Building (our quarterly email update) back better

Every three months we publish an email update. This time we have adopted a new format featuring views and analysis from our team as well as an update on what we have been working on. Register to receive future updates here.

Public health matters

The last six months have seen a renewed focus on health inequalities driven by the disproportionate impact of COVID-19 on marginalised groups and particularly Black, Asian and Minority Ethnic (BAME) communities and NHS staff. An engagement exercise by Professor Kevin Fenton highlighted the concerns of staff that racism and discrimination, particularly towards BAME keyworkers, were a “root cause to exposure risk and disease progression”.

As COVID-19 was spreading in February, the ‘Marmot Review 10 years on’ was published. It came a decade after Sir Michael Marmot’s initial review calling for health inequalities to be tackled. The 2020 update grabbed headlines for noting that life expectancy gone into reverse in some areas of the UK. It also noted that Black and Bangladeshi households were 7 and 15 times more likely respectively to be living in overcrowded housing compared to their white counterparts – something we now understand to be a key factor in COVID-19 risk.

But reading this report shows just how awareness about race and racism has progressed in the last few months. For example, whilst the report notes that the “intersections between socioeconomic status, ethnicity and racism intensify inequalities in health for ethnic groups”, this is the only time in its 166 pages that the word “racism” is referenced. This stands in contrast to income (mentioned 238 times) and regional variations (mentioned 110 times). Both the original report and its 2020 update are in many senses landmark documents for the strength of their argument in favour of the funding of public health services – but doubtless it should have given inequalities among ethnic groups and inequalities which stem from racial discrimination more attention. There’s evidence these inequalities exist even after you account for other factors, like income.

Ghosts of Chancellors past

There seems to be a conventional wisdom developing that Rishi Sunak will replace a beleaguered and unpopular Boris Johnson as Prime Minister before the next election and lead them to another election victory. However, having a sensible and reliable Chancellor take over from a flashier and more emotive Prime Minister has been tried before. As pollster Deborah Mattinson pointed out on a Times Red Box podcast recently, Gordon Brown was the most popular politician in the country before he became Prime Minister in 2007 and lead Labour to a defeat in 2010. 

A more obvious example of a previous Chancellor haunting us would be how, during Rishi Sunak’s emergency announcement, the BBC said that the ‘big question’ with these measures was how the government was going to pay for them. Given the record low costs of government borrowing, most economists would argue this really isn’t the issue right now, especially given the fact these emergency measures were estimated to cost just 0.4% of GDP.  Even the centre-right Policy Exchange has called for the government to go for growth and move away from the “austerity and orthodoxy of the past” whilst more left-wing voices are concerned about job losses. However, it seems George Osborne’s focus on austerity and fiscal responsibility in the wake of the 2008 financial crash continues to influence how the economy and public spending is framed by the media.

Kruger Review

Danny Kruger MP’s report of civil society commissioned by the Prime Minister was published last week. The list of proposals in the report are wide ranging, with NCVO CEO Karl Wilding anticipating that some of these would spark ‘heated’ conversations. The Charity Finance Group says that “it is heartening to see that he has recognised the crucial value of charities and social enterprise in our country’s response to the Covid-19 crisis”. The Small Charities Coalition is slightly more critical; it says that reading the report is ‘an interesting experience in itself’, noting that ‘not all assumptions are supported by evidence’. Whilst it notes some of the proposals are good, it says others are ‘controversial’ and ‘problematic’. The SCC and NCVO both noted the lack of reflection and coverage of inequality in the report.

Many of the issues with the report are likely down to it being produced at a relatively rapid pace, without much civil service infrastructure to back it up, by a single MP with an extremely large area to cover. It seems that the recommendations which are being taken forward by the Department of Culture, Media and Sport are those relating to volunteering, with less news on what’s happening to the others.

One of the big areas where change is likely to be most substantial is in how ‘value’ is measured. This is a theme which has come up in multiple policy areas recently. Kruger says the government should move away from looking for ‘value for money’ in spending towards ‘value for society’. Separately, former head of the civil service Lord Gus O’Donnell and Bank of England economist Andy Haldane are leading a commission looking at measuring the value civil society adds to the country. Finally, there’s been lots of discussion around rewriting the Treasury’s infamous ‘Green Book’, which is used to evaluate potential investment spending and is said to be biased towards London and the South East, to support the levelling-up agenda. The government has already committed to a new framework for procurement. However, as the initiated in this area will know, previous attempts to incorporate social value rather than just value for money have been hampered by the fact that in an age of austerity, value for money comes first, whatever the framework says. You can read more about austerity and the charity sector here.

Starmer’s strategy

Lots of ink has been spilled trying to figure out which way Keir Starmer will take the Labour Party. On the one hand, he was not the favoured candidate of the party’s left and is understood to have taken advice from New Labour Chancellor Gordon Brown (who appointed Starmer as Director of Public Prosecutions when he was Prime Minister). On the other hand, Labour seems to be more forthright on welfare under Starmer, with attacks on No Recourse to Public Funds and the benefit cap (under Corbyn, Labour said it would replace Universal Credit but never went into specifics), and before his tenure as DPP he supported numerous progressive causes.

It seems that he’s attempting to build a reputation for competency before he starts pushing any bigger policy transformations. His Director of Policy Claire Ainsley previously wrote about the need to make policy by starting ‘where people are on their economic interests and build up and out to challenge divisive social constructs like racism and sexism’. This implies a cautious approach, building support through talking lots about issue areas where progressive positions are popular before shifting or shaping public opinion on more controversial issues. One potential risk of this plan is that a view of Starmer as lacking courage or conviction could set in among the public before he starts to articulate firm positions. Although, in the latest Ashcroft poll, two of the most common words voters use to describe Starmer are ‘Competent’ and ‘Principled’. Maybe some people can in fact have their cake and eat it.

What we’ve been working on

The Commission on Alcohol Harm published its final report on alcohol harm which we helped write and compile. Our work included analysing over 140 written evidence submissions, organising several evidence sessions featuring experts by experience, charity leaders, academics, representatives from the alcohol industry and many others, and contributing to writing the final report. Baroness Finlay, the Commission’s Chair, spoke on BBC Radio Four’s World At One about the report and its important recommendations.

Alongside Dr Susannah Fisher, we’ve been working with the APPG on the UN Global Goals for Sustainable Development to coordinate an inquiry and write a report on how the Sustainable Development Goals provide a ‘ready-made road map to recovery from COVID-19’. You can read the report here.

The report we compiled for the Less Survivable Cancers Taskforce on early diagnosis was published and covered in the i and The Sun. The Taskforce’s first roundtable meeting with the Scottish Cancer Policy team in summer was such a success that we held another with them last week to discuss how cancer services can best be rebuilt and redesigned in the wake of the pandemic.

For Mind, the mental health charity, we’ve been working to map the impact of COVID-19 on children and young people’s mental health services in England through a mixture of quantitative and qualitative research and FOIs.

Our work with St John Ambulance is ongoing as their clinically trained volunteers continue to support the NHS and communities during the pandemic.

With RAIRDA (the Rare Autoimmune Rheumatic Disease Alliance) we published the results of a survey on how people with these conditions had been affected by COVID-19. Over 1,300 people responded to our survey, and the resulting report also shaped the Alliance’s response to inquiries by the Health and Social Care Committee and the Business, Energy, and Industrial Strategy Committee. In addition, their comments on an end to shielding were published in The Guardian.

As health services started to recover from COVID-19, we’ve organised two webinars for The Hepatitis C Trust to help services consider what they can do to support people with hepatitis C during the pandemic. We’ve been delighted with the overwhelmingly positive feedback from services and clinicians and are looking forward to building on this with a range of webinars taking place in October. The second phase of Dame Carol Black’s Review of Drugs launched a call for evidence which we helped the Trust submit evidence to.