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Burhan Miah: Private investment can help boost our meagre foreign aid

By Centre Write, Health & Social Care, Politics

The Government’s promise to “leave no-one behind” has been trampled on by none other than the government itself. The government wastes money on consultants who do not make any lasting impact on developing countries. International aid has propped up corruption in recipient countries, such as in Lebanon, where their ministers redistribute foreign aid into maintaining their hold in power through agreements with other parties, leaving many without adequate social services or education. Foreign aid is easily abusable and can hurt developing countries instead. However, those problems can be alleviated through private investment as an alternative to the current system. 

Utilising the private sector to facilitate the growth of developing countries is not the standard strategy for national governments. This is because the OECD definition of official development assistance (ODA) states it must be delivered by official public entities, and not by private companies. These rules encourage of the provision of taxpayer-funded aid, but the scale of it is too small for adequate progress in developing countries.  

While the UK spent 0.55% of its Gross National Income (GNI), or approximately £13 billion on aid in this year, by 2030, there is a need for $500 billion to be spent annually within low-income developing countries (LIDCs), and a further $2.1 trillion for emerging countries, which are only partially developed. But, in 2022, the total spending from the Development Assistance Committee, comprised of the world’s 32 major state donors, raised only a total of €211 billion for foreign aid. A different strategy is needed. State money globally can only meet the full need for foreign aid to a limited extent, but there is an opportunity for private finance to fill the gap. 

This is not an entirely novel idea. Already in 2019, Penny Mordaunt, then-International Development Secretary, was reported to have had conversations with cabinet ministers regarding how her department could focus on fundraising instead of spending. Her proposals then already included reforming OECD aid rules for investments in private initiatives. Current rules for ODA eligibility do not allow for this. 

Indeed, the UK has already launched initiatives to involve the private sector through its aid spending. Alongside other developed countries like Germany and Australia, the Private Infrastructure Development Group provides financial and strategic support to encourage private infrastructure investment in LIDCs. In addition to this, between 2011-2019, the Commonwealth Development Corporation (CDC), the profit-making investment arm of the then- Department for International Development, made 52 investments in foreign aid; mostly in Ghana’s energy and agricultural sectors. In response to this success, The UK’s 2022 Aid Strategy has set a target for British International Investment (formerly CDC) to raise £8 billion annually by 2025, which is already seeing success, potentially meeting the target three years early. 

Investment in the private sector in developing countries can bring significant benefits to the local community. Cadbury’s investment to secure consistent, high-quality cocoa from Ghana has improved the income of farming communities, benefiting 10,000 farmers and their families. In addition to supporting farmers financially, the investment has raised awareness on gender equality and child labour. For-profit companies that invest in local communities are incentivised to care about the wellbeing of the people living in them, because it can lead to greater productivity amongst workers. To this end, they make various kinds of philanthropic contributions, including grants and knowledge sharing. 

There are other benefits in private initiatives to develop LIDCs. They are not only more sustainable than taxpayer-funded aid but can also reduce developing countries dependence on debt caused by state aid, which is usually delivered through loans. This is because private initiatives lead to investment directly to recipient countries, without the need for the state to pay back loans. This advantage has led to such an approach has been supported even by the more populist members of the Conservatives, including Jacob Rees-Mogg and Priti Patel. 

Companies are already willing and eager to invest into developing countries. Despite the support the government has announced within the last few years, it is still a small proportion of the overall aid budget. The potential of private investment remains untapped. There is funding need for trillions and, while this need exists, investment into LIDCs will remain below adequate levels. It is necessary for governments to consider schemes to bring in further private investment for foreign aid, without which we will not meet the living conditions we want to see in developing countries. 

 

Burhan Miah was undergoing work experience at Bright Blue. Views expressed in this article are those of the author, and not those of Bright Blue.

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William Morris: A new programme of National Service would help tackle our mental health epidemic

By Centre Write, Health & Social Care, Politics

There is no escaping the continuing apocalyptic diagnoses about the state of young people’s mental health in this country. The news cycle regularly informs us about new record levels of one symptom of poor mental health or another: whether it be loneliness, anxiety or even suicidal thoughts. To help alleviate it, the UK Government should reintroduce a programme of National Service.

Throughout the COVID-19 pandemic, young people under 30 were constantly more lonely, more anxious, more stressed and were 10% more likely to report poor mental health as compared to the over-60s. Consequently, in 2019, just under a quarter of young people have self-harmed. Indeed, the leading cause of death for those under the age of 35 is suicide. This mental health epidemic points to a generation who are in crisis, struggling to find their identity and purpose in life, and, most importantly, are lonely.

It is important to alleviate the symptoms of loneliness at the start of adulthood so that those widespread feelings do not snowball into something worse, such as anxiety or depression. It is clear that loneliness increases the risk associated with those poor mental health symptoms. If young people do not have the community and the mechanisms to ensure positive mental health, then the crisis will only worsen.

To help provide young people with that lacking sense of community and duty, the Government ought to reintroduce a programme of National Service.

A 2022 academic study detailed that there are three key ways to end loneliness: expense, accessibility and structure. Many young people find it hard to participate in socialising if money and distance are a barrier and if an activity is unstructured, as it can often appear to lack purpose. A National Service Scheme which ran every summer for those between the ages of 18-22 would provide solutions to each of those three key issues, creating a generation that stands ready to face the challenges and demands of the twenty-first century.

While in one sense we may nowadays be more connected more than ever, it is often through the internet, which gives a false sense of intimacy and friendship. Young people are now spending over double the amount of time on the internet compared to the outside. Working and adventuring with others should instead be with real bonds, with real people, in the real world. Within a National Service programme, not only would fraternity and community inevitably be fostered, but those bonds would help to create a more positive and interconnected generation helping to alleviate anxiety and social exclusion.  Friendships in the real world are far more valuable than those online.

Indeed, a key job of government is to provide opportunities for young people, whether it be in schools or otherwise. Not only would a National Service programme provide career and skills opportunities, if appropriately structured, but personal development too. Given that 65% of 15-year-olds worry about their future career, National Service could assist in refining employment and financial skills which all too often do not get taught in schools.

Thus, through a new National Service, young people would experience new opportunities, but could also improve both their mental and physical health. Those who are active and participate in regular exercise are three times more happy than those who are not regularly active. The good habits of exercise benefit far more than just the body, and those could be facilitated by the programme.

There have been attempts to re-invent the spirit of National Service before, such as through the National Citizen Service scheme set up by the 2010-2016 Cameron Government. Yet it has failed to garner uptake, at only 13% of those eligible, despite a target of 45%.  A better scheme could work on an opt-out basis, as suggested in a report by the think-tank Onward, so the opportunity is the default for young people. With such a large group participating, not only could those who have felt loneliness have the opportunity to meet others, but a great experiment of social mixing would take place, helping break down the class and social barriers present in the UK society.

It would be a formative experience at the start of adulthood, providing friends and new skills to tackle anxiety and loneliness. National Service would break down barriers, bring young people together, give them new friends and new skills and, hopefully, help put the worries and anxiety that foster our mental health epidemic to rest.

 

William Morris is undergoing work experience at Bright Blue. Views expressed in this article are those of the author, and not those of Bright Blue. [Image: Maël Balland]

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Annabelle Walker: Childcare needs more than just demand side reform

By Centre Write, Education, Health & Social Care, Politics, Towns & Devolution, Welfare

The childcare crisis in the United Kingdom is more than just a pressing social issue; it’s a ticking time bomb with profound economic repercussions. The UK’s broken childcare system is an epidemic that has significant negative impacts on UK economic productivity and exacerbates the gender pay gap. Whilst initial progress has been made to address the crisis, specifically increasing demand for childcare, more needs to be done to address shortfalls in supply.

The astronomical cost of childcare has forced one in four UK parents to quit their jobs or drop out of education. This issue is highly gendered, with women predominantly bearing the brunt of unpaid domestic labour and childcare responsibilities. Consequently, women face a widening gender pay gap amid the relentless cost of living crisis. Bridging the gender gap could generate an extra £150 billion in GDP by 2025, with childcare provision playing a crucial role in unlocking this potential.

Additionally, investment in early childhood education (ECE) yields significant long-term socioeconomic benefits. Indeed, children who receive high-quality ECE are 14% more likely to be employed as adults, earn higher annual incomes, and can indirectly lower the likelihood of individuals engaging in criminal activities. Advancements in social mobility caused by ECE clearly highlight the need for a fully-functioning childcare system. 

Earlier this year, the UK government announced a £4 billion childcare reform package in response to the childcare crisis. The reforms included various initiatives such as the Extended Early Years Free Entitlement program, which grants children under three 15 hours of weekly free childcare, increasing to 30 hours per week by 2025. Additionally, the Government are attempting to incentivise new childminders with a £600 sign-up bonus to bolster recruitment in the childcare industry. 

Whilst these reforms are a step in the right direction, they largely fail to address the rapidly declining supply of childcare providers. It is imperative that the Government address this issue, as focusing solely on increasing demand for free childcare will create a chasm between expectations and capacity.

According to a nationwide survey by the Early Years Alliance, a substantial portion of childcare providers plan to offer only a limited number of places under the Government’s scheme for free childcare and charge privately for the rest. Eighty-three percent of providers expect an increase in demand under the new scheme, yet 60% will not be increasing the number of places they offer. This highlights the scheme’s fundamental flaw: demand is increasing, yet supply is not.

Supply is decreasing. There is a critical shortage of qualified childminders, with the number of registered childminders in England declining by 11% in just one year – falling to their lowest number since 2012. Ofsted data shows this results in a loss of more than 20,000 childcare places per annum. 

The number of staff employed by voluntary organisations and school-based nurseries is also declining. Childcare professionals are not accepting children eligible for government-funded care due to insufficient government payment. The only childcare providers to increase staffing between 2019 to 2022 were private nurseries, raising serious concerns regarding the perpetuation of socioeconomic disadvantage, given the benefits of ECE.

Ultimately, the financial viability of running a childcare business, coupled with low pay, increasing workloads and the cost of living crisis, is driving professionals away from the sector. Experts, such as Neil Leitch from Early Years Alliance, worry that government efforts to attract new childminders, such as sign-up bonuses, are unlikely to stem the exodus of existing professionals, and risk de-professionalising the workforce. 

To successfully tackle the childcare crisis, it is vital to increase the number of childminders and the capacity of existing providers. Expanding the workforce is the only way to bridge the supply-demand gap, increasing childcare provider participation in the Government’s currently ineffective childcare scheme. 

Boosting the workforce can be achieved in two ways. 

Firstly, recruitment of qualified childcare providers. Promoting early childcare careers to graduates via accessible Teach First style training programmes directly increases the size of the workforce. Germany’s ECEC training programme provides paid employment alongside the equivalent of a bachelor’s degree in vocational training for childcare. Hugely successful, the initiative attracts more applicants than places, highlighting the effectiveness of training programmes in recruitment. These programmes simultaneously increase the quality of ECE. Childcare providers with graduate and Level 3 qualified staff are shown to score highly on quality measures including learning, literacy, and language, and tend to be the most highly graded childcare settings. 

The second way to increase the workforce is by incentivising qualified workers to stay in the industry. To retain existing professionals, the Government should increase funding to match the increasing costs of providing childcare services. Currently, the Government pay professionals less than two-thirds of the estimated cost of the provision of free childcare. 

Furthermore, the Government must provide employees with professional development opportunities. Multiple countries have implemented effective strategies that retain qualified workers within the childcare sector. Slovenia’s early childcare system promotes preschool teachers to various titles, which correlates with pay rises. Promotion is based on years of experience, performance at work and engagement in additional professional development activities. Staff who are engaged, feel valued and can fulfil career ambitions are more likely to remain within their sector. The UK government should investigate implementing a similar model to decrease the mass departure from the UK’s childcare industry.

Therefore, childcare reforms must target the growth of childcare suppliers. Only by  increasing the supply of childminders and the capacity of existing providers can the UK fully resolve the childcare crisis, unlocking the untapped economic potential of parents who currently have no choice but to stay at home.

Annabelle Walking is currently doing work experience at Bright Blue. Views expressed in this article are those of the author, not necessarily those of Bright Blue. [Image: Arron Burden]

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The Rt Hon Sir Robert Buckland MP: The Rwanda scheme needs to be fairer, or we risk alienating voters

By Archive podcast, Centre Write, Health & Social Care, Politics, Towns & Devolution

Since its very inception, the principle of fairness has been the very foundation of the justice system in this country. Indeed, something cannot be fair if it is not just, and vice-versa. The United Kingdom has continued to champion justice ever since, with a strong emphasis on freedom and the rights of the individual being upheld by due process.  We have a long and proud legacy on this, from trial by jury and habeas corpus, through to the Police and Criminal Evidence Act and our leadership in drafting the European Convention on Human Rights.

It would be a travesty if such an admirable record were undermined by a knee-jerk response to a complex and sensitive issue. Without more work, the current Rwanda scheme threatens to erode the very sense of fairness that underpins so much of the British state and its functions, and, crucially, any policy that offends the innate British instinct of justice and due process will alienate voters and lose us the argument.

It is obvious that we must address the Channel crossings and dismantle the business model of the unscrupulous criminal gangs that profit from desperation and misery. Indeed, the perils of making the Channel crossing mean there is a humanitarian imperative that this Government’s approach is the correct one. The Government is right to challenge its critics to come up with other solutions, instead of a deafening silence.

It is also important to acknowledge that, when dealing with such a dangerous and desperate problem, we have to be firm to be fair. This means retaining the use of third countries as a last resort, but going back and looking at what can be done before their use to ensure we discharge our duties to vulnerable people while putting an end to their exploitation by a network of smugglers and criminals.

The latest report from the think tank, Bright Blue, can be looked to for inspiration for the path we need to take.  The use of humanitarian visas should be restored with safe routes subject to a quota. These policies would command popular support, too, resonating with the all-important public spirit of fairness and compassion.

It is vital we tackle this vexed and very human issue, but that can only be done with an approach that the public can get behind and that accords with proper due process and can withstand proper scrutiny. We simply have to move beyond facile arguments about the ECHR and “leftie lawyers” and start looking at solutions that pass both moral and political tests.

The Rt Hon Sir Robert Buckland MP is the former Justice Secretary. Views expressed in this article are those of the author, not necessarily those of Bright Blue. [Image: Gov.uk]

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Finn O’Hare: The Government can’t keep leaving sports on the bench

By Centre Write, Health & Social Care, Politics, Towns & Devolution

With one in six deaths in the UK being associated with physical inactivity it seems incredulous that tackling something as manageable as inactivity crisis has not been made more of a priority. Despite the government claiming that their policy on sport has been “to get more people in sport” for more than a decade, it is impossible to deem such policies a date – the UK is 20% less active than in the 1960s and projected to be 35% less active by 2030. The statistics lays bare the scale of the task ahead in reversing this worrying trend.

It is indisputable that those who are active in their childhood are more likely to remain active as they grow older, demonstrating why prioritising youth participation in sport is fundamental to tackling the inactivity crisis. The importance of prioritising youth sport cannot be overstated, with increased physical activity associated with widespread benefits on an individual’s mental and physical health, reducing the risk of dementia by up to 30%, cardiovascular disease by up to 35% and all-cause mortality by 33%. 

The impacts of increased inactivity amongst children are becoming clear, with the rate of obesity amongst children in the UK rising steadily over the last 15 years, regardless of how vocal the government has been in pledging to tackle the nation’s health and obesity since the pandemic – the 2023 government report concluded that 37.7% of year six age children obese or overweight, up significantly from 31.6% in 2006. 

It is clear that young people are not physically active enough, with just 47% of children meeting the UK Chief Medical Officers’ guidelines of taking part in an average of 60 minutes or more of sport and physical activity a day. Given that the majority of the nation’s children are not active enough, it can hardly be a surprise that tackling child obesity rates has proven so difficult. It is imperative that more be done to instil the importance of living an active and healthy lifestyle from a young age through the promotion of sport amongst young children and in schools, a mentality which should carry through to adulthood after being instilled early on. The evidence is clear that those who are active in their childhood are significantly more likely to remain activity for the duration of their life, and vice versa. The current generation of children is collectively unhealthy, a trend which if continued over time will only increase future pressure on an already struggling NHS, for whom physical inactivity is estimated as costing £0.9bn a year. With waiting lists already reaching record highs of 7.5 million in 2023, the importance of acting upon something as controllable as inactivity. 

While the causes of obesity are complex and multifactorial, it is driven by an imbalance in energy intake and energy expenditure. Given that physical activity is the most modifiable factor of energy expenditure and is responsible for roughly 25% of total energy expenditure, it clearly has significant power to impact the energy balance equation and in turn one’s likelihood of becoming obese. 

Furthermore, beyond the physical health benefits, the endorphins released by your body in response to exercise interact with receptors in your brain and have been proven to help ward off feelings of anxiety and depression, reduce stress, boost self-esteem and improve sleep. When we live in a time where 18% of 7 to 16-year-olds have a probable mental disorder, and mental health crisis care services are underfunded and understaffed, increasing activity has the potential to reduce strain on the NHS across multiple departments, as well as having multifaceted benefits on both children and society as a whole.

An increase in sports participation would also likely have benefits for educational attainment –  higher cardiorespiratory fitness is associated with higher brain function, improvements in cognitive control of working memory and levels of concentration, and consequently with higher results in tests, demonstrating the potential for the positive impact physical activity can have on an individual’s education. This further highlights the importance of investing in youth sport and the scope for improvements on an individual’s quality of life through an amalgamation of the aforementioned factors.

While the need for action appears to have been recognised at least to an extent by the government, which has implemented investment plans, such as the ongoing PE and sport premium funding established as a legacy to the 2012 Olympics, and the pledge in March 2014 of £150m a year for primary schools’ sport funding guaranteed until 2020.  And yet, 10 years on from their implementation, 4,000 hours of PE were lost at state schools over the past year, part of a wider trend of decline since the 2012 Olympics over which period there has been a 12% drop in school hours dedicated to sport – the plans can only be considered as a failure. This negative trend has been described as “a matter of immediate national concern”  by the Youth Sport Trust and should serve as the impetus for change, as it is irrefutable that the current plans are not working, and action needs to be taken to halt and reverse the decline – failure to do so is likely to have long term impacts on both the NHS and on individuals in terms of their physical health, mental health and educational attainment.

With this in mind, in tackle the inactivity crisis facing Britain it is clear that the government needs to do more to boost sport participation and activity levels amongst children, Increasing accessibility to all sports to all children. An acknowledgement of the far-reaching potential sport has to benefit an individual’s wellbeing academically, physically and mentally is a necessity to avoid at all costs allowing PE provision to decline as a result of core subjects being given additional time, a needless and dangerous scenario which 38% of teachers have said they felt is the case. Greater provision of compulsory sport in school hours, as well as the funding and resources to increase accessibility of after-school sports clubs is an absolute necessity.

While attempts have been made to show an interest in children’s sport the issue lies in the government directly contradicting itself with the advice and the policy they are issuing – while recommending children should take part in at least seven hours of sport a week, they are simultaneously stating in their own school sport and activity action plan that they intend to provide support for teachers and schools to deliver just two hours of high-quality PE a week. The need for a new approach and commitment to making physical activity a priority not just through words, but by implementing policies and funding to ensure children can readily access the levels of physical activity they are recommending is unquestionable. 

Without a radical and committed new plan, the UK faces falling further into an inactivity and obesity ‘epidemic’, a major concern given it already ranks fourth in Europe for having the most overweight and obese adults at present.

Finn O’Hare is currently doing work experience at Bright Blue. Views expressed in this article are those of the author, not necessarily those of Bright Blue. [Image: Jeffrey F Lin]

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Taylor Ross: The decline of funding in the adult social care sector

By Centre Write, Health & Social Care, Politics

The number of people in the UK aged 65 years or over increased from 9.2 million in 2011 to over 11 million in 2021, and the proportion of people aged 65 years and over rose from 16.4% to 18.6% within the same timeframe. Almost two million of those adults now request additional support in the form of adult social care. The UK is sleepwalking into a crisis – the need for publicly-funded social care for older adults has now become more pressing than it has ever been. 

The lack of a national budget for social care has been a major contributor to the decline in access to care for older adults across the country. In September 2021, the Government announced they would use £5.4 billion of revenue from the Health and Social Care Levy to reform adult social care, but, just a year later, the Levy was cancelled to reverse the rise in National Insurance contributions from businesses and employees. However, as a result, the extra funds for adult social care were lost, and the sector continues to suffer.

Without the Health and Social Care Levy, publicly-funded social care is only available through local government tax revenue, putting increased pressure on local government finances. This forces local governments to spend less on social care and ultimately leads to a fragmented social care system, with some areas across the country better off than others.

This is particularly important for poorer adults who are in need of social care. For, while those with assets over £23,250 are required to fund their social care themselves anyway, those with assets between £14,250 and £23,250 can receive partial funding from the local government and those with assets under £14,250 ought to be able to receive fully-funded care. However, due to the fragmented quality of the sector, those with lower assets may only have access to insufficiently-resourced care and have to resort to funding some of it themselves regardless.

The lack of funding for adult social care also puts more strain on the NHS, as those who are not receiving adequate care are more likely to seek hospital treatment. In 2021/22, the social care sector saw 165,000 vacancies — the highest number of vacancies the sector has ever experienced. 

At the same time, the quality of adult social care has been declining for years and is now sorely insufficient. According to a report by the Nuffield Trust, although the number of older people receiving state-funded long-term support has decreased by 10% since 2015/16, the number of adults over the age of 65 has risen by 8% since 2015. Indeed, between 2015 and 2020, 120,000 more people requested social care support, but 14,000 fewer people received it.

The decline in the number of people receiving social care can be linked to staffing shortages. As a result of cuts to social care workforce funding, there has been a 52% increase in vacancies in the social care sector from 2021 to 2022, as staff are leaving the sector for better wages.

Previous governments recognised the need for reform in the social care sector by commissioning the Dilnot Report to review social care in the UK and introducing the Health and Social Care Levy, which both sought to put a cap on lifetime care costs, in turn protecting people from spiralling care costs and providing more certainty around the costs of care. However, the former was not followed up on, and the latter was cancelled, making their attempts to fix the sector unsuccessful. The adult social care sector needs significant reforms to prevent it from collapsing. Without reform, it will become unsustainable.

Taylor Ross is a Research Assistant at Bright Blue. Views expressed in this article are those of the author, not necessarily those of Bright Blue. [Image: Dominik Lange]

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Taylor Ross: A mental health crisis is breaking the NHS

By Centre Write, Health & Social Care, Politics

For all the clapping we did, after the pandemic, healthcare workers, who had to bear the brunt of it, showed extreme signs of depression, anxiety and post-traumatic stress disorder. In June and July 2020, 45% of critical care workers, including doctors and nurses, reported having symptoms consistent with a diagnosis of severe depression, anxiety or post-traumatic stress disorder.

To address this, in 2020, the government invested £15 million to set up 40 mental health service hubs for the healthcare workers who worked on the frontline during the pandemic. The Mental Health Director of the NHS, Claire Murdough stated that “it is crucial that the NHS staff working tirelessly to protect the health of the nation throughout this pandemic are given the support they deserve.” Yet the funding for those ended on March 31 of this year, placing high-risk NHS staff at even greater risk of exacerbating their mental health symptoms.

In a study done by Neil Greenberg, Professor at King’s College London, one-in-seven intensive care unit staff and one-in-five nurses expressed thoughts of suicide or self-harm. And yet data from 11 of the 40 hubs showed 2,800 staff will be left without rapid access to mental health services after March, even though the demand for the hubs has risen by 72% between October 2021 and 2022.

This discontinuation of funding has left thousands of healthcare workers without adequate access to mental health services. The mental health hubs helped reduce symptoms of depression, anxiety and PTSD and contributed to the overall wellbeing of NHS staff. Indeed, the British Psychological Society (BPS) and Association of Clinical Psychologists – UK (ACP-UK) launched the campaign, #FundNHSHubs, to encourage the government to continue funding for a minimum of one extra year to allow the hubs to keep supporting NHS staff and allow them time to find an alternative treatment.

The closing of the mental health hubs has now resulted in NHS staff being forced to go through the standard NHS mental health system, where it can take over a year to receive just the initial appointment. This could lead to NHS staff taking more sick leave and will exacerbate suicide risk and burnout. In January 2023, anxiety, depression and other psychiatric illnesses were the most reported reasons for sickness absence in the NHS. Over 520,470 full-time equivalent days were lost, and mental health-related absences rose as a percentage of all absences from 20.8% in December 2022 to 23.3% in January 2023. Indeed, research from the British Medical Journal in 2021-22 estimated £8.9 billion was spent on temporary staffing because of sickness absence. Therefore, cutting the funding to the mental health hubs is likely to be more expensive – costing as much as £213 million if the increase in mental health-related absences between 2022 and 2023 is due to the lack of mental health hubs – than funding them. More than that, the cut in funding could ultimately put staff and patient care in jeopardy.  

Access to timely mental health resources resulted in more NHS staff returning to work, effectively alleviating the strain on the healthcare worker shortage. To save money and improve the quality of service, the government should continue funding extra mental health resources for healthcare professionals. Mental health support for healthcare workers should not just be seen as a short-term solution to the effects of the pandemic, but as a necessity to ensure the continued sustainability and efficiency of the NHS and the wellbeing of its staff.

Taylor Ross is a Research Assistant at Bright Blue. Views expressed in this article are those of the author, not necessarily those of Bright Blue. [Image: Nicolas J Leclercq]

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Martin Guy: Reform primary care funding or live with long waiting times

By Centre Write, Economy & Finance, Health & Social Care

Primary care is under significant pressure. Waiting times have been increasing, with the average wait time for a non-urgent face-to-face GP appointment being 10 days; up by 15% since last autumn. GPs need to see more patients than they do currently, and given the significant problems with GP recruitment and retention, existing GPs will have to be more efficient and productive in order to see more patients. This can be done by replacing the current funding model and introducing Payment by Results (PbR). 

Under PbR, each treatment is classified into Health Resource Groups (HRGs), which are groups of similar treatments under similar clinical conditions, each having a fixed tariff. Healthcare providers are paid per individual case, with the amount depending on which HRG the patient falls under. PbR encourages improvements to productivity and efficiency – providers who see more patients generate more revenue. 

PbR has been gradually introduced into secondary care between 2004 and 2007. As a result, waiting lists fell from 1.8 million in 2003/4 to 650,000 in 2007/8. Despite its clear success, PbR has only been used in secondary care (where care is given by a specialist), and not in primary care (typically the first point of contact, where care is given by a generalist).

Primary care is currently funded by a capitation model of ‘global sum’ payments, where each practice is paid according to the number of registered patients, weighted by the Carr-Hill formula which considers factors like rurality and demographics. Under this system, there is no financial incentive to see patients, as practices receive funding for having patients registered, not for treating them. Only the Quality and Outcomes Framework (QOF) gives this incentive, as it gives practices additional funding if they meet certain thresholds for patient care. However, QOF has been temporarily suspended to allow practices to focus on vaccination programs and recovery from Covid; and it only provided around 10% of practice budgets. In contrast, global sum payments account for around 50% of practice income. The lack of financial incentive to see and treat patients is a barrier to sufficient provision of primary care services. 

PbR and HRGs could easily be applied in primary care. Due to longer appointment times, face-to-face consultations could be reimbursed more generously than virtual or telephone consultations. Urgent appointments and more serious conditions could be reimbursed more generously too, providing a greater financial benefit for dealing with more difficult cases, encouraging practices to do so. Applying the Carr-Hill formula to PbR would ensure that funding continues to be fair across the country. PbR could be particularly effective in primary care, given that 61% of full-time GPs are partners. This means they own a stake in their practice, and receive a proportion of the annual profits, so there is a direct incentive from PbR. 

And unlike most other reforms advocated for the NHS, changing the primary care funding model to PbR would not require any additional funding. The existing budget would just be reallocated to be used in a more efficient way. The practices which receive less funding would be those that see fewer patients relative to their list size, so there would be an incentive for those practices to see more patients. 

Whilst PbR incentivises doctors to provide more care through seeing more patients, this may come at the expense of quality of care. To counteract this, QOF funding should be increased as a proportion of practice income. Practices would have a greater incentive to adhere to the level of care set out in QOF. In addition, Care Quality Commission (CQC) inspections ensure that practices do provide an adequate quality of care. 

PbR is already used in primary care in other countries with single-payer healthcare systems like the UK. In Australia, their GP practices are funded almost entirely by PbR payments. Despite Australia only spending 6.7% of total healthcare spending on primary care (compared to 7.7% in the UK), their average waiting times are around 4 days, a fraction of the waiting times in the UK. 

Waiting times in primary care are simply too long. This long-running problem has a solution, which has already proved its worth in the NHS, and delivers better results in primary care for our international peers. Applying PbR in primary care is a necessary step to bring down waiting times and ensure all patients get the care they need. 

Martin Guy is currently undertaking work experience at Bright Blue. Views expressed in this article are those of the author, not necessarily those of Bright Blue. [Image: Hush Naidoo Jade Photography]

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Anvar Sarygulov: Stepping up – public attitudes to addressing the cost of living crisis

By Anvar Sarygulov, Centre Write, Economy & Finance, Health & Social Care

Introduction

The cost of living crisis is hitting the finances of British families hard: the Consumer Financial Confidence Index has dropped to the lowest score in a decade and inflation reached 5.5% in January. 

But we are only at the beginning of this storm: the energy price cap is increasing by 54% in April 2022, and will increase by a further 52% in October 2022 if energy prices remain at current levels, while inflation is expected to peak at above 8% this year. 

The 3.1% uprating in benefits, based on inflation rates in distant September 2021, looks to be disastrously dated, leading to significant reductions in the real income of low-income households.

Bright Blue’s Social security after Covid-19 project aims to develop a policy programme that strengthens the UK’s safety net in the long-term and wins the support of the public and policymakers from across the political spectrum. But given the scale and pressures of the current challenge, and the need for the Government to act quickly and decisively to protect the poorest in the year ahead, we are publishing this short piece detailing extracts of our original polling evidence, giving new insight into what the public thinks about the cost of living crisis.

Methodology

We polled a nationally representative sample of 2,008 UK adults, in partnership with Opinium. Within this overall sample, we also have unweighted subsets of those who have voted for the Conservatives (672), Labour (494) and Liberal Democrats (178) in the 2019 General Election. 

Views on the cost of living crisis

Our polling illustrates that there is a clear expectation from the majority of the UK public that the benefit system helps to address the cost of living crisis, as shown in Table 1 below.

Table 1: Support of UK adults for statements on the role of government, by 2019 GE vote

Total Conservatives Labour Liberal Democrats
Benefit payments should be sufficiently high to allow people to pay for their costs of living, such as housing payments, buying essential food and heating their homes 72% 68% 83% 80%
It is the government’s responsibility to ensure that all people have financial support to meet their basic needs 67% 55% 83% 77%

Base: 2,008 UK adults

Overall, the public thinks that the government has a key role to play in maintaining standards of living for those on the lowest incomes: 72% of the UK public supports the idea that “benefit payments should be sufficiently high to allow people to pay for their costs of living, such as housing payments, buying essential food and heating their homes” and 67% of the public supports the idea that “it is the government’s responsibility to ensure that all people have financial support to meet their basic needs”.

These principles enjoy cross-party support: 83% of 2019 Labour voters support both statements. Meanwhile, while 2019 Conservative voters are less likely to agree, a majority still express support, with 68% supporting the idea that benefit payments should be sufficiently high and 55% supporting the idea that the government is responsible for ensuring people meet their basic needs. 

Furthermore, there is widespread perception that the finances of vulnerable groups have become worse off since the start of the Covid-19 pandemic, as illustrated in Table 2 below, which shows the net view (% of respondents who described the group as better off minus % of respondents who described the group as worse off)

Table 2: Net view of UK adults on whether the following groups have become worse or better off financially (better – worse) since the beginning of the Covid-19 pandemic, by 2019 GE vote

Total Conservatives Labour Liberal Democrats
Low-income working parents -54% -43% -72% -55%
Those on lower incomes -53% -41% -73% -58%
Those with long-term mental health problems -51% -45% -68% -51%
Those who care for people with long-term health problems -50% -45% -65% -48%
Those with long-term physical health problems -51% -43% -63% -49%
Unemployed people -33% -16% -57% -29%
Those on higher incomes 27% 23% 34% 46%

Base: 2,008 UK adults

There is a common perception among the UK public that a wide range of vulnerable groups have become worse off financially since the beginning of the Covid-19 pandemic. Overall, low-income working parents (-54%) and those on lower incomes generally (-53%) have the lowest net score among the whole UK population, though those with long-term health problems (-45%) and those who care for them (-43%) are also seen to be significantly worse off than before the pandemic. 

While 2019 Labour voters are more likely to think vulnerable groups have become worse off, with those on lower incomes (-73%) and low-income working parents (-72%) receiving the lowest net scores, 2019 Conservative voters also on average share this downbeat assessment. Conservatives are more likely to think that vulnerable groups have become worse off than better off, especially those with long-term mental health problems (-45%), those who care for them (-45%) and low-income working parents (-43%). 

But perceptions of the UK public are much more divided on whether a ‘typical benefit claimant’ receives sufficient or insufficient support from government with their regular expenses, as shown by Table 3 below.

Table 3: Perception of UK adults whether a ‘typical benefit claimant’ receives sufficient support from government to deal with the following regular expenses

   Less than sufficient Sufficient More than sufficient Don’t know
Utility bills Total 43 % 28 % 9 % 20 %
Conservatives 33 % 36 % 12 % 19 %
Labour 61 % 21 % 5 % 13 %
Liberal Democrats 48 % 23 % 6 % 24 %
Food costs Total 38 % 34 % 8 % 19 %
Conservatives 26 % 46 % 13 % 15 %
Labour 56 % 29 % 3 % 12 %
Liberal Democrats 48 % 27 % 4 % 22 %
Housing costs Total 34 % 35 % 10 % 21 %
Conservatives 22 % 47 % 13 % 17 %
Labour 54 % 28 % 4 % 15 %
Liberal Democrats 42 % 24 % 9 % 25 %
Childcare costs Total 34 % 30 % 11 % 25 %
Conservatives 22 % 40 % 16 % 23 %
Labour 54 % 24 % 6 % 16 %
Liberal Democrats 42 % 25 % 7 % 26 %

Base: 2,008 UK adults

As shown by Table 3, UK adults perceive benefit payments as either less than sufficient or sufficient at roughly equal rates, with a significant proportion also reporting ‘don’t know’. Government support with utility bills is the most likely to be seen as less than sufficient (43%), while support with housing costs is the most likely to be seen as sufficient (35%). 

For all types of costs polled, 2019 Conservative voters are most likely to see benefit payments as sufficient, while 2019 Labour voters are most likely to see them as insufficient.  Both 2019 Conservative (33%) and 2019 Labour (61%) voters are the most likely to see support with utility bills as less than sufficient out of all costs polled, but the large gap shows that Conservative voters are much less likely to think that the support is less than sufficient.

Conclusion

Our polling identifies that the UK public, across political divides, supports the idea that benefit payments need to be sufficiently high to allow people to pay for their costs of living, and that the financial support provided by the government needs to meet their basic needs. Furthermore, they believe that the pandemic has made vulnerable people financially worse off. 

But where there is disagreement amongst the public is whether current benefit payments for different types of costs are sufficient to meet needs of a “typical benefit claimant” 

Given the scale of the cost of living crisis, without further government intervention beyond what was announced in the 2021 Spring Statement, many more households are likely to struggle and become much poorer. The Household Support Fund, which provides low-income households with ad-hoc grants or vouchers through their local authority, is insufficient for the scale of the crisis, and to meaningfully help those on low incomes, the Government should bring forward the next uprating of benefits into this year, and match the increase in the Warm Home Discount to the rise in energy prices.

[Image: Pixabay]
April 8, 2022

Phoebe Arslanagić-Wakefield: The benefits, challenges and future of home working

By Centre Write, Health & Social Care, Housing & Homelessness, Phoebe Arslanagic-Wakefield

Today, we at Bright Blue launched our latest report, No place like home? The benefits and challenges of home working during the pandemic. Made possible by the partnership of Barrow Cadbury Trust and Trust for London, this extremely timely report investigated the nature of home working during the pandemic. 

Synthesising original Bright Blue polling and dataset analysis with existing literature on home working from both before and during the pandemic, the report explores the experiences of pandemic home workers, and particularly how those experiences varied among different socio-demographic groups, detailing both the leading non-financial benefits and challenges of home working during the pandemic.

We found that home working has become a very common experience across the UK, with the vast majority (68%) of UK workers having home worked at least some of the time since the start of the pandemic. This appears to have had a profound normalising effect – 51% of pandemic home workers told us they would prefer to continue home working most of the time after the pandemic. 

Certainly, many pandemic home workers reported experiencing a diverse range of practical, psychological and social benefits as a result of the home working model. For example, 57% of pandemic home workers were clearly pleased to have left commuting behind, choosing ‘no commuting’ as one of their top three ‘best things’ about home working. 

Many pandemic home workers also felt their sense of control over their workload had increased, especially in terms of their daily routine (56%), their control over how they work (55%) and the hours they work (51%). 

For some, home working appears even to have led to improvements in family life – 37% of pandemic home workers reported an improved relationship with their partner as a result of home working, and 38% said the same of their relationships with their children. 

But pandemic home workers also reported a range of practical, psychological and social challenges.  

According to our research, practical challenges also plagued many pandemic home workers. Fifty-three percent said that ‘poor internet’ had been a problem at least sometimes, with other practical issues reported by a majority of pandemic home workers including ‘noise disturbances’ (55%), a ‘lack of space’ (51%), ‘lack of ventilation’ (38%) and mould (35%). 

Pandemic home workers also identified psychological challenges with home working. Forty-four percent of pandemic home workers agreed that they felt lonely more often while home working and 47% said that they find it harder to disengage from work while home working. 

Concerningly and very seriously, 11% of pandemic home workers said they had experienced domestic abuse between March 2020 and February 2021, in comparison with 1% of non-pandemic home workers. That risk was even higher for disabled pandemic home workers where 27% reported experiencing domestic abuse. 

Overall, our evidence showed that neither the benefits nor the challenges of home working during the pandemic that we identified have been felt evenly or equally between home workers of different socio-demographic backgrounds. With home working here to stay, that must be addressed.

In light of all we uncovered, Bright Blue has used the report to put forward the following policies that are designed to mitigate the challenges of home working, and increase access to the benefits of them.

  • Introduce the right to ten days of domestic abuse leave per year. We recommend that the Government introduce domestic abuse leave, giving all employees the right to ten days domestic abuse leave annually – five days paid and five days unpaid. All full-time employees who have worked for the same employer for 26 weeks will have the right to domestic abuse leave in line with other statutory rights such as paid parental leave and statutory sick pay. The right should also apply to part-time and casual workers, according to minimum hours worked rather than salary thresholds, as is the case with other statutory rights. As is the case in New Zealand, to claim their leave, including retroactively, workers must provide their employer with proof.

 

  • Require all employers with 50 or more employees to train an employee as a designated point of contact for domestic abuse victims. This should be applicable only to medium to large employers, meaning those with 50 or more employees, in line with other thresholds for exceptions for smaller businesses from certain regulations. Designated points of contact will have to complete five days of specialist training with an approved provider, and their responsibilities will be to: signpost colleagues who are victims of domestic abuse to support services and assist them in accessing those services; advocate on behalf of colleagues who victims of domestic abuse in work-related matters; act as a point of contact for colleagues who are concerned others may be the victims of domestic abuse; and raise awareness of knowledge of domestic abuse in their organisation.

 

  • Commit to an annual price-indexed uprating of the Warm Home Discount Scheme rebate. Through the WHD scheme, eligible low-income households receive a single annual rebate on their energy bills, the value of which has been frozen since 2014. The Government should commit to an annual price-indexed uprating of the value of the rebate offered by the Warm Home Discount Scheme.

 

  • Government introduction of a new home improvement scheme, to give government-backed grants to benefit claimants, and loans for everyone else, to address issues with damp, mould and ventilation. Private landlords and homeowners will be able to apply for a one-off, low-interest government-backed loan of up to £1,000 with a long-term repayment schedule through energy bills. In addition, homeowners in receipt of one of the following low-income benefits will be able to apply to the scheme for a one-off grant of up £1,000: Employment Support Allowance; Jobseekers Allowance; Working Tax Credit; and, Universal Credit with a monthly income of less than £1,349. Examples of improvements which would fall under this government-backed scheme include but are not limited to: loft insulation; extractor fan installation; vent installation; and, professional mould removal. Successful loan and grant applicants will receive a voucher that allows them to make the improvement on a named property, redeemable with proof of the improvement having been carried out including a dated invoice from the installer. The voucher amount will then be paid directly to the installer.

 

  • Legally oblige landlords to provide tenants with a decent internet connection. The Government should amend the Landlord and Tenant Act (1985) so that landlords are obligated to maintain tenants’ access to a decent internet connection, and maintain the installations necessary for the supply of that connection. This mirrors obligations to maintain the installations necessary for water, gas, and electricity in the Landlords and Tenants Act (1985) and reflects the crucial importance of an internet connection. We define decent internet according to Ofcom’s definition – a minimum download speed of 10 Mbit/s and a minimum upload speed of 1 Mbit/s.

 

  • Establish a 2030 Government target for full-fibre broadband rollout to the hardest to reach homes. The Government says it will aim to reach 85% of homes by 2025 and has set aside £5 billion to complete the rollout to the remaining 15% of hardest to reach homes, but has not yet committed to a date for this. It should commit to doing so by 2030.

 

  • Introduce a government-sponsored accreditation scheme to encourage employers to support and improve the work-life balance of their employees. We recommend that government, specifically BEIS, endorse a new accreditation scheme that aims to incentivise and encourage employers to improve and support the good work-life balance of their employees. Two levels of accreditation could be available under the scheme. For instance, to be eligible for level one accreditation, an employer could have to implement policies that actively encourage flexible working arrangements. To achieve the higher level two accreditation, as well as meeting the requirements of level one, an employer could need to apply for and cover the cost of an assessment to establish that the employer has worked proactively to create a culture of good work-life balance in their organisation beyond the requirements of level one, and that they are implementing new and innovative policies to better support and improve the work-life balance of their employees, such as a right to disconnect for all employees.

 

  • Introduce a government-sponsored award of £150,000 to encourage all employers to support and improve the work-life balance of their employees. All level two employers, regardless of size, would be made eligible for an annual prize of £150,000 in recognition of outstanding work in creating and supporting a good work-life balance for their employees.

Phoebe is a Senior Researcher at Bright Blue. The report she references is found in the report No place like home: The benefits and challenges of home working Views expressed in this article are those of the author, not necessarily those of Bright Blue. [Image: Devon.gov.uk]

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