Background
By Jas Bains, Hafod Chief Executive
This is the third in a series of short papers setting out the case for a repurposing of the housing association sector. It embraces the existing challenges to deliver a radical and progressive vision.
The above argument has been given added traction against the recent backdrop of various policy announcements from politicians, think tanks and commentators calling for a revitalised preventative state. The UK Labour Party’s next general election early manifesto refers to outdated, dysfunctional systems, reticence to change borne of cultural, political and structural factors, challenging misguided targets, for honest conversations that are feasible and practical and to rebalance public and private ownership (‘Big Con’, Mazzacuto & Hollingsworth. UK Labour Party press releases May 2023).
Demos’ publication: ‘The Preventative State’ calls for a unifying new model for public services reform, focusing on stopping rather than servicing increasingly beleaguered populations. Using money within our systems more smartly to achieve transformative outcomes, silo busting, devolving power to neighbourhoods and a new universal approach to services to reduce demand in the long run. Others making similar noises include Institute for Public Policy Research, Tony Blair Institute for Global Change, Centre for Progressive Policy and Reform, to name but a few.
Patricia Hewitt, former Health Secretary, Hewitt Review (December 2022) focused on the oversight and governance of integrated care systems enabling their success through greater autonomy with a particular focus on real time data across the system. The report contains recommendations to empower local leaders to improve outcomes, fewer but more strategic targets reflecting local priorities and particular needs of communities. While Hewitt’s remit focuses on England, the issues are universal and therefore will be applicable across Wales, Scotland and Northern Ireland. The important thing to note is a wellness perspective helps generate fundamentally different models for integration between public services and interplay with non-state actors, models of social care, balance between institution and community-based support and future workforces. Importantly, it is also entirely consistent with Bevan’s founding vision of the NHS.
Neither is the argument exclusive to opposition political parties and centre-left leaning think tanks and commentators. “We know that the determinants of health are much broader than what happens in hospitals. They include housing, wider care and education. Joining up is an imperative…”(Helen Whateley, Minister for Social Care)
“Local leaders are best placed to make decisions about their local populations…with fewer top-down national targets, missives and directives and greater transparency to help us hold the system to account.” (Steve Barclay, Secretary of State for Health & Social Care).
And more broadly the levelling up mission retains its laudable aim of improving healthy life outcomes and narrowing health inequalities, albeit without a coherent vehicle to achieve it.
Labour’s narrative is that poor productivity is the consequence of poor health. This has resulted in a policy framework which recognises the high concordance between health and broader economic change. Whilst there are few new ideas there is an overall coherence and concordance of policy proposals. Alongside this is a stronger voice from the grassroots with community, voluntary organisations pressing the case to move away from preconceived, standardised services, empowering people to understand what matters to people and not waiting for permission. The emergence of civil society actors is perhaps the most significant aspect driving a radical agenda for change. In the case of housing associations spanning many decades being significant beneficiaries of state subsidy allowing their growth of huge assets. Crisis more than at any other times calls for mutual reciprocity. In the next section I talk about what would it take for existing institutions to deliver a whole systems agenda.
The consequence of existing structures is funders support individual programmes which generally do not allow for movement from one service to another and do not pay for integration roles, processes and performance measurements. Where there is some allowance, albeit marginal is what is commonly referred to as ‘contract wizardry’ – meaning the ability to figure out exactly what is allowable through each funding stream and then pressing against those limits, taking pieces of funding from various funding streams to develop services or initiatives. Whilst helpful, it can create an uncomfortable position with auditors and commissioners plus it adds to the administrative burden and cost.