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Sophie Colton: Reform social services or continue to put children at risk

By Centre Write, Health & Social Care

The inquiries into the deaths of Arthur Labinjo-Hughes and Star Hobson have brought about a series of discussions surrounding the effectiveness of the social services, and how they can learn from such cases for the future. 

The two cases of Arthur and Star were not unknown to the social services, with three referrals being made for Arthur, and over five referrals being made for Star. These, however, amounted to the cases being closed, with justifications being that they live in a “happy household”. In the meantime, both Arthur and Star were put through brutality and psychologically damaging punishments. Arthur was frequently made to stand in the hallway for up to 14 hours, with fear of punishment if he attempted to sit down, whilst Star was made to stand in the corner of a room, even when she had a fractured leg. The status of “happy household”, in these cases, was determined by a clean and tidy home followed by excuses made by the parents, with little interactions with the child at hand. 

Later, detectives found that Arthur did not have an adequate bed to sleep in, with a duvet being found under the stairs. It was later revealed that Arthur was sleeping on the living room floor. This should be an aspect that social workers check for, to ensure that the general wellbeing of the child is looked after. Whilst some may say that this could reflect poverty, it could ring alarm bells when seen in the context of cases where multiple referrals have been made. 

Both cases have also shown that there was poor professional judgement when it came to investigating potential bruising on the children. Arthur was subjected to multiple bruises, with camera footage showing unusual bruising on his shoulder, something doctors have quickly picked up on as being the result of an adult’s hand. Meanwhile, Star’s grandfather took photographic footage of Star’s face, showing a large bruise. When it came to social services investigating, however, they either did not look thoroughly enough or carelessly believed the lies that were fed to them from the parents. 

Social workers, particularly in cases where there has been material evidence, should carry out a thorough inspection into potential bruises on a child’s body. In cases where there is unusual bruising, they should have the power to immediately refer the case to a specialised police unit, to prevent further injury or in worst cases, death.

Adding to this point, social workers should have a duty to talk to the child at hand. Currently, social workers either fail to speak to the child, or they must ask permission from the parents to do so. In the latter case, parents may stay in the room and subject the child to psychological abuse through glares, or threat of punishment. In all cases of referrals, social workers should have the power to talk to the child alone to understand their thoughts and feelings. 

This could be paired with stronger education within schooling systems. When children have been subjected to abuse through a lot of their life, they will not know anything different, and may not be able to understand that what their carers are doing is wrong. The government’s current personal, social, health and economic (PSHE) education programme does not cover teaching on parental abuse or the social services. Education should start within early years, teaching children to understand that physical abuse from caregivers is wrong, to higher education, where teaching could include psychological and mental abuse. As a result, children will be better able to flag their abuse, and social workers will be able to get a better understanding of the situation through direct communication with the child.

Finally, the police and social services need to work more closely. This approach was recently adopted in Bethlehem, where a pilot programme integrated social workers into the city’s police department. However, in the UK, there seems to be a ‘pass the baton’ approach whereby social workers do the investigating and then pass on the case to the police, who have the power to remove the child from a dangerous household. 

Whilst it may not be feasible to train social workers to give them the understanding and power to be able to remove children from a household, it is feasible – as shown in Bethlehem – to create a division within the police that works closely with social workers. This division would have access to the information that social workers have and be on standby to remove a child from a household. The result of this would be a more efficient process of removing children from a dangerous household through limiting the delays which may occur through the ‘pass the baton’ approach. It will ensure that children are protected as soon as possible, potentially preventing further incidences.

The case of Arthur Labinjo-Hughes and Star Hobson were truly tragic. The delay in decisive action meant that social services were incapable of giving them the protection that they needed. A new and improved system of care needs to be enforced whereby social workers have the power to check for general well-being like an adequate bed to sleep in, alongside the power to individually talk to the child and search for unusual bruising. This, in conjunction with a better force of removal, through a joint team in the police, will enhance the protection of young people before it is too late. 

Sophie 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: Gov.uk]

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December 20, 2021

Tom Mepham: Are spikes in National Insurance the answer to the social care crisis?

By Centre Write, Health & Social Care

In September, Chancellor Rishi Sunak announced that, from April 2022, the Government will introduce a new UK wide 1.25% social care levy. This will tax earnings for employees, the self-employed and employers, in order to supposedly generate cash for the Government to invest back into the health and social care sector. Sunak stated that: “This significant £12bn-a-year long-term increase in public spending will improve people’s lives across the UK – but our health and social care systems cannot be rebuilt without difficult decisions.” Critics debate whether this tax hike is necessary – money is needed to tackle the social care crisis, but is this means of raising revenue regressive and punitive? 

Supporters of the levy say it is clear that the NHS needs significant reinvestment in order to fix the backlog within the social care system, and the investment will allow an increase in hospital capacity as well as the NHS with space for nine million more appointments and operations to take place. 

Furthermore, the rise in National Insurance (NI) will allow the Government to raise significant sums in a generally progressive manner and with relative ease. The Chancellor has said of the tax “It is fair: the more you earn, the more you pay”, which is generally the case if you exclude how the highest earners are treated.

Currently, all earnings between £9,568 and £50,270 are taxed at 12%, whereas any earnings over £50,000 are currently taxed at a rate of 2%. Therefore, higher earners are paying proportionally less of their income in NI tax. National Insurance only operates based on the income of the individual and can be calculated in a straightforward manner for each salary payment, without the need to adjust for other externalities such as asset ownership. 

However, the social care levy is regressive and unfairly burdensome for certain groups – young people as well as lower earners will be disproportionately hit in comparison to those who have reached the state pension age of 66. This is because those who have reached the state pension age are no longer asked to contribute towards NI and would not be paying anything towards this social care reform that would, crucially, be of most benefit to them. 

Those who hold assets would also be unaffected by the NI tax hike when compared to those in employment, as NI is an income based tax. Therefore, those working to raise funds for a house deposit are being held back in comparison with those who are already homeowners, ultimately leading to greater disparity between those on the property ladder and those trying to get on it.  

The employed are also being hit harder by the NI rise in comparison to the self-employed. The self-employed already have an existing reduced rate in NI of 9% (compared to current employer NI of 12%). Additionally, the self-employed will avoid paying employer NI as there is currently no equivalent for the self-employed. 

With the problems with a rise in NI clear, the Government should consider alternatives.

First, the Government should look back at previous eras of high economic growth presided over by Conservative governments – particularly where the Government provided greater freedoms to both the firm and the individual via fiscal policy that stimulates economic activity, while helping to promote wealth for all. For example, by lowering corporation tax. 

Under Chancellor George Osborne, cuts were made over a six year period (2010-16) from 28% to 19%, resulting in the Government’s corporation tax revenue climbing from £31 billion to £47 billion over six years. If the Government decided to lower corporation tax from the current 19% to a more desirable 15% rate for businesses, the UK could attract business investment nationally both from domestic as well as foreign industries, potentially leading to huge increases in tax revenue. This solution would not only provide revenue for the Government to invest into the social care system. It could also give the economy much needed stimulation post-Covid.  

Another alternative to hiking NI to fund social care is for the Government to explore zero rating the entire care industry. Zero rating would mean that the care industry could reclaim the tax on everything they purchase as well as recover the VAT on their costs and overheads. Although care homes are currently exempt from VAT, they are not zero rated. 

By zero rating the care industry, costs across the whole sector would be reduced because of the saved revenue that is spent through VAT, including costs associated with daily living such as food and energy bills. Money saved could help care homes offer more affordable care plans for those who need it, or at least help ease the financial pressure for social care providers. This is not currently covered in the £86,000 care cap. This care cap within the social care reform means that individuals will not need to spend more than £86,000 on their personal care over their lifetime. However, costs such as accomodation and meals are not included, and will obviously still need to be paid for. 

Overall, the current reform proposed by the Government, although not perfect, will ensure that care can be provided to those that require it. However, the method of raising the required level of funds should be reconsidered. Alternative methods which raise the required revenue for social care reform must be explored to increase funding for social care and provide benefits for wider society through the rewards of economic growth.

Tom 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: Number 10]

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November 23, 2021

Harry Ward: Overcoming vaccine hesitancy among young people

By Centre Write, Health & Social Care

This summer, the Government keeps telling young people to ‘Grab a Jab’, with no-appointment jabs making the process extremely accessible. However, the issue the Government faces is getting young people to the walk-in vaccination centres in the first place.  

Despite vaccines being available to all over 18s since June, the relatively low uptake from Britain’s under 30s is alarming. There are still millions of unvaccinated young people, with 30% of 18-29 year olds having not received their first dose. This lower uptake reflects vaccine hesitancy, which, despite steadily decreasing, remains higher for those aged 18-25 than for the population as a whole. 

Looking at health statistics, it’s difficult to understand why anyone would not get vaccinated. Public Health England data suggests that both the Pfizer and AstraZeneca vaccines have 90% efficacy against hospitalisation. Moreover, further PHE data estimates that vaccines have saved 84,000 lives and prevented 23.4m infections. Indeed, getting vaccinated protects yourself and others. 

So, what’s causing some young people to hesitate? Research suggests a number of key factors at play.

Firstly, ‘complacency’ – when a person doesn’t get vaccinated because they don’t think the disease will affect their health. Some young people are questioning ‘why do I need the jab when I’m fit and healthy?’.  While it is indisputable that Covid is less risky for young people, recent figures demonstrate that young people can still suffer seriously as a result of infection. There is an optimism bias, a “youthful sense of invincibility”, that acts as a barrier to vaccination.

Secondly, ‘confidence’ – when one lacks trust in a vaccine’s safety or in the institutions delivering it. Key concerns that dissuade young people from getting jabbed surround the vaccines’ side-effects and whether the vaccines have been tested comprehensively enough. 

Finally, ‘calculation’ – when an individual researches to weigh up the pros and cons of vaccination. This links closely with the previous factors as some cons are likely informed by ‘complacency’ and a lack of ‘confidence’.

Overcoming these causes of vaccine hesitancy is crucial in raising the vaccination rate among younger people. To address them, the Government’s main approach is to add incentives to encourage young people to get jabbed, thus introducing extra benefits that could outweigh the costs of vaccination in an individual’s ‘calculation’. 

A recent policy with this goal is the Government’s partnerships with businesses most used by young people (for example, Bolt and Deliveroo) who offer special discounts to those vaccinated.

However, one concern is that, by reducing the price of takeaways to encourage vaccination, the Government contradicts its own public health strategy. This concern is akin to the contradictions caused by the ‘Eat Out to Help Out’ scheme in 2020.  Research suggests a link between the use of fast food apps, like Deliveroo, and obesity. Thus, partnerships with companies like this seem at odds with the Government’s own well-publicised obesity strategy, which it identifies as key to reducing Covid-19 related death rates. This seemingly mixed policy agenda could cause some young people to lose faith in the soundness of the Government’s messaging.

The Government ought only to engage in partnerships that avoid this contradiction in order to maximise the coherence and, thus, success of its incentive-based approach.

Moreover, the Government should make additions to its vaccination communication and advertising campaign that targets young people. Currently, the adverts read, ‘Don’t Miss Out’, which reinforces the Government’s incentive-based strategy and, thus, contributes to overcoming the ‘calculation’ cause of vaccine hesitancy. 

However, policymakers should expand the content of communications in order to directly address the other causes of vaccine hesitancy. In other words, as well as introducing extra pros to vaccination, the Government should challenge the cons. 

Firstly, to reduce ‘complacency’, the Government could use informational adverts that emphasise the increasing numbers of young people suffering due to Covid-19. Nudging young people to reconsider their perceived invincibility could increase vaccination uptake. 

Secondly, educational adverts could be used to increase ‘confidence’ in the vaccine. The OECD argues that trust in vaccines’ safety is key to reducing vaccine hesitancy. For example, the Government ought to produce communications that remind us that you are more likely to get hit by lightning than you are to die of blood clots as a side-effect of a Covid-19 jab. Additionally, another approach would be communications that reassure young people that vaccines have been developed comprehensively. 

This broadened range of content should then be delivered in more diverse ways. While the Government should be commended for targeting social media, some young people don’t trust what the DHSC tweets. Why not spread positive vaccination messaging and information via people that more young people do trust, such as Instagram influencers? 

Overall, the Government can and should make improvements to its approach to combat vaccine hesitancy among young people. It’s all about trust: in the vaccines’ safety and in those encouraging vaccination. Vaccination rates among young people are increasing and small tweaks to Government strategy would consolidate and enhance this life-saving progress.  

Harry 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: John Cameron]

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August 23, 2021

George Tench: Why Britain must lead global vaccination efforts

By Centre Write, Health & Social Care

“The scientists have done it” the Prime Minister declared on December 2nd, after the first Covid-19 vaccine received regulatory approval. By February 14th all healthcare workers, adults over 70 and those who were shielding had been invited for vaccination.  These people were among Britain’s most vulnerable, accounting for 88% of our country’s previous 127,000 deaths from Covid-19. 

As of today, 37 million vaccine doses have been given in the UK, protecting over half our population, including those with serious underlying health conditions and the overwhelming majority of adults over 50. The Government and our hardworking NHS workers should all be congratulated for such a massive achievement.

The UK’s vaccine roll out is likely to proceed smoothly, meeting the Prime Minister’s target of offering a first dose to all British adults by the end of July. However, our experience here in the UK is rather unlike that in most of the world, where vaccine rollouts have been beset by serious obstacles. Though states in the EU have been vaccinating more slowly than the UK, they have nonetheless made much more progress than the world’s developing states. 

African nations such as Mauritania and Mali have vaccinated less than 1% of their populations, with only 643 vaccinations administered in the latter. Even wealthier African nations like South Africa, which has been ravaged by a new, more infectious variant of Covid-19, have still only managed to vaccinate around 10% of their population. Furthermore, given the lack of robust data on vaccination rates in many low income countries, it is virtually impossible to assess how the developing world as a whole is proceeding in the fight against Covid-19.    

Vaccine inequality between rich and poor nations is likely to widen, as the majority of new vaccine doses go to wealthy states like Britain, whose vulnerable people are already protected. Dr Tedros Adhanom, the General Director of the World Health Organisation, has been a vocal critic of what he refers to as the “vaccine nationalism” of rich states, claiming that the world is  “on the brink of a catastrophic moral failure” the price of which “will be paid with lives and livelihoods in the world’s poorest countries”. 

Covax, which aims to deliver two billion vaccine doses to low and middle income states, is woefully inadequate and unable to correct the vast vaccine inequality between rich and poor states. Although Covax has delivered millions of vaccines to developing nations, it is doing so too slowly and in too small quantities. For example, Somalia received 300,000 doses of the Oxford AstraZeneca vaccine through Covax, yet this is only enough to provide a single dose to around 2% of their 15.44 million person population. 

One reason for this is a lack of funding, another is the fact that wealthy states like New Zealand and Canada have drawn on Covax supplies to vaccinate their own populations. Despite Covax, rich states like Britain are still being delivered millions of doses, despite having already vaccinated the most vulnerable groups in society. So, should we really be vaccinating British 18 and 19 year olds so that they can safely return to pubs and clubs, while vulnerable people in the developing world continue to die from Covid-19?  

Beyond the moral considerations that liberal, democratic societies should make regarding the well-being of the vulnerable globally, a more equitable global vaccine redistribution is preferable from both an economic and public health standpoint. If it takes years for developing countries to vaccinate their citizens, then the virus could develop strains that render vaccines ineffective. Already, a South African variant has been found which is resistant to the AstraZeneca vaccine which has been used to inoculate the majority of the British population. Vaccinating our citizens might prevent the emergence of new variants in the UK, but Covid doesn’t respect national borders and vaccine resistant strains emerging abroad will inevitably reach our shores. 

Global vaccine redistribution could help to prevent the emergence of new variants that threaten to undermine all the progress Britain has made over the last few months. Critics of global vaccine redistribution often prioritise economic concerns over worries about virus mutations, stressing the importance of safely reopening Britain’s retail and hospitality industries. Yet, the best way to protect these sectors is to avoid the further lockdowns that could follow were vaccine resistant strains of Covid-19 to spread in Britain. Moreover, these arguments overlook the fact that  vaccine redistribution could actually help the recovery of the British economy, which is heavily reliant upon trade partners in emerging and developing markets. Until poor countries can get Covid-19 under control, via vaccination, their reduced imports and exports of both goods and services will cause a non-negligible drag on developed economies like the UK’s. 

The UK has led the world in its domestic vaccine rollout, now we should look beyond our borders and make similar progress redistributing vaccinations to vulnerable populations worldwide – the sooner the better. 

George 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: Number 10]

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April 15, 2021

Jude D’Alesio: What I learned as a care worker during Covid-19

By Centre Write, Health & Social Care

Losing my part-time job as a hog roaster was not how I envisaged the beginning of my Easter holidays. Instead, lockdown created a surge in the demand for care assistant roles in my home city of Cardiff.

I could lie to you and say that this was the job I had always dreamed of having, but truthfully I was not prepared to play my PlayStation for a whole summer and needed an activity to bridge the gap to until I resumed university in September.

However, I was not prepared for how much it would teach me about the politics of social care. Indeed, learning everything from how to wake a resident in the morning, how to talk to a person with dementia, how to feed someone in their bed, and how to detect when they are about to fall over, was a world apart from my law degree.

If I learned one thing as a care worker during Covid-19, it is that we need a new settlement for social care in Britain.

The Prime Minister and the Chancellor were swift in their response to the pandemic in the industry, boosting funding for councils as well as pledging that the promise to do ‘whatever it takes’ applies as much to social care as the NHS. So far, the pandemic has ensured that this valiant defence of social care is replacing the previous treatment of care as the poor cousin of the NHS.

Ensuring that the most vulnerable in society are safeguarded is a noble aim, though Gordon Brown’s proposed ‘death tax’ in 2010 reminds us that a realistic solution is unlikely to emerge from the left. Contrary to what some may think, I found that many of the residents under my care, no matter how mentally impaired, were concerned about their finances. Once, I was asked by a resident to go to the bank (unlikely to occur at 2am on a Sunday) so that they could pay for their meals, despite them being prepaid by the family. Elderly residents worrying about how their care is funded should not be commonplace in Britain.

It must be acknowledged that care homes were only able to focus all their efforts on beating coronavirus due to much of the normal care bureaucracy, such as routine Care Quality Commission inspections, being abandoned. I quickly learned that ‘inspections’ was considered a dirty word among my colleagues, who told ironic stories of being distracted all day by inspectors who were, unsurprisingly, concerned with completing their tick box exercises. If this fails to renew the Government’s impetus to cut stifling bureaucracy following the pandemic, I know not what will.

Another benefit which emerged in the industry was the rapidity with which elderly patients were discharged from hospital into care homes. By the end of my stint as a care worker, I learned that it was not uncommon for a new resident to be arriving every week from hospital, and given that the inert process of discharging elderly patients to care homes was a bane for policymakers, I hope that this new vigour sticks.

There is a paradigm throughout social care of focusing incessantly on negative metrics resulting from regulation: weight loss, bruises and aggressive behaviour, for example. Care homes must become less custodial and prioritise quality of life and happiness, not adopt a box-ticking exercise.

Conscious of how a large portion of my work was spent filling in checklists, I soon learned why many residents soon spiral into depression upon being admitted to a home. As such, I prioritised engaging in more interpersonal interactions with these people, who often had incredible stories from their childhood and profession – not to mention reassuring Conservative views!

Care homes have seen residency rates fall dramatically, with a simultaneous need to make them safeguard against Covid-19 which has squeezed profit margins. By the end of summer the place was half-empty, with the occupancy rate dropping every week.This combination of underlying financial weakness, falling revenues and rising costs means that many homes are on the precipice of closure. However, there is an understandable reluctance by the Treasury to countenance an expansion in the scope of the state.

A report by the Centre for Policy Studies concluded that countries where the state has provided full free social care without restrictions have seen costs spiral unsustainably, forcing them to restrict eligibility and cut back services. Establishing a national care service is, unfortunately, not an option.

We should provide a basic level of social care for everyone, funded nationally by taxation, but people buy out-of-pocket top-ups to purchase private insurance policies to cover additional care. This will end the injustice of some having to sell their homes to finance their care while reforming the structure of incentives to encourage private investment. As a Bright Blue report from 2010 rightly states, we want “taxpayers to keep more of their hard-earned money and that which does go into the welfare state will go to the most needy and most deserving – the very sick, the very old and the very disabled”.

Covid-19 has provided the impetus to reform our care system, and if I learned one thing as a carer it is that change is needed. I hope I am not proved wrong in saying that the energy from Downing Street thus far signals that we have a government which will get social care done.

Jude D’Alesio is a member of Bright Blue and one of the youngest councillors in the UK, serving on Long Ashton Parish Council in North Somerset. Views expressed in this article are those of the author, not necessarily those of Bright Blue.

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February 19, 2021

Sebastian Daszkowski: Is the government doing enough to address the obesity crisis?

By Centre Write, Health & Social Care

The long-lasting effects of COVID-19 on policy making will be experienced for many years. However, one of the less discussed policy shifts is Johnson’s campaign against obesity. Does it represent a paradigm shift or is Johnson merely tinkering with the system? 

It has been known for decades that obesity increases the risk of a variety of health conditions putting pressure on the NHS that amounts to £6 billion a year. Moreover, aside from increased cardiovascular, cancer and diabetes risk, a 2017 meta-analysis shows that a higher BMI is consistently associated with depression. This may be a result of stigma or a direct influence of an improperly balanced diet but nevertheless puts further pressure on struggling mental health services. 

The Government itself states that the urgency stems from evidence linking obesity to an increased risk of hospitalisation and death from COVID-19. It is also clear that being overweight is something Johnson attributes to his hospitalisation.  The new raft of measures encompasses a ban on TV and online adverts for foods high in fat, sugar and salt before 9pm; an end to ‘buy one get one free’ deals on unhealthy foods; mandatory calorie displays for large businesses; and, a new campaign to help people become more active and adopt healthier eating habits. 

As expected, the response from industry has been negative. But this is not due to an unreasonable assessment; the Advertising Association highlights that one of the Government’s own impact papers indicates that the ban on adverts would only remove, on average, 1.7 calories per day from children’s diets. 

Similarly, the British Dietetic Association and The British Nutrition Foundation both responded to the reforms welcoming the announcement but urging the Government to do more due to the scale of the problem. Both organisations highlight socio-economic inequalities and the obesogenic environment as major drivers of obesity. While the steps aim to address some aspects of the obesogenic environment, they nevertheless do not transform the ease of inactivity which so defines modern Britain, with survey data suggesting up to 37% of Brits never exercise and only 13% exercise regularly, and neither does it change the highly ingrained eating habits of tens of millions of British citizens. 

Appropriately addressing the obesity crisis will require much more than a few token policies. Indeed, it will require a more comprehensive shift driven by the recommendations of the dietetic workforce and incorporating many different policy insights. A government survey has suggested that only 28% of adults eat the minimum five portions of fruit and vegetables a day to maintain a reasonable level of health, and another report indicates that most people in the UK are staggeringly consuming three times the recommended daily sugar intake. This situation is unsustainable. 

The measures are collectively a step in the right direction as more support for people who want to lose weight is now available through the ‘Better Health’ campaign led by Public Health England. Nevertheless, a colossal challenge requires proportionately large changes and the Government’s new campaign is wholly inadequate. The campaign is not fully in sync with the opinions of industry experts and, therefore, stronger communication networks are necessary between them and Government. The public spending on the campaign must effectively translate into real and proportionate reductions in obesity- and this will only be possible when policy is informed by the best evidence on its causes.   

The Government needs to invest much greater resources into promoting the ‘five-a-day’ campaign as the high dietary fibre content of fruits and vegetables increases satiety and therefore their higher consumption will predispose people towards consuming less calories. Equally, data from Mexico suggests that the sugar tax is effective, and therefore disincentivising highly processed foods through ‘sin-taxes’ should also constitute a part of government policy, and not be limited to sugar. 

The ‘Eat Out to Help Out Scheme’ revealed the lack of true commitment to reduce the human obesogenic environment. Growing evidence indicates the complex network of factors beyond personal decisions driving dietary choices. Therefore, the Government must commit itself to a more substantial policy shift recognising these external influences. The cultural decline of tobacco serves as a template, and a similar effect on unhealthy eating habits will require greater public education and awareness, industry innovation, soft and hard regulation, and consumer-driven change. In other words, a monumental task that will most importantly require a long-term partnership between experts in government and those outside it, informing its decisions with the very best evidence. Cultural change is never easy, and complacency will only stall progress.

Sebastian 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: Number 10]

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December 4, 2020

Constance Talbot: Women’s Rugby: levelling the playing field?

By Centre Write, Health & Social Care

The number of women playing rugby has soared in recent years, with more than a quarter of global players now being women (2.7 million). In 2018 alone there was a 28% increase in female players. Women’s engagement off the pitch has also grown: 40% of rugby’s 400 million strong fanbase are women. With growing female engagement and participation, these are signs of positive movement towards gender equality in a previously male dominated sport and indeed sport in general. 

Changes have also been made at an organisational level. Governance reform has resulted in 17 female positions being added to the World Rugby Council and the addition of a quarter final stage to the World Cup in 2021. These are steps that World Rugby have taken to help achieve their stated aim that “By 2025, rugby will be a global leader in sport, where women involved in rugby have equity on and off the field”.  

However, behind these positive statistics, a murkier picture lies. Though female players are now paid individual match fees and classified as professional players (with England being the first team to go fully professional in 2019), the Six Nations Tournament was revealed to be the ‘worst offender’ for rugby’s gender pay gap. Major disparities between the prize money given to the winners of the tournament have been found, with the male champions receiving £5m and the women’s team receiving nothing. Moreover, government data on the Rugby Football Union shows that women are paid 20.7% an hour less than their male counterparts.

Testimonies from players also highlight the barriers the game still faces. Former England Captain Catherine Spencer has spoken out about the ‘vicious cycle’ women’s rugby is stuck in, whereby a lack of media coverage results in poor sponsorship deals. Giving credence to this claim, a recent YouGov survey revealed that only 26% of people would be happy to see more coverage of women’s sports at the expense of coverage of men’s sports. Canterbury’s use of female models instead of players for the promotion of the Irish team kit is another recent example of unequal exposure and emphasises how traditional stereotypes surrounding femininity and body image still create barriers for the sport. Since visibility is vitally important to transforming views on women’s sports and creating positive role models to inspire the future generation, it is an issue which must be addressed.

The Rugby World Cup was recently rebranded, so that the term ‘Women’s rugby’ will no longer be used in pursuit of gender neutrality and the elevation of the women’s game.  World Rugby has called the change “the ultimate statement in equality”. However, though the re-labelling of the World Cup has been celebrated, it has been also been heavily criticised. For some, the removal of the term ‘Women’s rugby’ has anonymised the identity of the sport and with it the celebration of women’s involvement. Indeed, it would have been just as simple to add ‘Men’s’ in front of the title, rather than erasing the phrase ‘Women’s rugby’, which may have inspired young girls desperate to try the sport. 

Young girls can use sports like rugby to challenge harmful stereotypes as well as experience benefits such as greater fitness levels and improved mental health. But schools are also hindering equality through their continued gendering of certain sports; only 43% of school girls are offered the same sporting opportunities as boys, with rugby considered a firmly male activity.

World Rugby and other organisations must promote women’s rugby as a financial opportunity worth investing in to media channels and sponsorship agencies, arguing that the quality of play will attract more viewers. Female players themselves must also be endorsed by the media to create role models that young girls can aspire to. In terms of education, teachers must make sure that girls have access to the same range of sports that boys do, and challenge their own preconceptions around male and female sports. This will allow young girls to try a wide variety of sports and feel confident in doing so. 

It is only through the normalisation of sports as gender neutral that equality can be achieved and it will take a society-wide effort, involving schools, the media and sports organisations.

Constance is currently undertaking work experience at Bright Blue. Views expressed in this article are those of the author, not necessarily those of Bright Blue. 

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November 27, 2020

Madeleine Murphy: Minimum unit pricing for alcohol is ineffective and punitive

By Centre Write, Health & Social Care

The Scottish Government sought to become a trendsetter with its introduction of minimum unit pricing for alcohol in 2018. It was the policy that they believed others would follow suit in implementing. Two years later, Wales has duly introduced a similar system. With two home nations currently pursuing minimum unit pricing, can it be said that this is a proportionate response to a real domestic issue, or simply punishment for the majority?

Minimum unit pricing forces the retailer to sell alcohol at a floor price, which is in accordance with the alcohol content of the drink. As set by their respective governments, the minimum price per unit of alcohol in both Scotland and Wales now sits at 50p. As a result, one of the more prolific wines commonly associated with binge drinking in Scotland, “Frosty Jacks”, has increased in price from £3.50 to £11.25 due to its alcohol content.

The primary reason why this law has been introduced is because if an individual were to abuse alcohol, they would be more likely to do so with something very affordable from the shelves. Therefore, the logic behind this law suggests that hiking the prices of cheap alcohol would act as a deterrent for those most vulnerable at purchasing and abusing it, to successfully reduce alcohol related deaths due to the existing observable link between cheap booze and alcohol harm. 

So, two years from its initial implementation in Scotland, how has the legislation played out in reality? Despite its youth, early reports and publications from the Scottish Government suggest that following its immediate implementation in 2018, alcohol sales in Scotland did indeed drop. Figures would show that the volume of alcohol sold per person decreased by 3.6%, declining from 7.4 litres to 7.1 litres with the heaviest drinkers being the most affected. However, full statistics are not expected until after the first five years of its introduction. 

Yet, was the overall aim to reduce alcohol consumption of the general public? Not entirely, if at all. It is important to remember that the policy was implemented with the goal of reducing alcohol related harm and death. Taking this into account, it is therefore interesting to note that alcohol related death in Scotland increased by 1.4% over the year of which the policy was first implemented, when the widely referenced Sheffield alcohol pricing model had predicted 58 fewer deaths following implementation. Likewise, for the first full year that the policy was implemented, the number of alcohol-related hospital admissions instead rose too.

While a reduction in consumption may be welcome for countries with deeply ingrained alcohol problems such as Scotland, the positive nature of the reduction is essentially negated by the continued prevalence of the aforementioned alcohol related death and hospital admissions, despite forecasting from the Sheffield alcohol pricing model. Therefore, for the policy to be truly hailed a success, it must show that it makes a genuine impact regarding harm, and not impact purely upon consumption rates. 

Moreover, however long it remains to be legislation, it is without a doubt that those who will be most affected by it will be the majority of moderate drinkers. What this policy does is raise the cost of living for those who want to enjoy cheap alcohol, making it more expensive. Therefore, this policy acts as a form of punishment for everyone, due to the inability of governments to find an effective solution to the problem of alcoholism.

For those that do suffer from problems with alcohol misuse, it must be asked if the price hike that comes hand in hand with minimum unit pricing for alcohol will adequately deter those individuals from buying the alcohol that they desire. In an interview with the BBC, prior to the implementation of the policy in Wales, a recovering alcoholic spoke about her thoughts regarding the policy. She explained her belief that the policy wouldn’t be worth it. Not only did she assert that it wouldn’t have made her think twice about buying alcohol, but she also suggested that there would instead be a rise in crime, as if someone can’t afford it, they will simply steal it. 

With recovering alcoholics arguing that the policy will not be as effective as what is suggested, perhaps nanny-statist, punitive policies such as minimum unit pricing for alcohol are not the answer to reducing the level of harm caused by alcohol. Instead, governments should invest in publicly available alcohol and substance abuse services. By supporting health and social care partnerships as well as alcohol and drug partnerships, alcoholism can be targeted directly at the source throughout local communities, instead of a widespread and disproportionate price rise.  

Investments should be made in research to allow for more direct effective methods of action and intervention to be brought forward and, importantly, improvements should be made in education for adults as well as children throughout the school curriculum regarding the effects of alcohol abuse. This would ensure there is an existing exposure to the harsh realities of addiction. Individuals at risk of harm from alcohol abuse need to have essential tools at hand to help themselves, something that price rises cannot offer.  

Only time will tell how minimum unit pricing for alcohol will develop and impact levels of alcohol abuse, substantially, or not so. With current trends highlighting no change in harm prevention in Scotland, and potentially similar results to develop from Wales, what should remain clear is that no one will learn how to get better or benefit simply from price hikes in stores, which do nothing but increase the cost of living for the public.

Madeleine 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: U3144362]

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March 17, 2020

Phoebe Arslanagic-Wakefield: Medical bias – not a woman’s world

By Centre Write, Health & Social Care, Human Rights & Discrimination, Phoebe Arslanagic-Wakefield

Despite forming half of the British population, women continue to suffer from persistent and significant gender inequalities in modern medical research and practice. The impact of this pernicious erasure of the female body, which can be seen in research, diagnostic waits, and even in a doctor’s perception of a patient’s physical pain level, leads to worse health outcomes for women. 

The state of endometriosis care in the UK is illustrative of the long-term effects of medical bias against women. This female-only condition results in debilitating pain by causing uterine tissue to grow on other organs, such as the liver or bladder. Two million women in the UK have endometriosis. In 2019, the largest study of its kind found that severe diagnostic delays leave UK women to suffer with endometriosis for an average of seven and a half years. By this late stage, the condition can be severe enough to result in infertility and life-long pelvic problems. Of 13,500 women with endometriosis surveyed by the BBC in 2019, half said the pain had led to suicidal thoughts. 

Repeated studies have shown that medical professionals take female pain less seriously. One study found that women with acute abdominal pain who present themselves to an emergency department are not only less likely to be given effective painkillers than men, they must also wait longer to actually receive them. Women’s pain is also less likely to be perceived as having a physical, organic cause. Instead, they are more likely to be referred for psychiatric help. Such attitudes are a major contributing factor to the average endometriosis diagnosis wait-time of seven and a half years. The effect can also be seen in the context of heart disease; women suffering heart attacks are 50% more likely than men to be initially misdiagnosed and, in England and Wales, are 7.4% less likely to be prescribed important preventative medications when leaving hospital following a heart attack. 

Even drugs are often not as safe or efficacious for women as they are for men. Sex has a startling effect on drug response; early male-only studies of aspirin showed that the drug had a clear protective effect against heart disease. A female-only study did not find the same; in women aspirin reduces stroke risk but not heart attack risk, whilst in men the opposite is true. The reasons for and extent of sex divergence in aspirin’s effects are not totally understood, yet it is one of the world’s most common medications. Though women are known to metabolise medications differently, clinical trials frequently fail to take this into consideration; a 2014 report condemned this state of affairs as ‘leaving women’s health to chance’.

The lack of understanding on how commonplace drugs like aspirin affect the female body is at least in part due to the fact that, until the early 1990s, the exclusion of women from medical trials was the norm; it was thought that treatments that worked well for men would work for women too. Furthermore, it was simpler when designing a new study to build upon older research that had also been male-only. Even studies on heart disease, which is the leading killer of women in the UK and US, were predominantly male-only until the mid-1990s. Today only a third of cardiovascular clinical trial subjects are women and only 31% of such trials report their results by sex.

As clinical trials continue to be weighted towards men, it is possible that many drugs continue to be less efficacious for women. A frequent explanation for the exclusion of women today is ‘the complexities of the menstrual cycle’.  The menstrual cycle does undoubtedly result in hormonal changes in the body which could have an impact on the effect of drugs. However, it is also a regular and predictable event that will occur throughout much of a woman’s life, making excluding women from trials illogical, considering that drugs are taken during the cycle.

The European Medicines Agency released a report in 2005 which argued that guidelines on including women in trials were unnecessary as gender representation was now adequate, but in 2019 new analysis of 1.5 million biomedical studies found that only one in three reported sex-related differences. Thus, whilst improving, an understanding gap around how drugs affect women persists. 

The issue of imbalance in medical trials is in some senses easier to fix than the wider issue at hand here; clearer guidance can be released, sex-specific reporting can be made compulsory. However, what endometriosis diagnosis delays, in conjunction with medical attitudes to female pain, highlight is a much thornier and deep-rooted issue. Patients must self-report their pain to medical professionals, and that communication is affected by implicit biases. Unconscious bias training courses have become fairly commonplace in the public and private sector; perhaps it is time to consider a similar model for medical professionals. 

Phoebe Arslanagić-Wakefield is a Research Assistant at Bright Blue.

November 21, 2019

Claudia Martinez: Getting it right for the NHS: Next steps for the Prime Minister

By Centre Write, Health & Social Care

Prime Minister Boris Johnson has made the NHS one of his top priorities. In his nine weeks in office, Johnson has already pledged £1.8 billion to fund capital works and equipment in hospitals, announced the creation of a £250 million AI lab and committed to supporting the healthcare workforce through greater investment in training and education. He also confirmed that this money would be provided in addition to the £20.5 billion per year by 2023/24 NHS funding settlement announced by Theresa May last year.

With extra funding and a ten-year Long-Term Plan in place, does this mean that the future of the NHS has been sorted? Well, not quite. The NHS still faces unprecedented financial and operational challenges as a result of mounting demand for care and resource constraints. These pressures are further exacerbated by the social care crisis, cuts to public health budgets and the UK’s impending withdrawal from the European Union. So, where should the Prime Minister focus his efforts?

First and foremost, the Prime Minister must address the growing workforce challenge facing the NHS. Staffing rates are failing to keep up with the pace of demand for services, with over 100,000 vacancies across the whole Service and over 40,000 in nursing. The uncertainty posed by Brexit is creating further challenges for providers, with 57% of Trust leaders worrying that they will not be able to maintain appropriate levels of staff to meet their patients’ needs. Staff satisfaction is also low, with 40% of staff feeling stressed and 20% experiencing harassment bullying and abuse at work. Failure to support the workforce risks impacting patient safety. Data from the Care Quality Commission warns how staff shortages are preventing Trusts to keep people safe from harm and abuse.

There are signs that the Government is waking up to the fact that a capable and appropriately skilled workforce is critical to delivering the Long-Term Plan and creating a sustainable NHS. The Chancellor’s commitment to increasing Health Education England´s budget for 2010/21 and reversing the cuts to the NHS Continuing Professional Development Programme is a welcome step towards up-skilling and developing key nursing and midwifery staff. Yet, it does not provide certainty over future funding for staff training and will certainly not solve the endemic staff shortages across the NHS. Worryingly, social care continues to be overlooked despite facing 110,000 unfilled staff vacancies and turnover rates as high as 30% per year. The upcoming NHS People Plan publication will provide the Prime Minister with the opportunity to put forward more ambitious policy proposals and provide clarity on the future of the NHS workforce.

Secondly, greater attention must be given to the delivery of an integrated, place-based system of care. The Long-Term Plan sets out bold ambitions for patients to access care in the community, with Sustainability Transformation Partnerships/Integrated Care Systems and Primary Care Networks playing a crucial role in supporting the wider reconfiguration of services and the delivery of new models of care. Yet, despite years of sustained effort, progress continues to be piecemeal and slow. Hospitals activity is increasing, with A&E attendances soaring by 22%  between 2008/09 and 2016/17 and providers consistently missing targets for waiting times. In many parts of the country hospitals at operating at full capacity and a lack of alternative provision is leaving patients with no alternative but to turn up at A&E. Johnson has made it his responsibility to ensure that no patient waits 3 weeks to see their GP, yet in July only 62% of those who wanted a same-day GP appointment got one. To deliver integrated care, the Prime Minister must address the pressures facing acute services, but also prioritise investment in community services and primary care. Despite commitments, Johnson has so far failed to do so, with only 6% of the £1.8 billion for capital investment in the NHS going towards primary care.

Finally, the ambitions of personalised, joined-up and high-quality care outlined in the Plan will not be realised unless decisive action is taken regarding future funding for social care. While the Prime Minister has said that he wants to fix the social care crisis “once and for all”, he has yet to commit to delivering a long-term funding solution.  With the much-touted Green Paper further delayed, and the latest spending round yet again delivering short-term funding to keep services afloat, the future of social care looks bleak.

The Prime Minister has the tools to reform the system for the better. Whether he can overcome short-termism and seize the opportunity remains to be seen.

Claudia Martinez is Research Manager and health policy lead at Reform think tank. Views expressed in this article are those of the author, not necessarily those of Bright Blue. Image licensed under the Open Government Licence v1.0.

September 19, 2019
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