Tag Archives: outcomes

A road less travelled: celebrating Gypsy, Roma and Traveller History Month – part 2

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June is Gypsy, Roma and Traveller History Month (GRTHM), which aims to raise awareness of and promote GRT history and culture.

It is widely recognised that raising awareness of different cultures is a key part of addressing prejudice and discrimination.

In this post – the second of two for GRTHM – we look at the inequalities and discrimination that GRT face across education, employment and health.  We also highlight work to address these inequalities and raise awareness of GRT communities’ rich cultural heritage.

GRT communities experience many educational and health inequalities

The recent House of Commons report, ‘Tackling inequalities faced by Gypsy, Roma and Traveller communities’, sets out a comprehensive review of the available evidence across a range of areas.

In education, Gypsy and Traveller children leave school at a much earlier age and have lower attainment levels than non-GRT children, and only a handful go on to university each year.  They also experience much higher rates of exclusions and non-attendance.

There are many reasons for this – from discrimination and bullying, to a lack of inclusion of GRT within the educational curriculum. There are also cultural issues to be addressed within the GRT community itself.

Scottish Traveller activist Davie Donaldson has spoken about the discrimination he faced in school where a teacher refused to “waste resources” by marking his homework because he was a Traveller, who she assumed was “not going to do anything with his education anyway”.  He also discusses how many Travellers within his own community felt he was betraying his roots by attending university. This clearly illustrates the multi-faceted nature of the issue of supporting GRT children in education.  The Traveller Movement addresses this and other related issues in their recently published guide to supporting GRT children in education.

Health outcomes for GRT communities are also very poor compared to other ethnic groups.  Their life expectancy is 10 to 12 years less than that of the non-Traveller population.  Maternal health outcomes are even more shocking – with one in five Gypsy Traveller mothers experiencing the loss of a child, compared to one in 100 in the non-Traveller community.

Poor health outcomes can be partially attributed to the difficulties that many experiences when accessing or registering for healthcare services due to discrimination or language and literacy barriers.  There is also a lack of trust among GRT communities which can result in a lack of engagement with public health campaigns.

Historic fear of engagement with public services

Indeed, there is a historic wariness of public services among many in the GRT community.

In the 1800s, many Travellers had a well-placed fear of the ‘burkers’ – body-snatchers looking to provide the medical schools with bodies for dissection.  Travellers felt particularly at risk because they lived on the margins of society.  There are many Traveller stories about burkers that have been passed on from generation to generation.

Similarly, a fear of social services intervention also exists, following the forced removal of children from Traveller families.  Some were taken into care, and others were deported to be servants in Canada or Australia.

Being aware of these cultural issues, along with the historic criminalisation and continued discrimination that GRT communities face, can help health and social services to understand and empathise with the GRT community when reaching out to them.

Poor employment outcomes and a lack of target support

Gypsies and Travellers were an essential part of the economy in the 19th Century and early 20th Century.  Many were skilled tinsmiths, silversmiths, basketmakers or other crafters.  They also played an important role as seasonal agricultural workers – for example, in the berry fields of Blair and farms of the north east of Scotland.  They moved from place to place, and bringing news and selling and trading their wares.  In the days before roads and motor vehicles, they were a lifeline for rural crofting communities who may have been many days travel away from the nearest settlement.

Time has rendered many traditional Traveller occupations redundant, and today employment outcomes for GRT groups are generally poor.

While more likely to be self-employed than the general population, the 2011 England and Wales Census found that Gypsies and Irish Travellers were the ethnic groups with the lowest employment rates, highest levels of economic inactivity, as well as the highest rates of unemployment.

However, unlike other minority groups, there has been no explicit government policies that support Gypsies or Travellers to enter employment or to take up apprenticeships and/or other training opportunities.  Many Gypsies and Travellers have also reported being discriminated against by employers, making it more difficult for them to find and stay in work.

A lack of robust data

There is a lack of robust data about the different GRT groups in the UK – even something as seemingly simple as how many GRT people there are.

This is because most data collection exercises – including the Census and in the NHS – do not include distinct GRT categories.  If an option exists at all, often it conflates the different GRT ethnicities into one generic tickbox, with no way to differentiate between the different ethnic minorities.  This is an issue that is being increasingly addressed and there are plans to include a Roma category in the 2021 census.

However, there are also issues with under-reporting.  Many people from GRT communities are reluctant to disclose their ethnicity, even when that option is available to them.  This stems both from a lack of trust and the fear of discrimination.

So, while the 2011 Census recorded 58,000 people as Gypsy/Traveller in England and Wales, and a further 4,000 in Scotland, it is estimated that there are actually between 100,000 to 300,000 Gypsy/Traveller people and up to 200,000 Roma people living in the UK.

Raising awareness of GRT culture

While this all may make for some pretty depressing reading, there are some promising signs of progress.

From Corlinda Lee’s Victorian ‘Gypsy Balls’ – where the curious public could pay to come and see how a Gypsy lived and dressed, to Hamish Henderson catalysing the 1950s Scottish Folk Revival with the songs and stories of Scottish Travellers – there have been attempts to promote Gypsy and Traveller culture among the settled population.

Today, organisations and individuals such as The Traveller Movement, Friends, Families and Travellers, and Scottish Traveller activist Davie Donaldson strive to promote awareness of and equality for the GRT community.

The recent Tobar an Keir festival held by the Elphinstone Institute at Aberdeen University sought to illustrate traditional Traveller’s skills such as peg-making, and there is a wonderful Traveller’s exhibition – including two traditional bow tents – at the Highland Folk Museum in Newtonmore.

There are even more events planned for GRTHM – including an exhibition of Travellers’ art and photography at the Scottish Parliament.

The hard work may be beginning to pay off – just last week, the government announced a new national strategy to tackle the inequalities faced by Gypsies, Roma and Travellers.

Using knowledge to fight prejudice

While there is without doubt an urgent need for practical measures to address the inequalities that the GRT community face – such as an increase in the number of authorised sites available – addressing the fundamental lack of awareness and knowledge of GRT culture is a key step towards eradicating prejudice towards GRT communities.

As well as raising awareness among the general public, there is also a need to for people working in public services – from health and social services to education and even politics – to have a better awareness and understanding of Traveller culture and history, and how this affects their present day needs and experiences.

Gypsy, Roma and Traveller History Month is an ideal opportunity to address the huge gap that exists in society’s collective knowledge about the GRT way of life, their history, culture and contribution to society. All of which can help to combat the prejudice and discrimination that they continue to face.

 Follow us on Twitter to discover which topics are interesting our research team.

A road less travelled: celebrating Gypsy, Roma and Traveller History Month – part 1

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Traditional Scottish Traveller bow tent at the Highland Folk Museum, Newtonmore

This month is Gypsy, Roma and Traveller History Month (GRTHM).

GRTHM aims to celebrate and promote awareness of Gypsy, Roma and Traveller (GRT) history, culture and heritage, and the positive contribution that GRT groups have made and continue to make to society.  It also seeks to challenge negative stereotypes, prejudices and misconceptions associated with GRT groups.

Over the next two blog posts, we will raise awareness of the many issues faced by GRT communities in the UK today, and highlight some lesser known aspects of GRT culture and heritage.

Gypsies and Travellers are not a homogenous group

One common misconception is that Gypsies, Travellers and Roma are a homogenous group.

In fact, GRT is a term which encompasses many distinct ethnic groups with their own cultures, histories and traditions.

This includes Romany Gypsies, who today are generally of English or Welsh heritage.  Gypsies first arrived in Britain in the 16th Century. The term ‘Gypsy’ was coined due to a common misconception that Gypsies originated from Egypt. However, recent DNA studies suggest that they actually originated from the Indian subcontinent.  Some Gypsies may prefer to be known as either English Gypsies or Welsh Gypsies specifically.

Irish Travellers are Travellers with Irish roots, however, a recent DNA study suggests they have been genetically distinct from the settled Irish community for at least 1000 years. Irish Travellers have their own language – Shelta (also known as Cant).

Scottish Gypsies/Travellers are indigenous to Scotland.  Their exact origins are uncertain, but it is thought that they may be descended from the Picts, and/or the scattering of the clans following the Battle of Culloden in 1746.  Certainly, Scottish Travellers tend to share many of the same Clan surnames – including Stewart, McMillan, McPhee and McGregor.

Scottish Travellers also have their own language – the Gaelic-based Beurla Reagaird.

European Roma are descended from the same people as British Romany Gypsies, and they are Gypsies/Travellers who have moved to the UK from Central and Eastern Europe more recently.  Some have arrived as refugees and asylum seekers. While they face many of the same issues as Gypsies, Irish and Scottish Travellers, they are also subject to a number of additional challenges.

There are also other groups that are considered ‘cultural’ rather than ‘ethnic’ Travellers.  These include Occupational Travellers such as fairground and circus owners and workers and New Age Travellers – individuals who have chosen a travelling lifestyle for ideological reasons.

Distinct ethnic minorities protected by law

Whilst there are some similarities between GRT groups in terms of lifestyle, economic, family and community norms and values – and certainly in terms of the discrimination and poor outcomes that they experience – there are clear genetic differences between each of the groups.

As such, Gypsies, Irish Travellers and Scottish Travellers are each considered ethnic minorities in their own right and protected as “races” under the Equality Act 2010.  Migrant Roma are protected both by virtue of their ethnicities and their national identities.

However, despite this protection, GRT groups are still subject to high levels of discrimination.

‘The last acceptable form of racism’

Indeed, prejudice and discrimination has affected GRT groups throughout history.

In the 16th century, any person found to be a Gypsy could be subject to imprisonment, execution or banishment.  Even after anti-Gypsy laws were repealed, discrimination continued.  In the 19th and early 20th centuries, it was not uncommon for doctors to refuse to attend to Travellers.  And despite Travellers’ strong Christian beliefs, churches would often refuse to bury their bodies within their grounds.

And today, GRT people have the worst outcomes of any ethnic group across a huge range of areas, including education, health, employment and criminal justice.  They have the poorest health and the lowest life expectancy of any ethnic group in the UK, and are subject to high levels of racism and hate crime.

GRT groups still face barriers to accessing health services.  As part of a mystery shopper exercise by the Friends, Families and Travellers (FFT) charity, 50 GP practices were contacted by an individual posing as a patient wishing to register without a fixed address or proof of identity. They found that almost half would not register them, despite NHS guidance to the contrary.

And while racism towards most ethnic groups is now seen as unacceptable and less frequently expressed in public, racism towards GRT groups is still common and often overt – even among those who would otherwise consider themselves ‘liberal’ or ‘forward thinking’.  This had led it to be termed “the last acceptable form of racism”.

The 2015 Scottish Social Attitudes Survey found that over 30% of people in Scotland would be unhappy with a close relative marrying a Gypsy or Traveller, and 34% felt that Gypsies or Travellers were unsuitable as primary school teachers.

Research by Travellers Movement has found that four out of five (77%) of Gypsies, Roma and Travellers have experienced hate speech or a hate crime – ranging from regularly being subject to racist abuse in public to physical assaults.

Prejudice and discrimination against GRT groups is not limited to the public – there is also evidence of discrimination against GRT individuals by the media, police, teachers, employers and other public services.

Even politicians have openly displayed anti-GRT sentiment.  In 2017, the Conservative MP for Moray Douglas Ross, stated that he would impose “tougher enforcement against Gypsy Travellers” if he were Prime Minster for the day.

His remarks were widely criticised.  Amnesty International’s Scottish director, Naomi McAuliffe, said “When our elected leaders use this sort of blatantly partisan speech, they set a terrible example that only serves to foster further discrimination and prejudice.”.

A lack of sites has led to a ‘housing crisis’

Mr Ross’s remarks reflect another common misconception about GRT communities – that they all live in caravans, purposefully choosing to set up on unauthorised sites.

The truth is that while Gypsies and Travellers have traditionally lived a nomadic life, living in bow tents, wagons – and even caves – over 70% of Gypsies and Travellers no longer live in caravans, having chosen, or being forced for one reason or the other – disability, old age, lack of suitable sites – to move into traditional ‘bricks and mortar’ accommodation.

For those who do still live in caravans, it is widely recognised that they face a ‘housing crisis’ – an urgent shortage of authorised sites to set up on, which threatens their travelling heritage.  It is this shortage that drives much of the use of unauthorised sites.

Of those sites that do exist, quality has been raised as a key issue.  Many sites can lack even the most basic amenities, and some are sited near recycling plants or in other undesirable locations.  Poor conditions and sanitation contributes to poor levels of health, exacerbating existing health inequalities.

Further inequalities

In our next blog post, we will look in more depth at the inequalities that GRT communities face – in health, education and employment.  We also highlight work to address these inequalities and raise awareness of GRT communities’ rich cultural heritage.

 Follow us on Twitter to discover which topics are interesting our research team.

Better outcomes for children, parents and society – why ‘family learning matters’

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mother reading to her son

Improving the circumstances of families from deprived backgrounds has been a key policy focus of government in recent years, with large amounts of resources and funding having been allocated to trying to improve families’ outcomes.

One approach to achieving this, which can lead to positive outcomes for both adults and children is family learning – the importance of which is receiving increasing attention.

What is family learning?

Family learning has been described as “any learning activity that involves both children and adult family members, where learning outcomes are intended for both, and that contributes to a culture of learning in the family”. It can involve both formal and informal provision, such as engagement with programmes such as Booksmart or attending events at libraries and museums.

Parents may not even be aware that activities such as reading to their children from an early age, or singing with them, constitutes a learning activity. Unfortunately, research indicates that a large number of parents do not engage in these activities at all, despite evidence that a home environment which encourages learning and communication is as important an indicator of a child’s achievement as parental income and social status.

Research from the National Literacy Trust, suggests that “parental involvement in their child’s reading has been found to be the most important determinant of language and emergent literacy”.

With real concerns raised over children’s basic skills in recent years, family learning could be part of the solution.

Lack of basic skills

Last year, the National Literacy Trust highlighted analysis which showed that 86% of English constituencies contained at least one ward with “urgent literacy need”.

The latest edition of the Scottish Survey of Literacy and Numeracy showed there was a seven point drop in P7 pupils who can write well or very well between 2012 and 2016. And in November 2016, 79% of Reception teachers in Wales surveyed for Save the Children reported seeing children starting school without the ability to speak in complete sentences. One primary headteacher highlighted the “huge need for parental awareness and engagement”.

In comparison, primary schools in Northern Ireland continue to rank among the best in the world in maths. The latest edition of Trends in International Mathematics and Science Study (TIMSS) shows that Northern Irish children are the best in Europe at maths, and sixth best in the world.

The education system in Northern Ireland prioritises a policy of Parental Involvement in Numeracy (PIN), and government policy is to impress upon parents the role that they must play in the development of essential basic skills. The government has also just launched its ‘Giving your child a helping hand’ campaign, which is aimed at increasing parental involvement in the education of their children.

As children spend only around 15% of their time involved in formal learning activities, i.e. in school, there is substantial scope for them to be involved in more informal learning activities that will benefit both their academic and personal development.

Benefits of family learning

Research has shown that family learning interventions could increase children’s overall development levels by up to 15 percentage points for those from deprived backgrounds, and induce an average reading attainment improvement of six months.

Survey findings published by Ofsted also found that participation in family learning courses improved children’s behaviour in class, as well as their relationships with their peers and teachers. Teachers also reported noticing improvements in their pupils’ confidence levels, and their communication and interpersonal skills.

For adults, family learning offers two key positive outcomes for parents: the development of their relationship with their child, and personal skills development.

As with children, the basic skills of adults in the UK remains a cause for concern. In 2016, the Joseph Rowntree Foundation published analysis which suggests that around five million adults in England lack the basic reading, writing and numeracy skills required to complete everyday tasks. Similar deficiencies have been found in Scotland, Wales and Northern Ireland.

Less quantitative evidence exists of the impact of family learning engagement on adult literacy levels. However, it has been found that the average portion of adult learners achieving a qualification on family literacy programmes is higher than those on standard programmes. An evaluation of the Family Learning Impact Fund (FLIF) found that 85% of learners taking part achieved some sort of progression through taking part in a FLIF course, such as going onto a higher level of learning, or new or improved employment.

The Department for Business, Innovation and Skills (BIS) has also highlighted a wider societal impact arising from adults taking part in family learning activities, in terms of participation in volunteering and community activities.

In addition to better outcomes for children, adults and society, family learning can also benefit the government. It is relatively low cost, as it draws on many existing resources such as libraries and museums.

Sheffield City Council, for example, has estimated that for every £1 they spend on family learning, a return on investment (ROI) of £7.58 is generated. This is down to the fact that family learning is a single intervention with the potential to achieve multiple outcomes – not only for parents and children in the present, but for future generations

Final thoughts

It could be argued that the socioeconomic benefits of family learning could help to ease the burden on government resources at the same time as improving families’ outcomes.

Clearly, the benefits of family learning to society and the government can’t be ignored – particularly with increasingly tight budgets.

Follow us on Twitter to see what developments in public and social policy are interesting our research team.

Focusing on the end result: outcomes based commissioning in health and social care

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In March 2016, the government announced that it was pairing up with the Blavatnik School of Government at the University of Oxford to create the Government Outcomes Lab (GOL). The aim of this partnership was to create a centre for excellence in commissioning research and practice – to find new and innovative ways for the public sector to commission projects, provide on the ground support to local commissioning teams and become a world class research centre on effective models of commissioning.

belangrijke-sales-opdracht2

Payment by service vs payment by results

Traditionally, governments contract third-party service providers on a ‘fee for service’ basis – so commissioners prescribe and pay for a particular service that they believe will lead to a desired outcome. More recently however, commissioning teams have started to introduce elements of ‘payment by results’ or ‘pay for success’ when commissioning services – so providers only get paid in full if they deliver the desired outcomes.

Social impact bonds

Social impact bonds (SIBs) are a tool to help outcomes-driven providers deliver on their projects, by giving them access to financing and management support from “socially-minded investors”. The idea being that this will broaden the pool of skilled providers, encourage smaller more locally based providers to tender for projects (who may have been reluctant to previously because of cost and lack of support) and, potentially, increase the chances of the service being successful.

One of the primary aims of the Government Outcomes Lab is to consolidate and promote as far as possible the use of social impact bonds to align social value based commissioning with commissioning for measurable outcomes – to promote a social value as well as an economic value in the way providers deliver on contracts. There are now 32 Social Impact Bonds across the UK, supporting beneficiaries in areas like youth unemployment, mental health and homelessness.

Gear

Benefits and challenges to outcome based commissioning

While to many people it may seem almost impossible to question the principle of outcomes based commissioning (to move from a system focused on process measures and targets to a system that is focused on improving the outcomes that matters to citizens and patients) the reality for commissioning teams, providers and service users is, in some cases, very far removed from this ideal.

In April 2012, the Audit Commission published its guidance on Payment by Results (PbR). This generated fairly positive messages around PbR but also advised commissioners to be aware of the risks:

“At its best, PbR can deliver savings and bring in new resources at a time when budgets are under great pressure. It also defers costs to commissioners to allow time to realise the benefits of change and preventative work….. However, PbR carries extra risks to securing value for money and requires higher level commissioning skills than more traditional approaches”- Audit Commission (2012)

Much of the literature on outcomes based commissioning models emphasises the importance of:

  • transparency;
  • agreed objectives;
  • agreed measurable outcomes;
  • communication and clear definitions of accountability between commissioners;
  • any social investors or third sector bodies with input;
  • providers;
  • and any secondary providers who may be awarded subsequent sub contracts

A more comprehensive list of pros and cons to outcomes based commissioning can be found here.

One high-profile intitiative which has faced more challenges than it has produced benefits is the “troubled families” programme. which aimed to support families with long-standing problems. The programme was heavily criticised for its payment by number (number of clients processed) rather than payment by specific outcome. The issue here appeared to be the lack of definition of outcomes and what was going to be expected of the provider in terms of service before they could be paid.

In this instance the organisations delivering the “troubled families” programme in some areas were being paid for the number of people who went through the service, rather than the number of people who completed the programme successfully, or saw notable improvement as a direct result of the input of the programme, and without taking note of the professional view of the quality of the service being provided (which was considered in some areas to be poor). This resulted in providers being paid for a service which, while many people used, did not actually achieve the expected outcomes. This is something which future commissioning bodies must take note of and act upon to ensure that any future agreements do not contain such massive loopholes with regards to payment.

Outcome Flow Chart

Outcome Flow Chart via Roma Learning Leaders

Outcomes based commissioning in health and social care

A number of different policy areas have begun to use outcomes based commissioning models with varied success (although as we have seen this can be as much to do with the quality of the provider and the transparency of the contract as it is about the implementation of an outcomes based model). Rather than focusing on inputs (e.g. number of doctors) or outputs (e.g. number of operations conducted, or amount of drugs administered), these commissioning models are based on achieving specific, predefined and measurable ‘outcomes’ (e.g. improved health).

In a specific health and social care context, outcomes based commissioning can, if done well, form a key part of a wider prevention agenda, as well as helping to improve personalisation of services. In Wiltshire for example, the council has employed outcomes based commissioning techniques in relation to its domiciliary social care teams. This example shows that when the right providers are selected and clear outcome measures are defined, the impact for service users can be significant, in a positive way: there is a strong focus on getting the best possible result for the customer in the way that suits them; with every visit having a clear purpose and a focus on achieving greater independence for the older person wherever that is possible (which is the overall wider outcome the commissioning teams were hoping to achieve – greater independence of service users and less reliance on the social care teams in the long term).

Some specific challenges in a health and social care context include coordinating payment for outcomes with direct (or personal) payment schemes and agreeing on realistic and well defined outcomes and time frames with service users (which if done well can have a very positive impact on the personalisation agenda of services) Attributing outcomes specifically to one set of interventions in health and social care can also be difficult, particularly if a service user is in receipt of a number of different strands of care, for example, primary care and domiciliary social care as well as having access to some remote telehealth facilities.

Commissioning for long term outcomes

If the issue of defining or attributing outcomes is a challenge for outcomes based commissioners, then the issue of planning for long term outcomes is even more difficult. This approach requires commissioners to have a long term view of the strategic aims of a programme, as well as requiring them to consider any factors which may influence or change these aims, and additionally to consider the scope of need in the future if other preventative measures are successful.

Advice for councils

The LGiU and academics at Oxford Brookes University, as well as many others, have published guidance for local authority commissioning teams, giving them some direction in relation to best practice in outcomes based commissioning. Some of the key “pointers” for councillors include:

  • Take time to get the right set of providers in place to deliver the new model and collaborate with them to get the best possible system in place – be thorough in research and consideration of tenders.
  • Be very clear what the likely outcomes are that any specific service is being asked to deliver.
  • Make the payment mechanism as simple as possible. Consider whether any rewards will be paid for good performance in delivering outcomes. Consider if payments should be made on each individual outcome achieved or for outcomes for sub-sets of the population e.g. hospital discharges.
  • Make use of the public, their opinions and data collected about them to assess the needs of the population and reflect this in the agreed outcomes.
  • Try to implement outcomes based commissioning as part of wider transformation within the organisation – in order to improve quality, reduce costs and improve efficiency (particularly in health and social care) other infrastructure and practices (such as IT systems and skills development in staff) need to be addressed in addition to commissioning models in order to bring about change.

Further reading about health and social care on our blog

Co-production in social care … a need for systems change

Why a holistic approach to public health and social care needs a wider evidence base … and how Social Policy and Practice can help

What’s happening to make big data use a reality in health and social care?

Equal to the task? Addressing racial inequality in public services

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huddleCLR

Throughout October, a series of events to promote diversity and equality will take place as part of Black History Month. Although there are many achievements to celebrate, it is an unfortunate fact that many people in the UK today still experience disadvantage due to the colour of their skin.

Over the summer, reports by the Equality and Human Rights Commission (EHRC) and the UN Committee on the Elimination of Racial Discrimination (CERD), found that racial inequality in the UK was ‘worryingly high’.

In its biggest ever review of race inequality in the UK, the EHRC concluded that:

“while for certain people life has become fairer over the past five years, for others progress has stalled and for some– in particular young Black people – life on many fronts has got worse.”

Audit of racial disparities announced

The government responded quickly by announcing an audit of racial disparities in public services. It promises to ‘shine a light on injustices as never before’.

From summer 2017, Whitehall departments will be required to identify and publish information annually on outcomes for people of different backgrounds in areas such as health, education, childcare, welfare, employment, skills and criminal justice.

As well as enabling the public to check how their race affects the way they are treated by public services, the data is also intended to help force services to improve.

The audit is being called ‘unprecedented’ – and it certainly is – up until now, public services in the UK have not systematically gathered data for the purposes of racial comparison. Indeed, according to the FT, very few countries, if any at all, currently produce racial impact audits.

‘Worryingly high’ levels of racial inequality

The audit will have its work cut out.  The review by the EHRC found that, compared to their White counterparts, people from ethnic minorities were more likely to be:

  • unemployed
  • on low wages and/or in insecure employment
  • excluded from school
  • less qualified
  • living in poverty
  • living in substandard and/or overcrowded accommodation
  • experiencing mental and physical health problems
  • in the criminal justice system
  • stopped and searched by police
  • a victim of hate crime
  • a victim of homicide

Institutional racism

Similarly, the CERD findings into how well the UK is meeting its obligations under the International Convention on the Elimination of All Forms of Racial Discrimination (ICERD) raised serious concerns about the level of institutional racism in UK public services. Omar Khan, of the Runnymede Trust, suggested that the findings would ‘embarrass the UK on the world stage’.

Longstanding inequalities in access to services, the quality of care received and patients’ health outcomes were criticised, as was the over-representation of persons belonging to ethnic minorities in psychiatric institutions.

The committee echoed the EHRC’s concerns regarding higher unemployment rates and the concentration of persons belonging to ethnic minorities in insecure and low-paid work.  They also criticised the use of discriminatory recruitment practices by employers.

In education, there were concerns regarding reports of racist bullying and harassment in schools, and the lack of balanced teaching about the history of the British Empire and colonialism, particularly with regard to slavery.

The committee also concluded that there had been an outbreak of xenophobia and discrimination against ethnic minorities, particularly since the EU referendum campaign.  Indeed, the rise in post-Brexit racial tensions has been widely acknowledged.

Equal to the task?

Although the audit has been welcomed by many, including the EHRC, others have raised concern about the extent to which it will tackle the root of the problem.  Danny Dorling, of Oxford University, remains sceptical, stating that “within two or three years every single one of these audits is forgotten”.

Some have noted that in order to be effective, the audit will also have to capture outcomes for migrant families, and for poorer White people, who also suffer from discrimination and disadvantage.  Others, including Labour’s Angela Rayner, shadow equalities minister, have noted that there is a ‘huge gap’ in the review as it would not include the private sector.

The EHRC have called upon the government to create “a comprehensive, coordinated and long-term strategy to achieve race equality, with stretching new targets to improve opportunities and deliver clear and measurable outcomes.”

Certainly, the data produced by the racial equality audit may well provide some basis for the establishment of such targets.

So while this October there is cause for celebrating the progress made so far, the findings of the EHRC and the CERD underline just how entrenched and far-reaching race inequality remains.  As the EHRC states:

“We must tackle this with the utmost urgency if we are to heal the divisions in our society and prevent an escalation of tensions between our communities.”

Follow us on Twitter to see what developments in public and social policy are interesting our research team.

 

Grandparents – the ‘hidden army’ of kinship carers

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mamy and the little boy

By Heather Cameron

Tomorrow is the International Day of Older Persons, designated by the United Nations in order to recognise the important contributions made by older people, while raising awareness of the issues of ageing.

Today there are around 600 million people aged 60 years and over world-wide. A number that is set to double by 2025 and reach 2 billion by 2050.

With people living longer and healthier lives, it is not surprising older people are playing a considerably more active and increasingly important role in society. Not least when it comes to contributing to the care of their grandchildren.

Extent of kinship care

Kinship care – when children are brought up by relatives or family friends in the absence of their parents – has grown markedly in recent years.

It is estimated that between 200,000 and 300,000 grandparents and other relatives are raising children who are unable to live with their parents. Common reasons cited for this include abuse and neglect, parental illness or disability, parental substance misuse, domestic violence or death of a parent.

In examining the prevalence of kinship care, drawing on census data, a recent University of Bristol study found that there has been a 7% increase in the kinship child population in England since 2001 – more than three times that of the population growth rate of all children in England, which was 2% over the same time period.

The study also found that one in two (51%) children were growing up in households headed by grandparents.

Positive outcomes

With regard to the children in kinship care, research suggests that they do ‘significantly better than children in care’, both emotionally and academically.

Indeed, a recent study on the educational outcomes of looked after children found that children in long-term foster or kinship care made better progress than children in other care settings.

The largest kinship carer survey in the UK, conducted by Family Rights Group, also highlights the effectiveness of kinship care in preventing children entering or remaining within the care system, to the benefit of both the child and the public purse. The data found that 56% of children had come to live with the kinship carer straight from the parents’ home, with 27% having been in unrelated foster care.

The caring contribution of grandparents has also been shown to have made a material difference to maternal rates of employment.

And as 95% of children being raised in kinship care are not officially ‘looked after’, billions of pounds are saved each year on care costs.

But while benefiting the public purse, and despite evidence that kinship children have better outcomes, many kinship families face a financial burden. The University of Bristol study found that 40% of all children in kinship care in England were living in households located in the 20% of the poorest areas in England (an improvement of only 4% since 2001), and three quarters (76%) of kinship children were living in a deprived household.

Impact on grandparents

As there is no statutory requirement for local authorities to make provision for kinship carers and no automatic right to child benefit, many receive no formal support; leading to financial hardship, and the stress that comes with it.

Many kinship carers have had to give up work or reduce their working hours, either permanently or temporarily. And this is often their main source of income.

A study from Grandparents Plus on discrimination against kinship carers found that of the 77% of grandparents that have asked for professional help, only 33% received the help they needed. And 30% said they didn’t receive any support at all.

The study also found that, overall, kinship carers score ‘significantly below average’ when it comes to their wellbeing.

Other recent research has suggested that regular and occasional care for grandchildren can impact on the mental health of grandparents. The findings indicated that ten additional hours of childcare per month increases the probability of developing depressive symptoms by 3.0 and 3.2 percentage point for grandmothers and 5.4 to 5.9 percentage points for grandfathers.

Policies that substitute informal with formal childcare, it argued, could improve the mental wellbeing of grandparents.

Of course there are positive impacts on grandparents too, many of whom find caring for grandchildren rewarding and who enjoy closer relationships with them, which can in turn have a positive effect on their health. As the research suggests:

“the effect of grandchild care provision on grandparents’ health seems to depend on its intensity, the cultural context, as well as on its stability and change.”

Final thoughts

It is clear that grandparents play an increasingly vital role in family life. But it seems this role is in need of greater recognition and support, if society is to continue to benefit from this ‘hidden army’ of kinship carers.

If you enjoyed reading this, you may also be interested in our previous blog on the economic opportunities of an ageing society, published on last year’s International Day of Older Persons.

Follow us on Twitter to see what developments in public and social policy are interesting our research team.

The power of personal budgets

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Image by Tristan Martin via Creative Commons

Image by Tristan Martin via Creative Commons

Described by supporters as having revolutionised the way the social care system in England is organised, personal budgets have developed to become the norm in social care commissioning in England.

One of the ideas underpinning personal budgets is the development of a new relationship between people who use care services and the organisations who provide them. The new approach was designed to move away from previous prescriptive services towards more bespoke, personalised models of care, where service users are directly involved in planning and deciding what care they receive, and how they receive it.

Within the personal budgets model an allocation of money is given to a specific person from their local authority, following an assessment of need. Money is allocated to the individual, who then works with a professional to work out the most appropriate support. The idea is based on the ideas of transparency, empowerment and personalisation of care.

There are 4 options for service delivery which recipients can chose from to best suit their care needs:

  1. Managed council budgets – where councils arrange the care that is needed following an assessment and an agreed set of outcomes to go alongside a pre-agreed care plan;
  2. Individual service funds – marketed as a more flexible option than local authority led management, this allows recipients to select an alternate organisation to manage an individual’s care budget, and deliver the required services;
  3. Direct payments – this option sees the money paid directly into the account of the person in need of support and allows them to buy care services from an agency or to employ their own carer, or a mixture of both;
  4. Mixed package – a combination of any of the options above, where recipients of support may give some of their budgets to a care provider (either a charity or local authority) but may get a portion of the budget paid directly to them so they can pay, for example, for additional carers to visit during the night.

Seniorin mit Pflegerin

Those in favour of personal budgets point out that the model promotes the personalisation agenda within health and social care in a way that no other policy does. It gives control of spending directly to the person in receipt of the support and has been heralded as a new age for transparency, increasing choice and control, reducing bureaucracy and cutting costs. Personal budgets have also become a key part of the health and social care integration agenda, as well as being highlighted within the recent reform of SEND (special educational needs and disability) care and provision.

Supporters also argue that one of the best and biggest changes between personal budgets and the original direct payment pilots are that personal budgets are designed to produce outcomes, not pay for a service. They are co-produced with the person in receipt of care, as well as professionals from a number of sectors, care providers and family, if appropriate, to ensure that care plans and agreed outcomes are established when the budget is allocated and that the payments achieve those outcomes.

pregnant carer giving pills and medication to her elderly pacient

However, studies have shown that there are big variations in service provision, choice can be limited and poor practice and processes can have a big impact on personal budget delivery and effectiveness. There has also been criticism of the high level of support within government for the model, despite the limited number of pilot roll outs and reviews into outcomes.

In 2016 a National Audit Office report was critical of the way that public services have monitored the impact of personalisation through personal budgets, as very little evaluation of their long term benefits and efficacy have been completed. The report stated that the Department of Health needed to “gain a better understanding of the different ways to commission personalised services for users and how these lead to improvements in user outcomes.” It is clear that there is a lack of evidence as monitoring does not allow service providers to understand how personal budgets improve outcomes.

Critics also argue that personal budgets are ineffective and cannot provide suitable care for everyone in need. They argue that there has never been, and never will be adequate funding to implement personal budgets properly. The principle is only effective, they argue, if there is an unlimited supply of both funds to pay for services and service providers delivering high quality service, which under current conditions of austerity there is not. Supporters counter however, that the concept of “self-directed support” is fundamentally a good one, but admit that poor delivery can deter some people.

Conclusion

Personal budgets can empower people in receipt of care, allowing them to take control of how their care is delivered. This recognition that care should be individualised is a big step forward for people who rely on care services on a daily basis.

However, reduced budgets, inconsistent service provision, and a lack of information for recipients has meant that some people have missed out on the benefits of personal budgets. In practice, services are patchy and evidence of actual benefits, in terms of improved outcomes, is lacking due to the limited number of research studies.

In order to fully realise the power of personal budgets for everyone in receipt of care, the provision, implementation and understanding of the model must be improved. Support for people to help them make the most informed decisions about planning their care packages should also be increased.

Now we’ve got a Local Government Digital Service Standard … what now?

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By Steven McGinty

After two months of consultation and the input of more than 60 councils, the final Local Government Digital Service Standard was published in April.

The standard, introduced by practitioner network LocalGov Digital, aims to provide a ‘common approach for local authorities to deliver good quality, user centred, and value for money digital services’.

According to Phil Rumens, Vice Chair of LocalGov Digital, the new standard provides a “big step forward” for local government digital services. He also highlights that it not only helps create better services, but enables this in a more joined up way.

In total, there are fifteen standards, including:

  • Understand user needs. Research to develop deep knowledge of who the service users are and what that means for the design of the service.
  • Ensure a suitably skilled, sustainable multidisciplinary team, led by a senior service manager with decision-making responsibility, can design, build and improve the service.
  • Create a service using the agile, iterative and user-centred methods set out in the Government Service Design Manual.

Differences from the Digital by Default Service Standard

Many will have welcomed the collaboration between LocalGov Digital and the Government Digital Service (GDS), the body responsible for digital transformation in central government. During the consultation stage, the GDS hosted a workshop with participants from over 30 local councils.

The Local Government Digital Service Standard is also heavily based on the GDS Digital by Default Service Standard, with only a few notable differences. For instance, in the local government standard, accountability for digital services lies with the appropriate council member or a senior manager responsible for the service, rather than a government minister (which is the case with the GDS standard). The local government standard also includes an additional requirement to re-use existing authoritative data and registers and to make data openly available.

 Will local councils adopt the new standards?

Local government is under no legal obligation to implement the Local Government Digital Service Standards. Gill Hitchcock, reporter at Public Technology.net, suggests that, although the standards look like a great initiative, they may lack the teeth to have any real impact.

Interestingly, in a recent interview, Phil Rumens appears to agree with this sentiment, highlighting that LocalGov Digital need to make the case for the new standards. He explains that regional peer networks will be created to allow councils to share their experiences of implementing standards and to promote their value to digital leaders. In September, a ‘standards summit’ will be held, bringing together local councils who have adopted the standards and the GDS.

TechUK view

TechUK, the industry body for the technology sector, has voiced support for the underlying principles of the new Local Government Digital Service Standard, and said it’s been encouraged by the involvement of GDS in the initiative.

However, techUK have highlighted their concerns over the wording of one particular standard:

“Where possible, use or buy open source tools and consider making source code open and reusable, publishing it under appropriate licences”

They contend that this goes against the government’s policy of creating a level playing field, and could lead to unintended consequences for SMEs trying to work with local government.

Jos Creese’s view

Jos Creese, an independent IT consultant and the man described as the ‘most influential and innovative UK Chief Information Officer’ by CIO UK, has written a briefing on the need for local GDS standards.

Similarly to techUK, Jos Creese welcomes the new local government digital service standards. Yet, he also highlights their limitations, noting that they are primarily focused on on-line transactions and channel shift (encouraging people to make use of digital services) and that they don’t consider the difficult issue of information flows across local public services.

For him, standards need to be accompanied by some form of practical guidance, and they must address ‘digital by design’ challenges, including digitising the high cost, high value, ‘relational services’, such as adult care, safeguarding, and adoption services.

In his concluding comments, he states that introducing standards may not be enough to transform services and that local government must consider outcomes, rather than just the methods used to develop services. He provides examples of suggested outcomes, including:

  • take up of digital services relevant to target user base
  • satisfaction of service users and reduced complaints
  • lower operating costs and greater measurable efficiency of operation
  • integration and linkage of related transactions, services and information

‘Digital Council of the Year’ – Wigan Council

This year, Wigan Council has been recognised by the Digital Leaders’ 2016 Awards for their successful digital transformation. Their new website provides a seamless user experience and services such as the Report It app and MyAccount have revolutionised the way residents interact with the council.

They have also been commended for their attempts to tackle digital exclusion by helping hundreds of residents, including the elderly, access the internet.

Additionally, the council’s strategy has focused on supporting business through introducing superfast broadband, encouraging businesses to build efficient websites, and funding digital apprenticeships.

Final thoughts

The new Local Government Digital Service Standard is a step in the right direction and provides a basis for developing good quality, cost-effective and user-centred digital services. There are, however, still many challenges that local government needs to face as they progress with their digital transformation journeys.

Wigan Council shows that when you put the ideas of the new standard into practice, it is possible to create excellent digital services that benefit residents and business.

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:

Secure care in Scotland: measuring outcomes and sharing practice

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By Rebecca Jackson

There are five centres which offer secure care in Scotland, with around 100 of Scotland’s most vulnerable children and young people placed within these units. Placements happen if they are deemed to be a risk to themselves, or others, within their communities, and it is felt that they can only be managed effectively within a secure care setting. These placements are arranged via the courts or the children’s hearing system.

 

National Secure Care Project

In 2014 the Scottish Government granted funding to the Centre for Youth and Criminal Justice (CYCJ) for a fixed term project to build on the work of the Securing our future initiative (SOFI) report in 2009. The SOFI report was a comprehensive analysis of the secure care estate in Scotland. It made recommendations for future practice in secure care and also suggested ways that the system could be made more efficient and young person centred. These included implementing and embedding the Getting It Right for Every Child approach and making full use of the Children’s Hearing and Early Years frameworks, including the SHANARRI indicators on well-being.

A scoping study was completed by CYCJ in 2015 which considered the current legislative and academic frameworks, as well as current practices of the 5 centres of secure care in Scotland. This followed the streamlining and takeover by Scotland Excel in 4 of the centres and Edinburgh City Council in the other.

The scoping study report, along with the project plan, highlights the aims and objectives of this new national programme:

  • identifying and promoting current best practice
  • identifying and exploring alternatives to secure care
  • building capacity within the secure care sector to draw comparisons and learn from the rest of the UK (and from each other)

Other key issues that the studies identified as needing to be addressed included:

Outcomes in secure care

One of the key issues raised by academics, policy makers and practitioners within secure care is the concept of outcomes. It’s been suggested that there is a need for both individual outcome targets for each child within secure care but also for a wider framework of general agreed outcomes to allow for better comparison between centres, which it is hoped will help raise standards of practice.

It is also recognised that long term, as well as the immediate, outcomes need to be assessed and researched. This ties in with the need for more emphasis on transitionary care and support. Although there is an expectation that local social workers will follow up on behalf of the secure care units, this isn’t always the case.

Key questions also have to be addressed from within the sector itself with regards to:

  • what are the aims of the centres
  • what exactly is meant by positive outcomes
  • what counts as an outcome
  • how can we look at a child or young person and say that a certain objective has been met, and can this be attributed to any one particular event, intervention or placement

These questions are not unique to the secure care sector but they do need addressed. Similarly there needs to be a wider acceptance that there are multiple outcomes and that these can be in terms of quality of life, process or change outcomes.

Sharing best practice and using staff as “knowledge brokers”

There is concern among practitioners and academics that, as a result of the changes to secure care provision implemented in 2014, secure care units are now reluctant to collaborate and share best practice.

The nature of the new secure care framework agreement means that, despite being referred to as a “secure care network”, the five centres are now in effect “in competition with one another” for individuals to be placed with them.

There is a risk that this constrains the sharing of best practice, ultimately reducing the collective standard of all five centres and therefore reducing the standard of care afforded to some young people. This was particularly highlighted in the 2015 CYCJ scoping report.

One of the key ways to share information and best practice is to allow the people who work within the centres, working with residents on a day to day basis, a platform to discuss and contribute to a wider discussion of best practice outside of their own individual centre.

Another potentially useful strategy would be to integrate approaches from traditional social work with regards to sharing ideas and information. This may also make it easier for social workers within and outside the secure care context to liaise with one another. Using staff members as “knowledge brokers” could be an efficient and effective way to allow staff to communicate best practice. Tools such as a digital platform, interactive app or online forum could help staff to share their experiences.

With the project scheduled to run until 2017, some of the issues highlighted here were discussed at an event hosted by CYCJ and WithScotland at the University of Strathclyde in April 2016. The hope is to increase collaboration and move the provision of care and creation of successful and useful outcomes frameworks forward as part of the wider National Secure Care Project.

Read more from our blog on supporting vulnerable children and young people across the UK:

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Health Champions – “unlocking the power of communities”

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Health Cubes_iStock_000022075266Large

By Heather Cameron

“On the societal level, we must understand that health is not an individual outcome, but arises from social cohesion, community ties, and mutual support.” Dr Gabor Maté

Health inequalities have long been an issue in the UK and despite continuous government commitment to tackling them, they continue to persist.

It is estimated that avoidable illness costs around £60 billion and that 1 in 4 deaths are preventable with the adoption of healthier lifestyles. Calls have therefore been made for radical changes in the approach to public health by improving health and wellbeing outside of the core public health workforce.

This is just the approach of the Community Health Champion model, developed by Altogether Better, which has demonstrated not only the positive impact on health but the social value of such an approach.

What are health champions?

Health Champions are volunteers from all walks of life who are provided with accredited training and support so they can undertake health promotion activities within their communities to reduce health inequalities and improve the health of the local population.

The Community Health Champion role began as a five year Big Lottery Funded programme (Wellbeing 1) in 2008. Over 18,000 Health Champions were recruited, trained and supported between 2008 and 2012, reaching over 105,000 people.

Through a combination of their training and own personal experiences, these volunteers empower and encourage people within their families, communities and workplaces to take up healthy activities, create groups to meet local needs and can signpost people to relevant support and services.

Challenges

While Wellbeing 1 succeeded in reaching many people in need, the programme also raised two specific challenges: in almost all cases, the work being done was invisible to the NHS; and securing ongoing funding to continue the support was difficult.

Peer support was later identified as the most appropriate way of trying to connect communities with health services.

Following this recognition and the success of the original model, further lottery funding was awarded to develop the Champion model and use it to engage champions, communities and health services (Wellbeing 2).

Co-production of health and wellbeing outcomes

The model was applied to health services specifically with the aim of addressing the apparent disconnect between the NHS and community-based services. It helps connect both patients with support in their communities and professional practices with those communities.

Many citizens have volunteered in different ways and in different settings. These include:

  • Practice Health Champions working closely with their General Practice to create new ways for patients to access non-clinical support
  • Youth Health Champions where children and young people are recruited, trained and supported to help young people more actively engage with and influence their own and their community’s health
  • Pregnancy and early years Health Champions who are interested in giving children a better start
  • Health Champions working within a specialist, hospital-based NHS service
  • Senior Health Champions who engage with older people, offering a complimentary approach to more formal programmes

Community-based health improvement initiatives such as this could help to strengthen community-professional partnerships and cross-collaboration among health, social and other services. And this in turn could lead to a reduction in health inequalities.

Positive outcomes

According to a recent evaluation of the Health Champions programme, Wellbeing 2 has resulted in a range of benefits:

  • 86% of champions and 94% of participants in the programme reported increased levels of confidence and well-being;
  • 87% of champions and 94% of participants in the programme acquired significant new knowledge related to health and well-being;
  • 98% of champions and 99% of participants in the programme reported increased involvement in social activities and social groups;
  • 95% of practice staff involved with the programme would recommend it and wish to continue.

Other benefits included reduced social isolation, increased levels of exercise/healthy eating and feeling physically better. One champion reported “this has helped me more than any medication might.”

Success stories  include the work of a cycle champion who has improved her own health and wellbeing, encouraged over 70 other people to improve theirs through taking up cycling, provided cycle training to over 50 people in 6 community groups and provided specific detailed help to 5 people.

Other successes have involved volunteers setting up football training, providing support to women with mental health issues, providing advice and support to ethnic minorities and providing advice on healthy eating.

In terms of monetary value, an  analysis of the social return on investment (SROI) of a series of Altogether Better project beneficiaries found a positive SROI of between £0.79 and £112.42 for every pound invested, highlighting the potential value of these initiatives to funders.

Final thoughts

At a time of increasing demands on health services and with the relentless squeeze on public sector resources, perhaps the move towards greater community empowerment and collaboration across sectors is the right one. After all, as I’m sure we’d all agree, prevention is better than cure.

If you liked this blog post, you might also want to read Heather’s earlier post on social prescribing

Follow us on Twitter to see what developments in policy and practice are interesting our research team.