Two NHS staff walk with an elderly patient outside St Thomas' Hospital in London. Photograph: Getty Images.
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We need a revolution in public services to tackle multiple needs and exclusions

By focusing on prevention, prioritising relationships and driving down power to the lowest level possible, we can provide the support the most vulnerable in our society really need.

Across the country there is a small group of people who face multiple problems like homelessness, substance misuse, mental health problems and offending. They slip between the cracks of mainstream public services and they fall out of a political debate that is unrelentingly focused on majoritarian concerns.

And right now, the tricky politics of multiple needs and exclusions is even harder than ever. All contemporary policymaking operates within a brutal fiscal environment (on current forecasts, UK government spending will fall from 44.7 per cent of GDP in 2012 to 39.4 per cent in 2017) and whilst strict adherence to the present austerity trajectory should not be seen as a political inevitability, whoever forms the next government will not simply be able to open the spending sluices again. But tight public finances needn’t be a block on innovation. Large chunks of cash were spent on the problem under the last government and still resulted in insufficient progress. Now there isn’t any money anyway, it’s perhaps time to rip up the old models and start again. 

By coupling centrally-mandated targets and structures with substantial investment, New Labour achieved some notable successes in raising the standard of living for the poorest and most vulnerable in society, particularly children and pensioners. Yet critics on the right and left have described Labour’s approach as "poverty plus a pound", overly focused on income transfers to meet statistical definitions of poverty, rather than addressing its broader, structural causes. What’s more, the preponderance of an overly technocratic and managerial statecraft was ultimately too unresponsive to complex human needs.

The answer, perhaps, lies in the "relational state", an idea to which increasing attention is being paid. Rather than doing things to and for people, a state that works with people; that’s more strategic and less controlling; that prioritises the strength of human relationships over outcomes. It’s an approach that is particularly relevant for the issue of multiple needs and exclusions, with all the evidence of the last 15 years pointing towards the relational approach as being the best way of reaching a hugely problematic and expensive group of a defined size. As Lisa Nandy argues in the new Fabian pamphlet Within Reach, we are all unique individuals with our own lives, contexts and distinct solutions: we need a richer, more complex approach to public services that works with the "whole person" to find structural answers to deep-rooted problems.

This will require designing services around people and driving down power to the lowest level possible, rather than catch-all systems. As Julian Corner has written, people who face multiple needs and exclusions "are effectively where all the faultlines in the existing systems converge". He argues they should therefore be a "litmus test for the effectiveness of services used by a much wider group of people". Rather than trickle down, effective service design should geyser up.

People’s problems rarely sit comfortably within one government department, and this is especially the case for those living chaotic lives. Politicians are finally looking seriously at the opportunities of greater service co-ordination, which can drive the cost-effective improvements in standards that neither the market nor the central state alone can deliver. This is coupled with renewed interest in localism in policy circles, in part due to the diminishing returns achieved from the centre over 13 years of Labour government, and in part due to a growing recognition of the democratic empowerment potential of central government "letting go". This doesn't mean abandoning the central state’s role, but changing it, so that it is acting more as a hands-off convenor, setting a series of questions which local authorities are then empowered to answer.

Politicians from all parties can agree there is both a fiscal, social and moral case for providing extra support for severely disadvantaged groups, though they have different emphases and goals – both the Centre for Social Justice's Christian Guy and Nick Clegg’s former adviser Richard Reeves suggest that a commitment to this case is shared across the political spectrum. By focusing on prevention, getting the relationships right, and seeing the whole person, we can provide the kind of support the most vulnerable in our society really need. By taking a long-term approach, with better policy co-ordination across Whitehall and service co-ordination at a local level, we can save money and strengthen communities at the same time.  

‘Within Reach: The new politics of multiple needs and exclusions’ can be found on the Fabian Society’s website here

Ed Wallis is the editor of Fabian Review

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The UK press’s timid reaction to Brexit is in marked contrast to the satire unleashed on Trump

For the BBC, it seems, to question leaving the EU is to be unpatriotic.

Faced with arguably their biggest political-cum-constitutional ­crisis in half a century, the press on either side of the pond has reacted very differently. Confronting a president who, unlike many predecessors, does not merely covertly dislike the press but rages against its supposed mendacity as a purveyor of “fake news”, the fourth estate in the US has had a pretty successful first 150-odd days of the Trump era. The Washington Post has recovered its Watergate mojo – the bloodhound tenacity that brought down Richard Nixon. The Post’s investigations into links between the Kremlin and Donald Trump’s associates and appointees have yielded the scalp of the former security adviser Michael Flynn and led to Attorney General Jeff Sessions recusing himself from all inquiries into Trump-Russia contacts. Few imagine the story will end there.

Meanwhile, the New York Times has cast off its image as “the grey lady” and come out in sharper colours. Commenting on the James Comey memo in an editorial, the Times raised the possibility that Trump was trying to “obstruct justice”, and called on Washington lawmakers to “uphold the constitution”. Trump’s denunciations of the Times as “failing” have acted as commercial “rocket fuel” for the paper, according to its CEO, Mark Thompson: it gained an “astonishing” 308,000 net digital news subscriptions in the first quarter of 2017.

US-based broadcast organisations such as CNN and ABC, once considered slick or bland, have reacted to Trump’s bullying in forthright style. Political satire is thriving, led by Saturday Night Live, with its devastating impersonations of the president by Alec Baldwin and of his press secretary Sean Spicer by the brilliant Melissa McCarthy.

British press reaction to Brexit – an epic constitutional, political and economic mess-up that probably includes a mind-bogglingly destructive self-ejection from a single market and customs union that took decades to construct, a move pushed through by a far-right faction of the Tory party – has been much more muted. The situation is complicated by the cheerleading for Brexit by most of the British tabloids and the Daily Telegraph. There are stirrings of resistance, but even after an election in which Theresa May spectacularly failed to secure a mandate for her hard Brexit, there is a sense, though the criticism of her has been intense, of the media pussy-footing around a government in disarray – not properly interrogating those who still seem to promise that, in relation to Europe, we can have our cake and eat it.

This is especially the case with the BBC, a state broadcaster that proudly proclaims its independence from the government of the day, protected by the famous “arm’s-length” principle. In the case of Brexit, the BBC invoked its concept of “balance” to give equal airtime and weight to Leavers and Remainers. Fair enough, you might say, but according to the economist Simon Wren-Lewis, it ignored a “near-unanimous view among economists that Brexit would hurt the UK economy in the longer term”.

A similar view of “balance” in the past led the BBC to equate views of ­non-scientific climate contrarians, often linked to the fossil-fuel lobby, with those of leading climate scientists. Many BBC Remainer insiders still feel incensed by what they regard as BBC betrayal over Brexit. Although the referendum of 23 June 2016 said nothing about leaving the single market or the customs union, the Today presenter Justin Webb, in a recent interview with Stuart Rose, put it like this: “Staying in the single market, staying in the customs union – [Leave voters would say] you might as well not be leaving. That fundamental position is a matter of democracy.” For the BBC, it seems, to question Brexit is somehow to be unpatriotic.

You might think that an independent, pro-democratic press would question the attempted use of the arcane and archaic “royal prerogative” to enable the ­bypassing of parliament when it came to triggering Article 50, signalling the UK’s departure from the EU. But when the campaigner Gina Miller’s challenge to the government was upheld by the high court, the three ruling judges were attacked on the front page of the Daily Mail as “enemies of the people”. Thomas Jefferson wrote that he would rather have “newspapers without a government” than “a government without newspapers”. It’s a fair guess he wasn’t thinking of newspapers that would brand the judiciary as “enemies of the people”.

It does seem significant that the United States has a written constitution, encapsulating the separation and balance of powers, and explicitly designed by the Founding Fathers to protect the young republic against tyranny. When James Madison drafted the First Amendment he was clear that freedom of the press should be guaranteed to a much higher degree in the republic than it had been in the colonising power, where for centuries, after all, British monarchs and prime ministers have had no qualms about censoring an unruly media.

By contrast, the United Kingdom remains a hybrid of monarchy and democracy, with no explicit protection of press freedom other than the one provided by the common law. The national impulse to bend the knee before the sovereign, to obey and not question authority, remains strangely powerful in Britain, the land of Henry VIII as well as of George Orwell. That the United Kingdom has slipped 11 places in the World Press Freedom Index in the past four years, down to 40th, has rightly occasioned outrage. Yet, even more awkwardly, the United States is three places lower still, at 43rd. Freedom of the press may not be doing quite as well as we imagine in either country.

Harry Eyres is the author of Horace and Me: Life Lessons from an Ancient Poet (2013)

This article first appeared in the 20 July 2017 issue of the New Statesman, The new world disorder