoliberalism, inequality and social control

Neoliberals argue that public services present moral hazards and perverse incentives. Providing lifeline support to meet basic survival requirements is seen as a barrier to the effort people put into searching for jobs. From this perspective, the social security system, which supports the inevitable casualties of neoliberal free markets, has somehow created those casualties. But we know that external, market competition-driven policies create a few “haves” and many “have-nots.” This is why the  welfare state came into being, after all – because when we allow such competitive economic dogmas to manifest without restraint, we must also concede that there are always ”winners and losers.”

Neoliberalism organises societies into hierarchies. Inequality is therefore an inevitable feature of the UK’s current mode of socioeconomic organisation. 

The UK currently ranks highly among the most unequal countries in the world.

Inequality and poverty are central features of neoliberalism and the causes therefore cannot be located within individuals.  

Neoliberals see the state as a means to reshape social institutions and social relationships based on the model of a competitive market place. This requires a highly invasive power and mechanisms of persuasion, manifested in an authoritarian turn. Public interests are conflated with narrow economic outcomes. Public behaviours are politically micromanaged. Social groups that don’t conform to ideologically defined outcomes are stigmatised, and outgrouped.

Shamefully, in a so-called first world, wealthy liberal democracy, othering and outgrouping have become common political practices.  

Replacing spent micro-managementspeak with more micro-managementspeak

The Nudge Unit, which was part-privatised in 2014, have now warned that some Government policies were reducing so-called “cognitive bandwidth” or “headspace” of the people they were designed to help. So more theoretical psychobabble to overwrite the previous psychobabble which didn’t work when applied via policy.

This is bland neoliberal managementspeak at its very worst. The policies are causing profound damage, harm and distress to those they were never actually designed to “help”. Let’s not permit an evading of accountability and techniques of neutralisation: the use of rhetoric to obscure the real intention behind policies, as well as the consequences of them. It’s nothing less than political gaslighting. 

Of course the report attempts to apply “the latest findings from behavioural science to improve government services.” In a neoliberal framework, there are many lucrative opportunities for private companies to experiment in the psychological management of populations who have become the casualties of political decision-making, for political ends. The ethical relativity, moral entrepreneurship and sheer financial opportunism on display here certainly reflect some fundamental neoliberal values and principles. The main one being profit over human need.

Dr Kizzy Gandy proposes that cost-effective “simple tweaks” to services could help improve the way services worked. “Government policies should help people to have less on their mind, not more,” she added. 

However, I propose that government policies in democratic societies should also be designed to meet the public’s needs, including alleviating poverty, rather than being about impoverishing targeted social groups and then undemocratically acting upon individuals, without their consent, directing them how to behave in order to accommodate government ideology and meet politically defined neoliberal outcomes.

Material poverty steals aspiration and motivation from any and every person that is reduced to struggling for basic survival. Abraham Maslow (a real social psychologist) explained that when people struggle to meet their basic physical needs, they cannot be “incentivised” to fulfil higher level psychosocial needs – that includes job seeking.

Further criticism 

Labour Shadow Work and Pensions Secretary, Debbie Abrahams, said: “Even the government’s own Behavioural Insights Team now recognise the mountains of evidence that the widespread use of sanctions is not leading to better outcomes for people seeking work. Indeed, this government team’s report suggests that sanctions may be operating as a barrier to finding a job.

“This government should be ashamed of their persistent failure to act on this issue over many years, after I, and other campaigners, have provided evidence of the devastating impacts of their sanctions policy.  I have committed to putting an end to Tories’ cruel and unnecessary sanctions regime, as part of our work to transform the social security system.” 

In fairness to the BIT, the report does say on page nine, among the listed areas of proposed future research: “A significant portion of behavioural science research focuses on improving the decisions of end-users – in this case people in poverty. But what about the decisions of service providers and policymakers? How can we improve the quality of their decisions to support people [to] escape poverty? And how can we build their empathy with those whose opportunities are at stake?”  

But who is nudging the nudgers?  I would think nudgers are “incentivised” by those providing the contracts that pay their salaries, on the whole. The government part-own the nudge unit.

Researchers from a variety of universities across the UK, using qualitative longitudinal interviews with nine groups of welfare service users from across England and Scotland, aim at determining longer-term effects of sanctions. The first wave findings from this collaborative ongoing study regarding the effects and ethics of welfare conditionality were released last year 

It was found that linking continued receipt of benefit and services to mandatory behavioural requirements has created widespread anxiety and feelings of disempowerment. The impacts of benefit sanctions are universally reported by service users as profoundly negative, having severely detrimental financial, material, emotional, psychological and health impacts. Some individuals disengaged from services, some were even pushed toward “survival crime”.  

The most surprising thing about these findings was the general lack of surprise they raised.

A recurring theme is that sanctions are grossly out of proportion to “offences”, such as being a few minutes late for an appointment. Many reported being sanctioned following administrative mistakes. The Claimant Commitment was criticised for not taking sufficient account of individuals’ capabilities, wider responsibilities and vulnerabilities. Many saw job centres as being primarily concerned with monitoring compliance, imposing discipline and enforcement, rather than providing any meaningful support. 

Power relations, class and economic organisation have now completely disappeared from public conversations about poverty. Neoliberal anti-welfarism, amplified by a corporate media, has aimed at reconstruction of society’s “common sense” assumptions, values and beliefs. Class, disability and race narratives in particular, associated with traditional prejudices and categories from the right wing, have been used to nudge the UK to re-imagine citizenship, human rights and democratic inclusion as highly conditional.  

This is not just about shifting public rational and moral boundaries to de-empathise the electorate to the circumstances of politically defined others. It also obscures the consequences more generally of increasingly non-inclusive, anti-democratic, prejudiced and extremely punitive policies.  

The bottom line is that government policies are expressed political intentions regarding how our society is organised and governed. They have calculated social and economic aims and consequences. In democratic societies, citizens’ accounts of the impacts of policies ought to matter. 
 
However, in the UK, the way that policies are justified is being increasingly detached from their aims and consequences, partly because democratic processes and basic human rights are being disassembled or side-stepped, and partly because the government employs the widespread use of linguistic strategies: euphemisms, superficial glittering generalities and techniques of persuasion to intentionally divert us from aims and consequences of ideologically (rather than rationally) driven policies. Furthermore, policies have become increasingly detached from public interests and needs. 

For example, the state has depoliticised disadvantage, making it the private responsibility of citizens, whilst at the same time, justifying a psychopolitical approach that encodes a punitive Conservative moral framework. 

According to the behavioural economist theorists, in their highly jargonised and fairly meaningless report, government policies are reducing so-called “cognitive bandwidth” or “headspace” of the people they were designed to help.

That the government imposes additional “cognitive costs”, as well as material and financial ones, on low-income groups, is hardly a groundbreaking revelation. 

I can put it much more plainly, and strip it of neoliberal psychobabbling: imposing sanctions on people who already have very limited resources is not only irrational, it is absurdly unjust, damaging, distressing and spectacularly cruel. 

See also:

Benefit Sanctions Can’t Possibly ‘Incentivise’ People To Work – And Here’s Why

Two key studies show that punitive benefit sanctions don’t ‘incentivise’ people to work, as claimed by the government

Welfare, Conditional Citizenship and the Neuroliberal State – Conference Presentation

 

 

Basic Income Guarantee gains popularity across the political spectrum

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Basic income (which is sometimes called “citizen’s income” or “universal income”) is the idea that absolute poverty can be alleviated by providing every member of a society with an unconditional subsistence income. Supporters of basic income argue that it would alleviate absolute poverty and would also motivate people to work because they would always better off, as work-related income would be additional to their subsistence income. 

Earlier this year I wrote  about the Labour Party’s consideration of the universal basic income as a part of its new policy, during their talk at the London School of Economics. John McDonnell said: “It’s an idea we want to look at. Child benefit was a form of basic income so it’s not something that I would rule out.”

At the very least, this indicates the idea of universal provision has regained some credence in the face of a longstanding and seemingly unchallengeable political norm of increasing means-testing and welfare conditionality, established by the Thatcher adminstration, and radically extended by the current government.

Although basic income is a feature in many proposed models of market socialism, and has been particularly popular with the Green Party, support for basic income has also been expressed by several people associated with right-wing political views. While adherents of such views generally favour minimization or abolition of the public provision of welfare services, some have cited basic income as a viable strategy to reduce the amount of bureaucratic administration that is prevalent in many contemporary welfare systems. Others have contended that it could also act as a form of compensation for fiat currency inflation

Though the details vary, the basic income model has been advocated by  Right-wing thinkers such as Charles Murray, Milton Friedman and the Adam Smith Institute, amongst others. Libertarians who object to income redistribution in principle usually concede that a Negative Income Tax is the least controversial form of welfare, because it is administratively simple and “perverts incentives” less than most welfare schemes. It is particularly appealing to many liberals and libertarians because it is unpaternalistic – it’s highly compatible with laissez faire and neoliberal economic models. However, the current government are libertarian paternalists, blending a small state ideology with a psychocratic approach to governing, using behavioural change techniques (Nudge) to fulfil ideologically-driven policy outcomes.

Last year, the Citizen’s Income Trust (CIT), which has given advice to the Green Party and often cited by the Greens, has modelled the party’s scheme and discovered a major design flaw. It was revealed that that 35.15% of households would lose money, with many of the biggest losers among the poorest households. At the time, Malcolm Torry, director of the CIT, which is a small charitable research body, said: “I am not sure the Green party has yet taken on our new research or the need to retain a means-tested element. We have only just published the new work.”

The criticisms of the scheme, as well as doubts about costings, led the Greens to make a temporary tactical retreat on the issue, with the party’s leader, Natalie Bennett, saying detailed costings for the policy would not be available in the manifesto last March. The Greens had proposed a citizen’s income of around £72 to every adult in Britain regardless of wealth and existing income, which would cost the Treasury around £280bn.

One longstanding criticism of basic income is that it would provide  payments to citizens that are already very wealthy, perpetuating social inequality, and wasting resources. Another is that it does not take into account the long-term impacts and provide adequate support for those who cannot work, such as those who are ill and disabled. Such detail matters very much, and we must not allow basic income to be used as an excuse for dismantling essential welfare support for social groups that need long-term aid to survive.

The CIT added that if the policy was applied without a means-tested component, then poorer households would end up receiving far less in state benefits than they would under the existing system. 

However, one of the strongest arguments for basic income is that people would no longer be compelled to work in order to meet their basic needs. This means that employers would find it difficult to exploit workers, and would be pushed to offer decent wages, good terms and employment conditions in order to attract workers. People would have greater freedom to pursue meaningful, suitable and appropriate employment rather than having to take any job to avoid poverty and destitution. De-commodifying labor by decoupling work from income liberates people from the “tyranny of wage slavery” and leaves a space for innovation, creativitity and rebalances power relationships between wealthy, profit-motivated employers and employees.

It seems that the idea of basic income is gaining support. Reform Scotland, an independent non-party think tank, also propose in their recent report – The Basic Income Guaranteethat  the current work-related benefits system is replaced with a new Basic Income Guarantee (BIG).

However, despite claims that the think tank is independent of political parties, Reform Scotland is a public policy institute which works to promote increased economic prosperity and more effective public services based on the libertarian paternalist notions and Conservative principles of limited government and personal responsibility. Reform Scotland is funded by donations from private individuals, charitable trusts and corporate organisations.

The calculations used in the report imply that a Basic Income Guarantee would cost more initially to implement, but the think tank argue that there are strong arguments (which are couched in Conservative terms) to suggest that it would lead to “changed behaviour” and “a bigger workforce.” The think tank proposes that there remains a “disincentive” to work (the so-called “welfare trap”) which is caused by the high level of marginal taxes faced by those moving into work or increasing their hours. In their report, Reform Scotland say: “Our conclusion is that the benefits system should protect the unemployed and under-employed but at the same time must reduce – and ideally remove – any disincentives to take work, particularly part-time work. The manifest failing of the present system is the cash penalty many face when they take a job.”

Reform Scotland is proposing a Basic Income Guarantee which is paid to all working-age adults and children, whether in or out of work. All earnings would be taxed, but the basic income would never be withdrawn, meaning that “work would always pay.”

The think tank argues that radical reform of the current welfare system is required and that a Basic Income Guarantee is the best way forward. This would give every working-age person a basic income from the state of £5,200 per year, and every child £2,600.  The income would be a right of citizenship and would be the same regardless of income or gender. It would be non-means tested and would not increase or decrease as someone’s income changes, thereby removing the need for the associated bureaucracy.

The Basic Income Guarantee would replace a number of means-tested work related benefits, as well as child benefit, and would be a new way of providing a social safety net.

Welfare spending on working-age people has decreased since 2010, and the report highlights a context of the rising costs of pensions, and of £207.6 billion spent on welfare in 2014/15, £114 billion was in relation to pensioners. Of this, about £93 billion is made up by the state pension and pensioner credit. The Reform Scotland proposals therefore relate to the remaining  £93.6 billion, spent on working-age adults and children.

The report, written by former Scottish Green Party Head of Media, James Mackenzie, and former Scottish Liberal Democrat Policy Convener, Siobhan Mathers, in conjunction with Geoff Mawdsley and Alison Payne of Reform Scotland, seeks to promote informed debate of this idea by examining what the level of the basic income might be and how much implementing it would cost.

Reform Scotland’s report also calls for a single department to be responsible for welfare payments, ending the current split between HMRC and the DWP.

Commenting on the report, author James Mackenzie, former Scottish Green Party Head of Media, said: Basic income is one of those ideas that should appeal right across the political spectrum. When I was unemployed I remember having to think hard about whether to accept part time or short-term work because of the impact on my income. We should be making it easier for people to work who can and who want to, not penalising them. Basic income does just that, as well as helping those who have caring responsibilities, or who want to volunteer or study. 

There’s a resurgence of interest in the idea around the world, especially in Europe, with proposals being considered in Switzerland, Holland, France and elsewhere. The principle is the same everywhere, but policy makers need to know more about the practicalities. Now, for the first time, we are providing some detailed information about how it could work in Scotland, either after independence or after the devolution of the necessary powers.”

Co-author Siobhan Mathers, Reform Scotland advisory board member and former Scottish Liberal Democrat Policy Convener said: “There is a great opportunity for Scotland to design a welfare system that best suits its needs in the 21st Century. We could leave behind the unnecessary complexity of the UK system and provide a fair Basic Income Guarantee for all. This would make any transitions in and out of work more manageable and provide a clear, fair safety net for all.”

We have seen an unprecedented increase in a dark, unaccountable bureacracy this past five years, with private companies such as Atos, Maximus, and the likes of A4E and other private welfare-for-work providers marking the increased conditionality of welfare support – for both out of work support, and soon, for support paid to those in low paid and part-time work.

Conservative inclination has been towards substantially raising the (increasingly privatised and for profit) administrative costs of welfare, whilst at the same time radically reducing the lifeline benefits for people needing support for meeting basic needs.

Conservatives may well raise the “something for nothing” objection to basic income, which is founded on the absurd idea that the only way people may contribute to society is through paid labor.

Yet non-remunerated activities such as bringing up children, caring for elderly or sick and disabled relatives, supporting vulnerable neighbours, community work, volunteering for charities or investing time and effort in other voluntary endeavours such as contributions to the arts, sharing knowledge, education, writing, are all clearly valuable contributions to society. But these skills and activities have been steadily devalued, whilst providing an increasingly disposable (“flexible”) labor force is seen by the Conservatives as somehow fulfilling the best of our potential.

Reform Scotland has previously argued, when putting forward its Devolution Plus proposals, that there is plenty of logic behind bringing together the policy areas associated with alleviating poverty that are currently devolved, such as social inclusion and housing, with benefit provision, which remains reserved. This would help to provide a more coherent approach to tackling poverty and inequality.

The debate on this issue will, no doubt, continue in the years to come.

 

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Study of welfare sanctions – have your say

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National Audit Office (NAO) is currently undertaking a study of benefit sanctions, in order to:

“… examine whether the Department for Work and Pensions is achieving value for money from its administration of benefit sanctions. This includes how benefit sanctions fit with the intended aims and outcomes of DWP’s wider working age employment policy, whether sanctions are being implemented in line with policy and whether use of sanctions is leading to the intended outcomes for claimants.”

I wrote two days ago about the Department for Work and Pensions document about the Randomised Control Trial (RCT) they are currently conducting regarding in-work “progression.” The document was a submission made to the Work and Pensions Committee in January, as the Committee have conducted an inquiry into in-work conditionality. The document specifies that: This document is for internal use only and should not be shared with external partners or claimants.” 

The Department for Work and Pensions claim that the Trial is about “testing whether conditionality and the use of financial sanctions are effective for people that need to claim benefits in low paid work.” The document focuses on methods of enforcing the “cultural and behavioural change” of people claiming both in-work and out-of-work social security, and evaluation of the Trial will is the responsibility of the Labour Market Trials Unit. (LMTU). Evaluation will “measure the impact of the Trial’s 3 group approaches, but understand more about claimant attitudes to progression over time and how the Trial has influenced behaviour changes.”

Worryingly, claimant participation in the Trial is mandatory. There is clearly no appropriate procedure to obtain and record clearly informed consent from research participants. Furthermore, the Trial is founded on a coercive psychopolitical approach to labour market constraints, and is clearly expressed as a psychological intervention, explicitly aimed at “behavioural change” and this raises some serious concerns about research ethics and codes of conduct.

Sanctions are “penalties that reduce or terminate welfare benefits in cases where claimants are deemed to be out of compliance with  requirements.” They are, in many respects, the neoliberal-paternalist tool of discipline par excellence – the threat that puts a big stick behind coercive welfare programme rules and “incentivises” citizen compliance with a heavily monitoring and supervisory administration. The Conservatives have broadened the scope of behaviours that are subject to sanction, and have widened the application to include previously protected social groups, such as sick and disabled people and lone parents.

There is plenty of evidence that sanctions don’t help people to find work, and that the punitive application of severe financial penalities is having a detrimental and sometimes catastrophic impact on people’s lives. We can see from a growing body of research how sanctions are not working in the way the government claim they intended.

Sanctions, under which people lose benefit payments for between four weeks and three years for “non-compliance”, have come under fire for being unfair, punitive, failing to increase job prospects, and causing hunger, debt and ill-health among jobseekers. And sometimes, causing death.

The Conservative shift in emphasis from structural to psychological explanations of poverty has far-reaching consequences. The reconceptualision of poverty makes it much more difficult to define and very difficult to measure. Such a conceptual change disconnects poverty from more than a century of detailed empirical and theoretical research, and we are witnessing an increasingly experimental approach to policy-making, aimed at changing the behaviour of individuals, without their consent. This turns democracy completely on its head. Policies are meant to meet public needs, rather than being used simply as tools of government to have the public meet ideologically-determined government outcomes.

This approach isolates citizens from the broader structural political, economic, sociocultural and reciprocal contexts that invariably influence and shape an individuals’s experiences, meanings, motivations, behaviours and attitudes, causing a problematic duality between context and cognition. It also places unfair and unreasonable responsibility on citizens for circumstances which lie outside of their control, such as the socioeconomic consequences of political decision-making.

It’s clear that the government intends to continue embedding sanctions in policies which were meant to provide a minimal income for people needing support. This is policy based entirely on ideology and traditional Conservative prejudice, aimed at punishing sick and disabled people, unemployed people, the poorest paid, and part-time workers, inflicting conditions of hardship, distress and absolute poverty on those social groups. Meanwhile, the collective bargaining traditionally afforded us by trade unions has been systematically undermined by successive Conservative governments, showing clearly how the social risks of the labour market are being personalised and redefined as being solely the economic responsibility of individuals rather than the government and profit-driven big business employers.

It’s important that we gather and present as much evidence as possible about the detrimental impact of welfare sanctions. The NAO study will run until the Autumn, so that gives us some time to have our say about our own experiences.

It is easy to make a submission to the study. Just go to the contact page and select welfare and benefits as the topic, and write “FAO Colin Ross” or “Max Tse” in the subject field. Alternatively,  you can email Colin Ross, the audit manager, directly at Colin.ROSS@nao.gsi.gov.uk

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Maslow’s hierarchy of human needs. If we can’t meet our basic physiological needs, it isn’t likely that we will be able to meet higher level psychosocial needs.

Related

We would like to hear your stories about how the cuts have affected you and your service. We want the wider public and politicians to understand the real life costs of public sector cuts. It can be hard to speak up alone, so we are collating everyone’s stories – together we have more power and a louder voice. We all have stories of frustration, fear and anger, so please use this as a way to tell the world about how the cuts have impacted on you and/or the people you work with. We are interested in stories from everyone who works in, uses, or needs Psychology services:

Psychologists Against Austerity campaign – call for evidence

Stigmatising unemployment: the government has redefined it as a psychological disorder

The politics of punishment and blame: in-work conditionality

Nudging conformity and benefit sanctions

G4S are employing Cognitive Behavioural Therapists to deliver “get to work therapy”

The new Work and Health Programme: government plan social experiments to “nudge” sick and disabled people into work

The importance of citizen’s qualitative accounts in democratic inclusion and political participation

Sanctions can’t possibly “incentivise” people to work. Here’s why

 


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The politics of punishment and blame: in-work conditionality

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The Department for Work and Pensions has submitted a document about the Randomised Control Trial (RCT) they are currently conducting regarding in-work “progression.” The submission was made to the Work and Pensions Committee in January, as the Committee have conducted an inquiry into in-work conditionality. The document specifies that:
This document is for internal use only and should not be shared with external partners or claimants.” 

So please share widely.

The Department for Work and Pensions claim that the Trial is about “testing whether conditionality and the use of financial sanctions are effective for people that need to claim benefits in low paid work.” The document focuses on methods of enforcing the “cultural and behavioural change” of people claiming both in-work and out-of-work social security, and evaluation of the Trial will be the responsibility of the Labour Market Trials Unit. (LMTU). Evaluation will “measure the impact of the Trial’s 3 group approaches, but understand more about claimant attitudes to progression over time and how the Trial has influenced behaviour changes.”

Worryingly, claimant participation in the Trial is mandatory. There is clearly no appropriate procedure to obtain and record clearly informed consent from research participants. Furthermore, the Trial is founded on a coercive psychopolitical approach to labour market constraints, and is clearly expressed as a psychological intervention, explicitly aimed at “behavioural change” and this raises some serious concerns about research ethics and codes of conduct. It’s also very worrying that this intervention is to be delivered by non-qualified work coaches.

The British Psychological Society (BPS) have issued a code of ethics in psychology that provides guidelines for the conduct of research. Some of the more important and pertinent ethical considerations are as follows:

Informed Consent.

Participants must be given the following information relating to:

• A statement that participation is voluntary and that refusal to participate will not result in any consequences or any loss of benefits that the person is otherwise entitled to receive.

• Purpose of the research.

• Procedures involved in the research.

All foreseeable risks and discomforts to the participant (if there are any). These include not only physical injury but also possible psychological.

• Subjects’ right to confidentiality and the right to withdraw from the study at any time without any consequences.

Protection of Participants

Researchers must ensure that those taking part in research will not be caused distress. They must be protected from physical and mental harm. This means you must not embarrass, frighten, offend or harm participants.

Normally, the risk of harm must be no greater than in ordinary life, i.e. participants should not be exposed to risks greater than or additional to those encountered in their normal lifestyles. Withdrawing lifeline support that is calculated to meet the costs of only minimum requirements for basic survival – food, fuel and shelter – as a punishment for non-compliance WILL INVARIABLY cause distress, harm and loss of dignity for the subjects that are coerced into participating in this Trial. Participants should be able to leave a study at any time if they feel uncomfortable.

The Economic and Social Research Council has recently issued a new research ethics framework, and the website has lots of useful guidance that is also worth referring to.

In the UK, the Behavioural Insight Team is testing paternalist ideas for conducting public policy by running experiments in which many thousands of participants receive various “treatments” at random. Whilst medical researchers generally observe strict ethical codes of practice, in place to protect subjects, the new behavioural economists are much less transparent in conducting behavioural research interventions.

Consent to a therapy or a research protocol must possess three features in order to be valid. It should be voluntarily expressed, it should be the expression of a competent subject, and the subject should be adequately informed. It’s highly unlikely that people subjected to the extended use and broadened application of welfare sanctions gave their informed consent to participate in experiments designed to test the theory of “loss aversion,” for example.

Unfortunately there is nothing to prevent a government from deliberately exploiting a research framework as a way to test out highly unethical and ideologically-driven policies. It is not appropriate to apply a biomedical model of prescribed policy “treatments” to people experiencing politically and structurally generated social problems, such as unemployment, inequality and poverty, for example.

Some background

I wrote last year about the Work and Pensions Committee’s in-work progression in Universal Credit inquiry. The Department for Work and Pensions (DWP) intends to establish an “in-work service”, designed to encourage individual Universal Credit claimants on very low earnings to increase their income. Benefit payments may be stopped if claimants fail to take action as required by the DWP. The DWP is conducting a range of pilots to test different approaches but there is very little detail about these. The new regime might eventually apply to around one million people.

We really must challenge the Conservative’s use of words such as “encourage” and “support” and generally deceptive language use in the context of what are, after all, extremely punitive, coercive  policies.

I wrote a statement at the time regarding my own submission to the inquiry, prompted by Frank Field’s spectacularly misguided and conservative statement. Here are a few of the issues and concerns I raised: 

Field refered to the Conservative “welfare dependency” myth, yet there has never been any empirical evidence to support the claims of the existence of a “culture of dependency” and that’s despite the dogged research conducted by Keith Joseph some years ago, when he made similar claims.

In fact, a recent international study of social safety nets from The Massachusetts Institute of Technology (MIT) and Harvard economists categorically refutes the Conservative “scrounger” stereotype and dependency rhetoric. Abhijit Banerjee, Rema Hanna, Gabriel Kreindler, and Benjamin Olken re-analyzed data from seven randomized experiments evaluating cash programs in poor countries and found “no systematic evidence that cash transfer programmes discourage work.”

The phrase “welfare dependencydiverts us from political discrimation via policies, increasing inequality, and it serves to disperse public sympathies towards the poorest citizens, normalising prejudice and resetting social norm defaults that then permit the state to target protected social groups for further punitive and “cost-cutting” interventions to “incentivise” them towards “behavioural change.”

Furthermore, Welfare-to-Work programmes do not “help” people to find jobs, because they don’t address exploitative employers, structural problems, such as access to opportunity and resources and labour market constraints. Work programmes are not just a failure here in the UK, but also in other countries, where the programmes have run extensively over at least 15 years, such as Australia.

Welfare-to-work programes are intimately connected with the sanctioning regime, aimed at punishing people claiming welfare support. Work programme providers are sanctioning twice as many people as they are signposting into employment (David Etherington, Anne Daguerre, 2015), emphasising the distorted priorities of “welfare to work” services, and indicating a significant gap between claimant obligations and employment outcomes.

The Conservatives have always constructed discourses and shaped institutions which isolate some social groups from health, social and political resources, with justification narratives based on a process of class-contingent characterisations and the ascribed responsiblisation of social problems such as poverty, using quack psychology and pseudoscience. However, it is socioeconomic conditions which lead to deprivation of opportunities, and that outcome is undoubtedly a direct consequence of inadequate and discriminatory political decision-making and policy.

It’s worth bearing in mind that many people in work are still living in poverty and reliant on in-work benefits, which undermines the Libertarian Paternalist/Conservative case for increasing benefit conditionality somewhat, although those in low-paid work are still likely to be less poor than those reliant on out-of-work benefits. The Conservative “making work pay” slogan is a cryptographic reference to the punitive paternalist 1834 Poor Law principle of less eligibility.

The government’s Universal Credit legislation has enshrined the principle that working people in receipt of in-work benefits may face benefits sanctions if they are deemed not to be trying hard enough to find higher-paid work. It’s not as if the Conservatives have ever valued legitimate collective wage bargaining. In fact their legislative track record consistently demonstrates that they hate it, prioritising the authority of the state above all else.

There are profoundly conflicting differences in the interests of employers and employees. The former are generally strongly motivated to purposely keep wages as low as possible so they can generate profit and pay dividends to shareholders and the latter need their pay and working conditions to be such that they have a reasonable standard of living.

Workplace disagreements about wages and conditions are now typically resolved neither by collective bargaining nor litigation but are left to management prerogative. This is because Conservative aspirations are clear. Much of the government’s discussion of legislation is preceded with consideration of the value and benefit for business and the labour market. They want cheap labour and low cost workers, unable to withdraw their labour, unprotected by either trade unions or employment rights and threatened with destitution via benefit sanction cuts if they refuse to accept low paid, low standard work. Similarly, desperation and the “deterrent” effect of the 1834 Poor Law amendment served to drive down wages.

In the Conservative’s view, trade unions distort the free labour market which runs counter to New Right and neoliberal dogma. Since 2010, the decline in UK wage levels has been amongst the very worst in Europe. The fall in earnings under the Coalition is the biggest in any parliament since 1880, according to analysis by the House of Commons Library, and at a time when the cost of living has spiralled upwards.

In-work conditionality enforces a lie and locates blame within individuals for structural problems – political, economic and social – created by those who hold power. Despite being a party that claims to support “hard-working families,” the Conservatives have nonetheless made several attempts to undermine the income security of a significant proportion of that group of citizens recently. Their proposed tax credit cuts, designed to creep through parliament in the form of secondary legislation, which tends to exempt it from meaningful debate and amendment in the Commons, was halted only because the House of Lords have been paying attention to the game.

The government intends to continue formulating policies which will punish sick and disabled people, unemployed people, the poorest paid, and part-time workers. Meanwhile, the collective bargaining traditionally afforded us by trade unions has been systematically undermined by successive Conservative governments, showing clearly how the social risks of the labour market are being personalised and redefined as being solely the economic responsibility of individuals rather than the government and profit-driven big business employers.

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Welfare sanctions can’t possibly “incentivise” people to work

Maslow

Abraham Maslow’s Hierarchy of Human Needs

A summary

The Conservative-led welfare “reforms” had the stated aim of ensuring that benefit claimants – who have been stigmatised and inaccurately redefined as economic free-riders are entitled to a minimum income provided that they uphold responsibilities, which entail being pushed into any available work. Conditionality for social security has been around as long as the welfare state. Eligibility criteria have always been an intrinsic part of the benefits system. For example, to qualify for jobseekers’ allowance, a person has to be out of work, able to work, and seeking employment.

But in recent years welfare conditionality has become conflated with severe financial penalities (sanctions), and has mutated into an ever more stringent, complex, demanding set of often arbitrary requirements, involving frequent and rigid jobcentre appointments, meeting job application targets, providing evidence of job searches and mandatory participation in workfare schemes. The emphasis of welfare provision has shifted from providing support for people seeking employment to increasing conditionality of conduct, enforcing particular patterns of behaviour and monitoring compliance.  In short, welfare has become a hostile environment, designed specifically to deter claims for support.

Sanctions are “penalties that reduce or terminate welfare benefits in cases where claimants are deemed to be out of compliance with  requirements.” They are, in many respects, the neoliberal-paternalist tool of discipline par excellence – the threat that puts a big stick behind coercive welfare programme rules and “incentivises” citizen compliance with a heavily monitoring and supervisory administration. The Conservatives have broadened the scope of behaviours that are subject to sanction, and have widened the application to include previously protected social groups, such as sick and disabled people and lone parents.

There is plenty of evidence that sanctions don’t help people to find work, and that the punitive application of severe financial penalities is having a detrimental and sometimes catastrophic impact on people’s lives. We can see from a growing body of research how sanctions are not working in the way the government claim they intended.

Sanctions, under which people lose benefit payments for between four weeks and three years for “non-compliance”, have come under fire for being unfair, punitive, failing to increase job prospects, and causing hunger, debt and ill-health among jobseekers. And sometimes, causing death.

I’ve always felt that it is self evident – common sense – that if people are already claiming financial assistance which was designed to meet only very basic needs, such as provision for food, fuel and shelter, then imposing further financial penalities would simply reduce those people to a struggle for basic survival, which will inevitably demotivate them and stifle their potential.

However, the current government demand an empirical rigour from those presenting criticism of their policy, yet they curiously fail in meeting the same exacting standards that they demand of others. Often, the claim that “no causal link has been established” is used as a way of ensuring that established correlative relationships, (which often do imply causality,) are not investigated further. Qualitative evidence – case studies, for example – is very often rather undemocratically dismissed as “anecdotal,” which of course stifles further opportunities for research and inquiry.

The Conservative shift in emphasis from structural to psychological explanations of poverty has far-reaching consequences. The partisan reconceptualision of poverty makes it much harder to define and very difficult to measure. Such a conceptual change disconnects poverty from more than a century of detailed empirical and theoretical research, and we are witnessing an increasingly experimental approach to policy-making, aimed at changing the behaviour of individuals, without their consent.

This approach isolates citizens from the broader structural political, economic, sociocultural and reciprocal contexts that invariably influence and shape an individuals’s experiences, meanings, motivations, behaviours and attitudes, causing a problematic duality between context and cognition. It also places unfair and unreasonable responsibility on citizens for circumstances which lie outside of their control, such as the socioeconomic consequences of political decision-making.

I want to discuss two further considerations to add to the growing criticism of the extended use of sanctioning, which are related to why sanctions don’t work. One is that imposing such severe financial penalities on people who need social security support to meet their basic needs cannot possibly bring about positive “behaviour change” or “incentivise” people to find employment, as claimed. This is because of the evidenced and documented broad-ranging negative impacts of financial insecurity and deprivation – particularly food poverty – on human physical health, motivation, behaviour and mental states.

The second related consideration is that “behavioural theories” on which the government rests the case for extending and increasing benefit sanctions are simply inadequate and flawed, having been imported from a limited behavioural economics model (otherwise known as nudge” and libertarian paternalism) which is itself ideologically premised.

I also explored in depth how sanctions and workfare arose from and were justified by nudge theory, which is now institutionalised and deeply embedded in Conservative policy-making. Sanctions entail the manipulation of a specific theoretical cognitive bias called loss aversion.

At best, the new “behavioural theories” are merely theoretical  propositions, at a broadly experimental stage, and therefore profoundly limited in terms of scope and academic rigour, as a mechanism of explanation, and in terms of capacity for generating comprehensive, coherent accounts and understanding about human motivation and behaviour.

I reviewed research and explored existing empirical evidence regarding the negative impacts of food poverty on physical health, motivation and mental health. In particular, I focussed on the Minnesota Semistarvation Experiment and linked the study findings with Abraham Maslow’s central idea about cognitive priority, which is embedded in the iconic hierarchy of needs pyramid. Maslow’s central proposition is verified by empirical evidence from the Minnesota Experiment.

The Minnesota Experiment explored the physical impacts of hunger in depth, but also studied the effects on attitude, cognitive and social functioning and the behaviour patterns of those who have experienced semistarvation. The experiment highlighted a marked loss of ambition, self-discipline, motivation and willpower amongst the subjects once food deprivation commenced. There was a marked flattening of affect, and in the absence of other emotions, Doctor Ancel Keys observed the resignation and submission that hunger manifests.

The understanding that food deprivation dramatically alters emotions, motivation, personality and that nutrition directly and predictably affects the mind as well as the body is one of the legacies of the experiment.

The experiment highlighted very clearly that there’s a striking sense of immediacy and fixation that arises when there are barriers to fulfiling basic physical needs – human motivation is frozen to meet survival needs, which take precedence over all other needs. This is observed and reflected in both the researcher’s and the subject’s accounts throughout the study. If a person is starving, the desire to obtain food will trump all other goals and dominate the person’s thought processes.

In a nutshell, this means that if people can’t meet their basic survival needs, it is extremely unlikely that they will have either the capability or motivation to meet higher level psychosocial needs, including social obligations and responsibilities to seek work. Abraham Maslow’s humanist account of motivation also highlights the same connection between fundamental motives and immediate situational threats.

Ancel Keys published a full report about the experiment in 1950. It was a substantial two-volume work titled The Biology of Human Starvation. To this day, it remains the most comprehensive scientific examination of the physical and psychological effects of hunger.

Keys emphasised the dramatic effect that semistarvation has on motivation, mental attitude and personality, and he concluded that democracy and nation building would not be possible in a population that did not have access to sufficient food.

I also explored the link between deprivation and an increased risk of mental illnesses, including schizophrenia, depression, anxiety and substance addiction. Poverty can act as both a causal factor (e.g. stress resulting from poverty triggering depression) and a consequence of mental illness (e.g. schizophrenic symptoms leading to decreased socioeconomic status and prospects).

Poverty is a significant risk factor in a wide range of psychological illnesses. Researchers recently reviewed evidence for the effects of socioeconomic status on three categories: schizophrenia, mood and anxiety disorders and substance abuse. Whilst not a comprehensive list of conditions associated with poverty, the issues raised in these three areas can be generalised, and have clear relevance for policy-makers.

The researchers concluded: “Fundamentally, poverty is an economic issue, not a psychological one. Understanding the psychological processes associated with poverty can improve the efficacy of economically focused reform, but is not a panacea. The proposals suggested here would supplement a focused economic strategy aimed at reducing poverty.” (Source: A review of psychological research into the causes and consequences of poverty – Ben Fell, Miles Hewstone, 2015.)

There is no evidence that keeping benefits at below subsistence level or imposing punitive sanctions “incentivises” people to work and research indicates it is likely to have the opposite effect. In 2010/2011 there 61,468 people were given 3 days emergency food and support by the Trussell Trust and this rose to 913,138 people in 2013-2014.

Hanna, Gabriel Kreindler, and Benjamin Olken re-analyzed data from seven randomized experiments evaluating cash programs in developing countries and found “no systematic evidence that cash transfer programs discourage work.”

The phrase “welfare dependency” purposefully diverts us from political prejudice, discrimation via policies and disperses public sympathies towards the poorest citizens.

Conservative claims about welfare sanctions are incommensurable with reality, evidence, academic frameworks and commonly accepted wisdom. It’s inconceivable that this government have failed to comprehend that imposing punishment in the form of financial sanctions on people who already have very limited resources for meeting their basic survival needs is not only irrational, it is absurdly and spectacularly cruel.

Minnes

 The Minnesota semistarvation experiment

This is a summary of a much longer, detailed piece of research and review work about welfare sanctions. You can see the original here

Further study of the impact of food deprivation and starvation on psychological and cognitive deterioration: The Psychological Effects of Starvation in the Holocaust

Cognitive function deficits and demotivation associated with food deprivation and hypoglycaemia: Blood glucose influences memory and attention in young adults

Nutritional deficiencies and detrimental consequences for mental health: Nutrition and mental health

A comprehensive study of the detrimental impacts of food insecurity on the development, behaviour, mental health and wellbeing, learning, educational attainment, citizenship and physical health of children in America: Child Food Insecurity: The Economic Impact on our Nation

Comprehensive computerized assessment of cognitive sequelae of a complete 12-16 hour fast

The Minnesota food deprivation experiment also established a link between food insecurity and deprivation and later unhealthful eating practice, eating disorders and obesity: Journal of the American Dietetic Association