Tom Tugendhat: We must step in to fund supported housing for military veterans

24 Jun

Tom Tugendhat is MP for Tonbridge and Malling and Chair of the Foreign Affairs Select Committee.

Tomorrow’s Armed Forces Day celebrations are a time for the country to thank the men and women who serve now, and the estimated 2.4 million British veterans who have served and sacrificed in the past.

It is a time to honour their service, but it is also a time to reflect about how we as a country can better serve their needs in the future.

However well our Armed Forces protect the physical and mental health of those who serve, we know that the very act of service can take a heavy toll.

According to research from the King’s Centre Military Health Research, PTSD is nearly twice as common in ex-service personnel as in the general public. Among those deployed in a combat role it is more than four times as high.

Too many homeless veterans are still sleeping rough on the streets of British cities and towns. Nearly 2,000 veterans live in supported housing, which is largely funded by charities and competitive grant funding, and as many as 4,000 of our service men and women are in urgent housing need.

Veterans who find themselves homeless often have complex needs. They need specialist provision with higher levels of staffing and greater expertise. Such services do exist – and they transform lives – but the financial future of these services remains uncertain.

As it stands there is currently almost no central direct government funding ringfenced for supported housing for British military veterans. It is the only sector of supported housing where the majority of funding comes from charities.

But many charities have withdrawn support. The main providers of specialist housing for veterans estimate up to 35 percent of charitable funding has been lost in the last decade.

That means that some vital facilities have either closed or scaled back. Riverside Housing’s specialist veterans’ support service, the Beacon, just a short distance from the world’s largest British army garrison in Catterick, has helped to support and provide accommodation for nearly 350 veterans affected by homelessness over the course of ten years.

However, the Beacon had to cease offering specialist support services to veterans in October last year, including support for PTSD, substance abuse, and physical disability. Its statutory funding had dwindled from £242,072 in 2012/13 to just £50,750 by 2020/21. That means it can no longer offer a place to live for veterans with complex needs.

What these services are crying out for is a sustainable funding stream that allows them to plan effectively and meet the needs of our veterans.

The four leading providers of supported housing for veterans, Riverside, Launchpad, Alabaré, and Stoll, estimate less than £3 million a year would secure the future of the 966 units that already exist, and provide 200 more to meet demand.

This is not just a way of meeting our responsibility as a society to those who risked their lives in our service. It is an investment in positive outcomes. Properly funded specialist supported housing gives veterans the stability they need to rebuild their lives.

It reduces costs to the NHS and other support services, by leading to fewer visits to A&E, reduced demand for GP and community mental health services, and fewer complications caused by drug and alcohol problems.

It allows veterans to get their finances in order, and to focus on living productive, fulfilling lives. It breaks the spiral that leads to rough sleeping, when positive outcomes become harder, and more expensive, to deliver.

It also means we get full value from other important investments. For example, veterans can now receive specialist mental health care as part of a new NHS service called Operation Courage.

Service men and women are trained to soldier on independently. It is well recognised that veterans take longer on average than others before asking for help and a lot of the issues that occur as a result of service can take several years to present themselves.

Because of this independence veterans are very reluctant to ask for the support they need in mainstream homeless services and homeless hostels are not suitable especially for those with complex needs.

Veterans need to be around and supported by people who understand the experiences they have gone through.

The current administration should be proud of its record in helping British military veterans. In his first week in office after becoming Prime Minister, Boris Johnson created the UK’s first ever Office for Veterans Affairs (OVA).

The OVA’s Veterans’ Strategy Action Plan released earlier this year contained pledges to ensure consistent data on veterans’ homelessness and to end veterans’ rough sleeping by 2024.

In this action plan by the end of this year the Department for Levelling Up has pledged to conduct research to understand the supply of supported housing, including that which meets the needs of the veteran community, and to provide an understanding of any needs gap.

As part of this review, I strongly urge DLUHC and the Treasury to recommend that central Government provides long-term, ringfenced statutory funding to cover all the supported housing needs of our military veterans, including those with the most complex needs.

The Government of the United Kingdom greatly values the contribution of all our veterans.

My worry is that these vital services have been left without statutory funding not because of a lack of empathy, or even political will, but because the funding situation is complex and therefore the issue has fallen through the cracks.

But when the issue falls through the cracks, so do the veterans; and that simply cannot stand.

We have the best servicemen and women in the world. They have served and supported us. It is our duty to support them when they need it.

Any readers of this wishing to show their support for statutory funding for supported housing for British military veterans can sign up here.

The post Tom Tugendhat: We must step in to fund supported housing for military veterans first appeared on Conservative Home.

Judy Terry: Councillors need power to challenge the failure of mental health treatment in Norfolk and Suffolk

26 May

Judy Terry is a marketing professional and a former local councillor in Suffolk.

For the fourth time since its inception a decade ago, Norfolk & Suffolk NHS Foundation Trust has been rated ‘inadequate’ by the Care Quality Commission (CQC) and remains in Special Measures, first imposed in 2015.

Following inspection in November/December 2021, the latest report was published on 28th April, highlighting further deterioration since previous excoriating assessments.

The CQC’s Head of Mental Health Inspection confirmed that ‘we have served the Trust with a Warning Notice, setting out a legally binding timescale for compliance, so its leaders are clear about what must be done to improve patient care and safety, which they have a legal responsibility to deliver’.

Crucially, governance processes failed to identify or address all risks leading to significant patient safety concerns, including illegal substances on a ward. In the two years to September 2021, there were 115 ‘unexpected or potentially avoidable’ deaths. Over 1000 complaints were received between April 2019 and March 2021.

Whilst local authorities have avoided comment (although Norfolk County Council made a statement to Cabinet), two MPs acknowledged that this is the worst mental health provider in England, demanding action: Labour’s Clive Lewis and Conservative, Tom Hunt. Good for them! Suffolk County Council’s Health & Wellbeing Board doesn’t even have the report on its May meeting’s agenda.

Meanwhile, as activists and bereaved families, who are always patronised and ignored, continue to campaign for the Trust to be split into two, with services tailored to each county, one has to wonder whatever happened to the local Healthwatch and Clinical Commissioning Groups’ report, ‘Mental Healthcare & Emotional Wellbeing 2019-29’. Recommending a fresh, joined up, approach, it was rushed out in draft a few days before the previous damning CQC report was released, noting 61 breaches of legal requirements.

But, to the present: Norfolk & Suffolk Mental Health Trust employs 4,227 staff (and is recruiting more) with a £305m budget (up from £227m a couple of years ago).

Here is a summary of the CQC’s key findings following its latest inspection, most of which repeat previous issues not resolved. ‘Inadequate’ was the outcome for whether services were safe, effective, and well led, whilst whether services are rated ‘requires improvement’:

  • Overall, caring services rated ‘good’, but staff did not feel respected, supported or valued and the Trust did not ensure that cultures were supportive of staff to provide care.
  • The Trust did not consistently maintain safe staffing levels or ensure there were enough suitably qualified staff to meet the needs of people using services. We found this was impacting on the level of safety for staff and patients. It also impacted on governance within teams, multidisciplinary team effectiveness and patient safety. The Trust did not provide support to teams to maintain good governance in providing high quality care.
  • The Trust did not ensure effective management of medicines was taking place effectively to maintain patient safety.
  • The Trust did not ensure staff were aware of ligature risks assessments and did not mitigate or remove ligature points in a timely manner to maintain patient safety. (Responding to the 2017 CQC report, Norman Lamb who was a Norfolk MP at the time, was ‘disturbed that 1004 ligature points identified for work were not addressed although this was raised before’ (in 2014).
  • The Trust did not ensure all patients had up to date risk assessments or plans to manage risks to ensure patient safety.
  • The Trust did not manage long waiting lists or monitor the risk within the waiting lists effectively to ensure patients did not deteriorate whilst awaiting treatment.
  • The Trust did not ensure staff carried out patient observations in accordance with Trust policy and National Institute of Health Care & Excellence guidance to protect patients from harm.
  • The Trust did not ensure patient outcomes measures were used to demonstrate progress made.
  • The Trust did not ensure staff had access to patient records or maintained accurate records regarding patient care, physical health checks and nutrition to meet or demonstrate meeting patient needs.
  • The Trust did not ensure staff undertook the mandatory training required to deliver safe care and treatment of patients, reporting, managing and learning from incidents.

Inevitably, the Trust “chair”, whose predecessor jumped ship prior to the last CQC report’s publication, responded with:

“We are deeply sorry and have already taken action to help us improve.

‘We now have a leadership team with clear and ambitious plans… we are determined to make the required changes with pace and focus.”

Amid calls for the Chief Executive to resign, a spokesman for the Campaign to Save Mental Health Services in Norfolk & Suffolk said:

“This current Chief Executive was the chief operating officer from August 2018, so this has happened on his watch and he has to fully accept his part in this.”

But he’s not going anywhere. In an interview with the East Anglian Daily Times, he defended his position, insisting he is the right man for the job and only formally took up his current post in September 2021, just two months before the latest CQC inspection:

“As operations officer I made sure operations were managed in the Trust, now my responsibility is much greater and I can help make a greater difference. I believe I have the right team around me and my background is as a clinical nurse. My entire career has been built around working in the NHS and mental health services. I am fully committed and want to be here to ensure we can embed the changes we need to make to improve.”

He fully accepts the CQC findings, but rejects campaigners’ demands to divide the Trust, saying it would take 18 months and ‘detract from what we are trying to do to turn things around. With integrated care boards coming in, we have a different opportunity to look at how we configure the system and make sure we can meet the needs of both counties.’

One of the biggest learnings he takes from the report is the need to pay closer attention to the fears and concerns of his own staff. ‘We need to take a more bottom-up approach, where staff feel they are being listened to’. What about those campaigners, who are uniquely sensitive to issues affecting patients, their families, and the wider community?

With a further inspection pending, to ensure action has been taken to comply with the Warning Notice, the Chief Executive notes that the Trust will not meet its goal to be in the top quarter of mental health trusts next year! Instead, ‘we need to make sure we meet the requirements of the report’s action plan and make continuous improvements.’

Campaigners want an independent inquiry into why the Trust is allowed to go from crisis to crisis, without anyone – past or present – being held to account for its serious failings. There have been eight Chief Executives in 10 years, contributing to management instability, following a radical redesign of services in 2013.

I have repeatedly asked why Norfolk and Suffolk county councils don’t each have a senior councillor on the Trust board, with support from a small joint panel to monitor progress, regularly reporting back to Cabinet and Full Council.

With such a poor record, surely it’s time for Jeremy Hunt to investigate through his Parliamentary Health Select Committee. One question which doesn’t appear to have been addressed is ‘what happened to the Improvement Director appointed by NHS Improvement to assist the Trust after CQC’s previous report?’ He seems to have disappeared without making any contribution to ‘improvement’ of this failing Trust.

Sebastian Rees: Recovering from the pandemic requires tackling the youth mental health crisis

15 Apr

Sebastian Rees is a researcher at Reform.

This Easter weekend feels a world away from the last year’s. We were still weeks from being able to socialise indoors, sit in a restaurant or do some ‘non-essential’ shopping. This weekend, families and friends will be celebrating together in the sunshine, rather than layering up to freeze in the local park with no more than 5 other people. What a difference a year makes.

Yet while the restrictions have been lifted, the after-effects of the pandemic continue to reverberate. Nowhere is that more the case than among young people. With schools closed, social restrictions in place, and access to support limited, the last two years have been devastating for children and teenagers.

Before the pandemic, one in nine young people had a probable mental health condition. That number has now jumped to one in six. Getting to grips with this distressing situation has to be a priority if the Government is serious about boosting education recovery, levelling up the country, and avoiding long-term costs to taxpayers.

The default when it comes to health is to call for more investment in NHS services. And ensuring CAMHS – Children and Adolescent Mental Health Services – has the resources it needs is vital. But if we’ve learnt anything from the constant injections of cash into the NHS, it’s that you can’t treat your way out of a crisis.

To the Government’s credit, they’ve recognised the need to move upstream – to support young people before complex treatment is necessary. This is better for them, and, unsurprisingly, better for taxpayers.

Schools have been the focus for achieving this since 2017, and it’s an approach that makes perfect sense. Schools are in constant contact with almost every young person; they are the place we make lifelong friends and develop the skills that prepare us for adulthood.

However, while the intention is right, the execution is falling short. In our latest report, ‘A revolution in mindset’, we argue that much more needs to be done to realise the potential of schools as enablers of good mental health.

To start with, schools need the tools to assess need. Currently, most schools are relying on ad hoc surveys or teachers picking up behavioural indicators. The problem with this is that many young people, particularly girls, internalise need. Experts told us this was particularly the case for pupils at risk of developing eating disorders, which have soared over the last decade. This means young people falling through the cracks, or identification coming too late.

Schools need a standardised survey to assess pupil wellbeing and identify poor mental health, something the Department for Education (DfE) should work with the Department for Health and Social Care to develop. They also need the tools to support those young people that need help.

Since 2019, the Government has been rolling out NHS funded Mental Health Support Teams (MHSTs) to schools across England. These school-based teams provide talking therapies to young people in one-on-one and group sessions. This is delivered by qualified mental health practitioners who tend to cover several schools in an area. In theory this is a great idea, and we spoke to teachers from around the country who felt it was making a real difference, but in practice we really don’t know if it is.

Despite putting nearly £400 million into this programme, we don’t have any outcomes data to know whether MHSTs are helping pupils recover. The Chancellor said in his Autumn Budget that every pound must be “spent well”. The DfE should take heed and urgently evaluate whether MHSTs are delivering value for money. And if it is found to work, the Government needs a much more ambitious roll out – by 2023 just 35 per cent of pupils will have access to an MHST.

But we can, and must, take even earlier steps to support young people’s mental health. PSHE provides a huge opportunity, but in its current form just isn’t working. An Ofsted report from last year found that young people felt that PSHE lessons were “not relevant to the reality of their lives”.

Or to put it another way, for too many pupils it is seen as a waste of time, when in fact it should be a key part of the curriculum equipping them with core life skills – from emotional regulation to conflict resolution. Or as Baroness Nicky Morgan puts it in her foreword to our report, it should put “character education” centre stage. This is exactly what happens in the Netherlands through the Skills for Life programme, which has been shown to significantly improve students’ self-efficacy.

Such an approach would kill two birds with one stone: young people would be better able to cope with adversity, and would also develop the valuable soft skills that so many employers report are lacking. Teacher training should be upgraded to include these new PHSE skills.

As we enjoy our restrictions-free Easter, and continue to move on from the pandemic, we must not forget the huge toll it has taken on young people’s mental health. The Government is right that schools hold the key to addressing this crisis, but without greater ambition, investment and reform it will come up short. It’s the least we can do for a generation of young people whose lives have been on hold.

Stewart Jackson: Why is a Tory Government risking criminalising professionals – and the health of young people too?

21 Feb

Stewart Jackson is a former Conservative MP and Special Adviser, and is the Founder and Director of UK Political Insight.

Given the precarious position that the Prime Minister finds himself in, one has to rank the Government’s commitment to legislate for the so-called Conversion Therapy Bill “in spring 2022” as particularly brave, foolhardy or tin-eared.

The need to engineer a rapprochement with the Conservative Parliamentary Party is inconsistent with such a divisive and unnecessary measure.

It appears to be driven by a desire to placate the shrill zealotry of Stonewall – now discredited by its absolutist stance on trans rights, and estranged from many former LGBT supporters with whom, along with other critics, it seems unwilling to engage.

Indeed, the Bill seems to be a solution looking for a problem. In a meeting with religious leaders, the Government Equalities Office, which is sponsoring the Bill, failed even to identify what the legal definition of “conversion therapy” actually is, according to one of those present.

Those advocating the changes are desperate to avoid scrutiny and rush through the legislation. Nonetheless, the Government extended the consultation on the Bill until earlier this month after threats of judicial review.  It takes a unique talent to unite the fractious Tory tribes against these proposals.

Those concerned by aspects of the Bill reportedly include Damian Green, Chairman of the Conservative One Nation Group; other former Ministers, such as Jackie Doyle-Price; such middle ground stalwarts as Pauline Latham and Sir Robert Syms; and social conservatives such as Miriam Cates, Sally-Ann Hart, and Tim Loughton. Not to mention peers, faith groups, charities, the Economist and, most recently, the Equality and Human Rights Commission.

The ECHR has rightly highlighted  the need for proper pre-legislative scrutiny, and has warned against the unintended consequences of rushed legislation.  Supporters of the measure have also failed to take into account evolving research from the United States on paediatric and youth gender dysphoria, and that fact that the Government’s own Cass Review on gender identity services for children and young people will not be published until this summer.

In a nutshell, there is concern that rushed and poorly drafted legislation will threaten the basic tenets of fairness, freedom of speech, religious belief and tolerance, and the professionalism and autonomy of a number of caring sectors – such medicine, nursing, therapy, pastoral care and youth work and education.  Not to mention parents and guardians, all of whom risk being criminalised by poor legislation and activists with a narrow and extreme agenda.

For there is a real possibility that certain types of private consensual and routine conversations regarding sexual orientation and gender identity will become subject to criminal sanction.  And that it will not be possible for those charged with helping children and young people in particular to have open and explorative discussions about sexual identity and gender issues.

Thus, in the case of gender dysphoria, legitimate alternatives to radical and life changing pharmaceutical and surgical interventions could effectively become illegal. Do we want primary legislation that prevents clinicians from offering their patients the best treatment for their unique medical issues? As Baroness Jenkin has said: “when a child is suffering, it is crucial that they are allowed time, space and supportive therapy to discover why they feel the way they do.”

Such a bar would impact on young people with mental health problems and suicide ideation. Some of the alternatives would be irreversible. Government pledges of a “common sense” approach will count for very little if the legislation enacted is interpreted in a draconian manner.

These deeply flawed proposals arose from the well-meaning intentions of the May Government, and are now driven by a small claque of social liberals in 10 Downing Street – irrespective of the fact that there is already, and rightly, widespread opposition to physical and mental coercion based on both sexual orientation and gender identity, and tough legislation in place to combat it. In this respect, the UK has always been a pathfinder internationally. Who wouldn’t want to protect vulnerable people from bullying and coercion?

There is also real possibility that the Bill will fall foul of the European Convention on Human Rights in regards to Article 8 (Respect for Private and Family Life) and Article 9 (Freedom of Thought, Belief and Religion).  And that the Government may find itself liable for punitive damages in future litigation arising from the practices sanctioned by the Bill.

Like other May Government landmines – think Stop and Search, Windrush and the Northern Ireland Protocol – ideas touted as common sense and the right thing to do can obscure intractable issues and bring about unintended consequences.

All in all, there is no compelling case for this new legislation, or even persuasive evidence that it is actually required.  And the Government’s failure to outline a proper case for it hasn’t helped to dispel fears of a fait accomplis, with MPs being railroaded to an arbitrary deadline.

The Prime Minister has enough on his plate already. He needs the courage to reject this proposal, and face down a tiny minority, most of whom would never vote for him and his party, not least for the health of his battered administration.

Robert Halfon: The Government’s education recovery funding has created another North-South divide

9 Feb

Robert Halfon is MP for Harlow, a former Conservative Party Deputy Chairman, Chair of the Education Select Committee and President of Conservative Workers and Trade Unionists.

Almost £5 billion has been spent on education recovery by the Government. This spending is welcome, but I worry this funding is not reaching the most vulnerable children in our communities.

The National Tutoring Programme (NTP), currently contracted to Randstad, has the potential to be one of the great interventions made to date to support young people’s recovery from the impact of the pandemic. And yet, despite significant investment, it is falling far short of its targets and it’s not going far enough or happening quickly enough.

Over 524,000 children were supposed to start tutoring this year but only eight per cent have actually begun.

The Education Policy Institute has found there has been a marked disparity in the take-up of the NTP between the North and the South. In the South, upwards of 96 per cent of schools were engaging with the programme compared to just 50 per cent of schools in the North. Recently, headteachers and tutoring groups described to us the inaccessibility of the hub and the lack of quality assurance about the tutors on offer.

Perhaps most importantly of all, the Department for Education’s own annual report, published in December, evidenced that the risk of the catch-up programme failing to recover lost learning is critical or very likely.

The Government must look again at the contract with Randstad and seriously consider enacting the break clause. If Randstad cannot up its game, it is time to say goodbye.

The ghost children

A recent report published by the Centre for Social Justice, Lost but not forgotten, highlighted that 758 schools across the country are missing almost an entire class worth of children. Indeed, around 500 children are missing in about half of all local authorities and over 13,000 children in critical exam years are likely to be severely absent.

The effects of persistent absence go well beyond just academic progress. It also means these children are at risk for safeguarding concerns such as domestic abuse or county line gangs. The tragic cases of Arthur Labinjo-Hughes and Star Hobson are an all too poignant reminder of this risk.

The Department’s recent announcements to tackle the postcode lottery of avoidable absence are a positive start, but more urgent action is needed. Prioritisation must be given to collecting real-time data about who and where these children are and the Government should use the underspend from the NTP to fund an additional two thousand attendance advisers to work on the ground to help find these children and get them safely back into school.

Charles Dickens wrote of: “so many things forgotten, and so many more which might have been repaired”.

If we are to save the Oliver Twist generation of “ghost children”, we must act now. If we do nothing, we will be haunted by them forever.

The exam conundrum

I welcome the Government’s plan to move back to regular examinations. Given that so many children missed school over the course of the pandemic due to school closures, it is understandable that Ofqual has decided to give pupils advanced information about some aspects of the topics that will be assessed to help support their revision.

But there are two elephants in the room. The first being that essentially, all students will now be running a 50m sprint, instead of a 100m race, yet they will all be starting from the same point. This may seem fair, but for disadvantaged pupils who learned the least during the pandemic, they will now be pitted directly against their better-off peers who were able to continue their learning at home.

The Government’s reply to this will be that the catch-up programme is designed to alleviate this problem, but as described above, despite the 524,000 target set by the NTP, it is currently only reaching eight per cent of pupils.

The second elephant, also referenced to above, is that according to the Centre for Social Justice, we know that over 13,000 children in exam years have not returned to school for the most part. So a system has been created where advantaged pupils will feel the benefit of the advanced notice, but their worse-off peers will struggle. Furthermore, we risk ignoring the 13,000 pupils in A-Level and GCSE year groups who have not returned to school at all.

Mental health

This week is Children’s Mental Health Week – a timely reminder about the need to address the challenges surrounding children’s mental health.

The statistics we are confronted with are pretty grim.

Just last year, 17.4 per cent of children aged 6-16 are reported to have a probable mental health disorder (up from 11.6 per cent in 2017). Eating disorders among young girls have risen by 46 per cent. The number of young people being referred to Child and Adolescent Mental Health Services have been steadily rising to 538,564 in 2020, representing an increase of 35 per cent from 2019, and 60 per cent from 2018.

The Government must rocket boost its proposals to put mental health professionals in every school. But interventions to support mental health must not be seen as crutches, but should be designed to teach resilience to prevent more serious escalation.

Work must also be done to tackle the wrecking ball of social media on young people’s mental health.

In 2021, 16.7 per cent of 11 to 16 year olds using social media agreed that the number of likes, comments and shares they received had an impact on their mood. Half agreed that they spent more time on social media than they meant to and one in three girls said they were unhappy with their personal appearance by the age of fourteen.

Companies like TikTok, which, whilst providing some entertaining, are sadly acting as a trojan horse for sexualised content and negative body image thereby perpetuating eating disorders which have increased by 400 per cent among young girls during lockdown. As with other social media platforms, TikTok algorithms are like “crack for kids”.

We know that half of all mental health problems manifest by the age of 14, and 75 per cent by the age of 24. With the clear links between using social media platforms and poor mental health, why are the tech giants not stepping up to do more?

The Treasury should introduce a two per cent levy on the estimated £4.8 billion of profits generated by the big firms. This levy could generate a funding pot of around £100 million which could be distributed to schools to improve mental health support and to provide digital skills training to help support children’s resilience online.

Given the scale of the mental health challenges facing our young people, action has to be taken now to prevent it becoming an epidemic.

Sarah Ingham: The Government’s Covid communications campaign made lab rats of us all

4 Feb

Sarah Ingham is author of The Military Covenant: its impact on civil-military relations in Britain.

“Millions of people took seriously a communications campaign, apparently designed by behavioural psychologists, to bully, to shame and to terrify them into compliance with minute restrictions …”

In the Commons’ debate on the Sue Gray report, Steve Baker’s intervention was one of the few which did not prompt the Prime Minister to remind us that he is currently under investigation by the Metropolitan Police.

The MP for Wycombe took the PM to task over Government messaging in connection with Covid. Not only had people meticulously followed the rules (unlike a certain First Lord of the Treasury and his wife, perhaps?), but their mental health had suffered.

Baker’s question on Monday highlights the growing unease that the messaging was unethical and its results malign. It also called into the question the role of behaviour psychology, the science of what drives our decision-making. It seems the Public Administration and Constitutional Affairs Committee will be looking into the use of “nudge” tactics in connection with the Government’s response to the pandemic.

Recent reports on Covid’s collateral damage highlight an increased risk of measles because the take-up of MMR jabs is the lowest in a decade, as well as an £8.7 billion loss thanks to defective and unsuitable PPE. Such missteps in connection with public policy – inadvertent or not – are quantifiable. Assessments about burning through taxpayers’ hard-earned money in a pandemic-induced public-spending spree are far easier than judging the impact of Covid comms and the tactics to ensure the acceptance of public health measures.

It must be remembered that back in early 2020, the Government was flying blind, needing to do something, anything, to protect us from a possible plague. In addition, behavioural science – which informed some of the messaging – is meant to tap into our subconscious minds. But even raising the subject of possible subliminal coercion risks comparisons with incel-prone nutters, breathless with conspiracy theories about how the Pfizer/Moderna/AZ clot shot will turn us all into lizards.

The Behavioural Insights Team (BIT), better known as the Nudge Unit, was set up by David Cameron in the early days of the Coalition to improve the workings of government by injecting an understanding of human behaviour into policy. Inside the Nudge Unit (2015) by its director David Halpern chronicles how small changes – such as reminders from HMRC that ‘most people pay their tax on time’ – can produce big results, at almost no financial cost.

Nudging has been used across government departments for the past decade. It has saved the taxpayer millions by, for example, reducing missed medical appointments. As Prof Halpern states, nudges work on an unconscious, automatic level: “Behaviourally-based interventions can operate below the conscious radar of busy citizens.”

According to Gray, “The UK Government put in place far-reaching restrictions on citizens that had direct and material impact on their lives, livelihood and liberties.” The overwhelming majority of us complied with the lockdowns. How far the Government and its agencies coerced us into this compliance, not least by deliberate fearmongering, is now coming onto the conscious radar of Britain’s busy citizens.

SPI-B, the behavioural science sub-group of SAGE, set out Options for Increasing Social Distancing Measures in a paper on March 22 2020. As it stated, “The perceived level of personal threat needs to be increased among those who are complacent, using hard-hitting emotional messaging.”

In 2020, the Government spent £184 million on Covid-related advertising, including on the message that if we went out, we could spread the virus and ‘People Will Die’. This is bullying, not bribing, taxpayers with their own money. Was the emetic ‘Don’t Kill Your Gran’ inspired by SPI-B’s recommendation that messaging needs to emphasise the duty to protect others?

With its calamitous forecasting record, if it were Paddy Power, SAGE would have gone bust long ago. Among members of SPI-B, three are from BIT, one is a communist and four declined to give their names. So much for transparency. Last month, Simon Ruda, a BIT co-founder, stated that fewer than one per cent of its staff supported Brexit. If behavioural science is meant to correct the biases that lead us into making poor decisions, surely diversity of opinion should be encouraged?

Spun off from the Cabinet Office in 2014, BIT is now a global consultancy with 250 staff. In December, the government announced it will sell its one-third stake to innovation agency Nesta, whose Chief Executive stated in the Financial Times that “tackling Covid has shown what, properly applied, behavioural insights can do.” Mask-wearing, apparently, shows compliance with social norms and is a wider signal for others to take precautions.

Project Fear 2.0 included the daily Terror at Tea-Time press conferences, with their update on the Covid death toll. Even today, the tally is a context-free zone. We are still told nothing about, for example, how many people have recovered from the virus and been discharged from hospital. Why not? We need some positive news, not more doom porn.

Who doesn’t know people who are still reluctant to leave their homes? After almost two years of relentless bombardment about disease and death, caution is understandable. Fearing contamination – especially during the Hands, Face, Space phase of messaging – householders disinfected their deliveries or left them outside their front doors for days.

Given we still have a state broadcaster and the millions shovelled their way, it is unsurprising that much of the media have become outposts of Orwell’s Ministry of Truth. In the context of the Government’s Covid response, we heard too few voices of dissent and too much cheer-leading for the dystopia it was creating.

The messaging and manipulation is beginning to look counter-productive. Children have foregone their MMR jabs not least because parents heeded warnings about avoiding GP surgeries and hospitals. On Wednesday, a study by John Hopkins University found that lockdowns had little impact, perhaps reducing the death rate by 0.2 per cent.

Last July, Laura Dodsworth published A State of Fear – How the Government Weaponised Fear During the Covid-19 Pandemic. Endorsed by Lord Sumption, it was dismissed by The Times’ David Aaronovitch as ‘an outrageously dumb book selling conspiracy hooey’. Thankfully, some MPs are finally starting to do their job of holding the Executive to account and we might get to see whose call is correct.

Public policy often tries to change our behaviour. Being encouraged to eat five a day is, however, completely different from being coerced into ceding our freedoms, human rights and liberty. Ethics vanished.

As Prof Halpern noted, “Many experiments are run which depend on the subject not knowing they are part of the experiment.”

We, the lab rats, eh?

Helen Barnard: Place-based philanthropy should play a starring role in levelling up

27 Jan

Helen Barnard is Associate Director at the Joseph Rowntree Foundation and Research and Policy Director at Pro Bono Economics.

Next month we expect the publication of the long-promised Levelling Up White Paper (political drama allowing). Discussion tends to focus on the role of the public sector and how to attract private investment but this overlooks the crucial role that civil society must play if levelling up is to be a success.

Many places in most need of transformation lack civil society organisations and miss out on the philanthropic giving which supports them. The white paper must include proposals to remedy this if it is to deliver on its ambition.

Past attempts show civil society is central to successful regeneration

Previous attempts at regeneration have shown that strong civil society involvement is crucial to success. Places with more civic assets and community participation saw the biggest and most sustained falls in deprivation under previous programmes. Failures often followed a lack of community involvement.

Civil society organisations provide unmatched insights into community issues, helping design schemes that truly meet local needs. Participating in civil society builds social capital, neighbourliness and trust. Communities that gain control over resources and decisions invest in spaces and services that nurture community life and pride in place.

Examples abound from the Big Local programme. On the Isle of Sheppey in Kent, a resident-led partnership has reinvigorated community life, with holiday play schemes, employment support, projects to tackle loneliness and improve mental health, as well as establishing a community hub as a shared place for advice and activities.

Polling for the Law Family Commission on Civil Society found that people in levelling up areas prioritise living standards, good jobs and decent pay. Achieving these requires civil society organisations. They employ nearly a million people and disproportionately unlock opportunities for those furthest from the labour market. Charities provide many of the mental health, social care and social prescribing services which boost people’s health and wellbeing, support employment, bring down reoffending and reduce pressure on GPs and hospitals.

But many deprived places lack a thriving charitable and philanthropic sector

Deprived places have fewer charities and voluntary organisations than less disadvantaged areas. Research by NPC shows there are 28 per cent fewer local charities per 1,000 people in Levelling Up Fund priority one areas compared to the lowest priority areas.

Recent research by Pro Bono Economics uncovers funding patterns that help to explain this. Looking at self-assessment tax records, people in the wealthiest parts of the country make seven times as many donations to charity as those in the most deprived areas (excluding London). Other research by New Local shows charitable grant funding disadvantages ‘left-behind’ communities. A University of Southampton study found charities in the most deprived local authority areas lost a fifth of their income from local government in recent years, while those in the least deprived places saw little change.

So how do we boost place-based philanthropy?

Pro Bono Economics research highlights significant opportunities to increase charity funding through philanthropy. A declining proportion of the public give to charity, high earners have become less generous and too few donations claim Gift Aid. Closing these giving gaps could raise nearly £3 billion for the country’s charities. This wouldn’t necessarily ensure greater funding flows to the places which most need it, but there are plenty of ways to achieve this.

“Diaspora philanthropy” was suggested by Danny Kruger in his 2020 report for the government. Many wealthy people now live in London or the South East but grew up in or near places in need of funding. Encouraging them to direct their philanthropy towards their former home turf could help fill the gap. Examples include Jonathan Ruffer in the Northeast and Andrew Law (also the funder of the Commission on Civil Society) in Sheffield who has donated to the University of Sheffield to fund student support and medical research.

There are risks in this approach, however, as Rob Williamson, Chief Executive of the Tyne & Wear and Northumberland Community Foundation, points out. Many places in most need of support don’t have connections with a wealthy donor, and the places donors feel most attached to won’t always be those that are most deprived. In addition, donors are more often motivated to give to specific causes rather than to a place. Community Foundations and giving circles, or cause networks, can play a crucial role in bridging between these interests.

Giving circles or cause networks connect donors with others who are interested in a particular issue. Many have links to one or more of the 47 Community Foundations around the UK. The Foundations bring together multiple funders and donors with local charities and other partners, creating connections between the needs of a local area and the interests of donors and funders.

Building on this, the Law Family Commission on Civil Society is exploring the idea of establishing local Philanthropy Champions, particularly in areas where civil society is weak. Metro Mayors could nominate a Philanthropy Champion to encourage giving by their peers, the business community, and wealthy individuals who grew up in their area. The champions could also spread best practice and work with mayors, councils, MPs and expert local organisations to understand local need and connect it with interested donors.

Wealth advisers could also play a much bigger role in raising awareness of and encouraging philanthropy and place-based giving. Currently, only one in five wealth advisors raise philanthropic giving with clients, and only half of higher and additional rate taxpayers are aware of Gift Aid.

Match funding schemes have a good track record in supporting philanthropic giving, particularly through increasing the amount donated and directing it towards particular appeals or causes. Matched donations are an average of 2.5 times higher than unmatched donations. Over a third of respondents to the Big Give survey said they gave to a matched funded appeal because of the matching contribution. These schemes are most successful when they have broad objectives and a flexible approach, enabling local variation and tailoring to donors’ interests.

Just as importantly, the Charities Aid Foundation highlights (from its experience delivering the Government’s Growing Place-based Giving Fund) the importance of developing local civil society infrastructure and capacity, not just handing out money. Long-term funding for core costs, particularly staff, is at the heart of this. Without this, money tends to flow into places which already have such infrastructure and capacity, rather than those which have most need of it. A new Levelling Up Match Funding Scheme could be designed to redress geographical imbalances by limiting it to certain areas or offering a higher level of match funding in levelling up priority areas than elsewhere.

The political landscape is mired in uncertainty, but we can be sure that the pressing need will remain to increase opportunity, living standards and the quality of community life in places that have long been neglected. Achieving that ambition will require serious and sustained policy focus and the full participation of a thriving social sector.

Emily Carver: The decision to mandate masks in classrooms is utterly indefensible

5 Jan

Emily Carver is Media Manager at the Institute of Economic Affairs.

To his credit, the Prime Minister has stuck to his guns and refused to follow the devolved administrations and bring in tougher rules.

This is a rational decision. We know that Omicron has proven to be milder than previous variants, and despite a surge in the number of people in hospital “with Covid”, the speedy roll-out of booster jabs has kept the number of patients on ventilators low. Indeed, the latest data shows that the number of people in ICU has in fact fallen in recent weeks and it not tracking the rise seen last winter. While pressure on the NHS is severe, it is manageable.

Even Professor Neil Ferguson, who predicted last month that there could be 5,000 Omicron deaths a day (over three times the peak last January) has admitted that this wave is “substantially less severe” than previous ones, and that he is now “cautiously optimistic” Omicron cases are plateauing among 18 to 50-year-olds in London, the age group that has been driving the recent wave.

Yet, despite the fact we are so very far from worst case scenarios (and Ferguson’s best-case scenario), the Government has decided that it is proportionate to demand children wear masks throughout the entire school day. It is now once again “recommended” for all secondary school pupils in England to wear masks eight hours a day, with only a short break for lunch.

Politicians have argued that mask-wearing is a small price to pay to keep schools open. The opposition has also parroted this line. But they’re not paying the price. It is not office workers or MPs who are being forced to don a sweaty, germ-ridden mask all day.

And where is the evidence that mask-wearing will slow down the spread of the virus, keep schools open, or indeed save lives? Surely there must be an extremely high bar to justify a “recommendation” that will impact children’s learning and quality of life?

According to the Health Secretary, the guidance is based on two assessments. First, the evidence that Omicron, though milder, is highly infectious. And second, that an “observational” study of 123 schools undertaken by the Department of Education supports the use of face masks in schools – a study which is yet to be published.

One of the major criticisms from those sceptical of the Government’s approach is that it has failed to communicate or publish cost-benefit analyses for its ever-changing patchwork of Covid rules and regulations. You would have thought that, when seeking to intervene in children’s lives, the costs should be even more meticulously assessed?

Anyone who has ever worn a face mask will know they inhibit basic social interaction. This may not be as important in some professions, but in schools it is essential. Only in November, Sir Jonathan Van-Tam defended the Government’s decision not to mandate masks in schools. He said they can be “quite inhibitory to the natural expressions of learning in children, involving speech and facial expressions. It’s difficult for children in schools with face masks”. This will be worse for those with special educational needs, or for the growing number of children already suffering with their mental health. Has his view changed?

It seems the Government is more interested in being seen “to do something”, even if that means children are scapegoated. Indeed, in a meeting of the Education Select Committee meeting, children’s minister Will Quince admitted that there was “very limited evidence as to the efficacy of masks in educational settings”, but that mask mandates would be used as a “precautionary measure” nonetheless.

Considering this, it’s hard not to see this weakly-evidenced intervention as anything more than a political decision used to appease those who would rather keep schools closed. Certainly, if the decision were left up to the teachers’ unions and some councils, schools would remain shut to most pupils, and teaching would continue online-only.

We’ve heard in recent days from the NASUWT that remote learning is “the only sensible and credible option at this time to minimise the risks to those working in schools and to safeguard public health”. The leadership of the NEU has warned its members that it is not safe for them to return to school until mid-January at the earliest and has even provided template letters for their members to refuse to go back to work.

Then there’s the added problem of the Government’s own increasingly unworkable Covid self-isolation rules – rules which are wreaking havoc on our public services.

Not only are head teachers fearing up to a quarter of staff will be off work in January, but one in ten NHS workers are out of action, rail services have abandoned popular routes, and councils have scaled back rubbish collections. Economists have predicted that the impact of one million people now estimated to be self-isolating could knock several percentage points off GDP, amounting to billions of pounds.

If the Government is serious about children’s education, maintaining a functioning economy and finally learning to live with a virus that is clearly going nowhere, it must rethink these rules. It is clearly unsustainable for working people who are asymptomatic, or who are suffering only mild symptoms, to isolate for seven whole days. And if keeping schools open is the priority, sending teachers and children home for an arbitrary period if they test positive for a virus is no longer defensible. Especially when for most the symptoms are now akin to the common cold.

Considering Omicron is less severe than some feared, and the impact of staff absences is so high, the argument for shortening the isolation period has significantly strengthened.  While it looks like the Government is continuing with its painful policy of encouraging the continuous testing of asymptomatic adult and children, it must at least reconsider its arbitrary isolation rules – reduce the number of days or better yet move to a test and release system to hasten teachers and children back into the classroom.

It’s time for the Government to weigh up the benefits and costs of its Covid policies – and leave children alone.

John Redwood: We cannot continue being governed by scientific advisers

23 Dec

Sir John Redwood is MP for Wokingham, and is a former Secretary of State for Wales.

I am no fan of the idea of news conferences held by Ministers flanked by scientific and medical advisers. The underlying spin that Ministers were simply following the science was constantly repeated.

Ministers hoped that the presence and the slide shows of the experts would buttress their case and turn government decisions and statements into underlying truths that no serious person could contest. It seemed to me to misrepresent the different roles of official advisers and Ministers and was likely to weaken both.

There were obvious flaws in this constitutional experiment. The first is the assumption that there is such a thing as “the science”. In fast moving areas like the epidemiology and treatment of a new disease there is no settled scientific view. There should rather be an intense period of collaborative and competitive research and trials to understand the disease better and to find out which treatments and vaccines work.

The Government’s senior advisers are mainly interpreters and summarisers of the better science and medicine going on. To do their job well they need to be global in vision and willing to look at evidence and breakthroughs from established and challenger institutions, companies and individuals wherever they arise.

The second is the assumption that the only policy consideration is controlling the virus. In practice within government some Ministers needed to make the case to keep more of the economy open. They should worry about mental health problems if too many people lost their jobs, show concern for the food and power supply problems if too many were stopped from working and ask how much damage a widespread and long lasting lockdown would inflict.

The Prime Minister and the whole Cabinet needed to balance the competing objectives and come to a balanced view. Within the Health Department itself the Secretary of State needed not just to find out what would have maximum impact on the virus, but also ask what actions were feasible given the need to continue to battle against cancer, heart attacks and other killers at the same time.

The third was to blur the usual distinction that advisers give their advice in private and in public let Ministers speak for the government, never undermining them. In return for anonymity and the confidentiality of their advice they are defended by Ministers should people wish to draw them into the political battles.

Once an adviser finds a public voice, they may try to preserve some distinction between facts and opinion or between analysis and policy decision, but the difference easily gets washed away. It often became clear that the scientists and medics on stage were going to take a cautious even pessimistic view and were therefore advocates of greater and longer restrictions.

The media soon made a story line out of alleged or actual differences between cautious medical advisers and generalist decision taking Ministers who needed to keep the lights on, and the nation fed, and deal with the part of the public who were not persuaded by the case for more restrictions. Governments cannot have independent advisers speaking against it in public. When advisers and Ministers no longer agree one side needs to resign or give in.

The fourth was to reveal the splits between the advisers who had made it to the government conference table and the advisers outside government who often disagreed or who felt ignored. The Government itself harnessed the private sector to find vaccines, which required study of the nature and presence of the virus. It was less willing to go outside for work on other ways of combatting the virus or on treatments. There was slower progress on expanding the range of available medicines to lessen the impact and shorten the duration of the illness, and less intense work on air purifying and cleansing in health locations despite the evidence of cross infections.

As a result of this experiment some of the government advisers became exposed to the kind of media treatment politicians live with but officials usually escape. The private lives and compliance of top officials with the advice and regulations became a matter of great interest to the media, particularly when some misbehaved in colourful ways.

Government Ministers found that they are still accountable for the wide range of decisions taken, however much they might like to think they were grounded in science. They did need to understand the social and economic consequences and the impact on other health conditions of their preoccupation in finding ways to limit the spread of the virus.

The latest arguments over Omicron are in part arguments over how we are governed. In recent days there has been some cross-party examination of the data. Why MPs ask are we told cases are doubling every other day when total cases are doing no such thing. The advisers explain they are citing Omicron. The MPs think it is the total cases that matters when it comes to hospital capacity and serious illness rates.

Some of the MPs who have been keenest to “follow the science” and to contract out the decisions on lockdown are now actively engaging with the data and realising there is considerable uncertainty. In the early days of this new mutant the scientists honestly tell us they do not know just how far and fast it will spread or how serious an illness it will give most people. Before we find out these crucial things it is a judgement over what to do that cannot be dictated by the science.

I hope we soon go back to the simple approach that advisers advise and Ministers decide. Ministers can command the best advice at home and abroad. They can seek a second opinion if the first does not make sense. They do need to cross examine the advice and make sure it is based on good evidence and great expertise.

The UK is fortunate to have many talented medics and scientists. Ministers should listen and learn. It is best if Ministers then decide and explain. If Ministers cannot explain in straightforward terms why the science has led them to a certain course of action they need to go away, think again and get better at carrying opinion.

It is Ministers jobs to decide and explain. It is scientists jobs on the official payroll to provide great explanations and analysis and when forecasting to be as accurate as possible. Some very pessimistic forecasts look like attempts to play politics to those of a different view, rather than well judged efforts to describe a fast changing and awkward future.

James Frayne: How will the public respond if the Government goes ahead with restrictions?

21 Dec

James Frayne is Director of Public First and author of Meet the People, a guide to moving public opinion.

The Government has left the public hanging on a decision about Covid restrictions over the Christmas holidays as it wrestles with emerging data. Part of ministers’ internal deliberations must include judgements on what the public can and will take.

Politicians always worry about their own popularity but reading public opinion here is more fundamental: if harsh new rules are imposed but then ignored, they’ll be disastrously counterproductive. As they consider opinion, what should the Government be asking? 

Are people worried about getting it?

It would seem not. While polls suggest more people are “worried” about Omicron than not (by 54 to 39 per cent), this isn’t translating into major behaviour change. According to a YouGov poll on December 14/15, clear majorities had made no radical changes to their lifestyles – suggesting their “worry” over Omicron is more about being locked down and inconvenienced than actually getting it.

In a separate poll, more people opposed than supported the following: restricting reasonably large-scale outdoor mixing; restricting indoor mixing; only allowing people out for exercise and shopping; closing pubs and restaurants; and stopping large-scale sports and entertainment events.

The upshot is this: if there’s relatively little fear, it’ll be impossible to lock them down. Of course, opinion and behaviour might shift; significant numbers of hospitalisations and deaths will unquestionably change minds extremely rapidly. At this point, however, the harsh measures floated by Sage aren’t viable.

What does adherence to existing rules look like?

Get on a bus or tube in London and likely somewhere between 20 and 50 per cent won’t be wearing masks. This is despite massive media coverage; Government warnings that non-compliance will see us locked down; and an explosion of actual cases.

Anecdotal evidence is reflected by a YouGov poll from December 9/10, which showed 17 per cent opposed mandatory face masks in shops and 20 per cent had personally not worn a mask in a shop at least once in the last week. If people won’t even put a mask on for a 10-minute journey, or in a shop, what chance that everyone will adhere to more serious rules? 

How many people are actually getting tested?

Everyone with symptoms should get tested, as should those who have had direct contact with confirmed cases. But I would be astonished if anything approaching a majority of these people are actually getting tested. YouGov’s poll from December 14/15 suggested 38 per cent were not currently testing at all in any circumstances, but this probably understates the figure (given the structure of the question).

Either way, this is still a large number and probably exists for several reasons: (a) people are judging that symptoms are light in the infected; (b) people are hearing pretty much everyone over 40 has had the opportunity for a vaccination so continued mixing doesn’t feel selfish or reckless as it once did; (c) no one wants to lock down over Christmas; and (d) many people’s experience with track and trace was so appalling that they won’t want to get back on to “the system”. 

What are parents saying?

Last year’s long winter lockdown was a nightmare for parents: not only having to juggle work with home schooling but (far worse) seeing previously happy children struggle with isolation, away from family and friends.

Earlier this year, my agency did a long piece of research on mental health during the lockdown; a third of parents with children under 18 said they worried about children’s mental health. It seems certain that most parents will just ignore similarly harsh rules and allow their children to meet family and friends on the quiet. (I wrote about the political impact of school closures in more detail for The Telegraph last week).

What does trust in Government look like?

The Government’s slide in the polls is primarily down to perceived failure on important issues like small boats and the cost of living, rather than hypocrisy on parties etc. That said, this stuff will matter on the specific issue of lockdowns. Very obviously, people are going to ask why they have to lockdown – for example putting their kids through terrible hardship – when there are pictures of Government officials apparently on the sauce when they shouldn’t have been.

An Ipsos-Mori poll from 8/9 December showed most people thought politicians and their advisers would not adhere to new restrictions, while a YouGov snap poll on December 8 showed most people think parties happened, which probably broke the rules. On lockdown restrictions, there’s no question the Government’s moral authority has diminished.

What else is on people’s minds?

While the polls revealed deep public concern about the economy from mid to late 2020, people were primarily worried about job losses – which mostly didn’t come to pass. Now, they’re much more worried about the cost of living and rising taxes and bills. These are concerns which are much more real and tangible. Juggling work, childcare and home schooling in the context of a harsh lockdown is going to be much, much more problematic. People will ask how they’re supposed to keep going.

Many politicians and commentators talk as if the Government was completely in control of public behaviour – as if the Government just needs to announce new rules and everyone will follow, even if reluctantly or grudgingly. This judgement is based on the apparent responsiveness of the public across most of 2020. But the public wasn’t as responsive as they appeared; rather, they themselves wanted a brutal lockdown – more brutal even than the one designed by politicians. They didn’t meekly follow; rightly or wrongly, lockdown was exactly what they wanted.

But now they don’t. The success of the vaccination programme, following on from that appalling winter, has radically changed opinion. Again, hospitalisations and deaths will change people’s minds. But without that tragic evidence, it seems unlikely the Government will carry opinion for a harsh lockdown. What would “resistance” look like? Riots and protests? No. More just large numbers of people quietly choosing what they accept and don’t; in a sense, large-scale, low-level civil disobedience. The problem for the Government is that this means no lockdown.