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How to dramatically improve health and save money in later life

April 14th, 2014

This blog first appeared as part of Independent Age’s series on a 2030 vision for later life.

A simple new law could improve health, particularly for the poorest, and save money in later life.

In public policy, the worthiest of intentions are no match for the hard lines of a budget spreadsheet. We know that investing in prevention is better than dealing with the consequences but one-year budgets and three-year spending reviews are one reason why only 4% of the health budget is spent on prevention, and only 6% of spending across government, according to National Audit Office analysis.

There are exceptions. Where governments can make confident forecasts they do take long-term decisions; the most recent example being the Chancellor’s announcement that the state pension age would in future rise in line with average life expectancy, to prevent the bill ballooning unsustainably.

But ONS analysis released last month revealed that 80-84 year olds in the richest areas of the country are in better health than people twenty years younger living in the most deprived regions. As the state pension age rises the poorest are hit far harder than the richest.

One – clearly impractical – way to address this unfairness would be to give each individual a ‘bespoke’ state pension age, so that we could all enjoy roughly the same proportion of our lives in retirement.

The only other solution is to dramatically reduce health inequalities, so that the state pension age does not discriminate against the most deprived. Poor health in later life not only renders the pensions system unfair, but puts enormous pressure on the acute health and social care budgets and significantly detracts from wellbeing.

So how do we stimulate the same long-term thinking and decisive action in tackling health inequalities that we have seen in relation to reducing pension liabilities? One solution, which the Early Action Task Force suggests in a report to be launched shortly is to tie the two issues together, by legislating to make rises in the state pension age conditional on falling health inequality. This would have two impacts.

First, it would ensure that raising the state pension age did not disproportionately disadvantage the poorest, since the SPA could only rise if the health gap between rich and poor was closing.

Second it would provide government with a strong fiscal incentive to tackle health inequality, since the sustainability of the state pension system would be riding on its success

Government would be forced to think long term about health inequality and consider investing now in order to save vastly more in both reduced healthcare costs and unsustainable pension payments. It would transform the experience of ageing, from one where a lifetime’s experience culminates in the diseases of old age, to one where we are all ready to thrive and live healthily for longer.

What do you think needs to happen to make the UK the best country to grow older in? What concerns you most about growing older and why? Join Independent Age’s 2030 Vision debate to share your views

Image courtesy of wikipedia

Fresh Thinking: The Morgan Stanley Strategy Challenge

April 10th, 2014

Thinking about old problems in innovative ways is second nature at Community Links where I am currently Head of Fundraising. However over the last few weeks I have been introduced to a whole new set of thinking – seeing things through another lens entirely.

Community Links is one of four charities benefitting from pro bono strategic consultancy support from leading global financial services company Morgan Stanley. The Strategy Challenge is a programme where 20 of their brightest stars of the future are split into four teams who compete to achieve the best outcome.

Each team is set a strategic challenge by a charity, and eight weeks later they must present their solution to the challenge to both Morgan Stanley management and the charity.

We’ve set a challenge around growing our integrated service delivery which is detailed by Community Links Chief Executive Geraldine Blake in the video aove. The challenge is being led by our programme teams but the Challengers from Morgan Stanley need to understand how the charity sector gets funded and so I was invited to spent two hours with them last week, providing an overview both of “fundraising” in general and specifically within the Community Links context.

I was nervous heading into the meeting as I felt sure that these bright people would ask me questions I could not possibly answer. And there were five of their brains to one of mine, so I was bound to be overwhelmed.

It is easy to reinforce the differences between the charity sector and the private sector; as a fundraiser who has worked with a lot of companies over the years, it is easy to get into the unequal mindset of donor and beneficiary, where we are so grateful for our donation that we add to the inequality that can exist.

I often consider the differences between my work and that of my brother, who works for a bank. Whilst I feel a great sense of mystery about what he and all of his colleagues DO in the bank, the biggest difference is perhaps in the organisational culture – and the values that drive each sector. As a fundraiser I am not focused on generating a profit (although our social enterprises do make some surplus). However we rely on corporate partners sharing some of their profits with the wider east London community for the benefit of us all. In the charity world financial management is about making the most of the limited funds we have; ensuring efficient use of scarce resources to make the biggest impact for our beneficiaries.

Whilst my brother’s remuneration doesn’t compare to mine – he talks about something called a “package of benefits” – and the superficial lack of suits, “short” hours and other material differences cross his mind, I’ve always assumed that what I do as a fundraiser is so fundamentally easy to understand that this mystique is one way; that too adds to the inequality. So I was fascinated to discover that five of Morgan Stanley’s brightest rising stars were not familiar with fundraising and listened to me as the expert (with a lot of interrogations, clarification and questioning of course).

As I walked out two hours later I was exhausted by the energy that had been expended and I felt my own personal imbalance of “us and them” had been significantly challenged.

Collaborative working brings its rewards. Collaboration between different sectors and bringing new perspectives, is the way to open up some great new thinking to devise sustainable solutions.

New report: How to measure early action spend

March 28th, 2014

It’s hard to plot a route if you don’t know your starting point, and it’s hard to invest more in early action if you don’t know how much you spend now.

We have consistently argued that that good intentions or warm words can hide low or dwindling spending on preventative services (Neil Reeder has called this Futurewash) and that only robust measurement of early action spend (particularly in public services) will promote investment.

Today we released a new paper (available in pdf here) exploring the process of classifying spending along a spectrum from early to late,drawing on work we did last summer with a group of 8 major third sector funders. They were keen to understand more about how their grant budget was split between early and late interventions so together we devised and refined a process and then applied it to over 1,500 grants worth £159m across all their portfolios. The short paper explains the process we used and some of the lessons for funders.

The paper is primarily aimed at funders wishing to explore how early action fits within their strategy, and it will form one of the resources made available to the Early Action Funder’s Alliance when they launch formally in June. However it will also be useful to charities and other agencies who want to delve into their own spending.

If you are interested in undertaking a similar analysis then please let us know. We’d be happy to help and very keen to know the outcome and your experience of the process, and to share it with others. Community Links undertook a similar exercise in 2012, which we reported on here and you may find useful.

Salvaging early action from the wreckage of the welfare cap

March 28th, 2014

I wrote a piece for Left Foot Forward yesterday suggesting that the annual cap on welfare spending – voted into law on Wednesday – is a crude piece of political maneuvering that will leave people poorer and ultimately cost the state more. But, I argued, there is a chance that it could also be used to shine a light on failures elsewhere in public spending and the structures of our economy which drive up benefit spending unnecessarily. In other words, it could be used to make a case for early action and – if a Labour government is in power after the next election – for ‘predistribution’. Wishful thinking? I’d be interested to know your thoughts.

The piece begins:

The welfare cap – put forward by government and supported by the opposition, and voted through almost unanimously last night – is a crude piece of political maneuvering playing on the public’s worst fears about the benefits system; but can we salvage something from the wreckage?

Politically the intent of the cap is clear; it makes it easier for governments who want to cut working age benefits, and makes it harder for governments who want to raise them. We saw this in action yesterday morning before the bill was passed when Iain Duncan Smith jumped on Labour’s support for the cap to demand that they justify their opposition to the bedroom tax.

But it’s already (politically) easy for governments to cut benefits and politically hard to raise them, so in this – at least in the short term – it changes little…

Read the rest here

Also worth reading on the welfare cap are: the report from Save the Children that it will push 345,000 children into poverty over the next four years; and this excellent analysis from Ha-Joon Chang demolishing the political proposition underpinning the cap, that welfare spending is ‘out of control’.

Budget 2014: The view from Canning Town

March 26th, 2014

Canning Town Tube Station RoundelThe commentary and analysis from last week’s budget continue to ripple go on. This morning, Labour’s Rachel Reeves was on the Today programme, voicing Labour’s support for the budget’s announcement of an overall cap on welfare spending. It’s amazing how much the policy wonks and political hacks of Westminster have managed to write in the last seven days about the economic and political implications of. A couple of my favourites were this from Julia Unwin on the multiple benefits that tackling poverty would deliver, and this from the IFS about some of the longer-term implications for the public finances.

On the day of the budget, service users and staff from Community Links Asta neighbourhood hub, along with our Chief Executive Geraldine Blake, were interviewed on BBC Radio 5 Live to give their impressions.  But these things take a while to sink in, so this morning I asked a few people in the queue for Community Links’ advice drop-in service about what they thought of the budget.

Not feeling it.

The first thing that was clear is that while the Chancellor focused on how the “economy is continuing to recover – and recovering faster than forecast”, people in our community in Newham are not feeling it. People repeatedly said that they hadn’t seen much increase in the availability of jobs hours or increased pay, but have seen prices continue to rise. Saiid, who’s lived in Newham with his wife and daughter for ten years, works in McDonald’s but is unable to get any increase in hours. He said he’s seen “no new jobs, no start-up companies”. Mother-of-two Gemma, who lives with her husband lamented how “house prices have gone up. Everything in the shops costs more. Travel costs more. It’s really hard for people on low incomes.”

A budget for budgeters?

People also repeatedly said that the focus of the budget is wrong – in particular, its focus on savers and pensioners. Several people scoffed at the idea of raising the ISA annual limit from £5,000 to £15,000 – indeed most people can’t save at all. Saiid asked: “Who can save? Our income is limited and prices are going up: Council Tax, electricity bill. There’s no surplus around here – how do you save? No Way!” Gemma agreed with a focus on savings but said it should be focused on those with lower incomes rather than high – she suggested an increase in interest rates for those saving least, and not those saving most. Many were keen on a focus on those on tight budgets rather than savers.

Help for those who need it most

At Community Links, we’re see increasing numbers of people coming to our advice sessions with absolutely no income, who are effectively in destitution. Rachel Reeves suggested this morning that the newly announced overall cap on welfare could act as an incentive for government to reduce demand for benefits. One way to achieve this reduction is to invest in the Early Action which empowers people to  work and live independently.

But if it just leads to salami slicing of benefits, taking money away from those who need it most, it could have terrible consequences. The reality is that everyone needs a safety net at some points in their life. At Community Links we’ve seen how simply reducing spending on welfare, without offering people the necessary support can lead to devastating impacts: worsening health, increasing desperation, an erosion of resilience and for many, destitution. We will be publishing a report about this on 1st April and hope to work with the government to improve the support offered to people as the ongoing changes are made.

There is a clear disconnect between Osborne’s “recovery” and the reality in our community. It’s essential that this disconnect is addressed in the future – and supporting well-heeled savers and rich pensioners is not the way to do that.

Listen to the BBC 5Live Budget day broadcasts from Community Links:

Learning from Scotland on prevention

March 10th, 2014

It may be a controversial thing to say at the moment but the UK government could learn a lot from their Scottish colleagues.

I shared a platform at the CIPFA conference last week with John Swinney, the Cabinet Secretary for Finance, Employment and Growth (effectively the Scottish Chancellor of the Exchequer). The minister spoke with passion and insight about the importance of prevention being “at the top of our agenda”, about “disrespecting boundaries” and about “supporting the redesign of public services” to “maximise the effectiveness of our combined resources”.

Most interestingly he expressed an anxiety about the £500m Change Funds which we have discussed previously on this blog (pdf). £500m is a serious sum of money even when set against the £60bn total cost of public services in Scotland but Mr Swinney worried that it might be a diversion when we need, he said, to be concerned with “maximising the effectiveness of every pound”.

I would certainly agree that there is a real danger of layering an extra programme over a failing system but I am inclined to give the benefit of the doubt to a half a billion pound programme that is explicitly dedicated to structural change. We shall be interested to follow the long term outcomes. Meanwhile I was thinking about the same issues here in London at meetings on either side of the trip to Glasgow.

On Wednesday the embryonic Early Action Funders Alliance met with selected partners to discuss a new Neighbourhood Early Action Fund and on Friday Task Force members discussed plans for a Treasury sponsored Early Action Loan Fund. The Loan Fund would aim to stimulate early action spending across government departments and agencies by overcoming some of the structural barriers. The Neighbourhood Fund will work through local partnerships led by the third sector but pursing similar objectives.

More will follow on this blog on both projects in due course but the link between the two, and the Scottish debate, was all about “systemic change”. Get it right, use the additional funding to reshape structures and reconfigure services and the money will have been well spent. Get it wrong , and paper over the cracks with additional, unsustainable “special projects” and we distract attention, and resources from the real issues.

That’s why we would welcome new money for early action in the chancellors budget next week but we would be even more pleased to hear Mr Osborne talk about Ten Year planning and budgeting, transition plans, treating early action like capital expenditure etc , etc. It is this kind, and only this kind, of fundamental systemic change that will truly “maximise the effectiveness of our combined resources” – an objective which, may have been most explicitly articulated by Mr Swinney but which finance ministers on both sides of the border would surely support.

Locality: the nationwide network for community-led organisations.

March 10th, 2014

Geraldine Blake. Chief Executive, Community LinksI was delighted last week to be elected as chair of the London Regional Network of Locality  – the nationwide network for community-led organisations.

Community Links is an active member of many federations and partnerships where we join with others to campaign for change and to amplify our impact … but there is something quite distinct about Locality.

Locality acts a central support helping member organisations build their capacity, launch new enterprises and win the investment to develop new community assets. Work on Neighbourhood Planning has supported communities to voice locally determined development priorities and the national Community Organisers programme adopts a ground-up approach that puts local people at the heart of deciding local services.

Locality is a “movement” as well as an organisation. It has grown from its early roots over 120 years ago in Toynbee Hall, east London and the other “University Settlements” where student volunteers lived in the Victorian slums working alongside local people to improve education, employment and living conditions. This was a radical move to develop a coherent set of practical solutions, rather than provide individual responses – and it played a significant part in developing the ideas of the Welfare State in the second half of the last century.

Times have changed – modern Britain may be unrecognisable to our Victorian Founders – but I’m sure they would understand the approaches we take. Innovation, community enterprise and control of assets are also represented strongly in another and more recent strand of history. The Development Trusts Association – saw rapid growth in the 1990s and merged with BASSAC to form Locality in 2011.

It is this coherence and practicality which persists throughout the history of the movement  – with at its core a set of solid values. Sharing expertise, finding news ways to solve old problems -  and, crucially doing it together with others – are in the DNA of our movement.

We have worked closely with Locality over many years, recently hosting five Community Organisers in the first wave of this government scheme. Last Autumn Community Links published a piece of research for Locality analysing the shifting public sector funding landscape which sees smaller organisations consistently at a disadvantage in public sector contract delivery. Our proposals for collaboration and building alliances are the practical response of committed organisations embedded within their communities who can deliver change. This change will not come from community organisations alone – it needs support from business and the engagement of government to make every community a place of possibility.

It was a closely fought election this week with an almost equal number of votes for all three candidates, so in the spirit of our collaborative movement I’ll be working closely with joint vice chairs Aaron Barbour of the Katherine Low Settlement (and formerly a Community Links colleague) and Lainya Offside-Keivani Chief Executive at Abbey Community Association.

As we continue to work within the communities of London we will collaborate with other partners and other sectors and co-ordinate support from our friends in city corporates. Combining the efforts of voluntary and community organisations we can influence policymakers  by sharing the real experiences of the people we work with – and in doing so, support local people to generate their own opportunities.

We need an assessment of the cumulative impact of welfare reforms

March 4th, 2014

“It doesn’t seem like they really want to help people at all.”

“They have their own ideas about [these] people.”

“What do they care? There’s no sympathy at all.”

These are quotes from users of our advice service in Canning Town, east London. For many of the people coming through our doors, it’s hard not to feel frustration at the impact and delivery of the government’s welfare reforms. And it’s hard not to feel that MPs are passing down drastic and often devastating changes without properly considering their impacts.

House of Commomns chamber welfare debateLast week MPs had to sit up and consider them. A Commons debate on the need for a cumulative impact assessment of welfare reforms saw MPs from across the country sharing stories of how the changes affected people in their constituencies. These stories highlighted how the combined impact of different reforms was leading to terrible situations. The woman in a coma who received a letter telling her to look for work was one of the more harrowing examples. She had been hit by changes to council tax at a time when her new experience of the work programme was already proving incredibly stressful. The combined effect was enough to get her sectioned.

By discussing such examples, MPs began to highlight the reforms’ very human impacts – something not captured in the various econometric models published by think tanks and others.

The debate came a year to the day since a last-ditch opposition attempt to halt the bedroom tax and followed an opposition debate on the bedroom tax on Wednesday. It came at a crucial time for the government to defend its corner on welfare reform. The contributions of the Archbishop of Westminster, 27 other bishops and 16 further faith leaders, compelled the prime minister to set out his record on what he agreed was a “moral” issue.

Last week coalition MPs were, not surprisingly, quick to make the case for the morality of the reforms, arguing that they brought back the “core principles” of the welfare system and were about “making things right and proper”. Most would agree that the reforms’ ultimate aims – to simplify the welfare system and “make work pay” – are laudable. But indicative evidence has suggested that, in some cases, reforms may be failing to meet their aims. Take the work programme: several studies have suggested it is failing those furthest from the labour market, including the homeless and people with drug or alcohol problems. The first in-depth evaluation of the popular benefit cap, carried out by the Chartered Institute of Housing, similarly found it was failing in its intention to encourage people towards work and into cheaper housing stock.

In order to really judge the ‘morality’ of the reforms, or their success in achieving their objectives, we need to properly understand the impact they are having on people’s everyday lives. Two years have passed since the Welfare Reform Act was made law, bringing about the widest-ranging changes the UK’s welfare system has seen in decades—a total of 39 individual changes to benefit levels, eligibility and conditionality. And yet the government has thus far made no plans to thoroughly assess the impacts of the reforms on some of the most vulnerable people in our society.

In spite of last week’s agreement across the benches on the need for a more in-depth understanding of the impact of welfare reforms, coalition MPs continued to rebuff calls for a full investigation, arguing that such a task would be too complicated. Closing the debate, minister for disabled people Mike Penning stated that a cumulative impact assessment would be “very complex”. Another argued that understanding the “wide range of contributors” involved in welfare reform would make such an assessment “extremely complex … an enormous task”.

But it is precisely these complexities which some of the most vulnerable people in our society are forced to navigate every day. For many of the people Community Links works with in Newham, it is the combined effects of different reforms, rather than any one individual change, which make situations unmanageable. As a mother-of-two affected by the bedroom tax and changes to council tax benefit recently told us: “[There are] too many things going on. And you have to do it alone, nobody cares.”

A more detailed look at the personal, experienced, human impacts of welfare reform is urgently needed, not just for sick and disabled people but for all those in poverty. The people we work with are constantly crying out about their experiences: “It’s a terrible situation. It’s like I’m shouting but nobody hears” one said recently. That’s why at Community Links we are finalising a piece of research looking at these cumulative impacts in Newham, which we will launch next month.

This time last year a challenge to the bedroom tax was defeated. This time next year we’ll be in the run-up to an election in which welfare will undoubtedly be centre-stage. Right now, the government must look cumulatively at the impacts of its reforms and whether they are succeeding in their stated aims, or even in the basic objective of providing a safety net for those who need it most. The recent debate has started to shed light on some of these impacts. But we need a thorough assessment, one which is removed from the partisan politics of Westminster palace and can help us to shape a social security system that works for all.

This post originally appeared on Politics.co.uk is a leading, impartial, UK political website;
on Friday 28th Feb 2014 we are grateful for permission to repost here

If we are in it together, we should get out of it together

March 3rd, 2014

Ask a civil servant in an off duty moment who they expect to be working for in 18 months time and, chances are, they will say a Liberal Democrat. Such is the electoral arithmetic at the moment that predicting a tight election and specifying the minority partner in the probable coalition is easier than identifying the winner.

This is why Community Links’ Early Action Task Force was pleased to meet with the Liberal Democrats Public Services working group last week and why all of us who care about public services should read their Consultation paper.

The read is a rewarding one:

“Liberal Democrats will improve services with powerful local leadership, by giving more power to users – individually and collectively – and by setting frontline staff free to do what they do best, running service systems that treat people as individuals and which can learn, respond and improve.

“…We think that managing services closer to where people live and in human-scale units encourages user and staff involvement and innovative service design that values deep relationships between service users and front-line providers.

“….We propose to ensure that every organisation delivering public services effectively involves users as partners in the delivery of services, ask any organisation bidding for a public service contract how they will, over the period of the contract, reduce users’  need to seek help, and how they will encourage mutual support among users… “ etc etc.

The words are very good and we welcome them

It’s the numbers that worry me.

Whilst politicians and commentators in the business world are spotting the spring shoots of economic recovery it is still November in the land of public services. We might expect a delay but this doesn’t feel like the predictable lag between the time when an uplift in the private sector ripples out into the public. This feels like a disconnect.

Eighteen months ago council leaders were talking about the “graph of doom” – the time when repeated budget cuts would reduce local authority services to care for the elderly and looked after children. Now even that seems optimistic. With a further swing of the axe promised in 2015/16 there is no end in sight.

On the contrary the Institute for Fiscal Studies (IFS) predict that by the end of this financial year 60% of the cost reduction programme will have yet to reach the front line. Even the resolutely non partisan IFS has been asking questions about whether it is reasonable and achievable to continue to cut on this scale

We talked with the Lib Dems about 10 year planning and about protecting early action spending, about social profit sharing and an early action loan fund.  All these ideas have been discussed on this site and have an important part to play. We are pushing them hard with all the parties in this manifesto year and sense real engagement but we can’t avoid the “meanwhile problem”.

At the start of this parliament there was a prevailing view that cuts were necessary but that the coalition government programme moved too far, too fast. As the economy appears now to be picking up for some but grinding others further down it is surely time to revive that discussion. If growth is accelerating should not the looming cuts, the 60%, now be revisited?

Majority and minority partners in a coalition government have a responsibility not only to ensure that we are all in it together but also that we all get out of it together. That, Danny Alexander, means responsible numbers as well as responsible words.