Opt-in, Opt-out? A new system for organ donation in Scotland

Guest blog by Findlay Smith

Credit: Soeren Stache / DPA/Press Association Images

The Scottish Government is in the process of bringing forward legislation to introduce a ‘soft opt-out’ scheme for organ donation. Public Health Minister Aileen Campbell stated that the move will be one step of many in a “long term culture change” regarding organ donation.

A ‘soft opt-out’ scheme operates on the assumption that lack of objection on an individual’s part can be considered ‘deemed consent’.

This means that people in Scotland will have a choice to:

  • actively opt in – being placed on the organ donor register; or
  • do nothing – which will now be treated as ‘deemed consent’; or
  • actively opt out – being removed from the donor register

 Current situation in Scotland

According to the British Medical Association, as of 6 March 2017 there were 530 people in Scotland waiting for an organ transplant, with more than 1 in 10 dying before receiving a transplant.

Scotland currently operates an ‘opt-in’ system – to be a donor, you must actively register with the donor card scheme.

Although support for organ donation is high among the Scottish public, and there are indications of support for deemed consent, less than half of Scotland’s population are registered organ donors, with 45% registered.

Aimed at increasing the rates of organ and tissue donation, a public consultation was held by the Scottish Government between December 2016 and March 2017. The results indicated that 82% of respondents supported the principle of a ‘soft opt-out’ system.

Comparison with Wales

One example cited by the Scottish Government of a successful ‘soft opt-out’ policy is in Wales. In 2015, following the passing of the Human Transplantation (Wales) Act in 2013, Wales became the first country in the United Kingdom to introduce deemed consent for organ donation.

Due to these changes being implemented very recently, it is too early to accurately assess the impact of deemed consent in Wales, as it can take several years for an observable change in donation rates.

However, despite the absence of concrete figures, there are some promising signs. The British Medical Association reported in December 2016 that 39 organs had been transplanted in Wales as a direct result of the change in laws.

The Spanish model

Looking elsewhere in Europe, Spain has the highest rate of organ donation in the world, at a reported 40 donors per million people in 2015.

Whilst they have a nominally similar system to Wales, in practice they operate in a different manner. Although Spain introduced an ‘opt-out’ system in 1979, the system itself is considered ‘insignificant’ when looking to explain their world leading donation rate, as in the decade following the change in legislation there was no substantial increase in organ donation. This may be due in part to the ‘opt-out’ process rarely being applied in practice, as family members always have a final veto.

Crucially, in addition to the change in system, Spain has also drastically improved the infrastructure used to identify and recruit potential donors. In 1989 the National Transplant Organisation (ONT) was established, and Transplant Co-ordinators were placed inside every hospital.

The role of the Transplant Co-ordinator is to identify potential organ donors as early as possible. What makes the Spanish model innovative (it has since been emulated elsewhere in Europe), is the widening of the pool of potential donors. Rather than focusing on people in intensive care, potential donors are also identified in accident and emergency rooms and hospital wards.

The role of family members in this process is also key. The early identification of potential donors allows a strong relationship to be built with family members. As they have the final say, getting them on board early can make a significant difference. The Scottish Government seems to be aware of this, having conducted a fact-finding mission to Madrid in 2015, consulting ONT Director Rafael Matesanz.

Final thoughts

The examples highlighted suggest that if the introduction of ‘soft opt-out’ legislation is to be successful, it may not solely be the result of the legislation on its own. Improvements in infrastructure, organisation, and dialogue with families of potential donors will also be crucial. Transitioning towards this change in practice will require a change in culture in the NHS around organ donation.

These steps taken in Scotland, which follow the lead of Wales and draw from the Spanish model, are also now being considered in England. Assisted by a lengthy campaign from the Daily Mirror, Labour MP Geoffrey Robinson’s Organ Donation (Deemed Consent) Bill was introduced to Parliament on 19 July 2017 and is due for debate on 23 February 2018.


Findlay Smith is currently in his final semester of study of the MPP Public Policy Programme at the University of Stirling. Findlay has recently completed a voluntary two week work experience placement with the Knowledge Exchange team in Glasgow.

What’s happening in the English education system and how does it compare to Singapore’s system?

by Stacey Dingwall

At the end of last year, we looked at the state of the Scottish education system following the publication of some disappointing Pisa results for the country. In this blog, we focus on some of the issues recently highlighted within the English education system, and how the system compares to that of Singapore – a system that is frequently identified as a model for other countries.

Pisa (Programme for International Student Assessment)

Although there was no significant change in England’s absolute score in the 2015 OECD survey of maths, science and reading, or in the country’s performance relative to other countries, England’s rankings did not experience the same decline seen in Scotland and Wales. While Scotland’s scores across all three areas were the lowest they had recorded in any other Pisa survey, pupils in England performed slightly above the OECD average in reading for the first time.

After a similar stagnation in scores were achieved in the previous Pisa survey, the Minister of Schools for England, Nick Gibb, promised reforms and funding in order to ensure that the country was able to better compete with the top performing countries. The 2015 results show that East Asian countries including Singapore continue to dominate the rankings, and are continuing to make advances.

Teaching

The success of Singapore’s education system has been attributed to its investment in its teachers. All of the country’s teachers are trained at its National Institute of Education and are selected from the top 5% of graduates. Teachers are required to commit to the profession for at least three years and are mentored by ‘master teachers’ at the start of their careers.

As we highlighted on the blog recently, the House of Commons Education Committee raised concerns about teacher training and recruitment in England in the report of their inquiry. The evidence the Committee received suggested that the government is failing to take “adequate” action to tackle what is described as “significant” teacher shortages in England. The report highlights data that more than 10% of teachers leave the profession after a year.

Teacher workload was also highlighted as a significant issue, and the Education Policy Institute gave evidence to the Committee that 60% of respondents to a survey they carried out identified it as a “key barrier” to accessing continuing professional development. EPI analysis also found that teachers in England average four days of CPD per year, compared to 12 in Singapore. Teacher CPD was identified as important for not only professionalism during the inquiry, but also for pupil outcomes.

The schools landscape

The quality of the teaching workforce in England is not the only area in which concerns have been raised over the impact on pupils. The education system in England is a complex one, and has become even more so in recent years with academies, free schools and the reintroduction of grammar schools. Government policy has not been consistent: the Education Bill and the academisation of all schools in England were both abandoned shortly after their announcement.

Last week’s Budget included the announcement of a one-off payment of £320m for 140 new free schools to be created, in addition to the 500 already pledged before 2020. However, there’s still no evidence that significant improvements at the primary level are associated with academy status, and differences at GCSE level between converter academies and other similar maintained schools are not statistically significant. At the end of last year, the EPI found that grammar school pupils’ higher GCSE attainment is not actually a result of better grammar school performance, but can actually be attributed to the high prior attainment and demographic of pupils at selective schools.

The EPI concluded that grammar schools are more likely to widen the attainment gap for disadvantaged pupils. It was further reported earlier this month by the Sutton Trust that a policy of ‘social selection’ is being operated in admissions to the best performing schools.

Research from the NFER has indicated that parents are confused about academies, and the different types that exist. A preference for schools to be accountable to local education authorities was also indicated, which conflicts with the government’s focus on expanding academies/free schools.

Singapore operates a centralised schools system, which is integrated and characterised by a prescribed national curriculum. English academies are not required to follow the national curriculum.

Funding for schools

Despite the Budget announcement, recent news in the education world has been dominated by claims from schools that they are underfunded. As we noted in a blog from last year, when the government announced its plans for total academisation, cuts of £600m to the Education Services Grant awarded to local authorities were also planned. Even though the policy has been abandoned, the cuts have not been reversed.

Analysis for the National Union of Teachers (NUT) found that under the government’s new ‘fair funding’ formula, 98% of schools would see cuts by 2020. Responding to the consultation on the formula, representatives from over a dozen Conservative-led councils said that they were “extremely concerned” over what they see as inadequate levels of funding.

At last week’s Association of School and College Leaders (ASCL) conference, headteachers told education secretary Justine Greening that current funding levels have resulted in them having to cut some subjects and support services, and increase class sizes. The day before the conference, the heads of over 1,000 schools in England wrote to parents and MPs to report the same issues.

The government insists that funding for schools is higher than ever before, at £40bn for 2016-17 and rising to £42bn in 2019-20 to take account of rising pupil numbers. However, Labour argue that as the budget does not provide for funding per pupil to increase in line with inflation, it actually represents a real-terms reduction in the funds spent for every pupil. In December, the National Audit Office published a report which said that as the government was only offering flat cash funding per pupil over the next five years, “Schools have not experienced this level of reduction in spending power since the mid-1990s”.

The latest data from the World Bank indicates that Singapore allocated a lower percentage of its GDP in 2012 than the UK: 3.3% vs 5.6%.

The future?

In an article published just before the Budget, Theresa May published an article which spoke of her government’s ambition to “make Britain the world’s greatest meritocracy”. Meritocracy is a key policy of the Singapore education system, and is identified as one of the main reasons for the system’s success. With evidence continuing to point towards disadvantaged pupils being denied the opportunities of their peers, and schools declaring that they don’t have enough funding to provide vital services, it’s clear that there is still some way to go before this ambition can begin to be realised.

Follow us on Twitter to see what developments in public and social policy are interesting our research team. If you found this article interesting, you may also like to read our other education articles. 

 

 

Community planning in the devolved UK

Community planning is all about how public bodies and other partners work with local communities to design and deliver services that suitably reflect the needs and priorities or a local area. Effective community planning incorporates strong partnership working and a shared vision which has been created especially to fit a set of local circumstances.

Providing effective and efficient services, promoting community engagement and enterprise and engaging the third sector are all things that could now be considered part of “community planning”. It is founded on the idea that communities know best; they know what they need, they know how it can be delivered and how they will use services in the most effective way to get the most value from them. With an increase in political devolution we have seen different approaches to delivering community planning emerge in England, Scotland, Wales and Northern Ireland. Some nations embraced it from a very early stage, others less so. However, it has become an increasingly popular model over recent years, with all four administrations now using some form of community planning model.

England

In England, the focus has largely been on housing and land use and the relationship between community plans (which consider services and public engagement) and local development plans (which focus more on the physical aspects of planning in the community, such as land use). Neighbourhood plans give communities the opportunity to develop a shared vision for and shape the development and growth of their local area. Neighbourhood plans are not a legal requirement, but a right which communities can evoke if they wish to. They are designed to fit alongside local authority produced “local plans” and provide an opportunity for communities to set out a long term vision for their area in terms of development, and “may encourage them to consider ways to improve their neighbourhood other than through the development and use of land.”

Scotland

The introduction of the 2015 Community Empowerment (Scotland) Act is a clear indication of the stance of the Scottish Government with regards to community planning. As well as statutory rights being strengthened with regards to consultation and community consultation, the legislation also places statutory requirements on public bodies with regards to supporting local community based service delivery, and actively engaging local people in decision making processes. As a result of the legislation 32 Community Planning Partnerships (CPPs) now exist in Scotland and they are responsible for developing and delivering community plans. These can take two forms:

  • a larger plan, which takes account of the whole CPP area (Local Outcomes Improvement Plan)
  • a smaller plan, which focuses on a smaller geographic area which has been identified as being in need of improvement (locality plan)

There is no limit to the number of plans CPP’s can create in a year, but the views of local communities are particularly important in creating these as that is the way to best reflect local needs and priorities.

In Scotland a consultation is also currently underway to consider ways to align community and spatial planning more closely, as it was recognised that planning for services should also be mapped along with physical development.

Wales

In a Welsh context the use of community planning focuses on resource allocation and the direction of resource to where it is needed. Promoting community cohesion and well-being through community planning is also something which can be seen in both Wales and Scotland. Increasingly, plans have attempted to incorporate a “place-centred”, “service focused”, “partnership led” approach, with the emphasis on individual need. It is hoped that by bringing service providers and other partners back in touch with the people who use their services that their views can be taken on in future planning projects. As in all community planning projects, partnerships are key; however in Wales one of the biggest challenges has been forming these partnerships and getting buy-in from local businesses. A similar challenge has also been seen with national level bodies.

This challenge of engaging national bodies in community planning has also been seen in Scotland. National bodies are expected to engage with rural and urban CPP’s in ways which reflect individual community need, something they had not been used to doing previously. As a result, promoting flexibility and adaptability and encouraging participation from a range of stakeholders in order to support the creation and delivery of community plans has been high on the agenda across the UK.

Northern Ireland

The situation in Northern Ireland is, to a large extent, still evolving. Executives at Stormont, as well as planners and developers, see engaging local people as important but they are also trying to find a model which works best for a Northern Irish context. Potential options for integrating community based models have included adopting models from England or Scotland respectively; creating their own model which takes elements from a number of different models; or making attempts to align the Northern Irish model closer to that of the Republic of Ireland.

Currently the legislative basis for community planning in Northern Ireland is set out in the Local Government Act (Northern Ireland) 2014. The Act makes a statutory link between community plans and local land use development plans, and makes the link between community planning for a district and well-being more explicit.

category-picture-community-development

Engaging difficult to reach communities in community planning

The views of local communities are particularly important when creating community plans, as their fundamental principle is to reflect service and resource need more effectively in order to benefit communities. As a result community planners across the UK face the unilateral challenge of getting people to engage. Different groups within a community may have different capacity and ability to engage. ‘Hard to reach’ groups are particularly important to the consultation process as it is often they who make the most use of services or have the greatest need for specific service provision. People in this group may include young people, older people, ethnic minorities or other socially excluded groups, and small businesses. They are also sometimes referred to as ‘seldom heard’ groups.

Methods to improve communication and consultation with hard to reach groups vary, but some potential barriers and solutions to engagement include:

  • Jargon and technical language – Policy and planning documents can be very long, and very dense, with lots of planning specific technical jargon, create an easy access version so that everyone can be engaged in discussions and not feel intimidated by “high level” documents.
  • Digital illiteracy – Increasingly consultation documents, some forums and copies of the plans themselves are held online, and improving access to these would help to encourage more people to participate.
  • Awareness and accessibility – Promoting consultations or community planning events, and holding them at a variety of times and in a variety of settings to allow people from different groups to attend. In addition providing them in multiple languages, using language that is more accessible for young people, or in a larger type size may also help to encourage people to participate.
  • Showing impact – Create follow up documents so that people can see how their input has made a difference. Even if the plan won’t be implemented for a number of months, let people know how what they said influenced or changed the decisions that were made.

It is clear that England, Wales, Scotland and Northern Ireland are at different stages in their community planning journey. However, they have all, in one way or another recognised the importance of engaging communities to identify needs and attempt to allocate resources accordingly. In many instances, these community agendas have not just been linked to spatial, or even service planning, but also to wider issues around inequality and well-being and how resources and planning across all areas can best be directed to tackle this. It may be that we see this reflected further in future legislation.


This blog reflects on a recent paper by Deborah Peel and Simon Pemberton “Exploring New Models of Community based Planning in the Devolved UK” a study funded by the Planning Exchange Foundation.

Idox Information Service members can access our research briefing on engaging communities in planning.

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English Planning in Crisis: new ideas to recapture the purpose of planning in England

Housing estate iStock_000004526499Medium

“Essentially, the values of planning have been stood on their head, to the point where we have to ask whether the system remains fit for purpose.”

This is the stark assessment from the authors of a new book from Policy Press. In English Planning in Crisis, Hugh Ellison and Kate Henderson reflect on planning reforms since 2010, and argue that “the rich Utopian tradition that underpinned the town planning movement in England is dead, and needs wholesale recreation.”

The importance of planning

English Planning in Crisis highlights how essential planning is to the quality of life, noting that some of its key achievements have included securing mixed-use developments, the provision of social and genuinely affordable homes and protecting some of England’s most important landscapes. At its best, the authors contend, planning can provide for rich habitats and green space, good quality design, inclusion and resilience. But now, they argue, the once visionary town planning movement has become “little more than a residual form of land licensing.”

Reform and decline

The authors acknowledge that the decline of planning in England did not start in 2010. But they reserve particular criticism for the deregulation of policy on planning, housing and the built environment introduced under the coalition and Conservative governments.

Among the reforms in their sights are the withdrawal of the Code for Sustainable Homes, which had allowed councils to adopt their own sustainability levels as a planning requirement for new residential development, and the Deregulation Act 2015, which removed local planning authorities’ powers concerning construction, layout or energy performance of new dwellings.

There is also concern about extending the Right to Buy to 1.3 million housing association tenants, which the authors say has the potential “to transform socially and economically diverse communities into exclusively wealthy ones.” Similarly, they contend that the Conservative government’s Starter Homes policy (offering new-build houses at a price below their market value) will largely be of help to high earners.

Taken together, according to the book’s authors, reforms introduced since 2010 have resulted in a planning system that delivers poor-quality places, badly-designed dwellings, houses that are affordable only to middle and high-income earners, and ignores the challenges of climate change and an ageing population.

Planning beyond England

Before putting forward their ideas for rethinking the planning system in England, the authors look at planning systems elsewhere. They suggest that approaches adopted in Wales and Scotland provide pointers to how the English planning system can get back on track. They are particularly complimentary about Scotland’s framework for the spatial development of the country as a whole, which they suggest provides certainty and long-term thinking about planning. The authors also praise two regeneration initiatives in the city of Hamburg which have transformed derelict land into sources of renewable energy.

Ten steps to rebuild planning

The second half of English Planning in Crisis sets out a collection of evidence-based ideas for rebuilding England’s planning system. These include:

  • Replacing the current fragmented approach to planning for the future with a clear vision
  • Establishing a government department for spatial planning
  • Engaging with communities and individuals to develop solutions to the nation’s problems
  • Transforming the planning profession from an “old boys club” into a new generation of diverse and inclusive placemakers
  • Reform of planning education
  • A framework of equal rights in planning decisions
  • A national debate on house-building
  • Ensuring new homes are accessible for the elderly and disabled
  • Delivering sustainable homes, including a new zero-carbon policy
  • Fair taxation of land values.

The authors stress that these proposals are underpinned by the values of the Utopian tradition that inspired examples of planning at its best, including garden cities and the 1947 Town Planning Act. These values include social justice, fair rights to participate in decisions, and the fair distribution of resources arising from the development of land and primary resources.

In conclusion, the authors of English Planning in Crisis argue that only by reclaiming those essential values can England’s planning system recapture its purpose:

“Our future depends on the discovery of those democratic and altruistic qualities that once formed the ethos of town planning.”


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Improving basic skills levels in England

a conference

by Stacey Dingwall

At the end of last month, the OECD published its review of adult skills in England, Building Skills for All. The review was commissioned by the Department for Business Innovation and Skills (BIS) after a 2013 Survey of Adult Skills in 24 OECD countries ranked England at 22nd and 21st in terms of young adults’ (aged 16-24) levels of literacy and numeracy respectively. For all adults (aged 16-65), the country was ranked in 11th position for literacy, and 17th for numeracy.

England’s skills levels reviewed

The latest review produced similar results, estimating that there are around nine million adults of working age in England with low levels of numeracy and/or literacy. This represents more than a quarter of adults aged 16-65 in the country. The lower levels of basic skills among young people are also noted again: while older adults (aged 55-65) in England have basic skills levels broadly similar to their peers in other OECD countries, the same cannot be said for younger adults. As the older generation reaches retirement age, this obviously raises concerns over the skills levels of the current and future workforce.

The findings prompted the OECD to recommend that as universities in England are “failing to develop quite basic skills” among their students, some students would be better suited to enrolling in further, as opposed to higher, education. If universities didn’t allow students to enrol without at least a GCSE C grade in maths, for example, or graduate without achieving a reasonable level of basic skills, the think tank believes that this would allow a rebalancing of the country’s education system, by targeting resources in areas where they are best suited.

Who or what is to blame?

Higher education bodies did not agree with this assessment of the current system, contending that the survey involved too small of a sample of students to support such a large reform. However, research conducted with employers on their experiences of recruiting young people has found evidence of a basic skills issue. Surveys carried out by the CIPD and Education and Training Foundation both heard from employers who were particularly concerned about young employees’ (current and potential) literacy and numeracy skills, as well as their ability to communicate in a professional manner, i.e. not in text speak.

Following the publication of the OECD’s 2013 report, the president of the International Council for Adult Education, Alan Tuckett, blamed England’s poor results on constant changes to the curriculum, arguing that this had distracted attention from adult education. He argued that there needed to be more investment in lifelong learning, highlighting that South Korea had achieved second place in the rankings, following such an investment. The country enacted its second Lifelong Education Act in 2007, defining lifelong learning as including “all types of systemic educational activities other than traditional school education”, including basic adult literacy.

Despite Tuckett’s criticism, the 2015 OECD review concludes that while it is still too early to evaluate the success of the government’s education reforms, including making maths and literacy courses a requirement in most 16-19 education, their objectives are the correct ones. In terms of funding for adults skills and education, however, recent news of a leaked memo suggesting that BIS agencies including the Skills Funding Agency are at risk of abolition due to further budget cuts is a cause for concern. It has already been confirmed that funding for the UK Commission for Employment and Skills (UKCES) is being withdrawn in 2016-17; supposedly as part of the government’s commitment to protecting core adult skills participation budgets in cash terms.

Good practice: the Citizen’s Curriculum

In 2014/15, NIACE developed the Citizen’s Curriculum approach, with the aim of ensuring that everyone is equipped with a core set of skills required for the 21st century:

  • English;
  • maths;
  • English for speakers of other languages (ESOL); and
  • digital, civic, health and financial capabilities.

The approach was piloted in 13 areas, delivered by a range of organisations including local authorities, colleges and charities. This initial phase sought to understand adults’ motivation for learning, as well as ensuring that they are being provided with opportunities for learning that are suited to their particular needs. This co-production aspect of the approach is seen as key to its success. With a particular focus on disadvantaged groups, including the homeless and ex-offenders, the pilots provided insight into what works in engaging disadvantaged learners. For example, the pilot carried out by the homeless charity St. Mungo’s Broadway found that embedding skills such as maths and English within independent living skills was particularly important, and helped to adequately prepare learners for moving on and progressing in life.

Following an impact assessment that saw 92% of participants indicate that they were motivated to progress to further learning opportunities, the second phase of the pilots was launched in October 2015. This will see previous participating organisations returning to build on their work in the previous phase, alongside new pilots testing the approach in different settings, or with different sets of learners.


 

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Further reading: if you liked this blog post, you might also want to read our other article on STEM skills in the UK.

Supercouncils: questions raised about new powers for England’s combined authorities

town hall photo

Image: James Carson

Just over a year ago, Manchester began blazing a trail for devolution in England. Ten local authorities in the Greater Manchester Combined Authority (GMCA) signed a deal with George Osborne, the Chancellor of the Exchequer, for the transfer of powers in areas such as transport and skills from central to local government.

Since then, the English devolution bandwagon has picked up speed. After the general election in May, the newly-elected Conservative government introduced a Cities and Devolution Bill , creating a framework for the transfer of powers to the regions, and making provision for directly elected mayors.

During the summer, the Chancellor invited cities, towns and communities across the UK to submit their own devolution proposals, and by September 38 submissions had been received (including a number from Scotland and Wales).

Meanwhile, further deals have been announced, giving greater autonomy to local authorities in Sheffield, Cornwall, the North East of England and the Tees Valley. In November, two further deals were announced for the West Midlands and Liverpool.

As its momentum gathers pace, questions have arisen over the nature and implications of devolution for England’s cities and regions.

The devolution time frame

In October, a survey for Local Government Chronicle (LGC) highlighted concerns about the devolution timetable. 69% of the 45 chief executives and deputies responding to the survey indicated that the seven-week timeframe given to put a proposal together had been too tight. Of those councils which had not submitted a bid, 38% said they could not arrange a partnership with another authority, while 8% said they could not convince politicians in their area to agree.  However, the survey also indicated that 15% of councils were holding back on bids to see how other authorities fared first.

Accountability, transparency, public involvement

Some of the key governance issues surrounding devolution were considered in a report by the Centre for Public Scrutiny.

The report was critical of the secrecy of the deal-making process, noting that details were only being released when agreements had been reached:

“Local people – anyone, indeed, not involved in the negotiations – need to understand what devolution priorities are being arrived at and agreed on. Increased public exposure in this process will lead to a more informed local debate. At the very least, the broad shape and principles of a bid for more devolved powers should be opened up to the public eye.”

The report argued that governance arrangements for the work that combined authority areas will be doing in future need to satisfy three conditions:

  • Accountability: decision-makers must clearly take responsibility, and engage with those seeking to hold them to account (non-executives, the public, and others)
  • Transparency: it must be clear (to professionals, elected councillors and the public) who is making decisions, on what, when, why and how
  • Involvement: a commitment to public involvement should be seen as central to good governance.

Directly elected mayors

In 2012, plans to replace local council cabinets with directly elected mayors were rejected by voters in nine English cities, including Manchester, Newcastle, Sheffield and Leeds.

However, the government has insisted that devolving powers to English regions is now conditional on the inclusion of directly elected mayors. In May the chancellor explained why he thought this was so important:

“It’s right people have a single point of accountability; someone they elect, who takes the decisions and carries the can. So with these new powers for cities must come new city-wide elected mayors who work with local councils. I will not impose this model on anyone. But nor will I settle for less.”

George Jones, Emeritus Professor of Government at the London School of Economics, has asserted that the concentration of power in one person is undesirable:

“…the advantage of collective leadership is it enables exploration of policy from different perspectives. Colleagues can consider possible impacts of policy in a variety of contexts, spotting pitfalls ahead and the consequences for different people and groups. A single person is unlikely to represent the diverse complexities of a large urban, metropolitan or county region area better than can collective leadership.”

The journey to greater autonomy for England’s regions has only just begun, but it’s already clear that the path to devolution will not be straightforward.


Read more about English devolution in our previous blogs:

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Debating the cost of alcohol to society

“Society is paying the costs – alcohol-related harm is now estimated to cost society £21 billion annually.”

So said David Cameron, launching the UK government’s alcohol strategy in 2012.

The prime minister was echoing the widely held view that alcohol is a financial burden on taxpayers. The British Medical Association has put the costs of alcohol harm in Northern Ireland and Wales at £680m and £1bn respectively, while the Scottish Government believes the annual cost of excessive alcohol consumption to be £3.6bn (equivalent to £900 for every adult in Scotland).

An alternative view

But now the popular view of alcohol as a drain on taxpayers has been challenged. A new report from the Institute of Economic Affairs (IEA) claims that the net cost of alcohol to the state is minus £6.5 billion.

The report found that the direct costs of alcohol use to the government in England – including NHS, police, criminal justice and welfare costs – amount to just under £4 billion each year, whilst revenues from alcohol taxes amount to over £10 billion. And it claims that even if the government halved all forms of alcohol duty, it would still receive more money in tax than it spends dealing with alcohol-related problems.

Commenting on the findings, the report’s author, Christopher Snowden said it was time to stop regarding drinkers as a burden on taxpayers:

“Forty per cent of the EU’s entire alcohol tax bill is paid by drinkers in Britain and, as this new research shows, teetotallers in England are being subsidised by drinkers to the tune of at least six and a half billion pounds a year.”

The report received a hostile reception from Alcohol Concern. Deputy chief executive Emily Robinson told the Daily Telegraph:

“Non-drinkers suffer the consequences of alcohol related problems every day; whether that’s from drink driving accidents, being the victim of crime or anti-social behaviour, family breakdown, waiting in Accident and Emergency departments for their turn, even through to the costs of street cleaning town centres after a Friday night.

She went on to argue that policies, such as minimum unit pricing (MUP), were needed to tackle the harm caused by alcohol.

A setback for minimum unit pricing?

The IEA report appeared on the same day that the European Court of Justice (ECJ) advocate general advised that the Scottish Government’s policy on MUP breached EU competition and free trade laws.

The proposal to introduce minimum retail pricing for alcohol appeared in the Scottish Government’s 2009 alcohol framework, and in 2012 the Alcohol (Minimum Pricing) (Scotland) Act 2 paved the way for the introduction of a minimum price of 50p per unit. The policy was challenged by the drinks industry, which believes that there are more effective ways of tackling harmful drinking.

While the advocate general’s advice may influence the ECJ’s final decision, The Scottish Government is standing by its policy. “While we must await the final outcome of this legal process,” said Scotland’s First Minister, Nicola Sturgeon, “the Scottish Government remains certain that minimum unit pricing is the right measure for Scotland to reduce the harm that cheap, high-strength alcohol causes our communities.”

The devolved administrations in Wales and Northern Ireland have set out plans to introduce their own MUP legislation. In England, the 2012 alcohol strategy included a commitment to introduce an MUP for alcohol. However, in 2013 the coalition government decided not to proceed with this, and instead to impose a ban on the sale of alcohol below cost price.

Last year, a report from Sheffield University suggested that below cost price policy would have small effects on consumption and health harm, while an MUP set at  a level between 40p and 50p per unit, was estimated to have an approximately 40-50 times greater effect. The research appears to support evidence from Canada, the first country in the world to introduce MUP, indicating that MUP could bring significant health benefits.

With the IEA report introducing a provocative new perspective, and the final judgement on MUP awaited, it’s unlikely that ‘last orders’ will be called any time soon in the debate on alcohol’s impact on society.


 

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Further reading*

Alcohol pricing and purchasing among heavy drinkers in Edinburgh and Glasgow: current trends and implications for pricing policies

Understanding the alcohol harm paradox in order to focus the development of interventions

Understanding the development of Minimum Unit Pricing of alcohol in Scotland: a qualitative study of the policy process

Alcohol’s harm to others

The cost of binge drinking in the UK

*Some resources may only be available to members of the Idox Information Service

Careers guidance: ready for the future?

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Image from Flickr user GotCredit, licensed under Creative Commons

By Stacey Dingwall

While there are many areas in which there are indications of recovery since the recession, the scale of youth unemployment is a persistent problem. According to the latest labour market figures from the Office for National Statistics (ONS), published on the 14th of October and covering the period July-August 2015, the unemployment rate for 16-24 year olds in the UK is currently 14.8%, compared to an overall unemployment rate of 5.4% for all 16-64 year olds who are eligible for work.

The youth (un)employment problem

Recent research has focused on the importance of improving the employability of young people in order to enhance their job prospects. Numerous employer surveys carried out by organisations including the Chartered Institute for Personnel Development (CIPD) and the UK Commission for Employment and Skills (UKCES) have indicated that employers are frequently unimpressed by the ‘work readiness’ of young people who apply for jobs with them. According to the UKCES, this can partly be attributed to the ‘death of the Saturday job’, and diminishing numbers of young people gaining valuable skills and experience for their future careers.

In its recent publications, Careers England has highlighted the important role of careers advice and education in tackling the youth unemployment rate. Their research highlights both the economic benefits of careers guidance, as well as those for the individual, including enhanced social capital.

Careers guidance, it is argued, “can play an important role in providing individuals with access to information and intelligence that is outside of their immediate social network, offsetting some of the disadvantages offered by inequalities in social capital”. Furthermore, it is suggested that those in receipt of careers guidance will be further aided by it as their working life continues, as it enables them to recognise the importance of networking to their career progression.

Good practice: Scotland

Over the summer, the Scottish Government announced a range of measures and initiatives to boost the employability prospects of the country’s young people. Alongside the announcement of over £5 million in funding for local government to help young people prepare for the world of work (as part of the Developing the Young Workforce youth employment strategy) came the promise of £1.5 million to support schools to provide careers advice to pupils from their first year of secondary school.

These announcements form part of the Scottish Government’s push to reduce youth employment in the country by 40% come 2021. Early indicators that this can be achieved look promising: figures released by the ONS in September covering the period May-July 2015 indicated that the youth unemployment rate in Scotland was at its lowest for this quarter since 2008, with the youth employment rate increasing by 25,000 to reach its highest level since the same period in 2005.

A particular careers guidance related programme that has been successful is My World of Work (MyWoW), an online careers service managed by Skills Development Scotland (SDS). A recent evaluation of the service by Education Scotland found that the value of the service is recognised by schools and colleges alike, with many FE support and teaching staff using it effectively and increasingly to engage learners in researching career options and exploring opportunities for further learning.

A key factor of the service is also its delivery online; as young people are used to engaging online, it is important that information is provided to them in their preferred format, as opposed to the traditional face-to-face interview with a careers advisor. Outside of the UK, countries including Finland have started to trial using social media in their delivery of career guidance.

An English ‘postcode lottery’?

In England, where responsibility for career guidance was devolved to schools in 2011, the landscape is currently a bit more fragmented. An evaluation of careers provision in schools and colleges published this year by Cascaid, a provider of careers information and guidance solutions, found that only 8% of schools/colleges have a systematic approach to integrating careers into the wider curriculum, while just over a third have a programme of activities with local universities and colleges.

English career guidance provision has also come under fire from the government: a 2013 inquiry into provision by the Commons Education Committee raised concerns over “the consistency, quality, independence and impartiality of careers guidance now being offered to young people”; and an Ofsted review following the devolution of responsibility to schools made criticisms including that provision was too “narrow” and not sufficiently coordinated so that all pupils were receiving appropriate guidance. Concerns about the inequity of career guidance have also been raised by the Sutton Trust, whose 2014 Advancing Ambitions report suggested that there was a ‘postcode lottery’ of provision in England.

The new Careers and Enterprise Company has been set up this year with £20 million of initial government funding, and it announced in September the nationwide roll-out of a network of Enterprise Advisers. These volunteers from employers will work directly with
school and college leaders to bridge the gap between the worlds of education and employment.

Future provision

Providing evidence to the Education Committee’s inquiry, the then Education Secretary Michael Gove suggested that careers advisors may not be an essential part of future careers guidance provision. Research has also indicated that pupils prefer to speak to someone they know, particularly subject teachers, with regards to their career ambitions. However, Ofsted’s review also found that the teachers in the schools they evaluated had not received sufficient training to provide information to pupils on the full range of options available to them. This is especially true of vocational education and career paths.

Considering the future of careers work in England, careers education and guidance consultant David Andrews proposes an option that could solve the problems raised above: schools employing resident careers development advisors with the responsibility of providing face-to-face guidance and working with teachers to deliver focused careers education programmes. Presumably this would include building links with local colleges and employers, something that has been identified as vital to increasing the youth employment rate, yet an area in which efforts have also been found to be lacking: per Ofsted, links between careers education and local employment opportunities in England remain “weak”.

Andrews also recommends the provision of an ‘all-age’ careers service in England. What is clear is that the careers education of the future must aspire to joined-up provision, involving clear communication between all parties. The provision of quality careers guidance is essential for not only the individual’s outcomes, but for the economy/society as a whole.


 

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Can Housing Zones help the housing crisis?

By James Carson

The UK government believes that brownfield land has a crucial role in meeting the need for new homes. But development of brownfield sites has often been held back because of the need for high upfront capital and delays in obtaining planning permission.

Last year, a new programme of Housing Zones (HZs) was launched by the chancellor of the exchequer and the Mayor of London with the aim of breaking down the barriers to brownfield development.

What are Housing Zones?

HZs are areas where home building will be accelerated by partnerships between local authorities, land owners, investors and builders. The areas proposed by local authorities (which may include brownfield sites and town centres) will receive a share of government funding that will unlock vital components of the HZ scheme, such as infrastructure, site acquisition and leaseholder buyouts. In addition, planning restrictions will be removed, enabling rapid delivery of residential development.

Housing Zones in London

London’s HZ programme was launched in 2014 as part of the Mayor’s housing strategy. The aim is to build 50,000 new homes in 20 HZs across the capital by 2025. The £400m programme is also expected to create 100,000 new jobs.

The first 18 zones in London include:

  • Abbey Wood, Plumstead and Thamesmead (Greenwich)
  • Hounslow Town Centre (Hounslow)
  • New Bermondsey (Lewisham)
  • Tottenham (Haringey)
  • Wembley (Brent)

Most London’s boroughs have published their HZ plans. Examples include:

  • The Royal Borough of Greenwich has identified Abbey Wood Plumstead and Thamesmead as an HZ, with the aim of providing 1,512 homes. The borough sees the programme as an opportunity to improve public space and infrastructure in advance of the arrival of Crossrail in 2018.
  • Hounslow’s HZ will create three residential sites with 3,478 new homes by 2025. The HZ will also host relocated council offices, a flexible community space and a new primary school.
  • Tottenham’s HZ plans include 10,000 new homes. Supporting this growth, infrastructure development will comprise a revamped Tube, bus and rail station at Tottenham Hale, three Crossrail 2 stations and overground rail upgrades.

Housing Zones beyond London

In his March 2015 Budget speech, the chancellor of the exchequer confirmed the creation of 20 new HZs outside of London. Among the areas included are:

  • Guildford and East Hampshire
  • Bristol
  • Derby, Stoke and West Lindsey
  • Wakefield and York
  • Gateshead.
  • Preston.

The Treasury hopes that central government investment of £200 million will result in up to 45,000 new homes in these regional HZs.

HZs: the reaction

There has a been a range of responses to the HZ initiative.

Home Group, the UK’s fourth largest housing association has warmly welcomed the new HZs:

“Enterprise zones worked for business when implemented correctly and the concept will work to help housing providers deliver the homes which are so desperately needed.”

The National Housing Federation (NHF) also welcomed the linkage of planning, housing and infrastructure delivery. However the NHF indicated that the HZ programme lacks ambition:

“Housing Zones are currently relatively small-scale, and the principles should be applied at a larger scale to genuinely tackle the housing crisis.”

The HZs received a cautious response from the Royal Institute of British Architects (RIBA):

“RIBA is wary of such a large release of public land on very tricky brownfield sites with lots of issues that require strategic planning at a local level. We await the detail on how the Government would support delivery of high quality infrastructure and ensure high standards of design in new development.

As host to one of the new regional HZs, Bristol City Council has welcomed the “much needed investment”. However, Hackney Council believes the HZ model is less appropriate for inner London boroughs because the challenges are more to do with making affordable housing viable than providing infrastructure.

The law firm Pinsent Masons has highlighted one possible unintended consequence of HZs.

“As Housing Zones pick up momentum, this may have the adverse effect of increasing surrounding land values and stimulating more right to buy, which may affect the viability of future phases.”

They may not match the 260,000 homes required to tackle England’s housing shortage, but the broadly positive welcome HZs been given suggests that they are a step in the right direction.


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How is health and social care integration being achieved in England?

By Steven McGinty

Since coming to power in 2010, the coalition government has introduced a series of major reforms to health and social care. They argue that these reforms are necessary for meeting the future needs of patients, as well as providing a more efficient public health service.  Central to these changes is the idea of integration, where services are delivered in a way that limits duplication, delivers more preventative care and targets resources more effectively. However, what has the government done to facilitate integration between health and social care?

In 2012, the Health and Social Care Bill was given royal assent and became an Act. The Act introduced a number of key changes to the way that healthcare is delivered, including:

  • the merging of a numbers of quangos, such as the Health Protection Agency and the National Treatment Agency for Substance Misuse, into one national body, Public Health England (PHE);
  • the abolition of Primary Care Trusts (PCTs), and the introduction of Clinical Commissioning Groups (CCGs), which are GP led bodies responsible for the commissioning of local health services, as well as a greater responsibility for local authorities;
  • the extension of the remit of bodies, such as Health and Wellbeing Boards, giving them extra responsibilities, including the development of strategies across health and social care to meet local public health issues;
  • the introduction of a new organisation, Healthwatch England, an independent body set up to promote the interests of patients in health and social care services.

In 2013, the government introduced a new funding mechanism known as the ‘Better Care Fund (BCF)’. This was a £3.8 billion pool of money to support health and social care bodies through the process of integration. Health and Wellbeing Boards (HWBs) are expected to provide plans to access the funding. These plans are assessed using criteria that includes:

  • how well data is shared between health and social care bodies;
  • how well plans protects social care services;
  • how it protects seven day a week services;
  • how well it reduces admissions to hospitals at weekends.

According to the County Councils Network, plans will have to show how services will be delivered in an innovative way that meets the local needs of people over the long term, in order to ensure funding.

In 2014, the government introduced the Care Act, a piece of legislation based on the 2011 Dilnot report into the funding of adult social care. The Act has been described as the biggest transformation in the care system since 1948, and introduces a number of significant changes, including:

  • that those who receive care from a regulated care provider or local council will be covered by the Human Rights Act, although those paying for care are not covered;
  • introducing a new cap of £72,000 on the cost of care for those eligible under the Act;
  • introducing duties for local authorities to offer prevention services, including the right to receive accessible information and advice, to try and reduce the numbers of people needing to go into hospitals.

The current Minister of State for Care and Support, Norman Lamb MP, has stated that the government is committed to integrating health and social care by 2018. However, it will be very interesting to see if the health care system can be fully integrated by that deadline and whether it can deliver the sort of outcomes expected.


Idox are involved in an innovative partnership with Calderdale Council. The council has developed an innovative case management tool to support their day-to-day work, in areas such as child protection, looked after children, and fostering and adopting.

Calderdale have teamed up with Idox, a specialist in providing technology, content and funding solutions to government, and are now offering their system to other local authorities. The partnership has already proven to be successful, with Calderdale and Idox providing their solution to councils in the Isles of Scilly and Leeds.

We blogged recently about the benefits of the system for integrated working. We have also looked at the barriers to the uptake of digital technologies in health and social care.

Further reading: